Lancaster Haven RCFE

Type of visit: Required - 1 Year

On 2/19/2026 at approximately 09:10 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the Administrator, Mildred Tripp and stated the reason for their visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted: The facility is a single-story building with three (3) bedrooms and two (2) bathrooms. The facility is currently occupying four (4) residents. There are two (2) designated staff rooms with one (1) designated staff restroom. The facility has an approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for six (6). Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 72°F. LPA observed a fire extinguisher to be located near the kitchen and dated 06/01/2025. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights to be located throughout the common areas. A working telephone was observed. LPA observed the fireplace to be covered and inaccessible to residents. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C) Laundry Room: The laundry appliances were observed to be located near the kitchen. LPA observed cleaning solutions and toxins stored appropriately within the laundry room and inaccessible to residents. The laundry appliances were observed to be in proper condition. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in cabinets located within the hallway’s passageway. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. The front of the facility has designated shaded areas for residents. There is no body of water located at the facility. Garage: The garage can be accessed from inside of the facility. The garage was observed to be kept locked and used for storage purposes. Medications: The medications were observed to be kept in a locked medication cart. The staff and residents’ files were observed to be kept in locked staff room located near the dining room. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Staff records: LPA conducted a complete file review of two (2) staff records. There were no immediate health and safety hazards observed during the day of inspection. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Case Management - Annual Continuation

This report was created to amend the LIC809-C and LIC809-D pages found on the One Year Required Annual report issued 12/05/2024. The pages were amended to correct the number of citations from four (04) to one (01). On 01/22/2025 at approximately 10:00 AM, Licensing Program Analysts (LPAs), Angelica Segovia and Abeye Duguma conducted an unannounced continuation annual visit. Upon arrival LPAs were greeted by Co-Administrator Mildred Tripp and disclosed the reason for today’s visit. Manager, Teodoro Tripp, arrived shortly after where he assisted with today’s visit. Based on LPA's observations, interview and record review, the licensee did not comply with Title 22, Division 6, Chapter 8, Article 11, Health-Related Services and Conditions 87606 Care of Bedridden Residents. Records revealed that 3 out of 5 persons are bedridden which poses an immediate health, safety or personal rights risk to persons in care. The facility also did not notify the fire authority having jurisdiction within 48 hours of accepting or retaining persons who are bedridden, as specified in Health and Safety Code section 1569.72. No other immediate health and safety issues observed. Appeal Rights given. Exist interview conducted and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Jan 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87606(a)(b) · Plan of correction due date: Jan 24, 2025

87606 Care of Bedridden Residents(a)..The licensee shall be permitted to accept and retain residents who are or shall become bedridden, if all the following conditions are met.. (b)A licensee shall notify the fire authority... within 48 hours of accepting or retaining any person who is bedridden as specified in Health and Safety Code section 1569.72. This requirement is not met as evidenced by; Based on record review, interview and observations, 3 out of 5 persons are bedridden which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 22, 2025

Plan of correction: The Administrator/licensee will send LPA documentation showing approval of fire clearance for bedridden residents.

Type of visit: Required - 1 Year

On 12/05/2024 at approximately 09:50 am, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. Upon arrival LPA was greeted by Co-Administrator Mildred Tripp and disclosed the reason for today’s visit. Manager,Teodoro Tripp, arrived shortly after where he assisted with today’s visit. LPA asked for census, staff, and resident files. LPA conducted a physical plant tour at approximately 11:00 am and the following was noted: There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and three (3) bathrooms currently occupying five (5) residents. One (1) bedroom is designated for staff use and additional room is being used as an office/staff room. The facility is fire cleared for six (6) non-ambulatory residents. Hospice waiver recently approved from two (2) to six (6) residents. Required postings such as Personal Rights, Facility Sketch, and Emergency/Disaster Plan were located at the main entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Both living and dining rooms are neat, clean, and organized. Both rooms are properly furnished and in good repair. Fireplace observed to be properly covered and inaccessible to residents. The facility maintains a comfortable temperature at 64°F. Fire extinguisher located in hallway and last inspected on 06/03/24. Additional required postings were observed aside the kitchen such as: Yes poster and Ombudsman. The kitchen observed to be fully stocked with two (2) days perishable and seven (7) days non-perishable food. Kitchen observed to be clean and inaccessible to pests. Knives and sharps observed to be locked in a kitchen drawer near the stove and inaccessible to residents. Cleaning solutions are kept locked in a cabinet under the sink. Stove observed to be working and in proper condition. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a shed at the backyard being used as storage and observed to be locked during visit. Smoke detectors and carbon monoxide observed to be working properly and were tested. The Garage can be accessed from the inside of the facility. The garage is attached to the home and is being used as storage. The garage is observed to be locked and inaccessible to residents. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning solutions and other chemicals and toxins are locked and secured in the laundry room. The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. LPA observed three (3) out of five (5) residents were bedridden without proper fire clearance approval. Residents have sufficient personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilets and showers. The hot water temperature was measured at 115.3°F. Towels and washcloths are not shared. Sufficient availability of clean lien stored in hallway cabinet. Medications: LPA observed medication in the medication cart to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the living room. Resident records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. An exit interview was conducted, one (01) citation was issued, appeals rights and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Dec 5, 2024

Allegation investigated: Staff are providing expired and left over food to a resident Staff retained residents with a prohibited health condition

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with administrator, Teodoro Tripp, and explained the reason for the visit. --- Staff are providing expired and left over food to a resident It was alleged that residents are being fed expired and leftover foods. To investigate the allegation, on 07/12/2024, LPA conducted a physical plant tour at around 10:15 AM, interviewed three (03) out of four (04) residents from 10:45 AM to 11:15 AM and interviewed two (02) staff from around 11:15 AM to 12:00 PM. During the physical plant tour, LPA did not observe any expired foods. During interviews with staff, all staff stated they do not serve expired or leftover foods, that they label and check all foods periodically to discard anything before it expires. (CONT. LIC 9099-C) Unsubstantiated During interviews with residents, all interviewed residents, including Resident #1 (R1), stated that the food is great and are unaware of being served expired or leftover food. LPA was unable to interview one (01) out of four (04) residents. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff retained residents with a prohibited health condition It was alleged that residents in the facility are on gastrostomy tubes. To investigate the allegation, on 07/12/2024, LPA conducted a physical plant tour at around 10:15 AM, requested documents at around 11:15 AM and interviewed two (02) staff from around 11:15 AM to 12:00 PM. During the physical plant tour, LPA did not observe gastrostomy tubes as residents were covered. A review of the Admissions Agreement and Hospice Plan of Care which indicates dates of admission and that Resident #2 (R2) and Resident #3 (R3) were admitted to the facility under hospice care with a plan of care for their gastrostomy tubes. During interviews with staff, all staff stated there are two (02) residents in the facility with gastrostomy tubes. Staff #1 (S1) added that residents were on hospice when admitted to the facility with nursing plan of care and were never in the facility as a standard client. Although gastrostomy tubes are deemed a prohibited health condition, facility has Hospice Care Waiver and is not required to submit written exception requests for residents or prospective residents with restricted health conditions as the residents have been diagnosed as terminally ill and are receiving hospice services in accordance with a hospice care plan and the treatment is specifically addressed in the hospice care plan. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards were noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 12, 2024 · control 31-AS-20240308132909

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with administrator Mildred Tripp for a one (1) year required visit for this facility. Purpose of the visit was stated. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. A tour of the physical plant was conducted with Ms. Tripp. The facility has four (4) bedrooms and three (3) bathrooms currently occupying four (4) residents. One (1) bedroom is designated for staff use and additional room is being used as an office/staff room. The facility is fire cleared for six (6) non ambulatory residents. Hospice waiver for two (2) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 73°F. Dual smoke/carbon monoxide detector is hardwired, tested and observed to be operational. There were four (4) fire extinguishers in the facility. It is located in the kitchen, dining room, living room and hallway . Fire extinguishers were observed to be full and last inspected on 06/02/23. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a shed at the backyard being used as storage and observed to be locked during visit. The garage is attached to the home and also being used as storage. The garage is observed to be locked and inaccessible to residents. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning solutions and other chemicals and toxins are locked and secured in the laundry room. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Dishwashing liquids and other cleaning supplies were stored in the kitchen cabinet below the sink and observed to be locked and inaccessible to residents. All sharps and knives were also observed to be locked in a kitchen drawer. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit to non-private rooms. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room is observed to be locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 115.7.°F to 118.7°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the medication cart to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the living room. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA also conducted a complete file review of staff records. Staff record appeared to be complete and updated. Disaster drill was last conducted on 02/10/24. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Apr 21, 2024

Allegation investigated: Facility staff yells at residents in care.

On 03/22/2024 at 9:33 a.m. Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit to this facility to investigate the above allegation. LPA met with Administrator Teodoro Tripp and explained the reason for the visit. An entrance interview was conducted. LPA conducted a physical plant tour at 9:52 a.m., and requested copies of facility documents relevant to the investigation at approximately 10:20 a.m., LPA reviewed the following for resdient #1 (R1); resident roster, LIC500, physician's report, appraisal/needs and services plan, pre-placement appraisal and admissions agreement. LPA interviewed staff and residents between 9:52 a.m. and 10:19 a.m. Regarding the allegation, facility staff yells at residents in care, it was alleged that a staff yelled at Resident #1 (R1). LPA attempted to interview four (4) out of four (4) residents. Two (2) of four (4) residents were non verbal and unable to communicate with LPA. Interview with Resident #1 (R1) and Resident #2 (R2) denied being yelled at by staff and denied witnessing any staff yell at residents. (Continued to LIC9099-C) Unsubstantiated (Continued from LIC9099) LPA's interview with the administrator and staff #1 (S1) denied yelling at residents and denied witnessing any staff yell at residents. Furthermore, interviews with administrator and S1 revealed no resident has complained about staff yelling at them or witnessing staff yell at other residents. Based on interviews conducted the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Mar 22, 2024 · control 31-AS-20240320161058