Laverne Senior Carehome

Allegation investigated: Staff allow resident to stay in her soiled clothing for extended periods of time Staff do not ensure resident is provided with transfer assistance to her chair Resident developed minor pressure injuries while in care Staff do not ensure residents call button is operational at all times Staff did not ensure residents personal property was safely secured Staff do not ensure resident is spoken to in an appropriate manner Staff handled resident in a rough manner resulting in resident sustaining a bruise

On 12/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent investigation and deliver complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with Assistant Administrator Lisa Pua. During the course of the investigation, interviews were conducted, and facility was toured. The residents’ call buttons are functional and operational during visit. Based on interviews conducted, staff changes residents brief throughout the day and as needed. Staff attend R1 and assist R1 in transfer. Allegation alleging staff allow resident to stay in her soiled clothing for extending periods were investigation in complaint 24-AS-20250410163831 and found to be Unsubstantiated. Based on interviews conducted and records reviewed, there was insufficient evidence to prove or disprove that staff did not ensure R1 is provided with transfer assistance to the resident’s chair, resident developed minor pressure injuries while in care, staff did not ensure resident’s personal property was safely secure, staff spoke to resident in an appropriate manner and staff handled resident in a rough manner resulting in resident sustaining a bruise. Therefore, the above allegations are found to be UNSUBSTANTIATED. Exit interview was conducted. A copy of this report was provided to Assistant Administrator, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 2, 2025 · control 24-AS-20250724084651

Allegation investigated: Staff do not provide adequate food service Staff do not follow proper food safety practices

On 12/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent investigation and deliver complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with Assistant Administrator Lisa Pua. During the course of the investigation, facility was toured. The facility has adequate perishable and nonperishable foods. Perishable food was observed stored in the refrigerator and freezer. Nonperishable food was observed stored in the pantry. Based on observation, the preponderance evidences has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Exit interview was conducted. A copy of this report was provided to Assistant Administrator, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 2, 2025 · control 24-AS-20250725095205

Allegation investigated: Staff do not allow resident access to personal belongings

On 12/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent investigation and deliver complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with Assistant Administrator Lisa Pua. During the course of the investigation, facility was toured, interviews were conducted, and records were reviewed. R1’s belongs were not observed at the facility. R1 have taken R1’s personal belongings after R1 relocated from the facility. Based on observation and interviews conducted, the preponderance evidence has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. Exit interview was conducted. A copy of this report was provided to Assistant Administrator, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 2, 2025 · control 24-AS-20250805122608

Type of visit: Case Management - Deficiencies

During an unannounced Complaint visit a Case Management visit was conducted due to use of U-Lock on entry door. At time of entry for complaint visit, LPA could hear a knocking on inside of door prior to opening. Upon entry LPA observed U-Lock at top left of entry door. LPA inquired about use of U-Lock & was told that it was for a client that wandered. During telephone call with Administrator (Admin) Arlene Bautista, LPA inquired about U-Lock installed at top left of entry door & notified that it was observed to be in use. LPA notified Admin that U-Lock was to be removed immediately. Immediate Civil Penalty would be issued during this visit. If photo of door showing U-Lock removed before midnight, that on-going civil penalties will apply. U-Lock in process of being removed during this visit. Photo to be submitted to LPA showing door with lock removed. Deficiency issued. Civil Penalty issued. Exit interview conducted with Admin by telephone. Admin authorized CG1 to sign report. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 29, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Jul 29, 2025

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. U-Lock observed at upper lefthand corner of front entry door. U-Lock not able to be unlatched without use of ladder &/or step stool, unless tall enough to reach. Immediate Riskthe state’s words, verbatim · CDSS document, Jul 29, 2025

Plan of correction: Facility agreed to remove lock @ time of visit. Lock in process of being removed @ time of visit. Photo of door lock removed to be submitted before end of day in order to stop accrual of civil penalties. Immediate Civil Penalty Issued. ($500.00)

Allegation investigated: Facility does not have proper fire clearance

On 07/11/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced subsequent complaint investigation and met with Assistant Administrator Lisa Pua. During the course of the investigation, the Department conducted interviews, reviewed records, and toured the facility. The facility has no fire clearance for bedridden resident and has admitted R1 a bedridden resident to the facility. Based on observation, interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6 is being cited on the attached Lic 9099D. An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator Assistant, whose signature confirms receipt of this report. Substantiatedthe state’s words, verbatim · CDSS document, Jul 11, 2025 · control 24-AS-20250410163831

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Jul 12, 2025

87202 (a)(2) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (2) Bedridden persons. This requirement is not met as evidenced by: Based on observation and records reviewed, R1 is bedridden and resides at the facility with no fire clearance for bedridden, which poses/posed an immediate health and safety and personal rights risk to the resident in care.the state’s words, verbatim · CDSS document, Jul 11, 2025

Plan of correction: Facility is not fire cleared for bedridden residents therefore cannot obtain bedridden residents to the facility. Licensee will provide a written statement detailing steps the facility will take to ensure to meet regulations by POC due date 07/12/25.

Type of visit: Case Management - Deficiencies

On 07/11/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced subsequent complaint investigation and met with Assistant Administrator Lisa Pua. During the course of the investigation visit, LPA toured the facility and reviewed residents’ records. The department observed R1 with no bed. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. An exit interview was conducted. A copy of this report and appeal rights was provided to Assistant Administrator, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 11, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(A) · Plan of correction due date: Jul 17, 2025

87307 (a)(3)(A) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (A) A bed for each resident, except that married couples may be provided with one appropriate sized bed. Each bed shall be equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding. Fillings and covers for mattresses and pillows shall be flame retardant. Rubber sheeting shall be provided when necessary. This requirement is not met as evidenced by: Based on interviews conducted, observation, records reviewed, R1 sleeps on comforter. No bed was observed provided for R1, which poses/posed a potential health and safety and personal rights risk to the resident in care.the state’s words, verbatim · CDSS document, Jul 11, 2025

Plan of correction: An exception with supporting documents will be submitted to the Fresno CCL by POC due date 07/17/25.

Type of visit: Required - 1 Year

On 11/18/24 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Assistant Administrator (AA1) Elisa Pua. LPA was granted entry. 5 clients were present during inspection.1 arrived to facility from Day Program. LPA toured facility with AA1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -7 degrees F and refrigerator temperature was maintained at 38 degrees F. Cleaning chemicals was observed stored and locked in garage. Fire extinguisher was observed with a service date of: 5/16/24. Fire drill last completed on 10/27/24. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at 118 degrees in both bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cabinet. Clients’ MARS was reviewed. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ files reviewed to have all the required documents. Samples of staff files were reviewed and observed to have all the required documents. No deficiencies issued during this inspection. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 12/2/24: Lic 308, Lic 500, Lic 610D, Lic 9020 and Administrator certificate. A copy of this report was provided to Assistant Administrator, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Nov 18, 2024

Allegation investigated: Resident sustained unexplained injuries while in care

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegation listed above. LPA met with Facility caregiver, Bienvel Yap , and explained the purpose of today's visit. Regarding the allegation Resident sustained unexplained injuries while in care. Facility staff reported incidents on 08/09/23, and 08/11/23 documenting Resident 1 did have behaviors while attending day program that could result in unexplained injuries. LPA interviewed two facility staff members who both stated Resident 1 does on occasion have behaviors at the facility that could result in possible injuries such as bruising or scratches . Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time. No deficincies cited today Per Title 22 Regulations. Exit interview conducted with facility Facility caregiver, Bienvel Yap, and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 10, 2024 · control 24-AS-20231109141012

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced Case Management visit. LPA met with facility Administrator, Lisa Pua and explained the purpose of the visit. LPA Hurt collected records for Resident 1 including Physician's report, Needs and services plan, and care notes. LPA Hurt reviewed Resident 1's Physician Report which is more than 3 years old. Resident 1 should have a Physicians report updated annually. The following Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Lisa Pua, and a copy of this report along with appeals right provided.the state’s words, verbatim · CDSS document, Nov 15, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Nov 29, 2023

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. The following requirement has not been met as evidenced by: Resident 1's Physician Report was last updated on 02/02/2020 which poses a potential, health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: Administrator will send current Medical Assesment for Resident 1 to LPA by 11/29/2023 POC date.

Type of visit: Required - 1 Year

On 11/08/2023, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA Medina introduced self, purpose of visit and allowed entrance by caregiver. Administrator, Elisa Pua arrived a short time later to conduct facility inspection. Arlene Bautista, Administrator Certificate #6024205740, expires 1/4/2025. Currently, five (5) residents in care. All residents were present during today's inspection and observed to be resting. Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water tested in both bathrooms with a water temperature of 120 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. LPA observed leftovers stored in the refrigerator and/or freezer observed to be properly stored and labeled. Medications observed to be locked and secured in kitchen cabinet. All medications observed to have original labels and administered as ordered. Smoke detectors tested and observed to be operational at time of visit. Carbon monoxide detectors present and visible in dining room and in hallway near resident bedrooms. Fire extinguisher has a purchase date of 5/19/23. Last fire drill conducted on 7/08/23 according to facility records. Cleaning supplies observed to be locked and secured under kitchen sink, in laundry room and in locked cabinet in the garage. Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed. No deficiencies cited during visit.the state’s words, verbatim · CDSS document, Nov 8, 2023