Lifetouch the Elegant Living Residential Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 12:25 p.m. to conduct a 1-year required annual visit. LPA met with Amelita Aquino, Administrator and Thelma Tablada. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: LPA toured resident rooms and observed that rooms were tidy, the lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational. The showers have non-skid mats/flooring. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for residents’ use. The fire extinguisher was last charged and inspected on 10/18/24. Administrator will send receipt for purchase of new fire extinguisher. The facility has carbon monoxide and smoke detectors that were tested and working. Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 4 non-ambulatory and 2 ambulatory residents. Facility has a hospice waiver for 6. The facility currently has 1 ambulatory and 3 non-ambulatory. (Continued on 809-C) Staffing and Training Records: The facility currently employs 5 staff and 2 administrators. Files reviewed had 1st Aid/CPR, Personnel Records/Application, TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Resident Records & Incident Reports: The facility keeps separate files on each resident confidential. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms. All forms were legible. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies and are inaccessible to residents in care. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR) and Medication Administration Records (MAR). LPA reviewed a sampling of residents’ medications, no medications were expired, and all medications were documented and tracked. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill/training on 11/3/25. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted and copy of report printed.the state’s words, verbatim · CDSS document, Nov 7, 2025

The state marks this report as 11 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erika Miller arrived at 11:30 a.m. to conduct a 1-year required annual visit. LPA met with Amelita Aquino, Administrator. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has at least a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: LPA was authorized to enter and inspect facility. LPA toured resident rooms and observed that rooms were tidy, the lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for resident use. The fire extinguisher was last charged and inspected on 9/26/23. Administrator provided proof that inspection is scheduled for 10/18/24. The facility has a carbon monoxide and smoke detector that were tested and working. Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 4 non-ambulatory and 2 ambulatory residents. Facility has a hospice waiver for 6. The facility to currently has 2 ambulatory and 2 non-ambulatory,1 of which is temporarily bedridden. (Continued on 809-C) Staffing: The facility currently employs 5 staff and 1 administrator. Files reviewed had current1st Aid/CPR, Personnel Records/Application, TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms. All forms were legible. Food Service:. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies and are inaccessible to residents in care. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill/training on 9/12/24. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted and copy of report printed.the state’s words, verbatim · CDSS document, Oct 17, 2024

Allegation investigated: Facility staff are not providing resident mail Resident is missing funds from account

At 2:05 PM, LPA Rankin and Jeffries arrived unannounced at the facility to issue final findings. LPA's met with Administrator Amelita Aquino. As to the allegation of, “Facility staff are not providing resident mail.” It was alleged that on approximately 04/26/2024, Resident 1 (R1) had not received any bank statements since they moved to the facility. It was discovered through observation and interviews the following information: In an interview on 05/01/2024, R1 was interviewed by Licensing Program Analyst (LPA) Jeffries. R1 stated that they are not sure if they are getting all their (R1’s) mail. R1 stated to LPA Jeffries, “I forget a lot of things lately.” CONTINUED on LIC9099-C Unsubstantiated LPA Jeffries observed R1’s desk, in R1’s room to have a basket on top of R1’s desk, with approximately 20 pieces of mail. In a telephone interview of R1’s responsible party (F1) on 05/02/2024, it was discovered that R1 has a family member who was R1’s Financial Trustee (F3). F1 provided contact information for F3. On 05/03/2024, LPA Rankin interviewed a witness (W1). W1 stated R1 confirmed current address listed on their account is the correct address. W1 confirmed multiple bank accounts and confirmed multiple unidentified charges to one of R1’s accounts. On 05/03/2024 R1’s Financial Trustee (F3) was interviewed via a telephone interview by LPA Rankin, F3 stated they (F3) could only see one account prior to the incident, but now all accounts information will come to F3 via e-statements. In an interview with Administrator Amelita Aquino it was stated that R1 received bank statements once per month at the facility, and S1 hand delivers all residents their mail directly. In an interview on 05/01/2024 with other residents in the facility, LPA Rankin was informed that they were receiving all their mail and not missing any mail to their knowledge. On 05/01/2024, LPA Jeffries interviewed Care Staff. Staff stated that the Administrator gets the mail and always gives the mail to the residents. On 05/02/2024, LPA Rankin interviewed Family Friend (F2), F2 was unaware that any of R1’s mail had been missing. Based on interviews, and observations, there is not enough evidence at this time to support the allegation of, “Facility staff are not providing resident mail” and it is unsubstantiated at this time. As to the allegation of, “Resident is missing funds from account”, it was alleged that multiple debit card transactions, dating back to April 15, 2024 had cleared (R1’s) account, and the transactions did not appear to be made by R1. On 05/01/2024, LPA Jeffries and Rankin interviewed staff and residents. LPA Jeffries interviewed R1, R1 stated that R1 doesn’t know how much money was taken or how it was taken. R1 stated “I forget a lot of things lately.” CONTINUED on LIC9099-C R1 stated they “do not know where their bank statements are at.” R1 stated on 05/01/2024, R1 went to the bank and changed the account number. On 05/02/2024 at 9:20 AM LPA Rankin and Jeffries interviewed F1 over the phone, F1 stated they knew R1 claimed their checkbook was missing, but that R1 has a history of "missing" items such as flashlights, bibles, and a magnifying glass, that were later found in R1's room. F1 stated there was a fraud issue with R1's bank card when R1 was at a facility prior to this facility. F1 stated a family member (F4) takes R1 to appointments. F1 also stated that F3 is the trustee for R1. On 05/02/2024 at 10:27 AM, LPA Rankin spoke with F1 again. F1 continued to give a history of concern for R1's family member F4, that F4 has a history of stealing from family members including R1. Documents provided by facility show that while R1 had possession of their card they had been visited or taken out of the facility on multiple occasions. Facility Log of visits or trips dated 04/15/2024, 04/16/2024, 04/17/2024, 04/18/2024, 04/19/2024, 04/20/2024, 04/21/2024, 04/22/2024, 04/23/2024, 04/24/2024, 04/25/2024, 04/26/2024, 04/27/2024, 04/28/2024, and 04/29/2024, with various people (F1, F2, F4, F5, F6, F7). On 05/03/2024 LPA Rankin spoke with a witness (W1). W1 confirmed that R1 has multiple accounts, and only one account was affected. W1 stated the unusual transactions were from a couple places including “Nike, Amazon, and Shein.” W1 stated they called R1 and asked R1 if they had given their card to anyone, R1 stated “no”, and R1 stated they had their card with them at that time and had not given it to anyone. W1 canceled the card for R1. On 05/03/2024 R1’s Financial Trustee (F3) was interviewed via a telephone interview by LPA Rankin. F3 stated they could only see one account prior to the incident, but that now all accounts information will come to F3 via e-statements. On 05/01/2024, LPA Jeffries interviewed staff in the facility, all who denied having any access to R1’s bank accounts, checks, or cards. At this time, there is not enough evidence to support the allegation of “resident is missing funds from account” due to the facility not safeguarding R1’s bank account and is unsubstantiated at this time. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, May 14, 2024 · control 29-AS-20240429150725

Allegation investigated: Staff did not safeguard resident's belongings. Staff did not treat resident with dignity.

At 1:00pm on 03/28/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings to the allegations to this complaint investigation. LPA met with Licensee, Amlita Aquino announced who he is and the reason for the visit. As to the allegation of, “Staff did not safeguard resident’s belongings.” It was alleged that Resident 1 (R1), on approximately 03/22/2024 had all of their belongings and medication missing or stolen. It was discovered through interview, observation, documentation, and admission that R1 had moved to a new RCFE on 03/03/2024. LPA interviewed R1 on 03/22/2024, R1 stated that they did not have any missing or stolen, and medications were locked up in the new facility medication cabinet, with one medication still on order. R1 also stated that a family member (F1) assisted them with their property on 03/03/2024 and had nothing missing. On 03/22/2024, LPA Jeffries observed documentation of R1’s intake inventory written on a plane piece of paper, CONTINUED on LIC9099-C Unsubstantiated LPA also observed R1’s room with R1’s belongings as indicated on the personal property inventory sheet; LPA also observed R1’s physical medications that were being secured by the facility per regulations. On 03/22/2024, LPA Jeffries reviewed R1’s Physician’s report (LIC602) which did not show any diagnosis of Dementia or Alzheimer’s as indicated in the original complaint. On 03/22/2024, LPA Jeffries interviewed R1’s Family Friend (F2). F2, stated that a F1 helped R1 with the move to this current facility and stated that they were unaware of any belongings or medications missing for R1. On 03/22/2024, LPA Jeffries interviewed Facility Administrator Amlita Aquino, who stated that R1 and F1 went through together of all R1’s personal property for inventory when R1 moved in on 03/03/2024 and nothing has been missing from the time that R1 moved into the facility as indicated on the inventory of R1’s personal property and LPA observations on 03/22/2024. At this time there is not enough evidence to support the allegation of, “Staff did not safeguard resident’s belongings.” and is unsubstantiated at this time. As to the allegation of, “Staff did not treat resident with dignity.” It was alleged that sometime between 03/03/2024 and 03/20/2024 that a staff member “barked” like a dog at R1. It was discovered through interviews and witness statements that LPA Jeffries on 03/22/2024 interviewed R1, where R1 stated, “no one has ever barked at me like a dog. All the staff hear a nice, and no staff has treated me disrespectfully. They (Staff) are very respectful …” R1 stated that they feel safe and respected in the new facility. On 03/22/2024 LPA Jeffries interviewed F2. F2 stated that they believed the staff is good and has not seen or heard of a staff being disrespectful to R1 or any of the residents at this facility. On 03/22/2023 LPA Jeffries interviewed facility manager Amlita Aquino, who stated that they did not know that any of their staff spoke disrespectfully to any resident including R1, and they would not keep a staff who was disrespectful to residents. Mrs. Aquino also stated some of the staff are new and still in training, but none have been disrespectful to anyone. Based on interviews, witness statements and R1’s admission, there is no evidence to support the allegation of, “Staff did not treat resident with dignity.” and is unsubstantiated at this time. Exit interview, report read, and report delivered.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 29-AS-20240322095953

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jenny Olson arrived at the facility announced at 2:30 p.m. to conduct a pre-licensing inspection. The LPA met with Amelita Aquino, Administrator. This is a new application. The current capacity is for six (6) residents, the facility currently has zero (0) residents. The fire clearance was granted on 10/17/2023; in which bedroom #1, #4, and #5 was cleared for non-ambulatory, and bedrooms #2,and #3 were cleared for ambulatory residents. There is one staff room. Applicant successfully completed Component II on 10/31/2023. Component III was completed during the visit. At 3:00 p.m., the LPA toured the physical plant areas inside and outside with applicant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in the drawer next to the stove. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. The gas was not turned on and will be turned on Friday 11/10/2023. Applicant will send LPA water temperature readings. BEDROOMS: There are seven (7) bedrooms in the facility; the facility has five (5) bedrooms for resident use, and two (2) staff room. The staff room will be kept locked. Lighting in the rooms appeared adequate. All resident rooms were set up with beds, nightstands, lamps, chests of drawers, chairs, and closet space. BATHROOMS: There are four (4) full bathrooms one in the main hallway next to the kitchen, one in the back of the house, one in the master (Room #1) and one upstairs in the staff room. The showers are equipped with nonskid mats. Grab bars were observed in the bathrooms. MEDICATIONS: Medications will be in a locked cabinet located in the facility kitchen and will be locked and inaccessible to residents in care. The first aid supplies were complete, including a first aid manual. Continued on LIC809-C COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. The facility smoke alarm system is hard wired; the smoke detectors and carbon monoxide were operable at the time of the visit. There is (1) fire extinguisher which was fully charged and last serviced on 09/26/2023. There is a functioning telephone on the premises. Emergency exiting plans/sketch, emergency telephone numbers, and personal rights are posted on the entry way wall. FILES: Resident and staff records are stored in staff room 1/Office. LAUNDRY: The laundry area is located in the laundry room (across from the main bathroom) which is accessible to residents in care. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with benches for resident use. There are no bodies of water noted on the premises. The facility has an attached garage used storage. There are no other structures on the property. INFECTION CONTROL: The facility has an adequate supply of PPE and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Facility is not in compliance with Title 22 Regulations at this time. Applicant will be required to complete the following corrections and submit documentation to LPA Jenny Olson within 10 days: - Video of water temperature measuring between 105-120 degrees Fahrenheit. Upon receipt of the above items, the physical plant will be in compliance with Title 22 regulations. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted, copy of report printed.the state’s words, verbatim · CDSS document, Nov 8, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 (4 non-ambulatory, 2 ambulatory) Census (if any clients in care): 0 COMP II Participants: Amelita Aquino Interview Method: Telephone interview On October 31, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 31, 2023