Lillie Care Home

Type of visit: Required - 1 Year

On 11/21/25 at 11:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Lillie Care Home for the purpose of conducting a required 1 year annual inspection. LPA met with staff, Shaquita Haywood and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 118 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed in sufficient two day perishable food supplies. LPA observed dinner being prepared at 11:30am, statements provided to LPA regarding food storage, preparation did not meet requirements for storage and food safety. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Nov 21, 2025

Type of visit: POC

On 1/23/25 Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced plan of correction (POC) to ensure the Plan of correction has been completed from previous citation. LPA observed the facility is still in process of completing POCs and have submitted documentation to address FAR issued by Alta Regional Center. LPA did observe that previously observed paint cans and items stored under a table on the patio are still present after LPA Gould issued an advisory note (technical violation) for the items not stored inaccessible to clients in care. LPA reminded the newly appointed administrator to complete all POCs by the POC due date. Per California Code of regulations, Title 22 The following deficiency is cited during today's inspection. Exit interview conducted and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a) · Plan of correction due date: Jan 31, 2025

Storage Space: Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by LPA observations of paint cans stored in the back yard under an outdoor table which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 23, 2025

Plan of correction: Licensee agrees to dispose of or store items inaccessible to residents by the POC due date: 1/31/25.

Type of visit: Required - 1 Year

On 12/18/24 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Lillie Care Home for the purpose of conducting a required 1 year annual inspection. LPA met with Staff Renee Ates and together conducted a tour of the home. LPA and staff evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean. LPA observed some paint cans stored under a table on the patio that need to be removed. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 115 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA reviewed the FAR by Alta Regional center and provided a deficiency for incidental medical care and discussed the appointment of a new administrator since the individual no longer works at the facility. LPA and staff discussed the required documents for administrator change. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 9020 client roster and current administrator certificate. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Dec 18, 2024

Type of visit: POC

Licensing Program Analysts (LPAs) Avelina Martinez and Pang Lee arrived at facility unannounced to conduct a plan of correction (POC) visit. LPAs met with Shaquta Haywood and explained the purpose of the visit on 11/15/2023. The purpose of this visit is to follow-up on citations issued on 10/19/2023 during an annual inspection visit. During the 10/19/2023 visit, LPA Martinez observe the following items to be not in good repair: exterior emergency gate, window screens, sliding glass door screen, fence boards, and freezer door. The deficiencies were cited on the day of 10/19/2023 visit. Moreover, LPA Martinez requested the following POC’s to be corrected by: 11/09/2023. Based upon this inspection, LPAs Martinez and Lee observed the following POC’s to be corrected. The Deficiencies cited have been cleared. Licensee complied with the terms of the plan of correction and corrected the deficiencies by the plan of correction due date. An exit was conducted, and a copy this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 15, 2023

Allegation investigated: Staff spoke inappropriately towards resident

Licensing Program Analyst (LPA) Tung Truong made an unannounced visit to the facility to commence a complaint investigation for the above allegation. LPA met with facility staff Darlene Boyd and explained the purpose of the visit. Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on records reviewed and interviews conducted, staff (S1) spoke to client (C1) inappropriately on 10/23/23. According to a voicemail, S1 can be heard talking to C1 in a degrading manner. S1 told C1 that she is lazy, and that other care home would not put up with her behavior. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. Exit interview was conducted, a copy of the report, LIC 9099-D and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Nov 2, 2023 · control 27-AS-20231026091124

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 9, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews and records review, the Licensee did not ensure residents were accorded dignity by Staff (S1). S1 spoke to C1 inappropriately on 10/23/23. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 2, 2023

Plan of correction: All staff and administrator shall take In-Service training on verbal abuse, and residents personal rights. Administrator shall send proof of training to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez and Scott Brooks made an unannounced visit to this facility to conduct an annual inspection on 10/19/2023 at 2:25 PM. LPA Martinez met with Renee Ates and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate and expires in September of 2024. The facility is licensed for 6 non-ambulatory clients. There are currently 4 clients who reside at this facility. The facility has a hospice waiver for 1. LPA Martinez toured the facility with on 10/19/2023 at 2:25 PM. LPA Martinez reviewed two employee files and two client files, and the files were maintained. LPA Martinez reviewed one medication administration record, and the record was maintained. First Aid Kit was complete. The fire extinguishers, smoke detectors, and carbon detectors were in good repair. Facility has cameras mounted in the common areas. The cameras are not in working order, however, facility sketch should be updated to reflect mounted cameras. LPA Martinez requested a copy of surety bond and liability insurance The facility has infection control plan and emergency disaster plan. All requested document should be emailed to LPA Martinez by October 26 2023 by 5 PM. LPA observed the facility to have an adequate food supply. The following items were not in good repair: Window screens, sliding glass door screens, exterior fence, wheelchair ramp, emergency exit gate/door, freezer had frost bite build up. The items should be repaired by November, 09, 2023. A Plan of correction visit will be conducted to inspect repairs. The facility water temperature measured at 105 degrees and facility temperature measured at 78 degrees. As a result, of this annual visit, the facility was cited for fire clearance and Maintenance and Operation. Citations can be found on the 809-D page. An exit interview was conducted, and a copy of this 809 report, 809-D Page, and appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Oct 19, 2023

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 9, 2023

87303 Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by Based on observation and inspection, LPA Martinez found the following items not to be in good repair: Facility window screens, exterior emergency door ramp, exterior fence boards broken and nails exposed, freezer has frost bite. This posed a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Oct 19, 2023

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 9, 2023

87203 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. This requirement was not met as evidence by: Based on observation and inspection the exterior emergency/fire gate was not in good repair. This posed a potential health and safety risk to client.the state’s words, verbatim · CDSS document, Oct 19, 2023