Little Brook Care Home #3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lavinia Muscan arrived on April 22, 2026 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (3) and staff files (2). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. Facility is current on fire drills. Staff training contained the required initial training. LPA and Administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. The disaster drill is current. The administrator's certificate is current. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to Administrator.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced and met with the caregiver to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms, five (5) bathrooms, and two (2) shower rooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 113.8 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguisher and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and also reviewed two (2) staff files. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jun 4, 2025

Type of visit: Office

An informal conference was conducted at 9:30am on June 13, 2024 with Sacramento North Regional Office via Microsoft Teams. The purpose of this informal conference meeting is to address the recently issued citations. The Administrator was told that this Informal conference is a part of the Administrative Action process, and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license. The following Licensing staff were present: Licensing Program Analyst (LPA) Angela Hood and Licensing Program Manager (LPM) Maribeth Senty The following facility representatives were present: Administrator Persida Pop The following topics were covered during today's meeting: · Licensee has four (4) newly licensed facilities and there are concerns with compliance at two (2) locations (Little Brook Care Home and Little Brook Care Home #3). · Administrator coverage at all facilities · Citations issued address the following topics: · Observation of changes in residents’ conditions · Arranging timely medical treatment · Medications being distributed as prescribed with accurate documentation · Ensuring all medication remain locked and inaccessible to residents **************************************************Continued on LIC809-C********************************************** · Ensuring transportation to medical appointments · Personal rights of residents to receive medical care · Eviction notices and notifying CCLD of evictions · Ensuring all annual training is conducted for staff · Ensuring all medical assessments for newly retained residents have been conducted within 1 year of admittance · Plan of corrections have been received for all citations · Technical Support Program referrals offered twice prior to meeting and were declined Administrator indicated that there are no residents at Little Brook Care Home #4. Administrator stated that they have a second Administrator to assist with the three (3) facilities that currently have residents. During discussion with Administrator, it was observed that the Administrator did not have a clear understanding regarding the importance of following physician’s orders regarding dialysis appointments. The Department reiterated that it is the facility’s responsibility to ensure the residents’ medical appointment, if missed, are rescheduled within the same week or that, if scheduled transport is missed, alternative transportation is provided to the appointment. The Department discussed technical support at least 5 times during the meeting and Administrator declined. The Department will continue to offer technical support. Administrator will continue to work with LPA to ensure the facility remains in compliance with regulations. Administrator agrees to contact LPA if Technical Support is necessary. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.the state’s words, verbatim · CDSS document, Jun 13, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday June 11, 2024 to conduct an annual continuation inspection. LPA Parks and Administrator Persida toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, living room, kitchen, and backyard. In the areas toured, there were no health or safety violations observed. Facility was clean and well organized. Fire Extinguisher has current inspection tag. First aid kit is fully stocked. All required posting were observed. No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the facility.the state’s words, verbatim · CDSS document, Jun 11, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday May 23, 2024 to conduct the unannounced annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (5) and staff files (2). Due to time constraints, LPA Parks will return at a later date to complete the annual inspection. See 809-D for deficiencies cited during todays visit. Exit interview conducted. A copy of this report along with appeal rights were emailed to the Administrator.the state’s words, verbatim · CDSS document, May 23, 2024

Allegation investigated: -Facility is not providing medications as prescribed -Facility is not keeping medications locked away

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 1/25/24, and met with Administrator, Persida Pop, to open and deliver findings into a complaint investigation regarding the above stated allegations. During today's visit, LPA observed the keys to the medication cart hanging from the cart. LPA attempted to conduct a medication count. However, the facility does not have documentation for when each medication bottle was started and a medication count could not be conducted. Based on observation and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Substantiatedthe state’s words, verbatim · CDSS document, Jan 25, 2024 · control 59-AS-20240122135356

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 26, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation and documentation reviewed, the facility did not ensure the start dates for each medication were documented and a medication count could not be conducted to ensure medications are being given as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Licensee agrees document when each medication bottle is started for each resident and to complete a statement of understanding by the POC due date of 1/26/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 8, 2024

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the facility did not ensure the keys were not hanging from the medication cart, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Licensee agrees to keep medication keys in a different location of the facility and will complete a statement of understanding by the POC due date 2/8/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Feb 8, 2024

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year... This requirement is not met as evidenced by: Based on observation and documentation reviewed, the facility did not ensure each resident had a completed Centrally Stored Medications Form, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Licensee agrees to either complete Centrally Stored Medications Forms for each resident or update their electronic system to indicate all required information for each medication provided. Licensee agrees to submit a statement of understanding by the POC due date of 2/8/24.