Lively Home Care

Allegation investigated: Staff did not follow reporting requirements. Resident was required to purchase hygiene supplies.

Licensing Program Analyst(LPA) Evelin Rios conducted a subsequent unannounced complaint investigation visit regarding the above allegations. LPA met with two (2) staff in the facility and explained the reason for the visit. Staff contacted the administrator to inform them LPA was at the facility. LPA met with the administrator shortly after. The investigation consisted of the following: On 04/30/25 LPA Rios conducted an unannounced initial complaint investigation visit. During the visit LPA requested a copy of the Register of Facility Residents (LIC9020) and Personnel Report (LIC500). LPA Rios conducted a physical plant tour of the facility inside and out. While conducting the physical plant tour LPA attempted to interview two (2) of three (3) residents. The two (2) residents did not respond to LPA's questions. LPA was able to interview one (1) of three (3) residents. LPA Rios reviewed and obtained copies of relevant documents to the investigation such resident's Medical Assessment, Appraisals, Unusual Incident Report and Admission Agreement. During today's visit LPA delivered findings. (Cont. to LIC9099-C) Substantiated The investigation revealed the following: Regarding the allegation: Staff did not follow reporting requirements. It is alleged staff did not submit an incident report for a fall sustained by Resident#1 (R1) on 2/12/25. Interviews with staff revealed staff notified the administrator regarding the incident and administrator is in charge of submitting incident report, notifying responsible party, and physician. Administrator stated they had submitted an incident report to the Department. Documents reviewed revealed incident report dated 2/12/25 was received by the Department on 2/26/25 notes, R1 was found in their bedroom floor after they yelled they “were falling”. Although the administrator submitted an incident report to the Department it was received after 14 days of the incident occurring. Therefore, the allegation is substantiated. Based on LPAs observations, interviews conducted , and record reviews, 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 and Chapter 8 are being cited on the attached LIC 9099D. Regarding the allegation: Resident was required to purchase hygiene supplies. It is alleged staff requested responsible party purchase toilet paper for resident. Interview with one (1) resident and their responsible party revealed facility’s administrator had required them to purchase toilet paper for the resident’s use. Interview with the administrator revealed that they had been providing toilet paper to R1 and continued to do so. They only asked R1’s responsible party to also provide toilet paper because R1 was using an increased amount. According to the Admission Agreement signed on 12/3/24 it notes R1 will receive basic services which include hygiene items of general use. Admission agreement does not include a clause to charge fees or require residents to provide their own toilet paper if additional toilet paper is necessary. Therefore, the allegation is substantiated. Based on LPAs observations, interviews conducted , and record reviews, 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 and Chapter 8 are being cited on the attached LIC 9099D. Deficiencies cited on LIC9099-D. Appeal Rights and report provided to administrator. The investigation revealed the following: Regarding the allegation: Staff neglect resulted in a resident sustaining an injury. It is alleged that R1 fell out of bed because the facility did not obtain bed rails or provide adequate supervision, resulting in the fall. Interview with one (1) resident reveled staff assist them as needed and they have not experienced any falls in the facility. The administrator reported that R1’s bedroom door is a required fire door that must remain closed because it does not automatically close when the smoke alarms go on therefore, R1 was provided a call button. Staff interviews revealed they conduct regular check-ins with residents every 1–2 hours. Staff present during the incident stated approximately one hour had passed between the last check in on R1 and when they heard R1 yell they were falling. Staff went to R1's bedroom and observed R1 on the floor on their rear end. R1 had initially stated they were ok but once assisted to the bed they complained about pain and staff contacted the administrator, R1's responsible party and 911. The administrator stated R1 often wrapped themselves in blankets, making it difficult for them to get out of bed. The administrator also confirmed that they received a request for a bed rail and had requested a physician’s order days prior to the fall. The facility did not have a physician’s order for a bed rail, prior to R1's fall. Although R1 sustained a fracture requiring surgery, there were no other documented falls, and there is not sufficient evidence to show that staff failed to provide appropriate assistance with supervision. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding allegation: Staff left resident in bed for an extended period of time. It is alleged R1 is left in bed as staff do not know how to transfer them from bed to wheelchair. Interview with one (1) resident revealed staff assist them as needed and are not left in bed for an extended period of time. Interviews with staff revealed R1 sustained a fracture on 2/12/25 upon returning to the facility on 4/10/25, R1’s mobility changed and required assistance to transfer from bed to wheelchair. Before the fall R1 was able to use a walker to ambulate. Due to the change in condition R1 spent more time in their bed than before. Review of Skilled Nursing Order Summary Report dated: 4/7/25 revealed R1 had a fracture to the neck of right femur. There were no physician’s orders or summary reports regarding care upon return to the facility. Staff interviewed, stated R1 was transferred to wheelchair to have breakfast in the dining area and R1 was able to communicate with staff about when they wanted to be transferred out of bed. (Continue to LIC9099-C) Even though R1 may have been spending more time in their bed there is not enough evidence to say staff were not assisting R1 with transfer assistance or with ambulating. Therefore the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation: Staff did not ensure medication cabinet was locked. It is alleged medication cabinet was observed unlocked. On 04/30/25, LPA Rios inspected the cabinet and drawers where medications are centralized, and observed all storage areas to be locked at the time of inspection. An interview with one (1) resident indicated they had not seen the medication cabinet left unlocked at any time. Interviews with staff revealed that the medication cabinet is always maintained locked until medications are being prepared or administered. The administrator stated staff are trained on medication storage procedures and understand that medications must be locked. Record review did not show any prior deficiencies indicating that the medication cabinet had been left unlocked. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation: Staff did not provide activities for residents in care. It is alleged there are no activities available for the residents. Interview with one (1) resident revealed they are asked to participate in activities. Interviews with staff and the administrator indicated that following R1’s fall, staff provided activities such as arm exercises, coloring, playing piano, and playing cards. According to staff, R1 did not have an activity schedule but chose activities based on their mood. Staff reported that R1 liked playing checkers with a friend and would be transferred to a wheelchair and taken to the living room when participating in activities. Staff and the administrator stated activities are offered and available, and residents are encouraged to participate based on their abilities and preferences. LPA observed supplies for in the facility to conduct activities and reviewed the facility's activity list. Based on interviews and observations, there is insufficient evidence to show that staff failed to provide activities for residents in care. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted copy of report provided to administrator.the state’s words, verbatim · CDSS document, Aug 17, 2026 · control 31-AS-20250424114506

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 28, 2026

Reporting Requirements 87211(a) Each licensee shall furnish to the licensing agency such reports as the Department may require ... (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence ... This requirement is not met as evidenced by: Based on interviews conducted with staff, the licensee did not comply with the section cited above in which R1 had a fall causing serious injury and the facility did not report the inicident to the Department timely which poses a potential health, and safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Administrator will review the regualtion cited and a written statement of understanding will be completed and submitted to the Department by POC due date 08/28/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(D) · Plan of correction due date: Aug 28, 2026

Personal Accommodations and Services 87307(a) ...The following provisions shall apply: (3) ... supplies necessary for personal care ... shall be readily available to each resident. ... the licensee shall assure provision of: (D) Hygiene items ... such as soap and toilet paper. This requirement is not met as evidenced by: Based on interviews conducted with staff, the licensee did not comply with the section cited above in requesting residnets to provide own toilet paper which poses a potential health, and safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Administrator will review the regualtion cited and a written statement of understanding will be completed and submitted to the Department by POC due date 08/28/26.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual visit. LPA was greeted by two (2) staff members. Staff contacted the administrator, Marfiebeth Topacio and informed her LPA was in the facility. The administrator met LPA shortly after and LPA explained the reason for the visit. LPA Rios conducted a physical plant tour of the facility inside and out and the following was observed: Common Areas: These areas include the living room and dining room for resident use. The common areas were observed free of clutter, and appropriately furnished. The dining table with chairs and the living room furniture, including a couch and armchairs, provide sufficient seating for the facility’s capacity. LPA observed all passageways to be clear and free of obstructions and no tripping hazards observed. Kitchen: Appliances and fixtures were observed functioning properly. LPA observed knives and sharps locked in a kitchen drawer. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. The administrator showed LPA pictures of meals prepared since January 2026, which showed a variety of meals. LPA also reviewed the facility’s two-week meal plan. According to the administrator, resident preferences are incorporated into meal planning. One (1) fully charged fire extinguisher was observed near the kitchen, with the last service date of 03/03/2026. Bedrooms: There are five (5) bedrooms designated for residents' use. Four (4) Bedrooms are for private use and one (1) bedroom is shared. The bedrooms were properly furnished. LPA observed extra linens available in the cabinets in the hallway. (Continue to LIC 809-C) (Continue from LIC809)Bathrooms: There are two (2) bathrooms designated for residents' and staff. The bathrooms are by bedroom #1, #2 and #3. The bathrooms were properly supplied with hand soap, paper towels and toilet paper. Hot water temperature was measured in both bathrooms and measured between 113.4 and 114.3 degrees Fahrenheit, within regulation. While touring the bedrooms, LPA interviewed one (1) out of four (4) residents. Surrounding Grounds: The backyard is fully fenced. Entry and exits were free of obstruction. LPA observed appropriate outdoor furniture. No bodies of water observed. The doors leading to the outsides were equipped with auditory alarms, which were turned on and observed to be functioning properly. Laundry room: The laundry room is located by the kitchen and dining area. LPA observed the laundry room locked. All cleaning supplies and detergents were stored in a locked cabinet within the laundry room. Records: Records are stored in a locked closet and cabinet located near the staff bedroom and Bedroom #5. From 2:25 PM to 3:35 PM, LPA reviewed facility documentation, including four (4) of four (4) resident files and three (3) staff files. LPA also reviewed the Emergency and Disaster Plan (LIC 610E), the facility’s current liability insurance, Register Of Facility Residents (LIC9020) and Personal Report (LIC 500). LPA obtained copies to update the Departments facility's file. LPA also reviewed the facility's most recent fire drill conducted on 03/18/2026. Staff and resident records were reviewed for compliance with all required licensing documentation. Medications are centrally stored and locked in a cabinet by the staff's bedroom. Medication requiring refrigeration were observed locked in a small fridge on the kitchen counter. Centrally Stored Medication Records are completed manually, and the facility maintains a Medication Administration Record (MAR). Facility has a fully stocked first-aid kit with manual in a cabinet under the medication. At 3:39 PM, LPA observed the administrator test a dual smoke and carbon monoxide detector. Detectors are hardwired and interconnected to other detectors located through out the facility. Detectors were observed to be functioning properly. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the annual visit. Exit interview conducted. A copy of this report provided to administrator.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Required - 1 Year

On 4/30/2025, Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual visit LPA Rios arrived to the facility and was greeted by two (2) staff. Staff #1 (S1) requested LPA sign in. S1 contacted the administrator, Marfiebeth Topacio and informed her LPA was in the facility. Marfiebeth Topacio met LPA shortly after and LPA Rios explained the reason for the visit. LPA is simultaneously addressing complaint control #31-AS-20250424114506. LPA Rios conducted a physical plant tour of the facility inside and out from approximately 9:03 a.m. to 9:30 a.m. While conducting the physical plant tour LPA attempted to interview three (3) out of three (3) residents. One (1) resident was sleeping and the other two (2) residents did not respond to LPA questions. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were observed clean, clear of clutter and properly furnished. Dining table fits the capacity of the facility. LPA observed passageways to be free of obstructions. Bedrooms: There are five (5) bedrooms designated for residents' use. Four (4) Bedrooms are for private use and one (1) bedroom is shared. The bedrooms were properly furnished with appropriate dresser, bedding, linens and had sufficient lighting. LPA observed extra linens available in the cabinets in the hallway. Bathrooms: There are two (2) bathroom designated for residents'. The bathrooms were properly supplied with hand soap, paper towels and toilet paper. Hot water temperature was measured in both bathrooms and measured between 109.4 and 120 degrees Fahrenheit, within regulation. (Continue to LIC 809-C)the state’s words, verbatim · CDSS document, Apr 30, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. At 10:00 am Ariel Acorda who a staff at the facility met with LPA, explained the reason for the visit. Administrator could not meet LPA at the facility today due to being out of town and designated staff Ariel Acorda to sign today's report. At 10:10 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 3/18/2024. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; one (1) maybe bedridden; two (2) hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the laundry room. Bedrooms: There were six (6) bedrooms designated for residents' and staff use. Bedroom #1, bedroom #2, bedroom #3, bedroom #4, and bedroom #5 are private and is used by residents. The bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 is vacant. Bedroom #6 is for staff room that is located beside the dining table. Continue to LIC 809-C Bathrooms: There are two (2) bathroom designated for residents' and staff use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 117.4 degrees Fahrenheit for bathroom #1 located in the hallway in between room #2 and room #3. Bathroom #2 is across bedroom #3. Hot water temperature was measured at 116.2 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. There is no garage in the facility just a car port. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the kitchen. Disposable bins for needles are located inside the locked laundry room. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is in between the dining room and staff room. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current appraisal. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Apr 30, 2024