Lorie's RCFE LLC #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 8:59 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Lorie Valadez, Administrator, and Claire Aviado, administrator designee and explained the purpose of the visit. 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: The facility has 5 resident bedrooms, 1 staff bedroom and 3 bathrooms currently occupying 5 residents. The facility has smoke and carbon monoxide detectors that were tested and working at the time of visit. The lighting is sufficient for the use of the facility and resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. 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 a fenced backyard for client use with plenty of shade. Operational Requirements: The facility has current liability insurance that expires on 9/11/26. The facility is operating in compliance with the granted fire clearance. Facility has sprinklers. The facility is approved for a capacity of 6. The fire clearance is granted for 2 bedridden residents. A hospice waiver is approved for 2 residents. Continued 809-C Personnel Records & Training: The facility employs 10 caregivers who work full-time and/or as relief as needed, and 3 administrators. Records are kept confidential. Files were reviewed for, but not limited to current 1st Aid/CPR, Health screening with TB results, Criminal Record statements, files were complete. The administrator file was reviewed for Continuing Education requirements and Administrator Certificate expire 8/14/2027. Staff have annual training completed for various required subjects/topics and hours for 2026. Resident Records & Incident Reports: The facility keeps resident records confidential. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for, but not limited do, current Physician Records and Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible, and records are kept complete. Food Service: The kitchen and storage areas were clean and maintained. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. The current menu and ingredients were present. Incidental Medical Services: Facility provides or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducted a quarterly disaster drill on 6/2026. 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. The fire extinguishers were last charged and inspected on 4/20/26. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit gate alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 20, 2026

Allegation investigated: Medication was not given as prescribed.

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the above facility to issue final findings. LPA met with Administrator Freda Robles and Administrator Desingee Claire Aviado, explained the purpose of the visit. During the initial visit on 6/5/25, LPA Rankin interviewed two administrators and obtained relevant documents. Additional interviews were conducted with relevant parties on 6/4/25, 6/6/25, 7/29/25, 7/30/25, and 8/4/25. LPA collected Resident 1’s (R1) hospice file, hospice handbook, text correspondence, pictures of R1, and additional records emailed from the facility. On the allegation – Medication was not given as prescribed: It was alleged that R1 was not provided with the medication Lasix as prescribed by their physician, resulting in swelling in their feet. R1 was admitted to the facility and hospice on 2/28/23. Continue on 9099-C Substantiated Upon review of R1’s facility file, documents show staff identified missing medication, two of which were Lasix and KCL (potassium). Both medications were listed on a physician’s verification form dated 1/23/23. Hospice Records state the following: Hospice charting visits on 3/1/23, 3/8/23, and 3/10/23 state: resident had edema, medications were reviewed, and caregivers demonstrated medication compliance. Additional notes from Hospice: 3/8/23: New note: “+1 edema noted to BLE (bilateral lower extremity)…3/10/23: New note: “3+ edema...and new fluid blisters noted to the top of (R1)’s feet.” 3/17/23: New note: “Pt encouraged to take (their) Lasix to assist with edema.” Hospice Medication list states Lasix and Potassium’s start date was 2/28/23. The facility's Centrally Stored Medication and Destruction Record (CSMDR) shows that “Furosemide” (Lasix) was ordered, filled, and started on 3/9/23, and potassium was started on 3/10/23. Correspondence confirms that an attempt was made by the administrators to get medication from hospice on 3/6/23. Both sets of messages confirm that the Lasix medication was received and given on 3/9/23. Correspondence received by LPA notes a conversation from the administrator, dated 3/9/23, which states the facility showed the Nurse Practitioner (NP) blisters on the top of R1’s foot. “It’s because of (R1)’s edema. Hopefully, when (R1) starts the Lasix, this will help (R1).” Nurse Practitioner notes on a “Physician Visits” form, dated 3/9/23, “Pt very SOB (short of breath). Increase Furosemide to 80mg Q am,” indicating the medication could assist in this symptom. When administrators were asked about the delay, they couldn't remember specifics due to the incident occurring over two years ago. Notes and messages indicated that the medication was discussed with the hospice nurse on 3/1/23 as missing. The administrator mentioned that the family brought part of the medication and was supposed to bring the rest. The administrator states they asked the nurse for the missing medication again on 3/6/23. Continue on 9099-C In an interview on 8/4/25, Hospice Nurse believed the family would bring the missing medication and admitted that the facility reached out on 3/6/23. Nurse did not confirm the medication was still missing until the second visit on 3/8/23. Hospice notes show that a rush order for Lasix was requested on 3/9/23. The hospice agency handbook provides that a pharmacist could assist with medication questions and there is a 24-hour hospice hotline, but no interviews or records show these resources were utilized. Records and interviews concluded that R1’s Lasix and potassium were not administered from 3/1/23 to 3/8/23. While attempts were made to obtain medication through hospice and the family, it is the facility's responsibility to follow physicians’ orders, ensure scheduled medications are administered, and arrange care appropriate to the conditions and needs of residents. Based on LPA’s observations, interviews conducted, and record reviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 29-AS-20250604165335

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 7, 2025

87465 Incidental Medical and Dental Care (a)A plan for incidental medical...care shall be developed by each facility. The plan shall encourage routine medical…care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical…care appropriate to the conditions and needs of residents. This requirement is not met based on interviews and record reviews, licensee did not comply with the section cited above when facility failed to ensure medications were received or ordered upon intake of resident and admittance of hospice care plan, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2025

Plan of correction: Licensee agrees to create intake process for all residents, including hospice, to ensure that all medications are reconciled, and received to ensure medication orders are followed. Licensee will provide a statement to Licensing stating how they will handle missing medications going forward.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:46 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Claire Aviado, administrator designee and explained the purpose of the visit. 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: The facility has 5 bedrooms and 3 bathrooms currently occupying 5 residents. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting is sufficient for the use of the facility and resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats/flooring. The pathways are clear of any obstructions. Disinfectant and cleaning solutions are inaccessible to residents in care and are locked in a cupboard in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. Operational Requirements: The facility has current liability insurance that expires on 9/11/25. 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 2 bedridden residents. A hospice waiver is approved for 2 residents. Continued 809-C Personnel Records & Training: The facility currently employs 5 full-time caregivers, and 3 administrators. Records are kept confidential. Files were reviewed for, but not limited to current 1st Aid/CPR, Health screening with TB results, Criminal Record statements, files were complete. The administrator file was reviewed for Continuing Education requirements and Administrator Certificate expires 8/14/25. Staff have annual training completed for various required subjects/topics and hours for 2025. Resident Records & Incident Reports: The facility keeps resident records confidential. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for, but not limited do, current Physician Records and Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible, and records are kept complete. Food Service: The kitchen and storage areas were clean and maintained. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. The current menu and ingredients were present. Incidental Medical Services: Facility provides or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Additional medication processes are being implemented. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill 3/2025. 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. The fire extinguishers were last charged and inspected on 4/23/25. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit gate alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 6, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rankin conducted a Case Management - Deficiencies visit to issue deficiencies on medication documentation errors which were discovered during a complaint visit. LPA met with the Administrator Freda Robles and Administrator Desingee Claire Aviado explained the purpose of the visit. During a record review conducted for a complaint visit on Resident 1 (R1), LPA noted that physician’s orders and medication lists from hospice do not match the facility’s Centrally Stored Medication and Destruction Record (CSMDR) or the Medication Administration Record (MAR). There are medications referred to in the hospice medication list that are not on the CSMDR, such as Albuterol, Omeprazole, Ondansetron, Tylenol, Folic Acid, Dulcolax, Senna, Hyoscyamine Sulfate SL, Coenzyme, and the high-risk medication Oxycodone. It was confirmed through the hospice agency that a “comfort kit” comes with Ondansetron, Dulcolax, Senna, and Oxycodone. Records and interviews concluded that R1 was admitted on 2/28/23 and that medications ordered by hospice were provided to the facility but not added to the CSMDR. It is the facility’s responsibility to ensure medications are prescribed by a physician, and that the record of dosages of medication, which are centrally stored, are maintained by the facility. Based on interviews conducted and record reviews, the facility did not maintain an accurate CSMDR. Medications sent to the facility and ordered by hospice were not noted on the CSMDR or on the MAR. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Aug 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(6)(B-E) · Plan of correction due date: Aug 7, 2025

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…and includes: (B) …name of the prescribing physician. (C)…drug name, strength and quantity. (D)…date filled. (E)…prescription number… This requirement is not met based on interviews and record reviews, licensee did not comply with the section cited above when the licensee failed to ensure medication records were complete and all medications in the facility’s possession were listed on the CSMDR, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2025

Plan of correction: Licensee agrees to audit medication records to ensure that all medications are recorded. Licensee agrees to review medication processes with staff involved in medication management. In service training sheet signed by all medication staff will be provided to licensing.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 9:15 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Claire Aviado, administrator and Lorie Valadez, licensee and explained the purpose of the visit. 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 a current Infection Control Plan. The facility has a sign in and out binder for visitors with hand sanitizer located in dining room area. The bathrooms have toilet paper, paper towels, hand soap, and all disinfectants sprays and cleaners were locked under bathroom sink. 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: The fire extinguishers were last charged and inspected on 2/5/24 The facility has 5 bedrooms and 3 bathrooms currently occupying 5 residents. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and are locked in a cupboard in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance that expires on 9/11/24. 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 2 bedridden residents. A hospice waiver is approved for 2 residents. The facility currently has 4 non-Ambulatory residents and 1 ambulatory resident. 1 resident is on hospice. Staffing: The facility currently employs 5 full time caregivers, and 3 administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and Administrator Certificate expires 9/12/24. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2024. 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 5 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, and records are kept confidential. Food Service: The facility handles and prepares food safely. 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. Continued 809-C Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, 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 4/17/2024. 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. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 13, 2024