Love 2 Care Homes

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Becky Mann made an unannounced visit to the facility to conduct a Complaint Control Number 56-AS-20260421083511. During the facility visit, based on LPA observations, interviews and record reviews the facility was not at a comfortable temperature which poses a potential health, safety or personal rights risk to persons in care. Deficiency issued. LPA observed the thermostat indoor temperature of 85 degrees Fahrenheit. The outside temperature is currently 102 degrees Fahrenheit. An exit interview was conducted where this report was discussed and provided to Rosalyn Walker, Caregiver.the state’s words, verbatim · CDSS document, Aug 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 80088(a)(1)(A) · Plan of correction due date: Aug 26, 2026

80088 (a) A comfortable temperature for clients shall be maintained at all areas. (1)The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F...(A) In areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. Requirement was not met: Based on LPA observations, interviews and record review, Licensee did not comply with section cited above. Thermostat was 85 degrees Fahrenheit and outside temperature was 102 degrees Fahrenheit which poses potential health, safety, personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Aug 26, 2026

Plan of correction: Staff contacted Licensee by phone and Licensee corrected the deficiency during the LPA visit. Licensee will maintain a comfortable temperature for residents at all times.

Allegation investigated: Due to staff negligence, resident was injured Staff did not ensure resident had clean linens Staff did not ensure residents room was cleaned properly Staff did not report incident to authorized representative Staff did not provide all medications to authorized representative when resident moved

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Jasmine Goudeau, Caregiver and explained the purpose of today's visit. The investigation consisted of LPA observations, pertinent document reviews, and interviews with staff and residents. The allegation that Due to staff negligence, resident was injured. Two (2) staff interviewed denied staff negligence that resulted in a resident being injured. Resident #1 (R1) and Resident #2 (R2) interviewed denied of staff negligence and have not been injured at the facility. Attempts to interview Resident #3 (R3) and Resident#4 (R4) were made; however, they were unable to provide information. The allegation that Staff did not ensure resident had clean linens. Two (2) staff interviewed stated that they clean the linens often. Based on LPA observations, residents’ linens are clean. R1 and R2 stated that the staff do keep their linens clean. Attempts to interview R3 and R4 were made; however, they were unable to provide information. Unsubstantiated The allegation that Staff did not ensure residents room was cleaned properly. Two (2) staff interviewed stated that they clean the residents’ room daily. Based on LPA observations, the residents’ rooms are clean. R1 and R2 stated that the staff do clean their rooms daily. Attempts to interview R3 and R4 were made; however, they were unable to provide information. The allegation that Staff did not report incident to authorized representative. Two (2) staff interviewed stated that they report incidents to the administrator. Interviews with R1 and R2 did not reveal enough evidence to corroborate the allegation. Attempts to interview R3 and R4 were made; however, they were unable to provide information. The allegation that Staff did not provide all medications to authorized representative when resident moved. Two (2) staff interviewed stated that they do provide all medications to authorized representatives when a resident moves out of the facility. R1, R2, R3 and R4 currently resides at the facility and have not moved out. Based on interviews with staff and residents, the allegations above are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy of this report was provided to Jasmine Goudeau, Caregiver at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 20, 2026 · control 56-AS-20260126093655

Allegation investigated: Staff neglect resulted in a resident's death Staff neglect resulted in a resident sustaining a pressure injury Staff did not meet a resident's catheter needs

Licensing Program Analysts (LPAs) Becky Mann and Lavette Farlow conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Jasmine Goudeau, Caregiver and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and residents. On 11/18/2025, the Department received a complaint with the allegation of Neglect/Lack of Care and Supervision – Staff neglect resulted in a resident's death. The Department investigation consisted of review of facility and medical records, observations, and interviews with pertinent individuals. Records obtained did not support staff neglect occurred. Resident #1 (R1) medical diagnoses included organ failures, dehydration, and severe UTI. Hospital records further revealed that R1 was admitted to the hospital due to decreased responsiveness/lethargy for 1 to 2 days. The Certificate of Death indicated that R1’s cause of death was septic shock due to acute encephalopathy, an acute left cerebellar stroke, and metastatic breast cancer. The allegation of Staff neglect resulted in a resident's death is unsubstantiated. Unsubstantiated The allegation that Staff neglect resulted in a resident sustaining a pressure injury. Interviews with Resident #2(R2) and Resident #3 (R3) revealed that they have not had pressure injuries while at the facility. Interviews with 3 staff stated that residents have not sustain pressure injuries while at the facility. The allegation that Staff did not meet resident’s catheter needs. Interview with witness revealed uncertainty about whether R1 had a catheter. The Department obtained and reviewed R1’s medical records which did not indicate prior use of a catheter on R1. Interviews with Staff #1 (S1), (S2), and (S3) revealed that R1 did not use a catheter throughout the stay at the facility. The hospital record revealed on 08/12/2025, at 1150 hours, while at the hospital, that a urethral catheter was placed. It was reported that the necessity was for critically ill patients requiring hourly urine output measure for clinical decision. Based on interviews with staff and records obtained, there’s insufficient evidence to prove that facility staff did not meet resident’s catheter needs, therefore, the allegation unsubstantiated. Based on evidence obtained during this investigation, the allegation above is Unsubstantiated. A finding of unsubstantiated means there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted where this report was discussed, and a copy of this report was provided to Jasmine Goudeau, Caregiver at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 5, 2026 · control 56-AS-20251118122519

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87465(e) · Plan of correction due date: Aug 6, 2026

87465 (e)For every prescription and nonprescription PRN medication which licensee provides assistance shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, a label on the medication. Requirement was not met: Based LPA observations and record reviews, Medication Administration Record (MAR) did not match bubble packs. The MAR was not marked when staff administered medication to residents, which poses immediate health, safety to persons in carethe state’s words, verbatim · CDSS document, Aug 5, 2026

Plan of correction: Administrator will train staff on how to use MAR (Medication Administration Record) to document medications being administered. Administrator will submit proof to LPA by Plan of Correction (POC) due date

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Becky Mann and Lavette Farlow made an unannounced visit to the facility to conduct a Complaint Control Number 56-AS-20251118122519. During the facility visit, based on LPAs observations, interviews and record reviews and the frequent visits to the facility the Licensee/Administrator Terri Jackson has not been able to show up at the facility. During the multiple visits, LPA has contacted Licensee/Administrator by phone. The Licensee/Administrator is not on the premises the number of hours necessary to manage and administer the facility which poses a potential health, safety or personal rights risk to persons in care. Deficiency issued. An exit interview was conducted where this report was discussed and provided to Jasmine Goudeau, Caregiver.the state’s words, verbatim · CDSS document, Aug 5, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87405(a) · Plan of correction due date: Aug 12, 2026

87405 (a)All facilities shall have qualified and currently certified administrator... The administrator shall have sufficient freedom from other responsibilities, shall be on premises a sufficient number hours to permit adequate attention to management and administration of the facility. Requirement was not met: Based on observation, interview and record review, Administrator did not comply with section cited above not having Administrator on the premises the number hours necessary to manage and administer the facility in compliance which poses potential health, safety, personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 5, 2026

Plan of correction: Licensee/Administrator schedule will be modified with hours during the week in order to maintain and manage the facility in compliance. Licensee/Administrator will send email to LPA by Plan of Correction (POC) due date

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced required 1-year visit to the facility. LPA met with Eula Jones, Caregiver and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). Licensed capacity of 6 with a current census of 6. LPA conducted an overall inspection of the facility, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as beds, mattresses, night stands, storage space, chairs and sufficient lighting. Bathrooms were clean and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested 118 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents. All the sharps are locked. There was a designated area for resident/staff files. Overall, the facility is clean, in good repair, and operating in a safe condition for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for the number of residents. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (4) resident files for admission agreements, updated physician reports, and needs and services plans. The 3 out of 4 residents did not have the physician reports on file. Deficiency cited. LPA reviewed (3) resident medications. LPA observed the 3 residents medications, the bubble packs did not match Medication Administration Record (MAR). Deficiency cited and civil penalty issued. Medications are kept locked and inaccessible to residents. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. LPA observed 1 out of 3 staff files did not have annual trainings on file. Deficiency issued. LPA unable to review Liability Insurance, deficiency issued. Based on the observations made during today’s visit, (4) deficiencies and (1) civil penalty were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC809D and LIC421FC was discussed and provided to Eula Jones, Caregiver.the state’s words, verbatim · CDSS document, Jun 23, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Becky Mann made an unannounced visit to the facility to conduct a Complaint Control Number 56-AS-20260522141210. During the facility visit, LPA Mann was unable to review all six (6) resident files. LPA reviewed three (3) out of six (6) resident files. The files were not available at the time of the visit. Deficiency will be issued as this poses an immediate health, safety and personal rights risks to residents in care. An exit interview was conducted where this report was discussed and provided to Eula Jones, Caregiver.the state’s words, verbatim · CDSS document, May 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87506(a) · Plan of correction due date: May 28, 2026

87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Requirement was not met: Based on LPA observations, interviews and record reviews, the LPA was unable to review all 6 residents files at the facility. LPA reviewed three (3) out of six (6) resident files at the facility which poses an immediate health, safety and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: Administrator will have the residents files at the facility at all times. Administrator will review regulation cited and submit a statement of understanding to LPA via email by POC due date.

Allegation investigated: Staff did not ensure there is a grab bar in the bathroom by the toilet

Licensing Program Analyst (LPA) Becky Mann conducted unannounced visit to the facility to initiate a complaint investigation. LPA met with Rosalyn Walker, Caregiver and explained the purpose of the visit. The investigations consisted of staff and resident interviews and facility tour. The allegation that Staff did not ensure there is a grab bar in the bathroom by the toilet. LPA conducted a facility tour and observed 2 bathrooms did not have a grab bar by the toilets which poses a potential danger to residents in care. Based on LPA observations, interviews and records review, the above allegations is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and provided to Rosalyn Walker, Caregiver. Substantiatedthe state’s words, verbatim · CDSS document, Apr 30, 2026 · control 56-AS-20260421083511

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87303(e)(4) · Plan of correction due date: May 7, 2026

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (4)Grab bars shall be maintained for each toilet; bathtub and shower used by residents. Requirement was not met: Based on LPA observations, Licensee did not have grab bars installed by the toilets for the 2 bathrooms in the facility which poses a potential danger to residents in carethe state’s words, verbatim · CDSS document, Apr 30, 2026

Plan of correction: Licensee will have grab bars installed in the bathrooms by the toilets by Plan of Correction (POC) due date. Licensee will send pictures of the grab bar installations to LPA

Allegation investigated: Staff did not provide resident's authorized representative with resident's records

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA Mann met with Rosalyn Walker, Caregiver and explained the purpose of today's visit. The investigation consisted of LPA observations, pertinent document reviews, and interviews with staff. The allegation that staff did not provide resident's authorized representative with resident's records. LPA Mann interviewed Staff #1 (S1) and they stated that the facility did not provide resident's authorized representative with resident's records. Based on LPA observations, interviews and records review, the above allegation is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and provided to Rosalyn Walker, Caregiver. Substantiatedthe state’s words, verbatim · CDSS document, Jan 6, 2026 · control 56-AS-20251229151915

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Jan 13, 2026

87468.2(a)(19)‘residents in privately operated residential care facilities for the elderly shall have all .. personal rights:’ ... ‘(19) To have prompt access to review all of their records ... Photocopied records shall be provided within two (2) business days... This requirement is not met as evidenced by: Based on LPA observations, interviews, and record reviews, staff did not provide resident's authorized representative with resident's records which poses a personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Jan 6, 2026

Plan of correction: Administrator will submit a Statement of Understanding to LPA by Plan of Correction (POC) due date

Allegation investigated: Staff are not adequately trained to meet resident needs. Facility accepted a resident who requires a higher level of care.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with care giver Eula Jones and contacted the Administrator Terri Jackson by a phone call. LPA explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review. For the allegation, Staff are not adequately trained to meet resident needs. During staff interviews 3 out of the 3 staff stated they are trained to meet residents needs. 1 out of the 3 staff stated, all staff members are trained before providing care. During resident interviews 2 out of the resident stated all staff members assist with their ADLs. Unsubstantiated During record review, LPA received copies of staff members training. For the allegation, Facility accepted a resident who requires a higher level of care. During staff interviews, 2 out for the 3 staff informed LPA they are not aware of a higher-level care resident. 3 out of the 3 staff stated, that when R1 returned from the hospital. They were trained to provided proper care. 3 out of the 3 staff stated that R1 family’s is now requesting one on one care to be provided. The facility does not provide one on one care. Based on the evidence found during the investigation, the (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided Eula Jones.the state’s words, verbatim · CDSS document, Aug 26, 2024 · control 56-AS-20240305091344

Allegation investigated: Administrator changed resident's advanced directive without authorized representatives consent Staff are mismanaging resident's medication Staff are not meeting resident's needs Staff are not providing activities for residents Staff are not conducting quarterly emergency drills Staff are not providing adequate food service to residents

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with care giver Eula Jones and contacted the Administrator Terri Jackson by a phone call. LPA explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record review. For the allegation, Administrator changed resident's advanced directive without authorized representatives consent. During staff interviews 2 out of the 3 staff stated Administrator did not change R1 advanced directive. 1 out of the 3 staff stated they did not change resident advanced directive without representative consent. In addition, 1 out of the 3 staff informed LPA that R1 was in year 2023 R1 was in hopsice. By the year 2024 R1 was discharge from hospice. Unsubstantiated During record review, R1 LIC627C authorizes the facility to make decisions for the resident during an emergency, signed by authorized representative. Furthermore, no sufficient documents to collaborate the alleged allegation. For the allegation, Staff are mismanaging resident's medication. During staff interviews 3 out of the 3 staff stated they have not mismanaged resident’s medication. During resident interview 2 out of the 3 resident stated they receive their medication. During medication audit, LPA observed medication dispensed properly. For the allegation, Staff are not meeting resident's needs. During staff interviews, 3 out of the 3 staff stated they are trained to meet each resident care plan. During residents 2 out of the 3 residents stated staff will assist with their ADLs. For the allegation, Staff are not providing activities for residents. During staff interviews, 3 out of the 3 staff stated activities are provided to all residents. 2 out the 3 residents stated staff provide activities in the morning and afternoon. 1 out of the 3 resident informed LPA they do not like to participate in activities. During record review, LPA received a copy of facility’s activity calendar. For the allegation, Staff are not conducting quarterly emergency drills. During staff interviews, 3 out of the 3 staff stated they are provided with emergency drills thought out the year. LPA received a copy of facility’s quarterly emergency drills. For the allegation, Staff are not providing adequate food service to residents. During staff interviews, 3 out of the 3 staff stated adequate food is provided to all residents. During residents’ interviews 3 out of the 3 residents stated they enjoy their meals. During facility tour LPA observed adequate food, LPA also received a copy of facility’s menu. Based on the evidence found during the investigation, the six (6) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided Eula Jones.the state’s words, verbatim · CDSS document, Aug 26, 2024 · control 56-AS-20240308121331

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with staff Eula Jones and was granted entry to the facility. The facility is a (3) bedroom (2) bathroom home and, with a kitchen/dining area, living room, attach garage. Licensed capacity is (6) current census (5). LPA was accompanied by staff Eula Jones to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested within regulation at 110 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (2) client file for admission agreements, updated physician reports, and needs and services plans. LPA also verified (2) medications. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screening. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Terri Jackson.the state’s words, verbatim · CDSS document, Jun 18, 2024

Allegation investigated: Staff do not provide resident activities Staff do not provide residents adequate food service Staff transferred resident incorrectly

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Care Giver Eula Jones and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour. For the allegation, staff do not provide resident activities. During interviews with residents, 4 out of the 5 residents stated the facility does not provide activities for them. R1 and R2 informed LPA the facility only provides a crossword sheet. R1 informed LPA they have offered ideas on what activities they should provide but the facility does not have enough staff. R1 stated the facility does not provide the activities that is listed on their calendar. In addition, R3 informed LPA they would prefer for the facility to provide exercise activities. Substantiated During interview with staff, 4 out the 5 staff informed LPA they do not provide activities for the residents. S1 informed LPA they provide crosswords sheets to residents, but no full activities that listed on the calendar. S2 informed LPA they are not able to provide activities because the facility has one staff per shift. For the allegation, staff do not provide residents adequate food service. During interviews with resident 4 out of the 5 residents stated the facility does not provide adequate food service. R1 informed LPA the facility does not follow the menu they provide. R1 stated the facility does not provide variety of foods considering their preference. R2 informed LPA they have suggested what meals they would like to receive, but facility does not accommodate their preference. R3 stated the facility food is not cooked properly and provided the same meal. In addition, R2 and R3 stated the facility does not provide what the menu states. During interviews with staff, 4 out the 5 staff informed LPA they do follow the menu that is provided to the residents. S1 and S2 stated the facility will not have the right indigents to create the dish. S1 and S2 stated they are not able to follow the facility menu because they do not have correct foods to create the dish. For the allegation, staff transferred resident incorrectly. During interviews with resident, 3 out of the 5 residents stated the staff transferred them incorrectly. R1 and R2 stated they require a two-person transfer with a Hoyer lift. Both residents stated they have been transferred by one person. R1 informed LPA the facility will have one staff on the shifts conducting all transfers by themselves. Both residents stated they did not allow for staff members to transfer them without two people. During interviews with staff 4 out of the 5 staff members admitted they have transfer residents incorrectly. 4 out the 5 staff members stated they are not able to be transferred residents correctly due to one staff member working per shift. Staff also indicated R1 and R2 are a two person Hoyer lift but are not able to provide two-person transfer due to staffing. 3 out of the 5 staff stated they were aware R1 did not want to be transferred by one person. Based on the evidence gathered during today’s investigation, the three (3) allegations listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met .During today’s visit, three (3) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to care giver Tiffany Zoller, along with a copy of the appeal rightsthe state’s words, verbatim · CDSS document, Dec 27, 2023 · control 56-AS-20231114102757

From the deficiency page — Deficiency type: Type B · Section cited: CCR 8755(b)(5) · Plan of correction due date: Jan 10, 2024

87555(b)(5) General Food Service Requirements(5)Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. This requirement was not met based on document review, interviews by not having planned melas consideration of resdients background and food habits which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 27, 2023

Plan of correction: Adminstrator will send LPA a food menu that includes residents cultural and food habits. Administrator will provide LPA what days the facility will go grocery shopping to ensure staff members are able to provide the dish listed on resident menu. POC due date 1/10/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(b) · Plan of correction due date: Jan 10, 2024

87219(b)Planned Activites Residents served shall be encouraged to contribute to the planning, preparation, conduct, clean-up and critique of the planned activities. This requirement was not met based on document review, interviews by not having encouraged residents to contribute and planned activities which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 27, 2023

Plan of correction: Administrator will send LPA their updated Planned Activites. Administartor will send LPA they have trained their staff to provide activities. POC due date 1/10/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jan 3, 2024

87468.1 Personal Rights of Residents in All Facilities (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met based on document review, interviews by staff not conducting a safe transfer for R1 and R2 which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 27, 2023

Plan of correction: Administrator will send LPA they have understood and read the regulation. Administrator will train staff how to transfer resident safely and will not violate their personal rights. Administartor will ensure there are two staff memebers to provide a two-person transfer. POC 1/3/2024

Allegation investigated: Staff are not adequately trained to meet resident needs

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with care giver Eula Jones and explained the purpose of the visit. The investigation consisted of staff interviews, and document reviews. For the allegation, Staff are not adequately trained to meet resident needs. During interviews with staff, all staff stated they are adequately trained to meet residents needs. Administrator informed LPA they provided training to staff before they begin assisting residents. All staff stated they receive training before they assistance residents on their own. During record review, LPA received staff training. LPA indicated all staff member are trained to be meet resident’s needs. Unsubstantiated Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to care giver Tiffany Zoller.the state’s words, verbatim · CDSS document, Dec 27, 2023 · control 56-AS-20231114102757

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility for a complaint. During the complaint visit, LPA Rico completed a case management visit to cite for two (2) deficiencies and one (1) civil penalty found during facility tour and record review. During facility tour, LPA observed R1 and R2 sliding door for their closet not working. During staff interview and record review. S1 confirmed to LPA they have been working since August 2023. During record review LPA confirmed S1 has a criminal record clearance but is not associated to the facility. LPA Rico informed Administrator that S1 must be associated to the facility. During today’s visit, two (2) deficiency and one (1) Civil penalty was assessed with the amount of $500.00 for failure to associate/transfer S1 Criminal Record Clearance to the facility were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report, LIC809, LIC809D, LIC421BG and Appeal Rights were discussed and provided to Care Giver Eula Jones.the state’s words, verbatim · CDSS document, Nov 16, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 30, 2023

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above by R1 and R2 sliding door not in good repair which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 16, 2023

Plan of correction: Licensee will provided proof that sliding door has been repaired. POC due date 11/30/2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(2) · Plan of correction due date: Nov 20, 2023

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working... (2) Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on observation, interview and records review, the Licensee did not comply with the section cited above by not transferring the criminal background clearance of Staff #1 to the facility who had been working at the facility which pose potential health, safety and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Nov 16, 2023

Plan of correction: Licensee will transfer S1 criminal record clearance to facility and provided proof to LPA POC due date 11/20/2023