Lucie's Shady Rest

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose De La Cruz made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licencee Lucie Zachay. The facility's license shows a maximum capacity of six (6) elderly residents, age 60 and above, five of whom might be non-ambulatory and one might be bedridden. Hospice waiver approved for four residents.. LPA arrived at 7:14 am and requested residents and staff files. At 9:14 am , LPA and S1 toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. During the tour, it was noted that the facility has two bedridden residents. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Around 12:00 pm, LPA and licensee checked the medications storage. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Three fire places where noticed with protective mechanisms. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC809] Per Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. One deficiency was cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). Plan of Correction were jointly developed with the Licensee. An exit interview was conducted with Licensee Lucie Zachay, to whom a copy of this report, the LIC 809-D pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Nov 24, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Iby Strong and David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Gilbert Zachay. According to the facility’s license, the facility has a maximum capacity of six clients, of whom all may be non-ambulatory and one of which may be bedridden. LPAs toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to client. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 120 degrees F. No pools or bodies of water on the premises. Per Gilbert, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Resident records reviewed had required documentation, Resident 1 (R1) did not have a physician report but Gilbert states it was created though not available at this time. Staff records reviewed did not contain one first aid certificate for Staff 2 (S2). One deficiency was cited today for S2 first aid training, and one technical violation was issued for no medical assessment for R1. An exit interview was conducted with Administrator Gilbert Zachay, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22), LIC 809-D and LIC 9201 were provided during the visit.the state’s words, verbatim · CDSS document, Nov 7, 2024

Allegation investigated: Facility not following COVID-19 Mitigation Plan

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings on the above-mentioned allegation. LPA met Administrator Gilbert Zachay and discussed the purpose of the visit. - On September 17, 2021, Community Care Licensing (CCL) received a complaint alleging facility staff were not wearing face covering while providing residents care as defined in the facility’s COVID-19 Mitigation Plan. During investigation, the Department collected pertinent facility documentation and conducted interviews. According to facility’s COVID-19 Mitigation Plan signed on January 23, 2021, “All facility staff are wearing a face covering while on the premises”. According to interview with outside source multiple facility staff was observed not wearing their face coverings on multiple occassions. Additionally, during investigation LPA Tellez observed staff and visitors without face coverings. -Based on interviews a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22. An exit interview was conducted with Administrator Gilbert Zachay, to whom a copy of this report LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to. Substantiated Continued from LIC9099-A Interview with outside medical provider revealed that R1 did not appear to be neglected by facility and was naturally declining. Records also revealed that R1 passed away as of September 4, 2021, due to disease progression. It was also alleged that licensee did not meet the resident’s needs as the staff was not adequately feeding the resident. Based on records reviewed, R1 had a poor appetite and would rarely eat. Interview with outside source revealed R1 was naturally declining in health which results in poor appetite. Medical records reviewed corroborated that R1 had poor food and liquid intake between August 24, 2021, to September 4, 2021. Additionally, it was alleged that staff were not appropriately trained to transfer residents to and from their bed. Records collected reviewed revealed all staff have beyond the forty hours of required training in assistance with activities of daily living and dementia care. Interview with outside source did not reveal any information to corroborate that staff are not properly trained. Interview with Administrator established that staff are trained as required. It was also alleged that staff are unable to communicate with residents due to language barrier. Based on the Department’s interviews, there was no evidence to prove staff are unable to communicate with residents. Interview with outside source revealed that staff do speak English, though some speak it as their second language. Based on observations, LPA Strong was able to communicate with staff present on today’s date. Lastly, it was alleged that R1’s hospital bed was not working, though no further details were provided. Based on records collected, R1’s bed was provided to resident by an outside medical provider. Interview with outside source revealed that if there were any issues with the bed, the bed would have been replaced. Interview with Administrator revealed that no beds have ever been left broken over a 24-hour period. Based on the Departments interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Administrator to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 7, 2024 · control 08-AS-20210917102005

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.7(a)(2) · Plan of correction due date: Aug 21, 2024

87468.1 Personal Rights of Resident in all facilities: "(a)Residents in all residential care facilities for the enldery shall have all of the following personal rights: (2) To be according safe, healthful....accomodations. This requirement was not met as evidence by: Based on observations the licensee did not accord 6 of 6 residents the right to have a safe and healthful accomodations.the state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: Licensee agrees to provide all staff with resident personal rights training by plan of correction date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA Domingo was welcomed by, identified herself to, and discussed the purpose of the visit with Monica Leon Caregiver and spoke with Licensee Maria Zachay on the phone. According to the facility’s license, the facility has a maximum capacity of six (6) clients, all of whom must be ambulatory. During today’s inspection, there were a total of six (6) clients in care, and per medical records, all were ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPA Domingo, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 74 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 110 F, Bathroom #1 sink was 110 F, and Bathroom #2 sink was 111 F. Refrigerator temperature was 35 F and freezer temperature was 0 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. [CONTINUED ON LIC 809C] [CONTINUED FROM LIC 809] No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Caregiver Monica Leon to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Nov 28, 2023