Luvinhome

Allegation investigated: Staff do not ensure hallways have adequate lighting

On 07/02/2026 Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to deliver complaint findings of a complaint received by the Department on 06/23/2026. LPA met with caregiver Keyshawn Melton who has Designation of Facility Responsibility (RP). A call was recieved from Licensee Anny Camerino and report was read to Licensee with a plan for RP to sign today's report. The complaint alleges that staff do not ensure hallways have adequate lighting. LPA made observations, took photographs, obtained documents and conducted interviews with both staff and four (4) residents. Continued on LIC9099-C Unsubstantiated Continued from LIC9099 LPA observed two long LED light fixtures in each hallway that could contain three (3) bulbs each, but each contained just two (2) bulbs and both light fixtures and their switches were observed to be operational and emitting bright light for each hallway. In interviews with four (4) of four residents LPA learned that the facility has lighting in both hallways and that residents are free to use the light switch to turn the lights on when in the hallway. LPA also learned that residents are repeatedly asked to turn the hallway light off when not in use. Additional interviews with two (2) staff members reveal that staff do not shut the hallway lights off on residents while they are using them but do ask residents to shut the hallway light off when not in use and will shut the lights off themselves when they see residents not using the hallway. Because the facility has operating hallway lights emitting adequate light for night use, and because staff do not turn the lights off on residents while in use, the complaint that staff do not ensure hallways have adequate lighting is unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Deficiencies Cited during visit. Exit interview conducted with RP Signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jul 2, 2026 · control 21-AS-20260623164444

Type of visit: Case Management - Other

At approximately 1:20 PM Licensing Program Analyst (LPA) Star Stevenson arrived unannounced for the purpose of getting a facility signature on an amended LIC809 Report created on 06/30/2026. LPA met with caregiver Keyshawn Melton who has Designation of Facility Responsibility (RP). A call was received from Licensee Anny Camerino and the purpose of today's Case Management visit and reason for Amendment of the 06/30/2026 LIC809 Document was explained. Report was review with RP, whose signature here denotes receipt.the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: Case Management - Legal/Non-compliance

***Amended Report by Star Stevenson*** At approximately 9:50 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a Non-Compliance Conference (NCC) inspection and was greeted by caregiver Keyshawn Melton who called Licensee Anny Camerino to advise of today's inspection. Licensee arrived at approximately 10:30 AM to further assist with todays NCC inspection. The facility was put on an NCC plan for 2 years ending 11/05/27 to bring the facility into compliance. The purpose of today's inspection was to follow up on areas of prior concern in the operation of the facility operation identified by the department including, but not limited to: Seeking Timely Medical Care Prohibited Conditions Personnel Records Resident Records Staff Training Requirements At approximately 10:00 AM LPA conducted a facility inspection with caregiver Keyshawn Melton and noted the following: Facility was a comfortable temperature, well lit, and without odors. Continued on LIC809C *amended report* continued for LIC809 Refrigerators were noted to be well stocked with a variety of healthy food, but a number of meats were noted to be stored in un-zipped zip lock bags and without the date they were removed from their commercial packaging and a Technical Violation of CCR 87555(b)(9) Food Service requirements was issued (See LIC9102 page) Water temperatures in sinks available to residents in care were between 105F and 120F as required by title 22 regulations. Upon entering the room of resident R1, a sheathed approximately 6" sharp knife was noted at bedside. Because of the diagnoses and mobility of other residents in care, licensee was asked to immediately secure R1's knive(s) and to keep them locked. R1 agreed to allow the licensee to remove the knife and secure while this LPA was in the home. Licensee is asked to develop a plan to allow R1 to maintain their knive(s) while keeping other residents safe and submit to LPA the plan by 07/29/2026. At approximately 10:30 AM, a walk though of backyard and side yard with licensee reveals high brush and grasses have been cut and vegetation over-hanging a storage shed has been cleared back and sharp or tripping hazards that could pose a risk to residents in care have all been removed. At approximately 11:00 AM LPA reviewed four (4) of 4 resident records and found all 4 had required files. At approximately 11:30 AM four (4) or four (4) staff files had required documentation as required by Title 22 regulations. All staff present were noted to have background clearance and evidence of required RCFE training hours Technical Violation is cited from the California Code of Regulations (CCRs), Failure to correct the cited Technical Violation could result in a future civil penalty assessment. This report was reviewed with Licensee Anny Camerino and Appeal rights were given.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Case Management - Legal/Non-compliance

At approximately 9:50 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a Non-Compliance Conference (NCC) inspection and was greeted by Licensee Anny Camerino. The facility was put on an NCC plan for 2 years ending 11/05/27 to bring the facility into compliance. The purpose of today's inspection was to follow up on areas of prior concern in the operation of the facility operation identified by the department including, but not limited to: Seeking Timely Medical Care Prohibited Conditions Personnel Records Resident Records Staff Training Requirements Facility and facilities refrigerators were found to be clean and without odors. Water temperatures in sinks available to residents in care were between 105F and 120F as required by title 22 regulations. Continued on LIC809C continued for LIC809 At approximately 10:10 AM, a walk though of backyard and side yard with licensee reveals high green grasses and brush and deteriorating gates and licensee is advised to mow high vegetation and reinforce gates and Technical Assistance is given for CCR Maintenance and Operation 87303 (a) which requires the facility shall be clean, safe, sanitary and in good repair at all times... At approximately 10:30 AM LPA reviewed four (4) of 4 resident records and found all 4 had required files. At approximately 11:00 AM Four (4) or four (4) staff files had required documentation as required by Title 22 regulations. At approximately 11:30 AM Administration of PRN and prescribed medications were observed to be logged. Medications were observed to be centrally stored and locked. The traditional role and scope of Technical Service Programming (TSP) was again discussed with licensee, and licensee would like to participate at this time with TSP to work toward Residential Care Facility for the Elderly (RCFE) best practices. Updated copies of the following documents were obtained during visit to update facility file: LIC500- Personnel Report Updated Liability Insurance Technical Advisory is cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited advisory could result in a future civil penalty assessment. This report was reviewed with Licensee Anny Camerino and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Legal/Non-compliance

At approximately 9:45 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a Non-Compliance Conference (NCC) inspection and was greeted by caregiver Mark Kho who called Licensee/Administrator Anny Camerino to advise of today's inspection. Licensee Camerino arrived at approximately 10:15 AM to assist with today's inspection. The facility was put on an NCC plan for 2 years ending 11/05/27 to bring the facility into compliance. The purpose of today's inspection was to follow up on areas of prior concern in the operation of the facility operation identified by the department including, but not limited to: Seeking Timely Medical Care Prohibited Conditions Personnel Records Resident Records Staff Training Requirements Facility and facilities refrigerators were found to be clean and without odors. At approximately 10:30 AM LPA reviewed four (4) of 4 resident records and found all 4 had required files. Resident (R1) moved in 8 days ago was missing an Appraisal Service and Needs and licensee will continue to fill out the form as they get to know the new resident. Continued on LIC809C continued for LIC809 Four (4) or four (4) staff files had required documentation as required by title 22 regulations. Administration of PRN medications were observed to be logged. Medications were observed to be centrally stored and locked. The traditional role and scope of Technical Service Programming was again discussed with licensee. No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Office

A Non-Compliance Conference (NCC) was conducted today in the Santa Rosa Regional Office. Present in the meeting was: Acting Regional Manager Bethany Moellers, Licensing Program Analyst (LPA) Star Stevenson and Facility Licensee/Administrator Anny Camerino. The purpose of today's office meeting was to discuss areas of concern in the facility operation identified by the department and placing Luvinhome,LLC facility on a Non-Compliance Conference (NCC) plan. Parties present during the meeting agreed to a NCC plan to bring the facility, Luvinhome,LLC into compliance. Items addressed during the meeting include, but are not limited to: Seeking Timely Medical Care Prohibited Conditions Personnel Records Resident Records Staff Training Requirements Parties present during the meeting agreed to a NCC plan for 2 years ending 11/05/27 to bring the facility into compliance. Technical Support Provider (TSP) assistance was offered to Licensees during this meeting and licensee will advise Community Care Licensing if she becomes interested. Continued on LIC809-C Continued from LIC809 The administrator and licensee was informed that civil penalties are under review by the Department per Health and Safety Code 1569.49 (f). Exit interview conducted with Administrator/Licensee, whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

At approximately 09:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by caregiver Mark Kho who has Designation of Facility Responsibility (RP) who called licensee/administrator Anny Camerino, who arrived at 10:10 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care, three (3) of which are present and one (1) away at day program. Facility is vendorized with the North Bay Regional Center (NBRC). At approximately 10:20 AM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, without odors and passageways were free from obstructions. Water temperatures in Residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, paper products, and incontinent care briefs available to residents. Residents' bedrooms were inspected and observed to be clean, have appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods. LPA observed one (1) instance of expired canned food and a technical violation was issued. LPA observed an emergency water supply, as well as, a 124 serving of emergency dry food. Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. LPA observed the locked contents of sheds on either side of the house to be full of additional care supplies and tools. Licensee states that each resident has their own internet access device. Facility has internet available to residents in care and the phone was tested an operational. Facility's fire extinguisher was observed charged and was last serviced 08/2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills with the most recent drill conducted 09/2025. Continued on LIC809-C... Continued from LIC809... LPA observed facility's infection control plan and emergency disaster plan which was last updated 09/17/2025. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights for emergency preparedness. At approximately 12:45 PM, LPA reviewed four (4) staff files and four (4) resident files. Two (2) of four (4) staff files reviewed were missing required documentation; Staff 1 (S1) was missing proof of health screening by an MD; Staff 2 (S2) did not have a health screening on site for LPA review and licensee was reminded of the requirement to have all resident and staff records on site for review (See LIC809D and repeat penalty). All staff have proof of current First Aid and CPR training. Licensee did provide evidence of initial 40 hours/20 hours annual training. One (1) of four (4) resident files reviewed were missing required TB screening (see LIC809D) Licensee/Administrator coordinates medical and dental visits for the residents and takes them to their appointments. Facility does not manage P&I monies. Updated copies of the following documents are to be submitted to CCL by 10/17/2025 LIC500 - Personnel Report (updated) LIC9020 Registration of Facility residents. LIC610E - Emergency and Disaster Plan (updated) Proof of liability insurance** Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights were given. Exit interview and discussion of two (2) type B violations, one (1) repeat violation and two (2) Technical Violations was conducted with Licensee who voiced understanding and understanding of Plans of Corrections (POCs). Licensee needed to leave before final report could be reviewed and asked that RP sign final reports. Signature on form by RP confirms receipt.the state’s words, verbatim · CDSS document, Sep 18, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff are not keeping facility clean, safe, sanitary and in good repair at all times.

At approximately 09:15, Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegation and met staff member Mark Kho who called Administrator Anny Camerino who arrived at 9:45 AM. In addition, LPA conducted an additional private interview with client 2 (C2). During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There was an allegation of “Staff are not keeping facility clean, safe, sanitary and in good repair at all times.” Complaint alleged the facility was in dirty condition including urine odors, a few dead cockroaches, fecal streaking throughout the hallway floor and dirty refrigerator” During visit on 08/05/2025, LPA conducted a walkthrough of the facility bathrooms and bedrooms and inspected refrigerators. LPA observed the following: home was without urine or other odors, bathrooms were clean, hallway floors and walls were clean. No evidence of cockroaches was seen. LPA noted evidence minor uncleaned and dried spills of sauce or other condiments in main kitchen facility fridge (photos take). LPA did not observe any broken appliances or other items available to residents. LPA observed cleaning products available for staff use. Continued on LIC9099-C Unsubstantiated Continued from LIC9099 Administrator noted that one client has made it a habit of cleaning continually since their admission and it may be that the facility was cleaner during my initial investigation than when the original complaint was made. Based on observations made, interviews conducted and records reviewed , this allegation is Unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator Anny Camerino. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 19, 2025 · control 21-AS-20250730085727

Allegation investigated: Personal rights

On 05/07/2025, the Department conducted a scheduled in-office meeting with facility where Licensing Program Analyst (LPA) Julie Florio delivered complaint #21-AS-20250205163033 investigation findings regarding the above allegation and met with Anny K. Camerino, Administrator and Licensee Ceasar Camerino. Reporting Party (RP) alleges a personal rights violation regarding the management of Resident 1’s (R1's) personal finances. LPA conducted 10-day complaint investigation visit at the facility on 02/14/2025 and obtained documents, made observations, and conducted interviews. During the visit, LPA obtained copies of R1’s physician’s report which indicated that R1 is unable to manage their own cash resources and a signed admissions agreement with North Bay Regional Center which states R1 agrees to the appointment of a third party financial advisor to manage their government benefits and finances. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... Based on record review and interviews conducted, LPA was able to determine that R1 has a known documented history of mismanaging their money and being confused about it. Based on record review, interviews conducted, and observations made, the allegation that the facility has committed a personal rights violation regarding the management of Resident 1’s (R1s) personal finances is UNSUBSTANTIATED. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 7, 2025 · control 21-AS-20250205163033

Type of visit: Office

At approximately 1:05 PM, an office informal meeting was conducted today in the Santa Rosa Regional Office. The following individuals were present in the meeting: Licensing Program Manager (LPM), Bethany, Licensing Program Analyst (LPA), Julie Florio and Star Stevenson and Administrator Anny Camerino and licensee Cesar Camerino. The purpose of today's meeting is to deliver findings of a complaint investigation and discuss a self-reported incident report to Community Care Licensing (CCL) on 3/27/2025. The incident report received informed that Resident's (R1) pressure injury was observed to have "gotten worse.” 3/26/2025 R1 was sent out 911 due to on-going pressure injury and additional change of condition. LPAs requested additional documents and upon review it has been determined that the facility retained R1 with a prohibited condition and failed to seek timely medical. On 3/14/2025 R1 was admitted to the LuvinHome facility with, per Skilled Nursing Facility (SNF) discharge documents on 2/11/2025 with a stage 4 pressure injury on sacral region. Medical assessment obtained, dated 1/23/2025 indicates a stage 2 pressure injury in same location. Preplacement assessment dated 3/6/2025 does not document any wound. Upon discharge from SNF, document dated 3/14/2025 was provided to facility indicating stage 4 pressure injury and discharge orders for home health. From admission to Luvinhome on 3/14/2025 to R1 being sent out 911 on 3/26/2025, R1 had no home health or wound care resulting in wound getting worse. R1 was admitted to the hospital on 03/26/2025. Administrator informed that there were attempts to contact physician to implement home health but were unsuccessful. An immediate $500 civil penalty is being issued today. The administrator and licensee was informed that civil penalties are under review by the Department per Health and Safety Code 1569.49 (f). Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.the state’s words, verbatim · CDSS document, May 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: May 8, 2025

87615 Prohibited Health Conditions: (a) Persons who require health services for... those specified below... shall not be admitted or retained in a residential care facility for the elderly:(1) Stage 3 and 4 pressure injuries. This requirement is not met as evidence by: Based on interviews and record review, administrator did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 7, 2025

Plan of correction: Administrator will submit to Community Care Licensing (CCL) a letter of understanding that they have read and understand Regulations 87615 (Prohibited Health Conditions) and 87616 (Exceptions for Health Conditions) by POC Due Date of 05/08/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87645(a)(2) · Plan of correction due date: May 8, 2025

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility...(2) The licensee shall provide assistance in meeting necessary medical and dental needs...This requirement is not met as evidence by: Based on interviews and record review, administrator did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 7, 2025

Plan of correction: Administrator will submit to Community Care Licensing (CCL) a letter of understanding that they have read and understand Regulations 87645 (Incidental Medical and Dental Care) by POC Due Date of 05/08/2025

Type of visit: Required - 1 Year

At approximately 12:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by Anny Camerino, Licensee/Administrator. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. All residents were present during today's inspection. Facility is vendorized with the North Bay Regional Center (NBRC). At approximately 12:20 PM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in Residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, paper products, and incontinent care briefs available to residents. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods. LPA observed 5 instances of expired food (See LIC809D). LPA advised Licensee to maintain an emergency water supply as well. Medications were centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. Licensee states that each resident has their own internet access device. Facility has internet available to residents in care and the phone was tested an operational. Facility's fire extinguisher was observed charged and was last serviced 08/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills with the most recent drill was conducted 09/2024. Continued on LIC809-C... Continued from LIC809... LPA observed facility's infection control plan and emergency disaster plan which was last updated 12/2022. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights for emergency preparedness. Licensee provided LPA with a copy of the facility's current liability insurance. At approximately 1:20 PM, LPA reviewed three (3) staff files and three (3) resident files. Three (3) of three (3) staff files reviewed were missing required documentation; Staff 1 (S1) was missing proof of negative TB results; Staff 2 (S2) was missing proof of a health screening and negative TB results; and Staff 3 (S3) was missing a personnel application and proof of a health screening and negative TB results (See LIC809D). All staff have proof of current First Aid and CPR training. Licensee was unable to provide proof of the required initial 40 hours of staff training for all staff as well as completion of the required initial medication training for all staff (See LIC809D). LPA advised Licensee to ensure compliance with and proof of all staff initial, annual, and medication training and that all are available for review by Licensing upon request. LPA provided Licensee Health and Safety Code (HSC) regulations 1569.625 and 1569.69 for reference. Three (3) of three (3) resident files reviewed were missing the required LIC625 Appraisal and Needs Service Plan (See LIC809D). Licensee/Administrator coordinates medical and dental visits for the residents and takes them to their appointments. At approximately 5:30 PM, LPA reviewed medications and medication records which are stored in compliance with regulation, However, LPA observed that the centrally stored and destruction medication logs for R1, R2, and R3 were not maintained in compliance with regulation (See LIC809D). Facility does not manage P&I monies. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Report (updated) LIC610E - Emergency and Disaster Plan (updated) LIC9020 - Resident Roster Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights were given. Exit interview conducted with Licensee whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Oct 17, 2024

The state marks this report as 12 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Facility not adhering to program plan and/or admissions agreement Facility not following general food service requirements Facility is not safe and in good repair Staff did not meet residents’ needs

On 4/25/2024, Licensing Program Analysts (LPAs) Tobola & Mutialu arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Anny Camerino. LPA toured the facility, reviewed resident records, made observations, interviewed staff and outside parties during the course of the investigation. Complaint alleges facility not adhering to program plan and/or admissions agreement. Based on a review of resident (R1) admissions agreement, it was indicated that R1's responsible party, with signatures on file, agreed to pay additional services for R1's meals. The facility provides an adequate amount of meals per day meeting admissions agreement care requirements. Due to contradicting information gathered and R1's Admissions Agreement approving the additional charges, the allegation is found to be unsubstantiated. Continued onto LIC9099-C Unsubstantiated Complaint alleges, facility not following general food service requirements. Based upon facility tour and observations, LPA found a sufficient and healthy supply of food items for residents in care. In addition, LPA was informed by Administrator that resident (R1) had a vegetarian diet. LPA confirmed that the items located in R1's labeled food containers were specifically for a vegetarian diet. The facility had utilized Meals on Wheels food services for additional food supply, however, facility appears to have sufficient food for resident needs, providing 3 meals and additional snacks per day. Due to contradicting information gathered, the allegation is found to be unsubstantiated. Complaint alleges, facility is not safe and in good repair regarding grab bars located in resident restrooms to be in disrepair. Upon LPA tour and observations, there are two restrooms available for resident use. LPA found that 1 out of 2 restrooms are in need of a grab bar. Upon interview with Administrator, grab bar replacement orders had been scheduled. In addition, there is still 1 out of 2 restrooms available for resident use with appropriate grab bars installed. Due to conflicting observations the allegation is found to be unsubstantiated. Complaint alleges, staff did not meet residents’ needs regarding resident (R1) reported to have a sudden change of health condition and reported to be less coherent. Upon LPA's multiple visits, resident (R1) was found to no longer be admitted to the facility for LPA to interview or observe. Due to unavailability of R1 and a lack of corroborating evidence the allegation is found to be unsubstantiated. A finding that the complaint allegations, facility not adhering to program plan and/or admissions agreement, facility not following general food service requirements, facility is not safe and in good repair and staff did not meet residents’ needs are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited.the state’s words, verbatim · CDSS document, Apr 25, 2024 · control 21-AS-20240118161109

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carol Fowler conducted a Required- 1 Year visit, on 10/10/2023 at approximately 9:00am, and met with Macristina Calata, Caregiver. Administrator arrived at approximately 10:19am Administrator Certificate, #6052482740, has expired 06/09/2023 Administrator has applied for renewal. . LPA observed one caregiver working at the time of arrival. There are currently four (4) residents in care. There is an approved hospice waiver for three (3) residents. Facility has a required infection control plan. Facility has an emergency disaster plan as required. The facility last conducted a fire and earthquake emergency drill on 11/02/2022. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden approval. All exits were free and clear of obstruction. Fire extinguisher, was serviced and tagged as required, expires 07/17/2023. LPA observed seven (7) smoke alarms, including 1 carbon monoxide detector, all working properly during the inspection. Facility was found to be clean, orderly, and at a comfortable temperature. Hot water was checked at 109.4 F, which is within regulation. Medications were stored and locked making them inaccessible to residents in care. Continue on LIC809C Continue from LIC09 Deficiencies observed during tour: There are currently four (4) residents in care. LPA reviewed three (3) of four (4) resident files; All resident files were found to be incomplete and missing from the facility. LPA could not reviewed staff files because they were not located at the facility. Facility last fire drill was conducted on 11/02/2022. Chemicals under kitchen sink were accessible to residents in care. Pre-poured medications 7days +. LPA is requesting the following documents be updated and submitted by 10/18/23: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to provide all information in all boxes as required) Infection Control Plan Control of property Copy of Current Liability Insurance Copy of current Administrator Certificate Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with the Administrator. Appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 10, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.