Lytton Gardens Community Care

Type of visit: Case Management - Other

On 9/1/12026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to follow up on an order of exclusion for S1. LPA Calandra was greeted by Anahi McKane, Executive Director and Dora Sanchez, Activities Coordinator and explained the purpose of the visit. According to Assisted Living Manager/Administrator, Anahi McKane, S1 does not currently work at the facility and has never worked at the facility in the past. Anahi also stated that she had received a copy of the Decision and Order According to the Licensee, S1 is not currently associated with the facility in Guardian and has never worked at the facility. LPA requested copies of the facility's staff schedule for the month of August and September 2026 and the facility's LIC 500 by 9/3/2026. No deficiencies cited during today's visit. An exit interview was conducted and a copy of this report provided to the facility representative via email.the state’s words, verbatim · CDSS document, Sep 1, 2026

Allegation investigated: - Staff does not ensure food assistance is provided per residents needs and services plan - Staff does not ensure call signal system is in good repair - Licensee does not ensure facility has sufficient staffing to meet the care needs of residents in a timely manner - Staff does not ensure hot water temperature is maintained for residents in care

LPA Jeung met with receptionist and administrator and observed kitchen operation at 401 Webster Street--where independent residents reside--reviewed staff and client files, interviewed residents, and checked hot water temperature in random rooms on the 1st and 2nd floors. Based on observations, interviews with staff and residents, and review of staff training documentation, these allegations are determined to be unsubstantiated. Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur. Special food requirements are met by kitchen and care staff, who are provided with written daily instructions. This includes residents who require food to be cut into small pieces. Emergency call system is available in all residents' rooms and a pendant alarm can be worn. A report of device activity response times is reviewed for the month of May 2026 and there are several clients who experienced long response times. However, it cannot be verified that this allegation pertains to the in room emergency call system. Furthermore, administrator has been pro-active and regularly (CONT.) Unsubstantiated reviews the Device Activity Reports to identify the residents who experienced unusually long response times and investigates the causes. There may be technical issues involved in some of these long responses, and administrator stated that this would be reported to a service provider. A client who regularly experienced long response times--according the the Device Activity Report--reported that response times by staff was OK. Staff did not complain that they were unable to meet the care needs of residents. Hot water temperature tested between 109 and 118 degrees F in 8 random rooms, although one resident reported that the hot water temperature sometimes fluctuates.the state’s words, verbatim · CDSS document, Aug 21, 2026 · control 26-AS-20260528082532

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d) · Plan of correction due date: Sep 4, 2026

PERSONNEL REQUIREMENTS--GENL All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill... as appropriate for the job assigned and as evidenced by safe and effective job performance. This requirement was not met, as staff #1 lacked skills to provide personal care & safely handle food. Licensee failed to ensure that staff are completent to provide personal care & sanitary food service practices, which posed a potential health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: Proof of correction to be submitted to CCLD BY DUE DATE, which shall include what measures have been taken to address staff #1 poor job performance.

Type of visit: Required - 1 Year

On 8/21/2026, Licensing Program Analyst (LPA) Grace Donato arrived unannounced at the facility to conduct an annual inspection. LPA met Manager, Anahi McKane, and disclosed the purpose of the inspection. LPA toured the facility. The facility is in one building with two floors for assisted living units. There are some repairs on going for facility updates. These areas are blocked for residents safety. Courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. No accessible bodies of water or hazards were observed. Facility was observed to be clean, well-lit, and equipped with the required furniture. Bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. All meals at the facility are prepared in a third party kitchen, Morrison Living, which is located next to the facility. The meals are brought from kitchen through food warmers to the facility and are served in the dining area at the facility. Fire extinguishers were found to be charged. Emergency drills are done quarterly. LPA reviewed five resident records and five staff records. All records are complete and updated. Centrally stored medications are updated. No expired meds on cart. No citations issued today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Aug 21, 2026

Type of visit: Case Management - Other

LPA Jeung met with housing administrator in the absence of facility administrator and advised that proof of corrections had not been received for deficiencies cited on 3/5/26 during complaint and case management visits. Deficiencies are recited and appear on following pages, as per California Code of Regulations, Title 22.the state’s words, verbatim · CDSS document, Jun 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f) · Plan of correction due date: Jun 12, 2026

BASIC SERVICES Basic services shall...include care and supervision as defined in Section 87101(c)(3) & HSC 1569.2(c)...the facility assumes responsibility for, or provides or promises to provide... ongoing assistance with ADLs without which the resident's physical health, mental health, safety, or welfare would be endangered. This requirement is not met, as evidenced by Acknowledgement Form given to clients, which states that clients should call 9-1-1 in case of a life threatening emergency. Licensee cannot absolve itself from responsibility to meet safety needs of clients.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: Plan of correction shall be subof/planmitted . Failure to submit timely pro of correction may result in civil penalty assessment

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(a) · Plan of correction due date: Jun 12, 2026

PERSONNEL REQUIREMENTS Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met, as significant delayed response times were experienced by residents in September and Ocober 2025 when they activated the emergency signal system in their rooms. This is reflected on facility's device activity reports, and verified by residents. Licensee failed to ensure timely response times when residents called for staff assistance, which posed a potential health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: Plan of correction to be sent to CCLD BY DUE DATE

Allegation investigated: - Residents needs are not being met

LPA Jeung met with administrator and obtained information about this RCFE and the adjacent buildings, which are operated by the same owner: there is a skilled nursing facility--licensed by CA Dept. of Health Services--independent HUD housing--which is not licensed by the state--a continuing care retirement community (CCRC)--licensed by the CA Dept. of Social Services. This licensed RCFE comprises units on the ground floor and 2nd floor only. The emergency call system covers the building that houses the RCFE as well as the independent units at 656 Lytton Avenue, where LPA observed the monitor at the reception desk. When a resident activates the call alarm, the room of origin and the time appears on the computer monitor and assisted living pager, which is carried by staff on duty 24 hours/day. In the bathroom of each assisted living apartment, there is a wall mounted Arial call station that is activated by pulling the string cord or pushing the big blue button. A portable pendant alarm and chain are issued to residents, as well, which can be worn around the neck. According to administrator, staff are expected to respond to residents' calls within 3 minutes. Continued on next page Substantiated LPA reviewed the Arial device activity reports for September and October 2025, which included the times that the devices were activated, from which room, and when staff responded. LPA identified residents who experienced response times over 20 minutes, according to the reports. Nine residents were interviewed about the response times when they activated their Arial call system, and at least 3 recalled waiting a long time for staff to come to assist them. Based on information obtained from facility staff and residents, this allegation is substantiated. The preponderance of evidence standard has been met. Deficiency of the California Code of Regulations, Title 22 is cited on a following page.the state’s words, verbatim · CDSS document, Mar 5, 2026 · control 26-AS-20251028111726

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Mar 19, 2026

PERSONNEL REQUIREMENTS Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met, as significant delayed response times were experienced by residents in September and Ocober 2025 when they activated the emergency signal system in their rooms. This is reflected on facility's device activity reports, and verified by residents. Licensee failed to ensure timely response times when residents called for staff assistance, which posed a potential health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Mar 5, 2026

Plan of correction: Plan of correction to be sent to CCLD BY DUE DATE

Type of visit: Case Management - Deficiencies

During complaint investigation visit, LPA Jeung observed deficiency of the California Code of Regulations, Title 22. Deficiency appears on a following page. Residents were given a REsident Pull Cord Acknowledgement Form, which states that by signing the form, they understand and acknowledge that "in case of a life-threatening emergency, I/we should call 911."the state’s words, verbatim · CDSS document, Mar 5, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f) · Plan of correction due date: Mar 19, 2026

BASIC SERVICES Basic services shall...include care and supervision as defined in Section 87101(c)(3) & HSC 1569.2(c)...the facility assumes responsibility for, or provides or promises to provide... ongoing assistance with ADLs without which the resident's physical health, mental health, safety, or welfare would be endangered. This requirement is not met, as evidenced by Acknowledgement Form given to clients, which states that clients should call 9-1-1 in case of a life threatening emergency. Licensee cannot absolve itself from responsibility to meet safety needs of clients.the state’s words, verbatim · CDSS document, Mar 5, 2026

Plan of correction: Plan of correction shall be submitted in writing to CCLD BY DUE DATE.

Type of visit: Case Management - Other

On 2/4/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to follow up on a Decision and Order(exclusion) of S1. LPA Calandra was greeted by Anahi McKane, Manager of Assisted Living/Administrator and explained the purpose of the visit. According to the Administrator, S1 has never worked at the facility and is not associated on Guardian. No deficiencies cited during today's visit. An exit interview was conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 4, 2026

Type of visit: Case Management - Other

On 1/30/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to follow up on a Decision and Order(exclusion) of S1. LPA Calandra was greeted by Anahi McKane, Manager of Assisted Living/Administrator and explained the purpose of the visit. According to the Administrator, S1 has never worked at the facility. During the visit, the Administrator spoke to Human Resources who stated they would disassociate S1 from the facility on Guardian. LPA requested copies of the current LIC 500-Personnel Summary Report and current staff schedule. No deficiencies cited during today's visit. An exit interview was conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Case Management - Other

On December 29, 2025, Licensing Program Analyst (LPA) Murial Han conducted a case management - other visit to confirm staff # 1 (S1) is not working at the facility. LPA met with the administrator and explained the purpose of today's visit. During today's visit, LPA toured the facility with the administrator who confirmed that S1 does not work at the facility. Based on the facility's monthly master work calendar for August, Septometer, October, November and December of 2025 and the LIC 500 (Personnel Report), LPA observed S1 was not on the schedule. No deficiency is cited today. This report is reviewed and discussed with the administrator. A copy is provided.the state’s words, verbatim · CDSS document, Dec 29, 2025

Allegation investigated: Facility is not meeting resident's basic needs

On 11/12/2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced 10-day complaint visit. LPA met with administrator, Anahi McKane and explained the purpose of today's visit. Regarding to the allegation of- facility is not meeting resident's basic needs, the reporting party stated that the private caregiver reported that resident- in-question (R1)'s mattress was smelly and the garbage can was filled with soiled diapers. The reporting party also stated that R1 recognized that the facility provided assistance with bathing, housekeeping and checking on him/her every night. As part of the investigation, LPA interviewed the administrator, R1, Staff #1 (S1) and Staff #2 (S2). According to the administrator, the facility provides housekeeping services once a week but resident's trash is being emptied on a daily basis. However, R1 did not want staff to collect his/her trash on a daily basis rather R1 would place the trash can outside of the apartment 2- 3 times a week for the housekeeper to empty it. The administrator stated that R1 is an independent resident who likes to perform his/her own activities of daily living (ADLs). Unsubstantiated LPA interviewed S1 and S2 and they stated that they have observed an odor in R1's room because R1 preferred to pile up a lot of soiled pull-ups in the trash can before allowing them to empty it and they were only allowed to change R1's beddings when R1 asked them to do so. They stated that R1 managed his/her own care and R1 wanted to do everything independently. LPA interviewed R1 who stated that for the most part, staff members are courteous and they are providing the care and services that R1 needs. After the investigation, this allegation is deemed to be unsubstantiated. Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 12, 2025 · control 26-AS-20251106134557

Type of visit: Required - 1 Year

On August 18, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Manager, Anahi McKane, and disclosed the purpose of the inspection. The facility consisted of one building with two floors for assisted living units. The Manager informed the LPA that the facility had 41 residents in care at the time. LPA initiated a walk-through of the facility, accompanied by the manager. LPA inspected randomly selected five (5) resident rooms. The rooms were found to be clean, well-lit, and equipped with the required furniture. LPA inspected the private bathrooms in random rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 112.8°F and 116.6°F. LPA inspected the main food serving area and dining area and found it clean. All meals at the facility are prepared in a third party kitchen, Morrison Living, which is located next to the facility. The meals are brought from Morrison Living kitchen to the facility and are served in the dining area at the facility. The refrigerator was observed to contain milk, creamers, juices, yogurt, bread, and butter. The freezer was observed to contain ice cream. Cereal boxes and fresh fruits were observed on a table in the serving area. A weekly dining menu and an alternate fixed menu was available to residents. LPA inspected the fire extinguishers mounted on the hallway walls and found them fully charged, with the last service tag dated January 30, 2025. Continued on LIC809-C The smoke detectors are tested quarterly by a third-party vendor, CodeRed Communications Inc., with the last service completed on 07/11/2025. The fire sprinklers testing is performed quarterly by Nor-Cal fire protection Inc., with the last service completed on 08/14/2025. The manager tested the carbon monoxide detector in the main hallway in LPA’s presence, and it was found to be functional. LPA inspected an auditorium on the first floor and observed 6 residents participating in workout activities. The auditorium and souyer room on the second room are used for resident activities. Activity calendar was posted one month is advance for the residents. All common areas were free from obstructions, and hallways were well-lit. LPA toured the outside courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and shaded area/umbrellas for residents’ use. No accessible bodies of water or hazards were observed. LPA observed and inspected a locked centrally stored medication cart in the medication room. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. 5 of 5 residents didn't not receive routine annual medical assessment. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 05/15/2025. The following updated forms are requested to be submitted to CCLD by 08/25/2025: 1) LIC 500: Personnel Report 2) LIC 308: Designation of Facility Responsibility Continued on LIC809-C 3) Certificate of Liability Insurance 4) Administrator Certificate(s) No deficiencies were cited during today's visit. An Advisory note was given. An exit interview was conducted with the Manager. A copy of this report was provided to the Manager,Anahi McKane, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Aug 18, 2025

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.

Allegation investigated: Staff are not providing adequate food service for residents Staff have not addressed roaches in the facility

On January 15, 2025, at 12:15 PM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Complaint Investigation visit. Upon arrival, the LPA was greeted by the Manager, Anahi McKane. The LPA disclosed the purpose of the inspection. The Manager informed the LPA that there were (42) residents in care. Regarding the allegation “Staff are not providing adequate food service for residents”, the Reporting Party (RP) stated “AL gets most of their servers through 'agency' who have never served food before and are not trained to serve in the dining hall. They don't know the basic health and food safety. Most of them don't wear gloves, they throw gloves in compost bins, don't know about temperature maintenance before serving food, leave refrigerated stuff on dining table for long causing the residents to complain about spoiled items. AL employees are eating food on the table the food to be served to the residents was placed. The employees keep their personal food in the same refrigerator where food for the residents is stored”. Continued on 9099-C Unsubstantiated LPA interviewed (3) residents (R1-R3). R1 stated they had not had any complaints about the quality, temperature, or hygiene of the food served at the facility, and if the food had not been warm, they had asked the staff to microwave it. R1 stated they had been given plenty of meal preferences, their requests had been met, and they had no complaints. R1 stated that the dining staff had worn gloves. R2 stated that the quality of the food had been fair but could have been better; sometimes the soup had been too hot, and the creamers and milk had not been spoiled. R2 stated that dining servers had worn gloves. R3 stated that the quality of the food had been alright and that they could customize options available from an alternate menu. R3 stated they had picked up food and brought it to their room, had warmed food in the microwave if necessary, and had never received any spoiled food. R3 stated they were not sure if staff had worn gloves in the dining area, as they had not eaten in the dining area. LPA interviewed (3) staff members (S1-S3). S1 stated they had passed around the food, had not touched the food, had always worn gloves, and had thrown the gloves in the trash bin. S1 stated the food temperature had been checked by the server in the kitchen before it was put on the table in the kitchen, and they had served coffee as well. No resident had complained to them about the food quality, and they had checked the milk expiration date. S1 stated they had been placed at the facility by an agency and that they had held a CNA license. S2 stated they had been a caregiver, had helped in the dining area, had always worn gloves, and had thrown the gloves in the garbage. S2 stated the server from the kitchen had always checked the temperature and had put it on the counter when the food was hot and in a little cooler when the food was cold. S2 stated they had not made or handled food but had just served the food, and they had verified what residents had ordered before giving it to them. They had never heard from any resident about spoiled food. S3 stated the residents had been given a weekly menu and an alternative options menu, and the residents had received what they had ordered. If residents had changed their minds, they had tried to accommodate. S3 stated that they had used a third-party vendor to prepare food for the residents and that the server responsible for food quality and temperature checks had come from the vendor only. They had never had issues with the quality or the temperature of the food. S3 stated the staff had stored their food in the staff refrigerator and not in the resident-use refrigerator. LPA reviewed S4's certification and in-service records. S4 had a ServSafe California certificate that had been issued on 12/27/2024 and was valid for three years, a Food Safety and Quality Assurance in-service training dated 9/19/2024, a Food Handling and Temperature in-service training dated 10/7/2024, an Associate Food Safety in-service training dated 10/16/2024, a Hand Washing in-service training dated 10/31/2024, and a Hand Hygiene in-service training dated 11/22/2024. Continued on 9099-C On 12/19/2024, LPA observed the dining area during lunchtime service, where the server (S4) had been standing behind the counter, putting food on the counter for the staff to serve. Two staff members (S1 and S2) were observed serving the food. S1 and S2 had been wearing gloves while serving food to the residents at the dining tables in the dining area. Residents were observed eating and enjoying their lunch. LPA observed a standing refrigerator in the dining area that contained milk and juices for the residents. LPA also observed and a freezer in the dining area that contained ice creams for the residents. Regarding the allegation “Staff have not addressed roaches in the facility”, the Reporting Party (RP) stated, “have roaches (they know about it and have pasted pictures regarding that too)”. LPA interviewed (3) residents (R1-R3). R1 stated they had not seen roaches too often and that bugs had been present when it was hot. R2 stated that a roach had been found in their closet the previous week, pest control had come and taken care of it, and they had not seen any roaches afterward. R3 stated that German roaches had started about seven months earlier, and a new pest control company had been hired by the facility. R3 further stated they had not seen a single roach in the last 10 days and that the facility had finally solved the problem. LPA interviewed (3) staff members (S1-S3). S1 stated they did not remember seeing any roaches. S2 stated they had roaches before, but not currently, as the company had come and sprayed. S3 stated the pest control company had been coming every two weeks, had last come on 12/11/2024, and had put traps on the floors. LPA reviewed pest control reports for the past two months. The Ecolab Pest Eliminator invoice number 6995717, for a service date of 12/11/2024, with the Service Program of Cockroach/Rodent Program and Outside-In Large Fly Program, indicated the following Conditions Found/Action Taken: “No rodent activity was noted during the inspection and/or service, no ant activity was noted during the inspection and/or service, and cockroaches were noted in one apartment.” For invoice number 6790324, for a service date of 11/14/2024, with the Service Program of Cockroach/Rodent Program and Outside-In Large Fly Program, the Conditions Found/Action Taken indicated: “No rodent activity was noted during the inspection and/or service, no fly activity was noted during the inspection and/or service, and no cockroach activity was noted during the inspection and/or service.” Continued on 9099-C On 12/19/2024, LPA visited three residents' (R1-R3) rooms and observed baits had been placed in R3’s room. No roaches were seen in any of these three rooms. LPA observed the dining area during lunchtime service, where baits had been placed, no roaches were seen, and no posted pictures regarding roaches were observed at the facility. Based on observations, interviews conducted, and records reviewed, the department has determined that the allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies were cited under the California Code of Regulations, Title 22. An exit interview was conducted with the Manager. A copy of this report was discussed and left with the Manager, Anahi McKane, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jan 15, 2025 · control 26-AS-20241213161119

Allegation investigated: Staff not wearing masks Resident was threatened with eviction

On 11/26/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Administrator Anahi Mckane and LPA explained the purpose of the visit. For the allegation of staff not wearing masks, reporting party (RP) stated that on 11/17/2022, staff not wearing mask at front desk of assisted living. Based on records review, the California Department of Public Health (CDPH) Mask Guidance, dated 9/20/2022 states that in the following healthcare and long-term care indoor settings, masks are required for all individuals regardless of vaccination status. Surgical masks or higher-level respirators (e.g., N95s, KN95s, KF94s) with good fit are highly recommended. This includes Adult and Senior Care Facilities. page 1 of 2 Unfounded According to Provider Information Notice (PIN) 22-28-ASC, effective 9/26/2022, it states that If there are differing requirements between the most current CDC, CDPH, CDSS, CDDS, Cal/OSHA, and local health department guidance or health orders, licensees should follow the strictest requirements. For the allegation of resident was threatened with eviction, Resident is not part of assisted living but resides in the independent living area. The issue with eviction is not governed by title 22. Based on interviews & records review, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. Report is reviewed and copy is provided. page 2 of 2 R1 did not say who attacked him/her. S2 was able to review cameras in the area and stated that nothing happened. R1 just came down to tell S1 that he/she was hit. S2 looked at the camera in the hallways on the fourth floor and nothing happened. Based on interviews, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Report is reviewed and copy is provided. page 2 of 2the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 26-AS-20221128161412

Allegation investigated: Facility does not have sufficient support staff to assist resident

On 11/26/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Administrator Anahi Mckane and LPA explained the purpose of the visit. For the allegation of facility does not have sufficient support staff to assist resident, Reporting party (RP) mentioned that the fuse blew in the room and suddenly there's no electricity know where the fuse box is. RP was asking someone to help him/her in her room. During today's investigation it was discovered that RP resides in independent living (IL). According to the interview with the administrator (ADM) the people living in IL have a number that they can contact for any maintenance issues in the building. Another Staff (S1) mentioned that there is a pull cord in the rooms that residents in independent living can use and after hours staff will be able to help. Based on interviews & records review, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. Report is reviewed and copy is provided. Unfoundedthe state’s words, verbatim · CDSS document, Nov 26, 2024 · control 26-AS-20221220120812

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Annual Continuation visit and met with Donna Quick. During visit, LPA Marrufo measured the water temperature in the hallway bathroom near the facility entrance. LPA observed the water temperature in the bathroom sink to be 122 F. LPA measured the water temperatures in the bathroom sinks of 4 resident living units and the water temperatures were 161 F, 120 F, 122 F, and 124 F. LPA reviewed 5 staff records and found them to be complete. LPA Marrufo reviewed facility maintenance records and observed the fire sprinkler system was last tested on 08/19/2024. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Donna Quick and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 28, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Aug 29, 2024

87303(e)(2) (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not met as evidenced by: the water temperatures in one hallway bathroom and 3 out of 4 observed resident living unit bathrooms were over 120 F, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 28, 2024

Plan of correction: Licensee agrees to submit a Plan of Correction by POC date to CCL stating how the licensee plans to ensure that the water temperatures in the faucets used by residents are between 105 F to 120 F.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Anahi McKane. During visit, LPA Marrufo toured the facility inside and out. LPA toured the facility kitchen and dinning areas. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete. LPA toured the outside exits and found them to be clear of obstructions. LPA reviewed 5 resident records and 5 Centrally Stored Medication and Destruction Records and found them to be complete. Due to time constraints, this annual inspection visit will need to be continued at a later time. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Anahi McKane and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 27, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator (ADM) Anahi McKane. The purpose of the visit was to cite the facility for deficiencies related to an incident that occurred on 06/30/2024 around 8 PM and that the facility reported to the Department via SOC341 Suspected Adult/Elderly Abuse Form on 07/02/2024. On Sunday 06/30/2024 at 8 PM, staff S1 heard sounds coming from the living unit of resident R1 that sounded like R1's Private Duty Care Giver (PDCG1) was verbally abusing R1 and throwing around objects in R1's living unit. Staff S1 stood outside of R1's living unit and made video recordings that captured the sounds of PDCG1's voice while PDCG1 was verbally abusing R1 and the sounds of objects being thrown around in the living unit. The SOC341 stated that R1 reported to facility staff that PDCG1 hit R1 in the lower right leg. During visit on 07/22/2024, LPA Marrufo reviewed three video recordings that Administrator Anahi McKane stated R1 took while standing outside of R1's living unit while PDCG1 was inside. LPA Marrufo could hear the sound of someone yelling and cursing from inside R1's living unit. LPA Marrufo interviewed R1 during visit. R1 stated during interview that PDCG1 was yelling and cursing at R1 and hit R1 in the lower right leg. R1 stated that staff did not come into R1's living unit to stop PDCG1 from yelling at R1. During interview on 07/22/2024, Administrator (ADM) Anahi McKane stated that on 06/30/2024, R1 called ADM and reported the incident of PDCG1 verbally abusing R1 and of loud sounds coming from R1's living unit. ADM stated that R1 reported to ADM that after 8 PM, PDCG1 went on a work break. ADM stated that PDCG1 returned to R1's living unit after PDCG1's break and continued to provide care to R1 until 3PM on 08/01/2024. ADM stated on 07/22/2024 and stated to have not yet submitted an LIC624 Unusual Incident/Injury Report to the Department. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information.This report was reviewed with ADM Anahi McKane and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 29, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Jul 30, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by: Licensee did not ensure that resident R1 was free from abuse and initimidation from R1's Private Duty Care Giver, which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2024

Plan of correction: Licensee agrees to submit a Plan of Correction to CCL by POC date explaining how the Licensee shall train staff on ensuring the personal rights of residents in care are protected, including when a resident is being abused by a private duty care giver. Once training is complete, the Licensee shall submit copies of training logs to CCL, including names of staff trained, training topics, and name(s) and qualifications of trainer(s).

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Aug 6, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: Licensee did not ensure that a LIC624 Unusual Incident/Injury Report was submitted to CCL with 7 days of the incident involving resident R1's private duty care giver verbally and physically abusing R1 on 06/30/2024, which poses a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2024

Plan of correction: Licensee agrees to submit a Plan of Correction by POC date stating how the licensee shall ensure that incidents involving abuse of residents will be reporting to the Department with an LIC624 Unusual Incident/Injury Report within 7 days of the incident occuring.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced case management visit and met with Administrator Anahi McKane. The purpose of the visit was to follow up with an SOC341 Suspected Adult/Elderly Abuse report submitted by the facility to CCL on 07/01/2024. The SOC341 report stated that on Sunday 06/30/2024 at 8 PM, staff S1 heard sounds coming from the living unit of resident R1 that sounded like R1's Private Duty Care Giver (PDCG1) was verbally abusing R1 and throwing around objects in R1's living unit. The SOC341 stated that R1 reported to facility staff that PDCG1 hit R1 in the lower right leg. During visit, LPA Marrufo reviewed three video recordings that Administrator Anahi McKane stated R1 took while standing outside of R1's living unit while PDCG1 was inside. LPA Marrufo could hear the sound of someone yelling and cursing from inside R1's living unit. LPA Marrufo interviewed R1 during visit. R1 stated during interview that PDCG1 was yelling and cursing at R1 and hit R1 in the lower right leg. During visit, LPA obtained copies of R1's Emergency Contact and Information Form, LIC602 Physician's Report, Resident Functional Evaluation, and the internal Incident Report submitted by R1 to Administrator Anahi McKane. LPA Marrufo requests that the facility submit copies of PDCG1's contact information and Home Care Organization documentation by 07/29/2024 No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Anahi McKane and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 22, 2024