Manny's Care Facility

Type of visit: Required - 1 Year

On December 4, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with facility manager Noame Leibov and explained the purpose of today’s visit. LPA was granted access into the facility. The facility is an RCFE licensed for six (6) ambulatory residents, of which two (2) may be non-ambulatory. The facility is a one-story structure located in a residential neighborhood. It consists of the following: (4) bedrooms, (2) two bathrooms, a living room, dining area, kitchen, washer, and dryer. The porch is covered and has seating area with small table and two chairs. There is a large backyard with an office space located in the detached garage where staff records and client records will be kept locked. LPA observed shaded outdoor seating area for residents. LPA observed passageways, walkways, driveways, steps and patios to be free from debris and or hazards. Kitchen was inspected and observed to be clean and operational. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for residents personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly. One fully charged fire extinguisher was found near dining room and living room. During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, a 30-day supply of Personal Protective Equipment (PPE) is available and sign in and out logs for visitors and staff are present in the facility. Smoke detectors and carbon monoxide detector were in compliance and operational. First aid kit is fully stocked with manual. An audit of residents #1-#3 (R1-R3) service files and staff #1-#3 (S1-S3) personnel files were complete and maintained in order. Deficiencies: At 2:20PM LPA observed staff medications stored in a unlocked kitchen drawer accessible to residents in care. At 2:23PM LPA observed a non operable window for room #1. At 2:24PM LPA observed an exposed wire for uncovered non operable door bell box. At 2:25PM LPA observed hot water delivering above 125 degree F. degrees and measured at 148.6 F. degrees. An exit interview was conducted, and a copy of this report along with appeal rights was provided to facility caregiver Ernawahy (Linda) Simpationo .the state’s words, verbatim · CDSS document, Dec 4, 2025

Allegation investigated: Staff did not meet a resident's hygiene needs Staff are retaliating against a resident

This is an amendment of the report dated 01/09/2025 to clarify the details of the investigation, the complaint investigation findings remain Unsubstantiated. Community Care Licensing Division (CCLD) conducted an unannounced visit to Manny’s Care Facility on 01/09/2025 and was greeted by Administrator Eliat Nahum (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S1-S3), residents (R1-R4). CCLD staff requested and reviewed copies of the following: Physician Report (dated 08/22/2023), Needs and Service plan (dated 09/01/2024), shower/sponge bath logs (date 01/09/2025). CCLD staff toured the facility with S1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff did not meet a residents hygiene need. It is being alleged that resident was not given a shower and had feces on resident body prior to being taken to the hospital for a medical procedure. CCLD staff toured the facility and noted the facility was clean. CCLD staff observed residents to be dressed in neat and clean clothes. CCLD staff did not observe any smell of incontinence or feces during interviews. CCLD staff reviewed bath/sponge bath logs (date January 2025), physician report (date 08/22/2023), needs and service plan (date 09/01/2024), for 1 of 4 residents. Records indicate that 1 resident needs assistance taking a sponge bath. Sponge bath log notes indicate that staff has given 1 resident a sponge bath daily. Interviews revealed the following: 3 out of 3 staff denied the allegation. 3 out of 3 staff indicate that a resident had taken laxative prior to the medical procedure, resident was given a sponge bath and diaper change prior to being taken to the hospital. 3 out of 4 residents indicate that they take a bath 1 or 2 times per week and staff does not prevent them from taking a shower. 1 out of 4 residents does not remember if they had feces on their body prior to being taken to the hospital and they were sleeping when they took the medical test. Regarding allegation: Staff are retaliating against a resident. It is being alleged that a staff retaliated towards a resident after filing complaints against the facility. During the investigation CCLD staff toured the facility and noted no negative interactions between staff and residents. CCLD staff reviewed physician report (date 08/22/2023), needs and service plan (date 09/01/2024), shower/sponge bath log notes (date 01/09/2025) for a resident. 3 out of 3 staff denied the allegation and staff indicate that staff never had any issues with any resident. 1 out of 4 residents indicate that staff has retaliated towards other residents for making complaints. 3 out of 4 residents indicate that staff has never retaliated towards them. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff did not meet a residents hygiene need”, “staff are retaliating against a resident” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Eliat Nahum S1.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 11-AS-20241231122907

Allegation investigated: Staff member sexually abused resident in care. Staff do not ensure that resident's hygiene needs are being met while in care. Staff do not ensure that resident receives medical attention as necessary while in care.

On 11/01/24, the Department conducted a subsequent unannounced complaint visit at this facility. The Community Care Licensing (CCL) associate was greeted by Caregiver Staff #2 (S2: Alfian Fnu). CCL associate explained the purpose of this visit is to investigate the allegation mentioned above. The investigation consisted of the following: A health and safety inspection 10/01/24 and 11/01/24. A review of Resigister of Facility Residents LIC 9020 (dated: 05/09/24), Personnel Report LIC 500 (dated: 03/11/24), Admissions Agreement and Contract (dated: 08/22/23), Physicians Report LIC 602A (dated: 08/17/23), Appraisal/Needs and Services Plan LIC 625 (date: 07/01/24), Medication Administration Record (MAR) (dated: 09/01/24-09/30/24), and CDSS/CCL Investigation Assignment Report (dated: 10/21/24). (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff member sexually abused resident in care. The nature of this complaint alleged a facility staff sexually assaulted resident #1 (R1). It is reported that a staff had inappropriately handled (R1) during a diaper change activity. There was no further detail information given on this matter. On 10/18/24, at 10:20 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed resident #1 (R1). (R1) was not able to describe how (R1) was sexually assaulted by staff. (R1) claimed to not know if the staff member is still employed. (R1) reported that the male staff has attempted to hurt (R1) several times and that the male staff is from a “cosmic space”. (R1) was not able to explain how (R1’s) medical needs were neglected. (R1) appeared to have a desultory conversation and made inconsistent statements throughout the interview. On 10/18/24, at 02:15 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (R1’s) directive and trustee witness #1 (W1). According to (W1), (W1) did not believe (R1) was touched inappropriately at the facility and did not have any concerns. (W1) stated that (R1’s) behavior has changed due to possible medication but described (R1) has always been unhappy. (W1) described (R1) as chronic complainer who tends to be satisfied rarely and will almost always find something wrong. On 11/01/24, between 10:11 am – 10:50 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (5) residents #2-#5 (R2-R5) who were unable to corroborate this accusation. (R2-R5) expressed that facility provided a comfortable and safe environment for residents in care. (R2-R5) have not observed or witness any type of abuse or assault on any individuals. (R1) claimed to have been assaulted by a male staff but refused to be provided further details on the matter. (R1) declined to answer the question if the staff treated her with kindness and respect. (R1) was uncertain if she is provided with a comfortable or safe environment. (R1) did claim to have no concerns for (R1’s) health or safety. (R1) gave inconsistent statements throughout the interview. (R2) claimed to share a room with (R1), reported no such inappropriate activity ever happened. (R2) claimed to have been a witness when the male staff member assisted (R1) during diaper changes and two female caregiver staff were also present. (R2) claimed to have never observed a male staff caregiver alone with (R1) and that female staff caregivers are always present to assist with (R1’s) incontinent needs. (Evaluation Report continues LIC 9099-C) On 11/01/24, between 10:51 am – 11:57 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (4) staff who refuted this accusation. (S1-S4) reported this accusation is false and that no such incident ever occurred. (S3-S4) are primary caregivers to (R1) explained to have been present that one time to assist with (R1’s) diaper change. (S3-S4) both provided consistent statements on accounts of what happened on that one occurrence during a diaper change with (R1) and the male caregiver present. (S3-S4) explained that the male staff only assisted to propped (R1) by supporting (R1’s) backside – there was no handling below the waist by the male staff during the incontinent activity. (S1-S4) confirmed that only female staffs assist female residents with personal and hygiene needs. (S1-S4) stated that male staff are assigned solely to assist with male residents. Based on the gathered information, there is no evidence to support the allegation mentioned above. Allegation #2: Staff do not ensure that resident's hygiene needs are being met while in care. The details of this complaint alleged the facility staff are not able to meet resident #1 (R1’s) hygiene needs while in care. It is reported that (R1) has not been showered in over a year and has not been give pain medication as prescribed. There was no further detail information given on this matter. On 11/01/24, between 10:11 am – 10:50 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (5) out of (5) residents #5-#5 (R1-R5) who were unable to support this accusation. (R1-R5) reported the facility staff are responsive when it came to assistance and that hygiene services provided are adequate. (R1) denied to have issues or concerns with (R1’s) hygiene care. (R1) was complimentary of staff and claimed the hygiene services provided were satisfactory. On 11/01/24, between 10:51 am – 11:57 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (4) staff who contested this accusation. (S1-S4) reported all the residents including (R1) are provided 24/7 personal and hygiene care services. (S1-S4) disputed the claim of (R1) not being showered for over a year nor had any assistance with prescribed medications. (S1-S4) reported that (R1) is on a routine schedule twice a day for sponge bath and medication management. Based on the gathered information, there is no evidence to support the allegation mentioned above. (Evaluation Report continues LIC 9099-C) Allegation #3: Staff do not ensure that resident receives medical attention as necessary while in care. The details of this complaint alleged the facility staff do not ensure resident #1 (R1) receives the necessary medical attention while in care. It is reported that (R1) would have to call emergency medical services and that care staff will not call paramedics for (R1) when requested. There was no further detail information given on this matter. On 11/01/24, between 10:11 am – 10:50 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (5) residents #2-#5 (R2-R5) who were not able to corroborate this claim. (R2-R5) reported the facility staff are responsive when it came to resident’s requiring medical attention and it is acted timely. (R1) claimed that the staff did not want to call emergency medical services (EMS) when (R1) required medical attention. (R1) did not want to elaborate on the nature of the matter but stated that (R1) had to do calls each time for (EMS) for assistance. On 11/01/24, between 10:51 am – 11:57 am, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (4) out of (4) staff who claimed this accusation is false. (S1-S4) has a history of making direct calls on (R1) personal phone to (EMS) or 911 Paramedics. (S1-S2) claimed that (R1) obligates the staff to dispatched for (EMS) or Paramedics when (R1) needs pain medication. (R1) is not experiencing a life-threatening condition such as: breathing problems, chest pain, bleeding, fainting, allergic reaction, injuries, or stroke. (S2) stated that it’s been advised to (R1), that (EMS) or Paramedics are only dispatched for life-threating conditions and if it has to do with (R1’s) medication, (R1) will need to be evaluate by (R1’s) physicians who will prescribe the medication. (S2) reported (R1) is currently on (19) prescribed medications and (2) out of the (19) is for pain. Based on the gathered information, there is no evidence to support the allegation mentioned above. (CDSS/CCL) associate was not able to obtain statements from resident #6 (R6) as the resident was not available for an interview. As a result of the Department reviewing (R1’s) Admissions Agreement and Contract (dated: 08/22/23), Physicians Report LIC 602A (dated: 08/17/23), Appraisal/Needs and Service Plan LIC 625 (date: 07/01/24), and Medication Administration Record (MAR) (dated: 09/1/24-09/30/24), revealed (R1) requires assistance with personal activities of daily living, mental condition consists of depression is treated with medications that presents side effects such as dizziness, agitation, anxiety, nervousness, and hallucinations (ref: NIH). Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegations mentioned in this complaint. 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, therefore the allegations are Unsubstantiated. An exit interview is conducted with caregiver Alfian Fnu, and a copy of the report is provided.the state’s words, verbatim · CDSS document, Nov 1, 2024 · control 11-AS-20240927164107

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Naome Leibov, Facility Manager and the purpose of the visit was discussed. Facility is licensed to serve 6 ambulatory residents of which 2 may be non ambulatory. None of the residents are diagnosed with dementia, (2) residents are receiving home health services. No residents receive hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (4) resident bedrooms, (2) Full bathroom, living room, kitchen with dining area, laundry room (located in the hallway) and an outdoor shaded patio area. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 115.1F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Naome Leibov, House Manager and Ernawaty Simpationo, caregiver and a copy of this report was left at time of visit.the state’s words, verbatim · CDSS document, Oct 25, 2024

Allegation investigated: Staff do not ensure facility is in good repair Staff do not ensure facility is kept in clean sanitary conditions for residents in care

On 09/19/24, Licensing Program Analysts (LPA), Wendy Gibbs and Yolando Rosser, conducted an unannounced complaint visit to the facility listed above. LPAs met with Designee Administrator, Eilat Nahum, and House Manager, Noame Leibov, and the purpose of today’s visit was explained. During today’s visit, LPA conducted a facility inspection, interviewed Resident R1-R4, interviewed Staff S1-S4, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, receipts from ABBA Termite & Pest Control aba Bee Emergency Response Team, and Facility Compliance Checklist. The investigation revealed the following: Substantiated Allegation: Staff do not ensure facility is in good repair The complaint allegation alleges that the cold-water knob in the shower and the sink does not work, a light fixture is missing a panel cover, and the ceiling and pieces of the wall are deteriorating and falling. During the facility inspection, LPAs tested the cold-water knob for the sink and observed it did not turn on. LPAs tested the cold-water knob in the shower and observed it did work properly. LPA observed in the bathroom and in the living room there is a section of the paint on the wall that is peeling. LPAs did not observe a light fixture missing a panel cover. During interviews with Staff S1-S4, were asked if there is anything in the facility that is in disrepair, three (3) out of four (4) stated to their knowledge there was nothing in disrepair. Staff S4 stated they did not inform S1 or S2 of the sink cold-water knob not working. Additionally, during interviews with S1 and S2 stated when staff or residents inform them of something needing repaired, they call and make arrangements for it to be repaired right away. During interviews with Residents R1-R4, were asked if the facility is kept in good repair, three (3) out of four (4) stated they are unsure if the facility is in good repair and one resident stated staff do not repair things. Additionally, LPA asked R1 if they let staff know if something needs fixed, and R1 stated no they didn't tell them. During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D. Allegation: Staff do not ensure facility is kept in clean sanitary condition The complaint allegation alleges that the tile floors in the bathroom and shower are not cleaned. During the facility inspection, LPA observed the grout between the tiles in the bathroom were observed black, the base board in R1’s room was observed dirty, and the window ledge in the living room and R1's room was observed dirty and had dead insects on it. During record review, LPA received and reviewed the Facility Compliance Checklist that is conducted weekly which entails S1 and S2 walking the facility to ensure rooms are clean and meet Tittle 22 regulations. LPA reviewed the Facility Compliance Checklist dated 08/5/24, 08/12/24, 08/19/24, and 08/26/24. During interviews with Staff S1-S4, were asked how often the bathrooms and showers are cleaned, four (4) out of four (4) stated the shower is cleaned after every use and the bathroom is cleaned multiple times a day. Additionally, during interviews with Staff S1-S4, were asked how often the facility is cleaned, four (4) out of four (4) stated the facility is cleaned 3 times a day and as needed. During interviews with Residents R1-R4, were asked if the facility is kept clean and sanitary, two (2) out of four (4) stated yes, the facility is kept clean. Additionally, during interviews one resident stated the baseboards and windows are not cleaned regularly. During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Designee, Eilat Nahum, and a copy of this report was provided. Allegation: Staff do not ensure facility is kept free of pests The complaint allegation alleges that the facility has an issue with spiders both inside and outside. During record review, LPAs received and reviewed invoices from a pest control company ABBA Termite & Pest Control dba Bee Emergency Response Team dated for services received on 1/31/24, 04/03/24, 06/28/24, and 07/26/24. During the facility inspection, LPA observed a spiderweb in the facility entrance, and in R1's room and dead insects on a window ledge in the living room. During interviews with Staff S1-S4, were asked how they keep the facility free of pests and insects, four (4) out of four (4) stated there is a pest control company that comes out regularly to provide services, they ensure surfaces are clean, and check for insects around the facility. During interviews with Residents R1-R4, were asked if the facility is kept free of insects, two (2) out of four (4) stated they have seen insects in the facility including a spider and flies. Unsubstantiated During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Designee, Eilat Nahum, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 19, 2024 · control 11-AS-20240911081913

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(6) · Plan of correction due date: Oct 3, 2024

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or non-ambulatory residents, based on the residents' needs. This requirement was not met as evidence by: Based on observations and interview, LPA observed the cold-water in bathroom 1 did not turn onthe state’s words, verbatim · CDSS document, Sep 19, 2024

Plan of correction: Administrator called and plumber came to replace the knob. LPAs tested the knob and observed it worked properly.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 3, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observations and interviews, LPA observed the paint peeling on a section of the wall in the bathroom and living room, window ledge in the living room had dead insects and dirt, and the base board in R1's room was observed dirty.the state’s words, verbatim · CDSS document, Sep 19, 2024

Plan of correction: Administrator will email pictures of the painted walls, cleaned baseboards, and cleaned window ledges to LPA. Administrator will conduct a training with staff regarding cleaning procedure and email training log to LPA at Wendy.Gibbs@dss.ca.gov.

Type of visit: Required - 1 Year

On 11/2/2023, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with facility manager Noame Leibov and explained the purpose of today’s visit. LPA was granted access into the facility. The facility is an RCFE licensed for six (6) ambulatory residents, of which two (2) may be non-ambulatory. There are currently four (4) residents in this facility. The facility is a one-story structure located in a residential neighborhood. It consists of the following: (4) bedrooms, of which (2) two are unoccupied and (1) one of those unfurnished; (2) two bathrooms, a living room, dining area, kitchen, washer, and dryer. The porch is covered and has seating area with small table and two chairs. There is a large backyard with an office space located in the detached garage where staff records and client records will be kept locked. LPA observed shaded outdoor seating area for residents. LPA observed passageways, walkways, driveways, steps and patios to be free from debris and or hazards. Kitchen was inspected and observed to be clean and operational. LPA and manger Noame Leibov toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for residents personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly. One fully charged fire extinguisher was found near dining room and living room. Continued on LIC 809-C During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, a 30-day supply of Personal Protective Equipment (PPE) is available and sign in and out logs for visitors and staff are present in the facility. Smoke detectors and carbon monoxide detector were in compliance and operational. First aid kit is fully stocked with manual. No deficiencies were cited at the time of this visit. An exit interview was conducted, and a copy of this report along with appeal rights was provided to facility manager Noame Leibov.the state’s words, verbatim · CDSS document, Nov 2, 2023

Allegation investigated: Staff did not provide a safe and comfortable environment Staff mismanaged resident's medication

THIS REPORT SUPERSEDES THE REPORT DATED 10/05/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility on 10/05/2023 and was greeted by Administrator Manacha Nahum (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10-day visit on 10/05/2023. LPA Calderon initiated an investigation for the above-mentioned allegations and conducted in-person interview with Assistant Administrator Eilat Nahum (A1). Unsubstantiated Investigation consisted of: LPA Calderon interviewed A1, S1-S2, and R1-R3. These interviews were conducted on 10/05/2023. LPA Calderon obtain and reviewed the following: physician’s report (dated 08/22/2023), Preplacement Appraisal (dated 07/27/2023) Medical Administration Record (10/2023), Incident report (dated 10/02/2023) for R1. The investigation revealed the following: Regarding Allegation #1: Staff did not provide a safe and comfortable environment. This complaint alleged that staff left a pair of scissors in R1 room unattended. On 10/05/2023 LPA Calderon obtained and reviewed the following: Service Records reviewed for (R1) revealed Preplacement Appraisal (dated: 07/27/23 and Physician’s Report (date: 08/22/2023), (R1) is not independent and requires assistance with activities of daily living (ADL). LPA Calderon conducted an interview with Assistant Administrator Eilat Nahum A1. A1 states that staff did not leave a pair of scissors unattended anywhere in the facility. A1 states that all knives and scissors are locked up in the kitchen. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that all knives and scissors are locked up and no scissors were left unattended anywhere in the facility. LPA Calderon conducted an interview with R1. R1 states that on an unknown date and unknown time R1 states that that unknown staff left a pair of scissors near R1 bed and R1 did not feel safe. LPA Calderon conducted an interview with R2-R3. 2 out of 3 residents state that they feel safe living at the facility and 2 out of 3 residents state that they have not seen a pair of scissors left unattended by staff. Regarding Allegation #2: Staff mismanaged R1 medication. This complaint alleged that staff left an open bottle of pills in R1 room unattended. On 10/05/2023 LPA Calderon obtained and reviewed the following: Service Records reviewed for (R1) revealed Preplacement Appraisal (dated: 07/27/23 and Physician’s Report (date: 08/22/2023), (R1) requires assistance with administration of medications. LPA Calderon conducted an interview with Assistant Administrator Eilat Nahum A1. A1 states that staff did not leave an open bottle of pills unattended anywhere in the facility. A1 states that all medications are locked up in the kitchen. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that all medications are locked up and no open bottles of medication were left unattended anywhere in the facility. LPA Calderon conducted an interview with R1. R1 states that on an unknown date and unknown time R1 states that that unknown staff left an open bottle of pills near R1 bed and R1 states that this happened many times but R1 does not remember when this incident happened. LPA Calderon conducted an interview with R2-R3. 2 out of 3 residents state that staff take care of their medications with no issues and 2 out of 3 residents state that they have not seen an open bottle of pills left unattended by staff. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff did not provide a safe and comfortable environment” “staff mismanaged residents medication” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Assistant Administrator Eilat Nahm A1.the state’s words, verbatim · CDSS document, Oct 5, 2023 · control 11-AS-20231002144324