Mariposa Valley

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced required Annual Inspection at the above-named facility. LPA was greeted by staff. Administrator Karina Ramirez Vazquez was contacted via telephone and arrived at approximately at 09:20 AM. LPA explained the purpose of the visit. Entrance interview conducted. RECORD REVIEW: At 09:40 a.m. a review of facility files was initiated. The LPA was not able to review their Infection Control Plan, Emergency Disaster Plan, or when they conducted their last emergency drill as the Administrator revealed that they misplaced them. Administrator revealed the facility did not have a current liability insurance. The LPA obtained a Client Roster and Staff Roster. The LPA reviewed five (5) out of six (6) resident files and five (5) out of five (5) staff files. All staff files were not at the facility, however the Administrator was able to get the additional staff files. The following was observed: Two residents did not have a pre-admission appraisal or care plans on file, two residents did not have their care plans signed by the resident and their responsible party, one resident did not have an updated care plan on file, two residents did not have their personal rights on file, one resident did not have an updated medical assessment, and one resident did not have their Admission Agreement signed by the resident or responsible party. All Staff did not have any current training on file, upon observation the owner revealed they had not conducted the training. One staff did not have a first aid/CPR training on file. Administrator revealed the staff had not conducted the training. INTERVIEWS: LPA interviewed three (3) residents. No concerns noted. Report will continue on LIC809-C (2ND PAGE). The facility is a one-story home located in a residential area. The LPA along with the Administrator toured the facility inside and outside to ensure resident health and safety and the facility is in compliance with Title 22 regulation. Various smoke alarms and carbon monoxide detectors were tested and functioned properly. The fire extinguisher was purchased 10/13/2025 and appeared fully charged. BEDROOMS: The facility has 4 (four) bedrooms total; 2 (two) are shared resident rooms and 2 (two) are private rooms. All resident bedrooms were observed to be furnished properly. All resident rooms had appropriate bedding. There is an ample supply of linens and towels stored in the cabinets in the hallway. RESTROOMS: The facility has three (3) full bathrooms for resident and staff use. All restrooms contained grab bars and slip-resistant surfaces. Hot water was measured within the required range. COMMON AREAS: Paint, windows, blinds, and floors are in good repair. The common living and dining areas are clean and properly furnished. A working telephone is present. There is one (1) fireplace in the residence, which was properly screened at the time of the visit. Chemicals are stored locked under the kitchen sink and in the locked entry closet. The LPA observed a camera in the entry hallway, and one in the corner of the dinning room and one in the ceiling corner in front of the kitchen. KITCHEN: The facility has a sufficient supply of non-perishable food, perishable food and an emergency supply of water is present. Knives are stored in a locked cabinet. Cleaning supplies were observed locked in a cabinet under the sink. The refrigerator/freezer was at the appropriate temperature (40*F and 0*F). OUTDOOR SPACE: Building and grounds are free from hazard. Patio area observed outdoor shaded seating area for resident use. There is a water fountain in the backyard with sufficient pebbles inside. Both outdoor exit gates were observed to be self-closing and self-latching. Report will continue on LIC809-C, 3rd page. MEDICATION REVIEW: Medications for two (2) residents were reviewed and observed stored properly in a locked closet. A medication audit for Resident 1 (R1) revealed that the start dates recorded on the Centrally Stored Medication and Destruction Record (CSMDR) did not match the actual start dates listed on the medication bubble packs. The LPA observed future start dates pre-recorded on the CSMDR for dates that have not yet occurred. The Administrator admitted to pre-documenting the CSMDR based on estimated medication counts, acknowledging that they frequently fail to correct the record if the medication is ultimately started on a different day. The LPA reviewed best practices with the Administrator, emphasizing that start dates must only be documented after the medication has actually been administered to prevent regulatory discrepancies. A medication audit for Resident 2 (R2) revealed that all start dates were missing from the CSMDR. The Administrator stated that R2 began all bubble pack medications on the 1st of the month but failed to log these dates on the record. Furthermore, specific medication discrepancies were noted: Sertraline 25mg: A pill remained in the slot for the 15th of the month, indicating a missed dose. Quetiapine 25MG (Bedtime): Bubbles #24 and #25 were observed to be empty. Because the audit was conducted during the day on the 24th of the month, bubble #24 (tonight's bedtime dose) and bubble #25 (tomorrow's bedtime dose) should have still been present in the pack. The empty slots indicate that these medications are unaccounted for. The Administrator could not provide an explanation for the missed, missing, or unaccounted-for medications. Pursuant to Title 22 CA Code of Regulations, the following deficiency was cited (refer to LIC809 -D). Exit interview conducted. A copy of today's report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 24, 2026

The state marks this report as 16 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Allegation investigated: Staff handled resident in a rough manner Staff did not report a change in condition Staff did not seek timely medical care for a resident in care

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation regarding the above noted allegations. LPA initially met with facility staff. Administrator was contacted via telephone and arrived at the facility shortly after the visit began. Entrance interview conducted. During today's visit, LPA interviewed one (1) resident at 11:54AM, interviewed Administrator at 12:08PM, and staff at 12:15PM. During an initial complaint visit conducted on 10/09/2025, LPA interviewed Administrator at 10:20AM. At 11:06AM, LPA along with Administrator conducted a tour of the facility, LPA interviewed two (2) staff at 10:25AM and 01:23PM. Additionally, LPA conducted interviews with Resident #1 (R1) and other relevant parties. Throughout the course of the investigation, LPA reviewed all documents obtained. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Allegation "Staff handled resident in a rough manner:" The complaint alleges that on 09/28/2025, a female facility staff was observed handling R1 roughly when assisting R1 in standing up from their recliner. LPA interviewed residents and staff present during the time of the allegation. Staff denied the allegation. Residents interviewed stated the staff are always gentle with the residents and have never been observed to be rough. R1 could not recall an incident where they were handled roughly. Facility staff interviewed indicated that R1's family member would get upset with the staff when they would assist R1 in standing up, as R1's family member wanted R1 to transfer independently. Documents reviewed for R1 indicated R1 is a "fall risk." Staff interviewed were aware R1 was at risk of falling, and therefore would standby and assist R1 as needed when getting up from a seated position and when R1 ambulated around the facility. Although there are cameras in the facility, the cameras are only on a live feed and not recorded, therefore no footage was available for review. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff handled resident in a rough manner” is deemed UNSUBSTANTIATED at this time. Allegation "Staff did not report a change in condition:" The complaint alleges that R1 had a pressure injury and skin abnormality that was not reported to the family. LPA reviewed documents for R1 from the time of admission to the facility. Record review revealed that prior to moving into the facility, R1 had been in a Post Acute facility. Documents obtained for R1's care at the alternate facility indicated R1 had blanchable redness on their buttocks area. At the other facility, this area was to be cleaned and covered, but no additional treatment was ordered upon discharge. Facility staff interviewed indicated R1 had redness on their back and buttocks area as well as skin discoloration on their lower left leg upon admission to the facility, which is consistent with the documentation reviewed from the post acute facility. Staff indicated they did not observe any indication of pressure injuries and that while at times, particularly after showering, the skin would have increased redness, but this was consistent since R1 moved in. LPA interviewed additional parties who indicated R1's skin does still have redness. Administrator stated that since this redness was present when R1 moved in, they believed this was a chronic condition R1's family was already aware of. Based on the information obtained during the investigation, the Report Continued on LIC 9099-C Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff did not report a change in condition" is deemed UNSUBSTANTIATED at this time. Allegation "Staff did not seek timely medical care for a resident in care" It was alleged that staff did not seek medical treatment for R1's skin condition or pressure injury. Record review revealed that R1's skin had redness upon admission to the facility on 08/16/2025. Administrator indicated that prior to R1 moving into the facility, she had asked the family about R1's preferred medical provider in order to communicate regarding R1's medical needs. However, R1 did not have a primary care physician at that time. Interview with R1's current facility staff revealed that to date, R1 still does not have an identified medical care provider. The complaint alleges that when R1 was taken out of the facility for an outing on 09/29/2025, R1's family member noticed redness on R1's back and an open wound on R1's buttocks. LPA reviewed documents from a dermatologist who provided care to R1 on 10/01/2025. Documentation indicated R1 had two (2) stage I wounds to their buttocks and one (1) without any staging identified on their upper back. Photographs of R1's lower back/buttocks were reviewed during the investigation. Staff interviewed stated that the redness on R1's back and buttocks was present at the time R1 moved into the facility and at no time was a pressure injury observed, including during R1's shower the morning of 09/29/2025. It is unclear as to when the pressure injuries were sustained and whether this occurred while R1 was at the facility or out of the facility with their family. R1 could not recall a time their back hurt or if they had any injuries. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff did not seek timely medical care for a resident in care” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 29-AS-20250930084548

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced required Annual Inspection at the above-named facility. LPA was greeted by staff. Administrator Karina Ramirez Vazquez was contacted via telephone and arrived at 10:13AM. LPA explained the purpose of the visit. Entrance interview conducted. At the time of arrival, there were 5 (five) residents in care and 1 (one) caregiver on duty. The facility accepts residents with a dementia diagnosis; has a hospice care waiver for two (2) residents; and a fire clearance for six (6) non-ambulatory residents. Currently there are no residents on hospice residing in the facility. The facility is a one-story home located in a residential area. Beginning at 11:08AM, the LPA along with the Administrator toured the facility inside and outside to ensure resident health and safety and the facility is in compliance with Title 22 regulation. Various smoke alarms and carbon monoxide detectors were tested and functioned properly. The fire extinguisher was purchased 09/16/2024 and appeared fully charged. BEDROOMS: The facility has 4 (four) bedrooms total; 2 (two) are shared resident rooms and 2 (two) are private rooms. All resident bedrooms were observed to be furnished properly. All resident rooms had appropriate bedding. There is an ample supply of linens and towels stored in the cabinets in the hallway. RESTROOMS: The facility has three (3) full bathrooms for resident and staff use. All restrooms contained grab bars and slip-resistant surfaces. Hot water was measured at 109.8 degrees Fahrenheit, which is within the required range. COMMON AREAS: Paint, windows, blinds, and floors are in good repair. The common living and dining areas are clean and properly furnished. A working telephone is present. There is one (1) fireplace in the Report Continued on LIC 809-C residence, which was properly screened at the time of the visit. Chemicals are stored locked under the kitchen sink and in the locked entry closet. KITCHEN: The facility has a sufficient supply of non-perishable food, perishable food and an emergency supply of water is present. Knives are stored in a locked cabinet. Cleaning supplies were observed locked in a cabinet under the sink. The refrigerator/freezer was at the appropriate temperature (40*F and 0*F). OUTDOOR SPACE: Building and grounds are free from hazard. Patio area observed outdoor shaded seating area for resident use. Both outdoor exit gates were observed to be self-closing and self-latching. RECORD REVIEW: Beginning at 12:00PM (resident files) and 01:20PM (staff files), the LPA began file review. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All 3 (three) staff files and 5 (five) resident files observed were in compliance with regulation. All trainings were observed to be complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility does not currently have an infection control plan. LPA discussed the facility's infection control practices with the Administrator and reviewed the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan was observed to be complete and updated annually, as required. Emergency disaster drills are conducted quarterly. MEDICATION REVIEW: Medications for two (2) residents were reviewed. Medications were observed stored in a locked cabinet. All medications reviewed were properly stored and documented on the Centrally Stored Medication and Destruction Record and appeared to be administered as prescribed. INTERVIEWS: LPA interviewed staff and residents. No concerns noted. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Oct 9, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection at the above-named facility. LPA were greeted by S1. Administrator Karina Ramirez Vazquez arrived at approximately 12:39 pm. LPA explained the purpose of the visit. At the time of arrival, there were six residents in care and one caregiver on duty. The facility is a Residential Care Facility for the Elderly (RCFE) The facility accepts residents with a dementia diagnosis; has a hospice care waiver for two (2) residents; and a fire clearance for six (6) non-ambulatory residents. Currently there are no residents on hospice residing in the facility. Entrance interview conducted. The facility is a one-story facility located in a residential area. A tour of the physical environment was assessed to ensure there are no safety hazards. LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. Entrance into the facility is into the foyer area and leads into a common area. The floor plan includes a dining area, kitchen, TV room, two private bedrooms, one shared bedroom with a private bath, one shared bedroom with no bathroom, and a bathroom at the end of the hallway accessible to all residents in care. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The facility was seen to be in good repair inside and outside. LPA observed the fire inspection was last conducted on 9/16/2024. LPA observed 10 dual carbon monoxide/smoke alarms were in good working order. The bathrooms have secure grab bars and no-skid flooring. Between 12:30 pm and 12:37 pm, LPA measured the water temperature of the hallway bathroom at 110.0 degrees Fahrenheit (F) and in the private bathroom, the water temperature measured at 109.7 degrees F. Please continue to 809-C, Pg 2. The kitchen consists of a refrigerator, built in oven, stove top, microwave, toaster/convection oven, 4-slice toaster, and a blender. The kitchen cabinets, refrigerator, stove, and counters are clean. The facility is sufficiently stocked with at least two days of perishables and seven days of non-perishables. Snacks and beverages are available for residents in care upon request. Sharps are kept in a cabinet above the microwave oven located in the kitchen. Cleaning agents are kept in a cabinet under the kitchen sink and in the garage. Medications are kept in a locked hallway closet. First aid supplies were observed to be in good order. Residents participate at will in music activities, television watching, indoor exercise, and backyard visitations with family members and guests, bird watching, and relaxation. Activities outside the facility include excursions to local businesses, eateries, and scenic drives. The front yard consists of a driveway, paved walk way and covered front porch leading to the front door. The backyard consists of a paved patio with sitting areas under a pergola, and plush planted shrubs and flowers. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Personnel records were reviewed for trainings, health screenings, and background clearances. All personnel records are current. All staff are properly associated to the facility. Residents’ records were reviewed for admission agreements, health screenings, and medications. All residents' records are current. Medications are given as prescribed. LPA recommended the street number of the facility be made more visible for emergency purposes. Exit interview conducted. No deficiencies noted. Copy of report issued at the time of the visit.the state’s words, verbatim · CDSS document, Oct 9, 2024