Megan's Place

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:36 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at 01:03 PM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 09:50 AM the LPA, along with facility staff #1 (S1) toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed a fire extinguisher mounted on the wall to be purchased on 05/08/2026. The kitchen contained a locked cabinet which contained facility files and locked under-sink storage which contained cleaning chemicals. LPA observed one (1) unlocked cabinet to contain supplements and Advil. LPA notified S1 who immediately secured the items. LPA observed one (1) unlocked cabinet to contain unsecured cigarettes. COMMON AREAS: This included the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a fireplace that was appropriately screened and contained no tools. LPA observed one (1) unsecured drawer in the living room to contain a bottle of Motrin. LPA notified S1 who immediately secured the item. The hallway was observed to contain a storage closet which contained extra linens for resident use. CONTINUED ON LIC 809C. COMMON AREAS CONT: The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:29 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are single occupancy resident rooms and two (2) are dual occupancy resident rooms. LPA and S1 toured all four (4) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #3 and #4 contain direct exits to the outdoors of the facility. BATHROOMS: There are two (2) bathrooms at the facility. One (1) designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 127.4 and 139.1 degrees Fahrenheit, which is outside of the range required by regulation. LPA observed the private resident bathroom to contain unsecured cleaning supplies in the under sink cabinet. LPA notified S1 who immediately secured the items. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the backyard of the facility to contain an extra fridge/refrigerator. LPA observed this refrigerator to contain unsecured medications. LPA notified S1 who immediately secured the medications. LPA observed an unsecured lighter on the outdoor table and an unsecured bottle of floor cleaner on the side of the facility. LPA notified S1 who immediately secured the items. LPA observed one (1) window screen attached to bedroom #2 and the facility’s sliding door to contain tears in the screening material. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage contained an extra refrigerator, the facility’s washer and dryer, laundry chemicals, care supplies, and adequate emergency food and water supplies. CONTINUED ON LIC 809C. RECORD REVIEW: Record review began at 11:06 AM. 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, consent forms, and personal rights. Three (3) staff files were reviewed. LPA observed two (2) staff health screening forms to be blank and not completed by a physician. LPA observed one (1) staff member to be missing proof of a negative TB test. LPA observed one (1) staff file to be missing a completed LIC 501 (Personnel Record) and required information including the employee’s Social Security number, date of employment, educational background, past experience, etc. Five (5) resident files were observed. Four (4) resident files were observed to contain appraisal needs and services plans that were last updated more than twelve (12) months prior. MEDICATION REVIEW: Medication review began at 12:30 PM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were logged on their respective centrally stored medication and destruction record sheets. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/07/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. Both residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed two (2) staff members. One (1) staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. One (1) staff member interviewed was knowledgeable on their roles and responsibilities but struggled to appropriately identify the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, emergency disaster plan, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, May 13, 2026

The state marks this report as 11 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:35 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at 10:07 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:08 AM the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a fire extinguisher mounted on the wall to be purchased on 04/11/2025. The kitchen contained a locked cabinet that contained facility files and locked under-sink storage containing cleaning chemicals. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. Continued on LIC 809C. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage contains an extra refrigerator, the facility’s washer and dryer, laundry chemicals, care supplies, and adequate emergency food and water supplies. COMMON AREAS: This includes the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains a fireplace, it is appropriately screened and contains no tools. The hallway was observed to contain a storage closet which contained extra linens for resident use. The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:45 AM and were functional at the time of the visit. During the fire alarm test LPA observed the fire door leading to bedroom #4 to fail to close. LPA observed the fire door to be missing the magnetic latch and the self-closing mechanism to improperly installed rendering it non-functional. LPA informed the Administrator that this is a violation of the facility’s fire clearance and is a zero-tolerance violation. An immediate civil penalty in the amount of $500 will be assessed on today’s date (04/18/2025). The Administrator expressed understanding and confirmed that that a repairman would make necessary repairs to the door no later than 04/23/2025. The Administrator confirmed that the fire door will remain closed until repairs are completed. All exits in the facility were observed to contain functioning auditory alarms. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are single occupancy resident rooms and two (2) are dual occupancy resident rooms. LPA and facility administrator toured all four (4) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #3 and #4 contain direct exits to the outdoors of the facility. Continued on LIC 809C. BATHROOMS: There are two (2) bathrooms at the facility. One (1) designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. LPA observed one (1) sink in the common resident bathroom to be leaking water into the cabinet located beneath the sink. The Administrator confirmed that a repairman would be arriving to complete necessary repairs by end of day tomorrow (04/19/2025). The water temperature was initially measured to be between 137.8 and 140.0 degrees Fahrenheit, which is outside of the range required by regulation. The Administrator adjusted the temperature on the hot water heater during the visit. LPA tested the water temperature again at approximately 01:30 PM and measured the temperature to be 109.6 degrees Fahrenheit which is in compliance with regulation. RECORD REVIEW: Record review began at 11:06 AM. 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, consent forms, and personal rights. Two (2) staff files were reviewed. All staff files contained all required documents and trainings. Six (6) resident files were reviewed. Two (2) resident files were observed to be missing required signatures and documentation including consent forms, personal rights, and safeguards for property and valuables. MEDICATION REVIEW: Medication review began at 12:58 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/11/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. Continued on LIC 809C. INTERVIEWS: LPA interviewed three (3) residents. All residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed two (2) staff members. Both staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies and civil penalty were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 18, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Staff did not provide proper hygiene care for resident

Licensing Program Analyst (LPA) Trevor Byrne conducted a complaint visit for the above allegation. LPA arrived to the facility at 02:00 PM. LPA met with facility staff who contacted the facility Administrator Annie Osborn.Entrance interview conducted and the reason for the visit was explained. During the initial visit on 11/01/2024, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted interviews with the Administrator, two (2) staff members, two (2) residents, one (1) witness and obtained copies of documents pertinent to the investigation between 09:06 AM and 12:09 PM. During a follow-up visit on 12/17/2024 between 10:53 AM and 12:15 PM, LPA conducted a brief physical plant tour and interviewed the facility Administrator and the hospice company that treated Resident #1. During today’s visit LPA delivered findings for one (1) allegation. Continued on LIC 9099C. Substantiated The allegation of “Staff did not provide proper hygiene care for resident” alleges that facility staff did not provide proper hygiene care for resident #1 (R1) resulting in their wound becoming infested with maggots. During the 11/01/2024 visit LPA Byrne interviewed the facility Administrator who stated that due to the condition of R1 they were only able to give the resident bed baths for fear of damaging R1’s skin. Additionally, the Administrator stated that on 10/24/2024 once paramedics arrived to transport R1 they observed a maggot on R1. On 12/20/2024 LPA interviewed witness #2 (W2). W2 stated that on 10/24/2024 they observed R1’s wound to have multiple maggots inside of it. An interview with a witness #3 (W3) revealed that they observed R1’s wound to be bloody and puss filled beneath the bandage. W3 also confirmed observing the maggots on R1. Based on the information obtained during interviews there is sufficient evidence to support the allegation that Staff did not provide proper hygiene care for resident. Therefore, the allegation is deemed Substantiated at this time. The facility Administrator was unavailable to sign this report but has designated a staff member to sign on their behalf. This report was read to the Administrator via phone call at the time it was delivered. The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 29-AS-20241028155908

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(b)(8) · Plan of correction due date: Jan 3, 2025

87468.1 Personal Rights of Residents... (b) All residents...shall be protected from all of the actions specified in this subsection... (8) Deny or restrict medical or nonmedical care that is appropriate to a resident’s organs and bodily needs... This requirement is not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as R1's facial wound became infested with maggots while in care at the facility which poses a potential health or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Dec 20, 2024

Plan of correction: Licensee will submit a statement of understanding to CCLD confirming that they have read the entirety of CCR 87468.1 and that they understand the importance of seeking timely medical care and respecting resident's rights to CCLD no later than POC due date.

Allegation investigated: Facility staff did not seek timely medical care for resident Unlawful Eviction

Licensing Program Analyst (LPA) Trevor Byrne conducted a complaint visit for the above allegations. LPA arrived to the facility at 10:53 AM. LPA met with facility staff who contacted the facility Administrator Annie Osborn. The Administrator arrived to the facility at approximately 12:11 PM. Entrance interview conducted and the reason for the visit was explained. During the initial visit on 11/01/2024, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted interviews with the Administrator, two (2) staff members, two (2) residents, one (1) witness and obtained copies of documents pertinent to the investigation between 09:06 AM and 12:09 PM. During today’s visit between 10:53 AM and 12:15 PM, LPA conducted a brief physical plant tour and interviewed the facility Administrator and the hospice company that treated Resident #1. Continued on LIC 9099C. Substantiated The allegation of “Facility staff did not seek timely medical care for resident” alleges that facility staff did not seek timely medical care for R1’s facial wound. During the 11/01/2024 visit LPA Byrne interviewed S1. S1 stated that they noticed the wound on R1’s face bleeding through the bandage on 10/15/2024, the day that the Resident arrived to the facility. S1 immediately informed the facility Administrator of the resident’s wound. During the interview with the Administrator, they stated that R1 was first seen by a hospital on 10/18/2024. When asked why there was a delay in seeking treatment the Administrator stated that R1 was doing okay, they thought they could take care of the wound. The interview with W1 confirmed that R1 was first hospitalized on 10/18/2024 and returned to the facility later in the evening on the same day. Based on the information obtained during interviews there is sufficient evidence to support the allegation that facility staff did not seek timely medical care for resident. Therefore, the allegation is deemed Substantiated at this time. The allegation of “Unlawful Eviction” alleges that the facility did not follow proper eviction procedures for the eviction of R1. During the 11/01/2024 visit LPA Byrne interviewed the facility Administrator. The Administrator stated that during the time R1 resided at the facility they had not signed an admission agreement. The Administrator stated that R1 was sent to the hospital on 10/24/2024 and did not return to the facility. The interview with W1 revealed that on 10/24/2024 they were present at the facility when paramedics arrived to transport R1. W1 stated that the Administrator plainly told them that R1 could no longer stay at the facility due to being a liability. W1 stated that, “Without a question she was evicted.” LPA Byrne reviewed the facility file and confirmed that no eviction notice was submitted to the regional office regarding R1. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of unlawful eviction. Therefore, the allegation is deemed Substantiated at this time. The following deficiencies were cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted. The allegation of “Resident sustained unexplained facial wounds” alleges that Resident #1 (R1) sustained an unexplained facial wound while in the facility’s care. During the initial visit on 11/01/2024 LPA interviewed the facility Administrator. The Administrator stated that the resident arrived to the facility with a wound present on their face, this was corroborated by an interview with a family member of R1 (W1) who stated that the wound on R1’s face was present prior to their acceptance into the facility. An interview with Staff #1 (S1) revealed that they observed the wound on R1’s face the day they arrived to the facility and immediately informed the Administrator. Based on the information obtained during interviews there is not sufficient evidence to support the allegation of resident sustained unexplained facial wounds. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 29-AS-20241028155908

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Dec 31, 2024

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required... This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as a lawful eviction for R1 was not submitted to CCLD prior to the resident's eviction from the facility which posed a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: The licensee will submit a statement of understanding to CCLD confirming that they have read the entirety of CCR 87224 and understand the importance of following proper eviction procedures.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Dec 31, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall... (1) The licensee shall arrange...for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interview the licensee did not comply with the section cited above as medical care for R1's facial wound was sought 3 days after first being identified which posed a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: The licensee will submit a statement of understanding to CCLD confirming that they have read the entirety of CCR 87645 and understand the importance of seeking medical care for residents in a timely manner.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 09:05 AM to conduct an unannounced Case Management visit at the facility today. LPA met with Administrator Annie Osborne. The LPA advised the Administrator of the reason for the visit. During an investigation into a complaint at the facility, LPA Byrne interviewed the facility Administrator. Interviews with the Administrator revealed that Resident #1 (R1) was admitted to the hospital on 10/18/2024 or 10/19/2024 and again on 10/24/2024 and the Administrator did not submit an Unusual Incident/Injury Report (UIR) or written report to the Department. LPA informed the Administrator that a written report shall be submitted the Department within seven (7) days following an incident involving the facility’s residents. During file review it was also observed that R1 did not have a completed medical assessment signed by a physician prior to being accepted as a resident, a signed admission agreement, or a pre-placement appraisal. During the interview with the Administrator, they confirmed that they did not have did not have a medical assessment or signed admission agreement (resident admitted 10/15/2024) for the resident and had not conducted a pre-placement appraisal prior to accepting R1. LPA informed the Administrator that pre-admission appraisals and medical assessments signed by a physician are required for all residents prior to accepting them into their care. During the physical plant tour LPA observed Resident #2’s (R2) bed to contain full bed rails. LPA reviewed R2’s file which revealed that R2 is not on hospice and does not have a physician’s order for full bed rails. LPA informed the Administrator who confirmed that R2 does not have an order for full bed rails. The Administrator removed the bed rails during the inspection. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 1, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Nov 15, 2024

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year.... This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as resident 1's file was observed to contain an incomplete medical assessment which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee will submit a statement of understanding confirming that they have read the entirety of CCR 87458 and that they understand the importance of completing a medical assessment prior to accepting a client into their care no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87457(a)(2) · Plan of correction due date: Nov 15, 2024

87457 Pre-Admission Appraisal General (a) Prior to admission, the... resident ...shall be interviewed by the licensee... (2) The...resident's...her background, including...medical background... shall be discussed. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as no preadmission appraisal of resident 1 was completed prior to accepting resident 1 into care which poses a potential health and safety rick to clients in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee will submit a statement of understanding confirming that they have read the entirety of CCR 87457 and that they understand the importance of completing a pre-admission appraisal prior to accepting a client into their care no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 15, 2024

87211 Reporting Requirements (a)... licensee shall furnish to the licensing agency such reports... (1) A...report shall be submitted to the licensing agency...within seven days... (D) Any incident...health of any resident... This requirement is not met as evidenced by: Based on record review and interview the licensee did not comply with the section cited above as no special incident reports were submitted for the hospitalization of Resident 1 which poses a potential health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee will submit a statement of understanding confirming that they have reviewed the entirety of CCR 87211 and that they understand the importance of accurate and timely reporting. Licensee will submit the statement to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Nov 4, 2024

87608 Postural Supports (a) ...Postural supports may be used under the following conditions. (5)... (B) Bed rails that extend the entire length of the bed are prohibited except for ...hospice care... This requirement is not met as evidenced by Based on observation and record review the licensee did not comply with the section cited above as a resident's bed was observed to contail full bed rails, the resident is not on hospice and does not have a doctor's order for full bed rails which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee will remove the full bedrails from the identified resident's bed and will submit a statement of understanding that they have read CCR 87608 and understand the proper use of postural supports. licensee will submit proof no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(c) · Plan of correction due date: Nov 15, 2024

87507 Admission Agreements (c) Admission agreements shall be signed and dated...no later than seven days following admission... This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as a resident's file was observed to contain an admission agreement that was not filled out or signed which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 1, 2024

Plan of correction: Licensee will submit a statement of understanding confirming that they have read the entirety of CCR 87507 and that they understand the importance of completing admission agreements in a timely manner. Licensee will submit documents to CCLD no later than POC due date.

Allegation investigated: Facility did not provide a safe environment for residents.

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:55 a.m., the LPA met with staff and explained the reason for the visit. At 10:42 a.m., the Administrator Annie Osborn arrived at the facility. At 10:05 a.m., the LPA along with staff conducted a physical plant tour. Between 10:06 a.m. and 1:04 p.m., the LPA conducted interviews with the Administrator, one (1) staff and four (4) residents. At 1:05 p.m., the LPA obtained copies of pertinent documents. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: 1.) Facility did not provide a safe environment for residents. It was alleged that a resident’s dog was roaming freely outside the facility and attacked another dog. The complainant’s concern is that the dog’s presence at the facility is not creating a safe environment for the residents in care. During the time of the visit, the LPA conducted interviews with four (4) residents, including Resident #1 (R1). R1 explained that R1 was babysitting a dog for a week at the beginning of July 2024. R1 said that the dog escaped the facility through an open side gate. R1 said that the facility’s side gates are normally closed. R1 said that while the dog was out, the dog attacked another dog. R1 said that the dog was not aggressive and that the dog did not show any aggression towards the other residents or staff. R1 stated that they do have one (1) dog of their own that stays at the facility. R1 said that R1’s dog remains by R1’s side and is not aggressive and has no issues with staff or residents. Resident interviews revealed that the residents feel safe at the facility and did not bring up any safety concerns regarding dogs. Administrator interview revealed that the side gates do stay closed, however on Mondays one of the side gates stay open in order for the gardeners to have access to the backyard. The Administrator stated that side gates will remain closed from now on. Interview with R1 and the Administrator revealed that the dog has left the facility and will not be returning. The Administrator said that R1’s own dog is nice and not aggressive and has no issues with R1 having a dog at the facility. The Administrator stated that herself and her staff are always checking on the health and safety of all the residents in care and would not allow an aggressive dog at the facility. The information obtained during the investigation did not include evidence sufficient 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 allegation is deemed Unsubstantiated at this time. Exit interview conducted. No citations issued. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 30, 2024 · control 29-AS-20240722131443

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 05/22/2024. At 1:00 p.m., the LPA met with the Administrator, Annie Osborn and explained the reason for the visit. RECORD REVIEW: Starting at 1:05 p.m., the LPA reviewed records for five (5) residents and all regularly scheduled staff. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. The LPA conducted a personnel file review for all staff regularly scheduled and reviewed for, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Personnel files reviewed were observed to be in compliance. At 1:43 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for five (5) residents. No errors observed during the medication review. At 2:10 p.m., the LPA conducted a brief physical plant tour to ensure there are no health and safety hazards. No deficiencies cited at this time. Exit interview conducted. A copy of the report of provided.the state’s words, verbatim · CDSS document, Jul 30, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 12:00 p.m., the LPA met with staff and explained the reason for it visit. At 12:25 p.m., the Administrator arrived at the facility. Starting at 12:29 p.m., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:31 p.m., hot water measured at 107.0-degree Fahrenheit. First aid kit is located inside the kitchen. Medications are stored in locked cabinet inside the kitchen. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms, three (3) for resident use and one (1) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: The facility has two (2) bathrooms. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at 12:39 p.m., hot water measured between 107.2 and 109.4-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: At 12:40 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Passageways were free and clear from obstruction. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged. At 12:42 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. The LPA reviewed the following: Infection Control Plan and Emergency and Disaster Plan. Due to time constraints the LPA will return to complete the annual at a later date. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 22, 2024