Meraki of Sacramento

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 7/15/26 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit.. Administrator arrived to assist. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home is clean and residents appeared to have care needs met by sufficient staffing. An accidentally broken window in the dining area is under repair. The exit yard gate to be repaired to open freely. LPA reviewed 4 resident files. Files are complete and well organized. Currently there are 4 residents, , who are under 60 years of age. a RCFE is defined as having 75 percent of residents who are are sixty years of age or older. As 2 of 12 exceeds that threshold, exception requests have been submitted for R3, R4, R5 and R6. R3 and R4 did not need exceptions. However, exceptions are to be requested and granted prior to a residents' R5 and R6's admission. LPA reviewed 2 staff files. Files are complete. What constitutes annual medication training was discussed. A deficiency is being cited as a result of todays inspection. Exit interview conducted with Administrator and due to computer issues a copy of report is emailed to licensee for signature.the state’s words, verbatim · CDSS document, Jul 15, 2026

Allegation investigated: Staff left resident in soiled diaper for a period of time.

On 10/24/25, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator. LPA conducted records review , observation and extensive interviews. LPA is unable to find and or meet the preponderance, per policy. Records found that R1 had limited communication ability, incontinenece care needs and was dependent for transfers. Interview with R1 found that no specific incidents, dates or times could be identified where incontinece needs were not met. Staff interviews found that R1 frequently called for assistance by call button or shouting out and, at some of those times, called for incontinence care and was found to not have been incontinent. Report continued on 9099-C Unsubstantiated At the time of the previous inspection, R1 and their room and was found by LPA to be clean dry and odor free. R1 has since moved from the facility to another of their choice. As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview with administrator and report provided.the state’s words, verbatim · CDSS document, Oct 24, 2025 · control 59-AS-20250917083432

Type of visit: Office

On 10/14/25, Regional Manager, Alycia Rayner, Licensing Program Analyst (LPA), Kevin Mknelly, and Licensing Program Manager, Maribeth Senty , were present for an Office Meeting today with John Stir This meeting was called due to questions regarding the management of the facility. Topics discussed during this meeting were: Financial control and management of the license Administrator role and responsibilities Association of staff Administrator time Actions agreed to: Administrator, Samantha Shaw, and licensees will accept and review all referrals for admission This licensed home will be removed for another licensee's website as a related home Samantha Shaw will have her association corrected today Samantha Shaw will be administrator at this facility only. No deficiencies are cited from this meeting A copy of this report is provided.the state’s words, verbatim · CDSS document, Oct 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 7/8/25 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit.. Administrator was present to assist. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home is clean and residents appeared to have care needs met by sufficient staffing.. LPA reviewed 4 resident files. Files are complete and well organized. LPA reviewed 2 staff files. Files are complete. No deficiencies are being cited as a result of todays inspection. Exit interview conducted with licensee and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jul 8, 2025

Type of visit: Case Management - Deficiencies

On March 26/2025 Licensing Program Analyst, Kevin Mknelly conducted a case management visit and met wit the Administrator. The purpose of the inspection was to follow-up on a issue observed on 3/25/25. On 3/25/25, LPA met R1. R1 was observed in their bed and was interviewed by LPA. Following the visit, LPA requested a copy of R1's physician's assessment at the time of R1's admission. The physician's assessment for R1, identified the resident as bedridden. LPA's interview with R1 supported that R1 is dependent for all care, transfers and repositioning. This facility does not have a fire clearance for bedridden residents. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. This report was reviewed with the administrator. Copy of the report, civil penalties and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 26, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Mar 27, 2025

Fire Clearance0 (a) All facilities shall maintain a fire clearance approved ... the ... department, or.... State Fire Marshal. Prior to accepting or retaining any of the following types of persons, ... (2) Bedridden persons This requirement was not met based on records, observation and interviews. This posed an immediate risk to R1. Civil panalty appliedthe state’s words, verbatim · CDSS document, Mar 26, 2025

Plan of correction: Licesnee will relocate R1 or receive an exception granted by the fire authority for R1 to remain in the facility with conditions. Licensee will notify LPA of R1 location or granted clearance exception by POC date of 3/27/25 at 5 PM. Absent a fire depatment exception, R1 is to be relocated. Until R1 relocates licensee will ensure there are staff deignated to have eyes on R1 to ensure safety of r1 and their environment.

Allegation investigated: Staff are not ensuring that resident's incontinence needs are being met.

On 12/12/24, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Samantha Shaw, Administrator to deliver complaint findings for the above allegation. LPA reviewed resident records, facility records and conducted extensive interviews. LPA finds that the allegations cited above are substantiated. It was reported by a witness that on 10/25/24 a outside agency came to the facility to assess R1 and found R1 to have been incontinent and have wet bedding. LPA conducted a complaint investigation visit on 10/30/24 and found R1’s room to have a strong smell of urine. R1 records state that R1 experiences incontinence, has communication deficits, weakness and uses a wheelchair with assistance to transfer. The Appraisal Needs and Services Plan does not identify the incontinence management plan. Interview with caregiver on 10/30/24 found staff does not have a clear understanding of R1’s pattern of incontinence episodes or to have a clearly defined toileting schedule. Substantiated Administrator, Darius Stir, at the time of the incident, did not consult with the appropriately skilled professional to design a incontinence care program. LPA also conducted a collateral visit at the facility R1 had relocated to. R1 was found to be out of bed. R1 was clean dry and odor free an R1’s bed/ bedding was odor free. As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with Samantha Shaw . Copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 59-AS-20241025151136

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Jan 10, 2025

Managed Incontinence (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by observations and statements. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: Licensee will review all resident files. For those residents determined to have incontinence, licensee will contact the appropriately skilled professional to design incontinence plans. Licensee will submit the plans to CCL by the POC date of 1/10/24.

Type of visit: Case Management - Deficiencies

On 12/12/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with Samantha Shaw . On 10/25/24, the department received a complaint regarding care of R1. During the investigation, the following additional deficiencies were found: R1’s records were incomplete. ID/ Emergency contacts were blank, The Admission Agreement on file was for a facility other that this licensee’s and the medical assessment, the Needs and services plan on file does note clear plans and measurable methods for evaluating how to meet resident needs and on file does not identify the resident’s cognitive impairment. On 10/25/25, staff interviewed stated that R1 has as needed (PRN) medications for pain. Staff were not able to provide LPA with a copy of the required documentation of PRN medications administered. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 12, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b) · Plan of correction due date: Jan 10, 2025

Resident Records(b) Each resident’s record shall contain at least the following information: …(8) Names, address, and telephone numbers of the resident’s representative…(15) The admission agreement… This requirement was not met based on records review. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: Licensee will conduct an audit of all current resident records and provide CCLD with a list of resident records reviewed and verification they are complete, current and accurate by the POC date of 1/10/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(c)(3) · Plan of correction due date: Jan 10, 2025

Incidental Medical and Dental Care(c) (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met based on interview and records review. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: Licensee will conduct an audit of all current resident records and provide CCLD with a list of resident receiving PRN medications and that forms are in place for the required PRN administration docuentation by the POC date of 1/10/25.

Type of visit: Case Management - Other

On 5/11/23, Licensing Program Analyst (LPA), Kevin Mknelly, Regional Manager, Alycia Rayner and Licensing Program Manager, Maribeth Senty were present for a Non-compliance Conference via Microsoft Teams today with Licensee Ioan "John" Stir. On 9/3/24 the department received a death notification for R1. As R1's passing was unexpected, the department conducted case management visits to gather additional information. Following the investigation it was found that R1 had experienced a decline in their health, over several months for which medical care was not sought, R1's physicians report was a year out of date and R'1's medications were held for five(days) without a physician's order. Topics discussed during this meeting were: · Administrator qualifications · Incidental Medical and Dental Care Services violations · Personal Rights violations · Licensee oversight · Reporting/ communication with physicians · Record keeping · Timely medical care · Staff training · Timely Needs and services plans · Observation of Resident-change in condition procedures for administrator and staff. (added 10/10/24) In today's meeting, the licensee agreed to the drafted non-compliance plan as outlined in LIC 9111. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy will be signed and returned to CCLD. This report is delivered via email to Licensee for review and signature.the state’s words, verbatim · CDSS document, Oct 10, 2024

Type of visit: Case Management - Deficiencies

On 9/12/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with caregiver, Princess Allen . LPA spoke with Darius Stir by phone and reviewed the report contents. On 9/3/24 the department received a death notification for R1. As R1's passing was unexpected, the department conducted a case management visit, on 9/10/24, to gather additional information. LPA received resident records, interviewed 2 caregivers and the Administrator. LPA received contact phone numbers in order to conduct additional interviews. LPA reviewed R1's medications. During the 9/10/24 visit, staff interviewed could not provide details about how long R1 had been declining, loss of weight nor decreased oral intake. Interview with Administrator described R1 had significantly declined to the extent that Administrator was seeking to establish a new primary care physician with the intent to initiate hospice care services. Administrator also stated that written records were not kept of R1’s decline and records found that R1 had not had regular/ required physician evaluations since 2021 to 8/30/24. R1 had a diagnosis of Dementia. Lastly, the medication review and interview with Administrator found that R1 had their medications refilled on 8/26/24 yet Administrator held all of R1's medications , 8/26/24- 8/31/24, because Administrator was concerned about possible adverse effects given R1’s condition. There was not medication hold issued by a physician. On 9/10/24, Administrator also stated that they have been operating the home for the licensee and in doing so, are currently leasing the home from the licensee. LPA directed the Administrator to discontinue the lease so that the licensee reestablishes control of property. Report continued On 9/12/24, LPA conducted follow- up interviews with the following: A Southern CA tele-health service who wrote an LIC 602 physician’s report dated 8/30/24 for R1- a physician’s assistant (PA) conducted the phone evaluation. R1 was unable to participate in the evaluation due to dementia. Height, weight and blood pressure were not assessed. The facility does not have a waiver in place for a non-physician medical profession to conduct and sign the evaluation. An area health care provider was contacted by Administrator on 8/28/24 to enroll R1 and to establish Hospice Serviced. Hospice services were approved to begin 9/4/24. The provider provided a death certificate that listed: immediate cause of death as (A) advanced dementia, Parkinson’s disease- onset 10 years; underlying cause of A- poor oral intake with a time for “6 mo”; weight loss – “3 m”; and failure to thrive “1 mo”. LPA contacted a family member contact- R1’s family member described R1’s passing as sudden but not unexpected as R1 had been declining since a 2021 hospitalization. Described the care at the facility as very good- R1 gained weight after admission as R1’s food intake had increased at the home. Family had not seen R1 in “many months”. Family was not informed of R1’s recent decline. Family was notified of R1’s passing by the coroner on 8/31/24. These findings demonstrate that Administrator, Darius Stir, did not fulfill the duties and responsibilities of administrator, while Samantha Shaw was absent, when Darius Stir did not demonstrate knowledge of the requirements for providing care and supervision appropriate to the residents; nor did he demonstrate knowledge of and ability to conform to the applicable laws, rules and regulations. Report continued Since the LPA visit of 9/10/24, three residents have been sent for medical care. Administrator will submit incident reports for each within 7 days of resident hospitalization. LPA observed 6 of 9 residents present. resident care needs appear to be met by 2 caregivers. 3 of 9 residents are currently not present and are at the hospital. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. An immediate civil penalty in the amount of $500.00 is to be assessed for a resident sustaining a serious bodily injury while in care at this facility. As a result of resident’s injury, the violation warrants a civil penalty assessment based on health and safety code 1569.49. At this time, the civil penalty assessment is under review. LPA will return at a future date to assess a civil penalty if warranted. Report reviewed. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Sep 12, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Sep 13, 2024

Observation of the Resident… When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met based on statements and records that R1 was demonstrating significent decline, changes were not recorded and a physician was not informed timely. This posed and immediate risk to R1the state’s words, verbatim · CDSS document, Sep 12, 2024

Plan of correction: Licensee will submit proof that observation, documentation and physician contact training is completed by Darius Stir by the POC date of 9/13/24.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(4) · Plan of correction due date: Sep 13, 2024

Incidental Medical and Dental Care (a) (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met based on statements and observation that R1's medication was held for 6 days without a physician's hold order. This was an immediate risk to R1the state’s words, verbatim · CDSS document, Sep 12, 2024

Plan of correction: Licensee will submit proof that all staff who dispense medicaton are scheduled for 6 hours of medication training with training scheduled within 7 days by the POC date of 9/13/24.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405 · Plan of correction due date: Sep 13, 2024

Administrator - Qualifications and Duties(d) The administrator shall have the qualifications specified...(2) Knowledge of and ability to conform to the applicable laws, rules and regulations.This requirement was not met based on staements and records. This poses a immediate risks to residents.the state’s words, verbatim · CDSS document, Sep 12, 2024

Plan of correction: Licensee will

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Sep 26, 2024

Incidental Medical and Dental (h)... medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year.This eas not met based on records. Potential risk to residentsthe state’s words, verbatim · CDSS document, Sep 12, 2024

Plan of correction: Licensee will audit and correct all resident centrally stored records and submit completed records for the past 2 months by the POC date of 9/26/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(b) · Plan of correction due date: Oct 3, 2024

Medical Assessment (b) The medical assessment shall include, but not be limited to: (physical exam, by a physician, is complete, contains height, weight, blood pressure, Tb clearance and prescribed medications). This requirement was not met by statements and records. This posed a potential risk.the state’s words, verbatim · CDSS document, Sep 12, 2024

Plan of correction: Licensee will submit new LIC 602s for residents who received reports based on telehealth and signed by a physician's assistant by the POC date of 10/3/24.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.191(b) · Plan of correction due date: Sep 13, 2024

Sale of licensed facility- Except as provided in subdivision (e), the property and business shall not be transferred until the buyer qualifies for a license or provisional license within the appropriate provisions of this chapter. This requirement was not met based on statement that the licensee leased the facility property to another party. This posed a potential risk to residents.the state’s words, verbatim · CDSS document, Sep 12, 2024

Plan of correction: Licensee will submit a statement that all other leases for the property are rescinded and that the licensee retains control of the property by the POC date of 9/13/24.

Type of visit: Case Management - Other

On 9/10/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit and met with caregivers. The Administrator, Darius Stir, was notified and arrived to assist. On 9.3.24 the department received a death notification for R1. As R1's passing was unexpected, the department conducted a case management visit to gather additional information. LPA received resident records, interviewed 2 caregivers and the Administrator. LPA received contact phone numbers in order to conduct additional interviews. LPA reviewed R1's medications. The administrator and LPA discussed issues of observation, documentation and notifications of medical professionals. The Administrator will institute additional procedures at the home. LPA requested that a LIC 500- Staff Roster and LIC 9020- Resident Roster be submitted by email. As a result of today’s inspection, no deficiencies are cited at this time. Report reviewed. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 7/25/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator arrived to assist. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA advised an exception needed for resident furniture removal for behavior. LPA advised the North walkway be cleared and gate repaired. LPA reviewed 5 of 7 resident files. Files incomplete and citations issued. LPA reviewed 2 staff files. Medication training incomplete. Citation issued. Deficiencies are being cited as a result of todays inspection. Exit interview conducted with licensee and copy of report and appeal rights left at the facility.the state’s words, verbatim · CDSS document, Jul 25, 2024

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: POC

On 6/13/24, LPA Mknelly conducted a POC visit for citation issued on 6/7/24 with POC due by 6/10/24. LPA met with house manager and explained the reason for the visit. Upon arrival LPA observed that the front gate is not locked from inside the gate. The department has not received the POC: plan for staffing to address resident wandering and exit seeking behaviors as well as a waiver request if they wish to pursue the necessary clearance for a locked perimeter (See 87705(I) for waiver requirements) as of this date. LPA and house manager again discussed the needed components of the plan, that civil penalties are being assessed today and that the penalty will continue to accrue until the POC is faxed to the department. As a result of today's visit, no additional citations are being issued at this time. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, Jun 13, 2024

Type of visit: POC

On 6/7/24, LPA Kevin Mknelly conducted a plan of correction visit for the citation issued on 5/28/24. LPA met with the house manager and explained the reason for the visit. The plan of correction has been completed. When present on 5/28/24, LPA observed and discussed the locking of the facility gates. LPA was not aware of a locked perimeter waiver and fire clearance for locked gates in place. On 6/6/24, LPA notified Darius Stir via email that a file review was conducted, a locked perimeter waiver was not found and that absent the waiver, the gates may not be locked. At today's inspection, the gates were again found to be locked. A regulation violation citation and civil penalties are therefore assessed. The gates were unlocked while LPA was present. A copy of this report civil penalties and appeal rights are provided.the state’s words, verbatim · CDSS document, Jun 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(I)(2) · Plan of correction due date: Jun 10, 2024

Care of Persons with Dementia(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates:(2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement was not met based on obervations by LPA on 5/28/24 and 6/7/24. This posed an immediate risk to residents.the state’s words, verbatim · CDSS document, Jun 7, 2024

Plan of correction: By the POC date of 6/10/24, Licensee will submit a a plan for staffing to address resident wandering and exit seeking behaviors as well as a waiver request if they wish to pursue the necessary clearance for a locked perimeter (See 87705(I) for waiver requirements).

Type of visit: Case Management - Incident

On 5/28/24, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit and met with Darius Stir. The department received an incident report for an incident involving R1. On 5/22/24, staff found R1 to be in their bed at 6:30 AM and unresponsive. Emergency services were called and transported R1 to an area hospital. R1 was found to have had a medication overdose and was found to have a different resident's medication bottle in R1's pocket. (At the time of this report the other resident to whom the medication were prescribed has not been identified. LPA and Darius toured the facility to include, R1's bedroom, staff room location, where keys are kept and the kitchen/ medication areas. By reports, the kitchen was locked and medication cabinet keys were hung in the kitchen. R1 was suspected of accessing the kitchen through a window/ counter between the kitchen and living room. There were no awake overnight staff on the night of 5/21/24. Live-in staff were present but not alerted to need assistance to residents. Approximately 2 weeks prior to 5/22/24, R1 was suspected of possible accessing keys and having entered the staff office. The keys were moved to the locked kitchen. R1 has not yet returned to the home. Licensee will submit the following records to CCL: R1's LIC 602, Pre-appraisal and LIC 625 currently on file. Licensee will request R1 release hospital records for 5/22/24 emergency and hospitalization. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, May 28, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: May 31, 2024

Care of person's with dementia- (A) In addition to requirements...Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision.This requireent was not met when R1 demonstrated possible need for ON supervision, it was not put in place and keys were not secured. This posed an immediate risk to R1.the state’s words, verbatim · CDSS document, May 28, 2024

Plan of correction: While R1 is away from the home, ON care appears appropriate. Licensee has installed camera's in the home and will update their plan of operations. Licensee will submit a plan for securing dangerous items and keys to those spaces to include proof of staff training of the plan. The plan of correction will be submitted by 5/31/24.