Michael Andrew Center

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver Xiomara Sevilla, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single- story building with 6 residents' bedrooms, 2 staff rooms, 3 bathrooms, a dinning room, a living room, an office area, a kitchen, an outdoor area, and a detached garage with a laundry room. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen under the sink and inaccessible to residents in care. The smoke detectors and carbon monoxide detectors were operable. LPA observed fire extinguisher to be in compliance with the department's requirements and with an expiration date of 08-22-2026. The water temperature was tested within regulations measuring 114.7 F Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise residents during the visit. The Administrator holds a current administrator’s certificate with the expiration date of 07-14-2027 and CPR certification with the expiration date of 04-08-26. Record Review and Resident/Staff Files: LPA reviewed files for 2 staff members, confirming criminal clearance, updated training, and health screening. 2 residents' files were reviewed and contained all required documentation. LPA observed first kit to be available for the residents in care. The residents and staff files were kept locked and inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the living room area. LPA reviewed medications for 2 residents confirming that all medication were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 07-20-2025, which met the department's requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Caregiver Liriomay Gumpal.the state’s words, verbatim · CDSS document, Sep 26, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Yolanda Delgado is conducting this unannounced case management visit on this date to check on the health, safety, and welfare of clients in care. LPA learned that five (5) clients currently reside at this facility with one (1) client hospitalized since March 17, 2025. Two (2) staff is currently present. LPA was later met by facility administrator Romeo Labastida. During this visit LPA toured the facility on the inside and outside. LPA assessed the food supply and found that it exceeds the minimum requirement of a 2-day supply perishable and a 7-day supply of non-perishable foods. LPA toured the perimeter of the facility and observes that there are no obstructed pathways or doorways. LPA toured the living room and dining room. LPA notes that the facility is clean and well maintained. LPA toured resident bedrooms. LPA observed that the beds have the appropriate linens, that the clients have adequate clothing, closet and personal items displayed in their rooms. Clients and staff were interviewed. Based on the information obtained today LPA does not observe any immediate threat to the health, safety, and welfare of the clients residing at this facility. There are one (1) deficiency being issued per Title 22, Division 6 of the California Code of Regulations. This report, LIC809D, LIC811, and Appeal Rights was reviewed with Romeo Labastida, and copy provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Jun 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b) · Plan of correction due date: Jun 5, 2025

Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by: Based on observation and interviews, the Licensee did not comply with the above regulation with at least two staff (S4, S5). LPA Delgado learned that S4 and S5 are not associated to this facility. This is an immediate safety risk to all residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2025

Plan of correction: Licensee agrees to complete and associate by end of business 6/4/2025 in order to continue to have S4and S5 work or be at the facility. Licensee to provide LPA Delgado with proof of submitted request by 5pm on the due date indicated.

Allegation investigated: Staff member pushed resident resulting in a fall and injuries.

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with staff Sunny Rosette and explained the reason for today’s inspection. Administrator (AD) Anita Labastida appeared via telephone. The investigation into the allegation that a staff member pushed resident resulting in a fall and injuries revealed the following: During the course of the investigation, Department staff inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, a facility Incident Report dated September 19, 2022, the facility’s Progress Notes for Resident #1 (R1), R1’s Physician’s Report dated July 10, 2022, R1’s Preplacement Appraisal dated July 19, 2022, and R1’s Medical Records dated September 18, 2022. Unsubstantiated It was alleged that on September 18, 2022, R1 had a fall at the facility, sustained bruising to the left thigh and a large hematoma on their back, and that R1 stated that a staff at the facility had pushed them. When interviewed, R1 reported that Staff #1 (S1) was the one who pushed them and S1 pushes them every day. When interviewed, S1 reported that R1 had accused them multiple times of pushing them, but S1 denied ever having pushed R1. Per S1, R1 is confused and unstable on their feet due to having Huntington’s Disease, R1 falls frequently, when S1 tries to catch R1 during falls or otherwise assist them during falls R1 would accuse S1 of pushing them, and that on September 18, 2022, S1 was not present in the room when R1 fell. Interviews with AD and one staff corroborated S1’s statements. Another staff reported that they were in R1’s room when they fell on September 18, 2022, and that R1 was standing by their bed while the staff was picking up R1’s dinner plate, R1 fell backwards landing on a small laundry basket and breaking it, the staff called S1 from another room to assist before 911 was called, R1 did not accuse S1 of pushing them at that time, and they have never seen S1 push R1. Attempts to interview R1’s responsible party were unsuccessful. A facility Incident Report dated September 19, 2022, states that R1 fell on September 18, 2022, because they suddenly stood up and lost their balance after eating dinner. The facility’s Progress Notes for R1 document instances of R1 having falls, R1 accusing staff of pushing them, staff denying pushing R1 and stating that R1 fell by themselves, staff reminding R1 to use their walker, and staff requesting that R1 not make accusations that they are being pushed by staff. Per R1’s Physician’s Report dated July 10, 2022, R1 has Huntington’s Disease with severe Choreiform movements and R1 is non-ambulatory. R1’s Preplacement Appraisal dated July 19, 2022, indicates R1 has balance issues and forgets to use their walker. Per AD, R1 had communicated that they did not want to live at the facility and AD believes R1 would fall on purpose when they did not get what they wanted. Per the facility’s Progress Notes for R1, R1 was taken to the hospital on October 2, 2022, for an unrelated reason and did not return to the facility as they needed a higher level of care. S1 and another staff stated that sometimes when R1 was falling, staff would catch R1 to prevent the fall. Per S1, whenever S1 would catch R1 during a fall and lift R1 back up, R1 would accuse S1 of pushing them, and R1 may have been perceiving S1’s assistance as S1 pushing them. R1 also made a statement that S1 threatened them once on September 18, 2022. Interviews with AD, S1, and other staff did not disclose any information regarding this alleged incident and the facility’s Progress Notes for R1 do not document that S1 threatened R1 or that R1 ever accused S1 of threatening them. R1’s Medical Records dated September 18, 2022, indicate that R1 did not report being threatened by S1 to hospital staff while they were hospitalized for three days, although R1 did report that S1 had pushed them. The current residents and staff of the facility were not present at the facility on September 18, 2022, and R1 did not have a roommate. LPA interviewed AD and all current residents and staff and did not obtain information corroborating that staff are threatening residents. The information obtained is conflicting. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegation that a staff member pushed resident resulting in a fall and injuries occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 18-AS-20220919163257

Allegation investigated: Staff do not keep facility at comfortable temperature Staff are disrespectful to residents

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Staff #1 (S1) Sunny Rosette and explained the reason for today’s inspection. Administrator (AD) Anita Labastida arrived during the inspection. The investigation into the allegations that staff do not keep facility at comfortable temperature and staff are disrespectful to residents revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster and staff roster. CONTINUED Unsubstantiated Regarding the allegation that staff do not keep facility at comfortable temperature: it was alleged that staff are refusing to turn on the air conditioner, residents are suffering from the heat in the facility with only fans in their rooms, and that on September 8, 2022, at 2:07PM the air conditioning in the facility was off and the thermostat read 87 degrees Fahrenheit. LPA inspected the facility, conducted health and safety checks on the 5 residents present, and observed no health and safety issues. LPA observed the thermostat read 66 degrees during today’s inspection and LPA’s thermostat read 68 degrees which is the minimum required temperature per regulations. Three out of three residents interviewed did not corroborate the allegation and stated that the facility turns the air conditioning on in the summer and the heater on during the winter and that they each had an air conditioner in their room which allowed them to control the temperature. LPA interviewed two staff who denied the allegation. LPA interviewed AD who denied the allegation and stated they will ensure the facility is heated to at least 68 degrees and cooled to at least 85 degrees moving forward. The information obtained did not corroborate the allegation. Regarding the allegation that staff are disrespectful to residents: it was alleged that the temperature at the facility was 87 degrees Fahrenheit and in response a concern about the heat, AD told a resident that if they want AD to turn on the air conditioner they needed “to pay her more money.” Three out of three residents interviewed did not corroborate the allegation. LPA interviewed two staff who denied the allegation. LPA interviewed AD who denied the allegation. The information obtained did not corroborate the allegation. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Nov 20, 2024 · control 18-AS-20220912164610

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with House Manager, Anita Labastida, who was informed of the purpose of the visit. At the time of the visit there was (3) staff and (6) residents present. The facility is a one story home with (9) bedrooms, (6) rooms are for clients and (3) bathrooms. No pools or firearms are being kept at the facility. Infection Control: The LPA observed the hygiene supplies, PPE equipment, and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The smoke detector and carbon monoxide was operational, and the hot water temperature 120F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed (4) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Three (3) client files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in closet. LPA reviewed client medications for (2) client and found all medication listed on MARS and accounted for. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire drill 7/15/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies such as a first aide kit, emergency food and water. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 11, 2024