My Home II

Allegation investigated: Staff did not prevent resident from developing a pressure injury

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to deliver the findings for the above allegations. LPA met with Administrator Mark Yule and explained the reason for the visit. On 06/13/25, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. On 06/16/25 at 4:40 PM, the department initiated the complaint visit. On 09/12/25, the department conducted interviews with staff, residents, and witnesses on different dates and times from 07/09/25, 07/24/25, 09/09/25, 09/11/25, and 10/14/25, obtained copies of of the facility records relevant to the investigation, and obtained and reviewed hospital records on 07/11/25. Regarding the allegation: Staff did not prevent resident from developing a pressure injury, it was alleged that Resident #1 (R1) has a Stage IV pressure injury and blanchable redness on R1’s heel. Substantiated (continued from LIC 9099) A record review revealed that R1 was admitted to the facility on 03/15/25. On 04/11/25 R1 was brought to the hospital clinic and was diagnosed with a Stage 2 or 3 pressure wound and was eventually referred to and was admitted for home health services for wound care. On 04/29/25, due to wound improvement, the Home Health services terminated. On 06/04/25 however, care staff from the facility called the hospital due to R1’s decline and wound at the sacral region. Care staff was advised to call 911 but called R1’s family member and R1 was brought to the Hospital’s Emergency Room where R1 was diagnosed with Stage IV pressure wound. On 06/14/25, R1 was discharged to a Skilled Nursing Facility (SNF) for pressure wound, further treatment, and recovery. Based on the information gathered during the course of the investigation, the allegation is deemed substantiated at this time. Citation issued, appeal rights explained and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 19, 2026 · control 31-AS-20250613145222

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87466 · Plan of correction due date: Jun 22, 2026

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. 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 is not met as evidenced by: Based on interview and records review, licensee failed to ensure that the resident was immediately sent for medical attention when observed to be so, this poses an immediate health and safery risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2026

Plan of correction: The Administrator agreed to conduct an in service to all the staff to avoid future occurence of the same inaction and will submit to CCL on or before the POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Willie Pataueg for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 09:30 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of five (05) bedrooms and two (02) bathrooms for residents and one (01) room and restroom for staff. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for one (01). The facility is currently occupying five (05) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. Laundry detergents, cleaning agents and other toxins are locked away. (continued on LIC 809-C) The living and dining room are neat and clean. The facility maintains a comfortable temperature at 77°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged and last purchased 10/03/2025. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 118.8°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 11, 2025

Allegation investigated: Staff financially abused resident

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Mark Yule and explained the reason for the visit. LPA conducted physical plant tour at 10:15 AM, requested copies of facility documents relevant to the investigation and interviewed staff and resident between 10:25 AM to 12:10 PM. Regarding the allegation that Staff financially abused resident, it was alleged that Staff #1 (S1) attempted to borrow money from Resident #1 (R1). LPA's interview with R1 on 02/11/25 at around 12:10 PM revealed that, R1 did not lend money to S1, they were just talking about it together with R1's brother. LPA's interview with R1 today revealed that there was no financial transaction happened between R1 and S1. LPA's interview with S1 on 02/11/25 at around 11:44 AM revealed that S1 was told by their landlord that they were selling the house because the landlord is moving out of state and S1 had the right of first refusal on the house and intended to buy the house. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) S1 secured the loan from the bank but needed the cash down payment immediately because the landlord needed to close the deal which prompted R1 to request for an exploratory talk with R1 fiduciary, which did not happen. Further, R1 dropped the would-be financial transaction with S1 altogether and today's interview with S1 also revealed that S1 successfully acquired the house and currently in escrow. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 31-AS-20250205121127

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) conducted an unannounced case management visit at this facility to issue a deficiency in conjunction with the complaint investigation on complaint dated 02/11/25 with complaint control number 31-AS-20250205121127. During the course of the investigation LPA found a deficiency on the conduct of Staff #1 towards Resident #1 (R1), wherein S1 planned or intended to borrow money from R1. Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 1, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Apr 8, 2025

To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by: Based on LPA's interview, the licensee did not protect the resident's right when S1 intended to borrow money from R1, this poses a potential personal rights risk to the resident in care.the state’s words, verbatim · CDSS document, Apr 1, 2025

Plan of correction: The staff dropped the intention and no financial transaction occur. Administrator agreed to submit a statement understanding the regulation cited on or before the POC date.

Type of visit: Case Management - Other

On 2/10/25 at 10:15AM Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced Case Management visit to the facility to check on the resident(s) who were evacuated due to the wildfires that had taken place. LPA was greeted by the caregiver. LPA stated the reason for their visit. Administrator Mark Yule arrived shortly after to assist with today’s visit. LPA asked for census, staff and resident rosters. Administrator stated that this facility did not have to be evacuate during the fires. However, the facility did accept a total of one (1) resident who was displaced from the wildfires. Resident 1 (R1) was relocated from Lakeview Hospice which perished due to the wildfires. A physical plant tour was conducted at around 11:00AM to ensure the health and safety of residents. Sufficient supply of two (2) days perishable and seven (7) days non-perishable foods observed. Emergency food supply located in kitchen. All sharps and toxins observed locked and inaccessible to residents. Relocated residents: Evacuated resident has been placed in appropriate single room with proper bedding, nightstand, chair, and lighting. LPA observed bedding and furniture in proper condition. Sufficient supplies of hygiene observed for residents. LPA observed R1’s medication and file properly stored in locked cabinet. LPA observed resident in their room watching television. Fire drill: Last fire drill was conducted 12-01-2024. LPA observed fire extinguisher located near the kitchen and dated 2-10-25. The last annual was completed on 09-10-24. Fire alarms and Carbon Monoxide detectors were last tested on 09-10-24 and noted to be in good condition and working properly. Emergency Disaster Plan for Residential Care Facilities for the Elderly posted immediately upon entrance along with required postings. No immediate health and safety issues observed. Exist interview conducted and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Feb 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Gary Tan, initially met with staff Josephine Pataueg for a One (1) Year Required visit for this facility. Staff called the administrator Mark Yule who arrived 10 minutes later. LPAs explained the reason for the visit. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan. Signs of Covid 19 prevention protocol signs were posted indoors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the side yard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with the administrator at 1:30 PM. The facility is a single storey building with six (6) residents' bedrooms and two (2) bathrooms currently occupying four (4) residents. There is an additional bedroom and bathroom designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents. Hospice waiver for one (1) resident. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 76°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were observed to be filled and last bought on 10/22/23. (continued on LIC 809-C) The side yard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. The swimming pool is appropriately fenced and was observed to be locked during visit. There is no garage at the facility only driveway at the front. There is a shed at the side yard being used as a storage for old equipment and other supplies. The laundry area is located inside the staff bathroom and observed to be locked and inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in the cabinet under the sink. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 108.0°F to 111.5°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed the medication cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aid kit has complete tools and supplies. Client records: Client records are reviewed. Client records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 06/19/2023. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, initially met with staff Josephine Pataueg for a One (1) Year Required visit for this facility. Staff called the administrator Mark Yule who arrived 30 minutes later. LPA explained the reason for the visit. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the side yard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with the administrator at 9:30 AM. The facility is a single storey building with six (6) residents' bedrooms and two (2) bathrooms currently occupying four (4) residents. There is an additional room and bathroom designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents. Hospice waiver for one (1) resident. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 76°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were filled and current. The side yard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. The swimming pool is appropriately fenced and was observed to be locked during visit. There is no garage at the facility only driveway at the front. There is a shed at the side yard being used as a storage for old equipment and other supplies. The laundry area is located inside the staff bathroom and observed to be locked and inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in the cabinet under the sink. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 111.3°F to 116.2°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed the medication cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aid kit has complete tools and supplies. Client records: Client records are reviewed. Resident #1 (R1) has a Dementia diagnosis but Medical assessment is not current. Staff records: LPA conducted a complete file review of staff record. Staff present did not have current first aid and health screening on file. Disaster drill was last conducted on 09/19/2023. Required posting are observed to be complete and current and displayed properly at the facility. Citation issued. Appeal rights discussed and given. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Oct 22, 2023