Nina's Home

Allegation investigated: Staff moved resident without notifying authorized representative Staff moved resident without resident's consent

On 06/29/2026 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit to deliver findings. LPA met with Care Giver, Elvira Flores Sosa, explained reason for visit and was permitted entry into the facility. Licensee, Yanina Garcia was contacted and stated they were unavailable to come to the facility. Licensee gave permission to complete visit with Care Giver, Elvira. LPA completed a health and safety check on residents in care. During the complaint investigation interviews were conducted and documentation was requested and reviewed. Interviews completed with Licensee confirmed R1 was moved to another facility they own. Review of records does not support that notice was provided to the responsible party and resident. The allegations listed above is SUBSTANTIATED. The preponderance of evidence standard has been met per California Code of Regulations, meaning the allegation occurred or has occurred.the state’s words, verbatim · CDSS document, Jun 29, 2026 · control 24-AS-20251202153815

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: Jul 10, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition...shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents. For purposes of this paragraph, "involuntary" means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident. This requirement was not met as evidence by R1 being moved to another facility owned by Licnesee and responsible party not being notified. This poses a potential health safety and or personal rights violation.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: Licensee will provide a plan of correction in writting no later than close of business 06/30/2026 to CCL. Licensee will complete POC as written as proof of correction.

Type of visit: Case Management - Health Checks

On 04/21/26 Licensing Program Analyst (LPA) M. Garcia arrived at the facility to complete an unannounced health and safety check on residents in care. LPA met with Care Giver, Elvira Sosa Flores, explained reason for visit and was permitted entry into the facility. Licensee was contacted and arrived some time later. Prior to the Licensee arriving, the previous Administrator, Leticia Rodriguez arrived to assist LPA with paperwork until Licensee arrived. LPA completed a tour of the facility. A health and safety check was completed on residents in care. During visit Fresno-Madera Long Term Care Ombudsman, Rosallen Yung arrived for a visit at the facility. This health and safety check is being completed for an incident report (LIC 624) the Department received 4/21/26. Incident report stated power was lost at 10 am on 04/20/2026 for address: 2570 W. Alluvial Ave Fresno CA 93711. This is a licensed facility owned and operated by the Licensee. Due to the electrical box needing to be repaired 2 of 6 of the residents were relocated to this location (licensed facility). R1 and R2 were observed at the facility. Incident report indicated R3, R4, R5 and R6 were relocated to: 5154 W. Birch Ave Fresno CA 93722 (unlicensed home). 3 of 5 residents observed at kitchen table eating breakfast and 2 of 5 observed in bed inside their rooms. Food source of 7-day non-perishable and 2-day non-perishable observed. Electricity and heating/cooling source functioning. The following issues were observed during todays visit: Facility moved residents prior to properly notifying the Department per regulations. CONT... CONT... 2 of 6 residents were moved from the licensed location to an unlicensed location not listed on the incident report provided to the Department. When asked Licensee identified the correct locations. Facility records show the facility does not have an active administrator. Facility has approval for 1 resident receiving hospice services and currently has 3. Facility fire door was observed propped open. Facility exit was observed with a white stick in the bottom of the door preventing the door from properly opening. Medications were observed at the facility without a MARS/Centrally Stored Medication Record. Documentation of medication distribution was not being completed. TB injection not being properly stored/refrigerated. Chemicals observed unlocked and accessible posing a danger to residents in care. Deficiencies will be issued during an office meeting. Exit interview completed with Licensee, Yanina. A copy of this report provided.the state’s words, verbatim · CDSS document, Apr 21, 2026

Type of visit: Required - 1 Year

On 01/06/2026 Licensing Program Analyst (LPA) M. Garza arrived at the facility to complete an unannounced annual visit. LPA met with Licensee, Yanina Garcia, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 5 resident was present during visit. 3 residents receiving hospice services and 1 resident receiving home health services at time of visit. Pathways and doors were clear and free from obstruction inside facility. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last purchased on 1/3/26 and observed fully charged. Last fire drill on conducted on 07/30/25. Resident rooms observed to have the required furnishings and with adequate lighting. Chemicals and medications were located in locked closets/cupboards. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: Facility does not have an active administrator in place. 2 of 5 residents are bedridden and facility does not have an appropriate fire clearance. 3 of 5 residents are receiving hospice services and the facility has an hospice wavier for 2 residents. Outside freezer observed to be leaking water and measured at 13 degrees F. Oxygen tanks observed unsecured in hallway closet off kitchen. Freezer in kitchen measured at 8 degrees F. Interviews with staff and residents disclosed staff is conducting testing and injections for restricted health condition. 2 of 5 residents have a Homrestricted health condition and an exception request has not been submitted. CONT... CONT... Water temperature tested at 128.8 degrees F. False statement(s) made by S2 and Licensee to LPA regarding R2's testing/injections being completed by a family member and by S2 regarding home health services being provided for R1. Personal rights, nondiscrimination notice and complaint information is not posted at the facility. 1 of 3 resident records reviewed did not have an updated medical assessment within the last year. Disaster Preparedness Plan- assembly points are not identified on the facility sketch. One shelter location is not outside the immediate area. Fire drills are not being conducted quarterly. Deficiencies cited per California Code of Regulations, Title 22. Deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. *****Immediate civil penalty in the amount of $500 assessed for fire clearance deficiency.***** LPA requested the following documents to be submitted to CCL by 01/16/2026: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview was conducted with Licensee, Yanina, Administrator, Shemeka Turner and Caregiver, Marc Fuentes. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, civil penalties and appeal rights were discussed and provided to Licensee.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Case Management - Other

On 9/18/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. LPA met with Care Giver, Mario Contreras, explained reason for visit and was permitted entry into the facility. Licensee, Lanina Garcia was contacted and arrived some time later. LPA completed a health and safety check on residents in care. There are currently 5 residents in care. 3 of 5 residents receiving hospice care at this time. LPA reviewed resident files including hospice binders, completed interviews and toured the facility. During review of files it was observed that 2 of the 5 residents are diabetic. Medical records indicate that R1 takes injections 3x daily. Interview with Licensee disclosed that R1's brother-in-law comes to the facility to do the injections for R1. R2 takes medication in the form of a pill. MARS was reviewed and indicated that R1 did not have injectable medications in am, and mid day as prescribed. Review of records indicate that R1, R2 and R3 are all receiving hospice services. License was informed the hospice wavier at this facility will be reduced from 2 to 1 and could not accept any new hospice residents without an exception effective 2/6/25. Review of Department records do not indicate hospice exceptions were requested for 2 additional residents after this date. Licensing fees were due for the facility in December 2024. At this time, the facility is late on licensing fees and owes an amount of $741.50. Deficiencies cited per Title 22. If not corrected, deficiencies will have a direct impact on residents in care. Exit interview completed with Licensee, Lanina. A plan of correction was developed by Licensee and reviewed by LPA. A copy of this report, deficiencies and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87606(c) · Plan of correction due date: Sep 19, 2025

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement was not met as evidence by: record review, interviews and LPA observations. The licensee did not comply with the section cited above in that the facility has a hospice wavier for 1 resident. 3 residents at the facility are currently receiving hospice care. 2 of 3 residents on hospice observed to have grab bar (trapeze) above their bed to assist in repositioning. This poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: Licensee will immediately notify fire department they have 2 bedridden residents in the facility. Licensee will submit exceptions for R1 and R2 to CCL by POC date as proof of corrections.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87464(f)(1)(c) · Plan of correction due date: Sep 18, 2025

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). (c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidence by: LPA observation and record review. The licensee did not comply with the section cited above in that R1's MARs shows 2 injectable medications were not provided to R1 (2x on 9/18/25). This poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: Licensee stated they will get an update prescription list from hospice and discharge all medications R1 is not taking. Licensee stated they will talk with hospice to see if R1 can be placed on a pill form of medication. A copy was provided to LPA during this visit. ***Deficiency cleared.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.185(b)(1)(F) · Plan of correction due date: Oct 3, 2025

1569.185 Fees for license or applications; use of revenues; collected; denial or forfeiture (b) (1) In addition to fees set forth in subdivision (a), the department shall charge all of the following fees: (F) A late fee that represents an additional 50 percent of the established current annual fee when a licensee fails to pay the current annual licensing fee on or before the due date as indicated by postmark on the payment. This requirement was not met as evidence by: records reviewed. The licensee did not comply with the section cited above in that the Licensee did not pay the current annual and past due fees associated to facility. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: Licensee stated they will make payment for the annual and past due fees. A receipt will be sent to CCL as proof of correction by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87628(a) · Plan of correction due date: Oct 3, 2025

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement was not met as evidence by: records reviewed. The licensee did not comply with the section cited above in that R1 is receiving injectable medications they are unable to provide to themselves and a medical professional is not providing. This poses a potential health safety and or personal rights risk to resients in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: Licensee stated they will get written documentation from the physician and family member stating it is okay for the family to provide the injections to R1. Licensee stated they will provide documentation to CCL by POC date as proof of correction.

Allegation investigated: Staff are unable to communicate effectively with the residents

On 1/9/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit. Visit is being conducted to deliver complaint findings. LPA met with Licensee, Lanina Garcia explained reason or visit and was permitted entry into the facility. Administrator, Phoeun Marez was contacted and arrived some time later. LPA completed a health and safety check on residents in care. Residents observed in living room watching television and in rooms. During investigation LPA completed interviews, conducted visits and reviewed documentation (Resident roster, staff roster with contact information, staff schedule for September/October 2024, physician’s reports, needs and service plans, visitors log). During visits LPA observed S1 and S2 unable to effectively communicate with residents, visitors and LPA. Staff are utilizing a translating device to communicate. Interviews conducted expressed concern of “staff not being able to communicate with emergency services ” or “meet the residents needs”. CONT... Substantiated CONT... The Department has found this allegation has met the preponderance of evidence standard per Title 22. This allegation is SUBSTANTIATED. Deficiency cited per Title 22. Exit interview completed with Administrator, Phoung Marez. A copy of this report, deficiency and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 24-AS-20241017120820

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 17, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidence by: LPA observation and interviews conducted. Observation of S1 and S2 utilizing a translation device to communicate with residents, visitors and other staff.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Staff (Simon) that was previously working and not able to communicate is no longer at the facility. Licensee stated they will submit a copy of the new schedule with the new staff that are working at the facility as proof of correction.

Allegation investigated: Staff interfered with the residents visitations

On 1/9/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit. Visit is being conducted to deliver complaint findings. LPA met with Licensee, Lanina Garcia explained reason or visit and was permitted entry into the facility. Administrator, Phoeun Marez was contacted and arrived some time later. LPA completed a health and safety check on residents in care. Residents observed in living room watching television and in rooms. During investigation LPA completed interviews, conducted visits and reviewed documentation (Resident roster, staff roster with contact information, staff schedule for September/October 2024, physician’s reports, needs and service plans, visitors log). LPAs’ interviews with residents, observations and visits conducted (10/23/24, 12/13/24 and 1/9/25) do not support this allegation. Visitors were observed at the facility without interference. Although this allegation may or may not have occurred, it does not meet the preponderance of evidence standard per Title 22. This allegation is UNSUBSTANTIATED. Exit interview completed with Administrator, Phoung. A copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 9, 2025 · control 24-AS-20241017120820

Type of visit: Case Management - Deficiencies

On 1/9/25 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete an unannounced case management visit. LPA met with Licensee, Lanina Garcia and Administrator, Phoeun Marez explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. This case management visit was is being conducted for issues that were observed during a complaint visit. The following issues were observed: Living room carpet has hole near transition from living room to kitchen. Transition from living room to kitchen in need of replacement. Carpet in master bedroom doorway was lifted and in need of repair. Outside back patio observed with moss in need of cleaning. Refrigerator in garage leaking liquid in need of replacement. Garage observed with clutter in need of removal. Deficiencies cited per Title 22. Exit interview completed with Licensee, Lanina and Administrator, Phoeun. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 9, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 17, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: LPA observation of tear in carpet near transition from living room to kitchen in need of repair. Transition from living room to kitchen in need of replacement. Carpet in master bedroom doorway was lifted and in need of repair. Outside back patio observed with moss in need of cleaning. Refrigerator in garage leaking liquid in need of replacement. Garage observed with clutter in need of removal.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Licensee stated they will be having maintenance work on the transition and carpet. Patio will be pressure washed. Pictures will be provided as proof of correction. New refrigerator will be purchased. Licensee stated they will supply the receipt and picture as proof of correction. Licensee stated storage unit will be rented. Receipt and picture showing garage is cleaned will be sent as proof of correction.

Type of visit: Required - 1 Year

On 12/19/24 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Direct Care Staff, Elizabeth, explained reason for visit and was permitted entry into the facility. Staff, Mark Fuentes was contacted and arrived a short time later. Administrator, Phoeun Marez was contacted and arrived some time later. LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. Residents observed in common areas and in rooms. There was 2 residents on hospice at the time of the inspection. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced . Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. Chemicals and medications were located in locked closets/rooms. LPA observed sufficient seating under covered patio areas. The following issues were observed during todays visit: Scissors were observed in nook area unlocked and accessible to residents in care. Staff at facility upon arrival did not have CPR/1st Aid. Water temperature measured at 129.7 degrees F. Living room carpet has hole near transition from living room to kitchen. Dog urine in master bathroom. Master bedroom has dirty brief. Carpet in master bedroom doorway was lifted and in need of repair. Flooring in hallway bathroom observed lifting and in need of repair. Bedroom #3 observed with paint in need of touch up near night stand. Inside refrigerator observed with liquid at the bottom in need of cleaning. Inside refrigerator missing racks in freezer. Hole in garage behind door in need of repair. Debris observed behind washer and dryer in need of cleaning. Left side gate is not self-latching. Concrete on patio observed with moss in need of cleaning. CONT... CONT... Refrigerator in garage leaking liquid. Freezer observed with severe frost bite and refrigerator missing shelves in need of replacement/repair. Garage door observed dirty and in need of cleaning. Food observed in pantry was not properly sealed. Expired food was observed in pantry. Food observed in outside refrigerator/freezer was severely frost bitten and in need of defrosting. Facility was not observed with the required 7-day non-perishable food source. Facility has Disaster Plan in place however, areas listed need to be update with accurate information. LPA requested the following documents to be submitted to CCL by 12/27/24: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview completed with Administrator, Phoeun. A copy of this report, deficiencies, TV's and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 19, 2024

Allegation investigated: Staff are unable to communicate with residents to ensure that their needs are met Staff speak inappropriately to a resident(s)

On 10/02/2024 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced visit to deliver complaint findings. LPA met with Administrator, Leticia Rodriguez, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. LPA observed residents in common areas and in rooms. During the investigation interviews were completed and documentation was reviewed. The following was found: Allegation: Staff are unable to communicate with residents to ensure that their needs are met During the investigation documentation was reviewed, interviews completed, and observations were made during visits. RP alleged staff only speak and read Spanish preventing them from communicating with residents and meet their needs. RP alleged staff are unable to read the residents' prescriptions and distribute their medications as prescribed. LPA’s interviews with staff showed staff were knowledgeable in needs and services to be provided to residents. This allegation is UNSUBSTANTIATED. CONT... Unsubstantiated CONT... Allegation: Staff speak inappropriately to a resident LPA completed interviews with staff, RP and residents. LPA was unable to verify this allegation. The allegation is UNSUBSTANTIATED. Although the allegations may or may not have occurred, the preponderance of evidence standard has not been met per Title 22. The allegations listed above are UNSUBSTANTIATED. Exit interview completed with Administrator, Leticia. A copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 3, 2024 · control 24-AS-20240417091828

Allegation investigated: Staff does not administer resident's medication as prescribed Staff did not ensure that a resident's medication was stored locked Staff do not safeguard residents' personal belongings Staff do not treat resident with dignity and respect Staff do not ensure that residents are properly supervised Staff handled a resident in a rough manner Staff do not meet a resident's dietary needs

On 10/03/2024 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced visit to deliver complaint findings. LPA met with Administrator, Leticia Rodriguez, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. LPA observed residents in common areas and in rooms. During the investigation interviews were completed and documentation was reviewed. The following was found: Allegation: Staff does not administer resident's medication as prescribed During record review of the MARs, LPA observed that R1 was not being provided their prescription of Ativan as prescribed. Record review (4/1/2024 and 4/12/2024) showed that R1 was receiving their medication (3 mg every 2 hrs.) but should have been receiving (1mg every 4 hrs.). On 4/14/2024, R1 had a missed medication at 7am and did not receive it in the required timeframe (rec’vd @1pm). R1 has a prescription for use of Thicken in liquids but staff is not providing it. This allegation is SUBSTANTIATED. CONT... Substantiated CONT...Allegation: Staff did not ensure that a resident's medication was stored locked During investigation LPA completed interviews with RP and received pictures provided by RP. RP disclosed that the facility has medication throughout the facility that are unlocked and accessible to residents in care. Pictures provided showed medications in an unlocked dresser drawer. During LPAs visit to the facility on 4/19/24 medications were unlocked inside the refrigerator. This allegation is SUBSTANTIATED. Allegation: Staff do not safeguard residents' personal belongings During investigation RP alleged facility did not safeguard R1 and R2’s personal belongings. During review of the admission agreements, it was observed items were not itemized by the licensee but by the family only. Items still not located at move out: laptop, hearing aids, wheelchairs, clothes, medications, supplies for R1 and R2. Documentation does not support that these items were not properly safeguarded and returned to residents upon move out. This allegation is SUBSTANTIATED. Allegation: Staff do not treat resident with dignity and respect During interviews with staff and RP it was disclosed that staff are taking photographs and videos of R1 and sending them to the Licensee. Staff do not have the family’s consent to do this. These pictures/videos were of R1 in compromising positions/incidents and inappropriate to take. During a visit on 4/19/24 LPA observed staff walking into residents’ rooms without permission to enter, moving a resident without explanation and staff raising their voice at R2. This allegation is SUBSTANTIATED. Allegation: Staff do not ensure that residents are properly supervised During interviews with RP and staff it was disclosed that staff are sleeping during the night shift. Interviews disclosed R2 had a drop in their glucose levels and called for assistance, but staff did not come to assist them. During review of documentation, it was observed that R1 wanders throughout the night and R2 needs assistance with their medical condition. This allegation is SUBSTANTIATED. Allegation: Staff handled a resident in a rough manner During interview with RP it was disclosed caregivers laugh and mock R1 when needing assistance. Interview disclosed RP observed S1 pulling R1 in a rough manner while transferring without assistance. During visit on 4/19/24 LPA observed staff pick up R1 from a sitting position and lay them down on the couch without notifying R1 they were going to move them. R1 showed signs of pain by saying “ouch” and rubbing their legs. LPA asked if their leg hurt and R1 replied “yes”. This allegation is SUBSTANTIATED. Allegation: Staff do not meet a resident's dietary needs During investigation LPA completed interviews with RP, staff and residents, completed visits of the facility and reviewed documentation. During facility visit on 4/19/24 LPA observed expired food in the pantry, improperly stored food in refrigerator/freezer and observed staff cooking. Interviews with residents indicated they do not have a variety of food served that is meeting their dietary needs. This allegation is SUBSTANTIATED. The allegations listed above have been found to be SUBSTANTIATED per Title 22. Deficiencies cited on attached 9099D. Exit interview completed with Administrator, Leticia. A copy of this report, deficiencies, and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 3, 2024 · control 24-AS-20240417091828

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 4, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by LPA observation of MARS reviewed from 4/1/24-4/12/24 showing R1 did not receive their medications as prescribed. It was also observed that R1 was not being provided liquids with thicken during a visit conducted on 4/19/24.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Facility will provided POC in writting to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a)(1) · Plan of correction due date: Oct 14, 2024

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1)Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement was not met as evidence by: LPA observation of pictures provided by RP of medications unlock in a dresser drawer, medications unlocked in the facility refrigerator and drawers during a visit on 4/19/24.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: ...

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.153(d) · Plan of correction due date: Oct 3, 2024

1569.153 Theft and loss program; standards, property inventories and surrender of personal effects; secured areas A theft and loss program shall be implemented by the residential care facilities...include all of the following:... A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility... This requirement was not met as evidence by: LPA’s review of the admission agreement and interview with RP disclosing R1 and R2 did not discharge with all of their belongings/medication/supplies.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Items that are currently unaccounted for by facility will be looked for an returned to families. Administrator to provide receipt of items to CCL as verification of items returned. Administrator stated that all staff training will be completed. Administrator will provide a in-service sign in sheet and training material to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Oct 14, 2024

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)...(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance... This requirement was not met as evidence by: LPA interviews disclosing staff are taking photographs/videos of R1 without consent. LPA observation of staff walking into residents’ rooms without permission to enter. Moving R1 in a rough manner without explanation. Raising their voices at R2 during visit on 4/19/24.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Administrator stated that all staff training will be completed. Administrator will provide a in-service sign in sheet and training material to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Oct 14, 2024

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia... (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs...(A)... shall have at least one night staff person awake and on duty... This requirement was not met as evidence by: LPA interviews staff they are sleeping during the night shift. Documentation reviewed shows R1 wanders throughout the night and R2 needs assistance with their medical condition.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Administrator stated they will replace batteries in all call buttons to ensure they are functioning properly. Administrator stated that all staff training will be completed. Administrator will provide a in-service sign in sheet and training material to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Oct 14, 2024

87555 General Food Service Requirements (a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidence by: LPA observations on 4/19/24 of expired food in the pantry, improperly stored food in refrigerator/freezer and observed staff cooking. Interviews conducted with residents indicated residents do not have a variety of food served that is meeting their dietary needs.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Administrator stated that all staff training will be completed. Administrator will provide a in-service sign in sheet and training material to CCL by POC date.

Type of visit: Case Management - Deficiencies

On 10/03/2024 Licensing Program Analyst (LPA) M. Garza arrived at the facility completed an unannounced visit to deliver complaint findings. LPA met with Direct Care Staff, Otilio Barragan, stated reason for visit and was permitted entry into the facility. Administrator, Leticia Rodriguez was contacted and arrived some time later. LPA completed a health and safety check on residents in care. Residents observed in dining area having lunch. During this visit it was observed that Staff #1 (S1), Otilio Barragan was present and working at the facility. Facility does not have personnel file on S1 and they were working without a Criminal Background Clearance or facility association. Per Administrator, S1's first day at the facility was 10/02/24. Based on today’s visit, deficiencies are being cited in accordance with Title 22 on the attached LIC 809D for the dates of 10/02/2024 through 10/03/24. An immediate civil penalty in the amount of $200 is being assessed for fire clearance. An exit interview completed with Administrator, Leticia. A copy of this report, deficiencies and Appeal Rights were given to Administrator, Leticia.the state’s words, verbatim · CDSS document, Oct 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(b)(1) · Plan of correction due date: Oct 4, 2024

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record This requirement was not met as evidence by: LPA observation of S1 working at facility and Licensee not ensuring all staff present at the facility have received criminal record clearance and been associated to the facility. This poses an immediate health, safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Staff was immediately removed from the facility and not to return to work until fingerprint/background clearance completed. Licensee stated they are going to provide a POC in writing to CCL by POC date.