Np Care Home

Type of visit: Required - 1 Year

On November 1, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Krystal Adams and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden elderly residents ages 60 and above. The facility is approved for (2) hospice residents. Currently, the facility has (1) resident in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, one (1) staff bathroom, living area, dining area, kitchen, outside covered patio area, and a laundry room. A garage is being used for storage and office space. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 110.2 degree F. A comfortable temperature of 74 degree was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. The facility has conducted Fire Drills 10/31/25. LPA observed First Aid Kit was maintained. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility has as 30-day Personal Protective Equipment (PPE). An audit of residents #1-#5 (R1-R5) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. A review of staff CPR/First Aid training is current. The facility has the current administrator's certification on file for Kyrstal Adams #7011810740 valid 05/11/2024 through 05/10/2026 and for Ronic Tatum #701182470 valid 05/11/24 through 05/10/26. The facility is current on Community Care Licensing annual dues. No deficiencies issued. An exit interview was conducted with Krystal Adams, and a copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 1, 2025

Type of visit: Required - 1 Year

On 11/14/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the Care Inspection Tool. LPA was first greeted by Caregiver Pamela Speights and explained the purpose of today’s visit. Administrator Krystal Adams later joined LPA for the inspection visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden elderly residents ages 60 and above. The facility is approved for two (2) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, one (1) staff bathroom, living area, dining area, kitchen, outside covered patio area, and a laundry room. A garage is being used for storage and office space. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature properly measured between 105.0 F and 120.0 F. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored, yet accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available, maintained properly. A fire extinguisher was charged, and smoke detectors and carbon monoxide were operable. The facility has a working landline telephone. The last fire drill was conducted on 10/18/2024. Continued on LIC809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report with CCLD. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided to Krystal Adams.the state’s words, verbatim · CDSS document, Nov 14, 2024

Allegation investigated: Resident lost part of his finger and a laceration under eye while in care due to an unwitnessed fall.

This complaint report supersedes the report completed on 7/19/24. On 11/2/2024, Licensing Program Analyst, LPA Alfonso Iniguez conducted a subsequent complaint visit at the facility name above, LPA meet with Pam Speights/Facility staff and explained the purpose of the visit. The department found that on 7/19/2024 a civil penalty was not rendered, therefore, on today's visit a new citation with a civil penalty will be rendered. Evaluation Report continues LIC 9099-C... Substantiated This complaint report supersedes the report completed on 7/19/24. Investigation Revealed the Following: Allegation: Resident lost part of his finger and a laceration under eye while in care due to an unwitnessed fall. This complaint alleges the facility provided insufficient supervision for Resident # 1 (R1). The lack of supervision resulted in R1 sustaining a left finger injury and a laceration under the eye as a result of an unwitnessed fall. The department interviews with Resident (R1), Staff (S1), House Manager/ Crystal Adams (S2), and Administrator/Ronic Tatum (A1), indicate the following: On 03/01/22 2:40 PM, staff #1 (S1) stated she assisted R1 in R1’s wheelchair to R1’s bed for a nap. S1 then went to the kitchen. S1 stated approximately twenty minutes later, she heard a “thump” noise in R1’s room and went to check on R1. S1 stated she observed R1 had fallen and was on the floor near R1’s bed. S1 stated she observed R1’s hand was bleeding. S1 stated she then observed an injury on the dip to the tip of R1’s left 5th finger had sustained an avulsion injury and part of R1’s finger pad torn off. S1 stated she also observed a laceration under R1’s left eye.S1 stated she found the skin torn off of R1’s finger on the floor. S1 placed the skin in a bag and on ice to be taken to the hospital with R1. S1 stated R1 is a fall risk. The department conducted an interview with S2, who stated that on 03/01/2022, she left the facility to run errands when the incident occurred and was not present when R1 sustained injuries. The department conducted an interview with A1 who confirmed S1 was working when R1 fell; however, she was unable to confirm any additional staff members were working when the incident occurred. A1 reported the facility census is (6) Residents. R1’s Family Member (W1) was contacted after the incident occurred and W1 transported R1 to Kaiser Permanente West Los Angeles Medical Center Urgent Care. Evaluation Report continues LIC 9099-C... This complaint report supersedes the report completed on 7/19/24. The department found the facilities staffing was insufficient when this incident occurred as S1 was the only staff member working with (6) Residents when R1 fell and sustained significant injuries. The preponderance standard has been met; therefore, the allegation is substantiated. Deficiencies are being cited an the LIC9099-D. An immediate civil penalty of $500 is warranted accordance with California Health and Safety Code. See LIC421IM. Currently an enhanced civil Penalty determination is pending. Exit interview was conducted and plan of correction was developed with the Administrator. A copy of this report and Appeals Rights was provided to Pam Speights/Facility Staff.the state’s words, verbatim · CDSS document, Nov 2, 2024 · control 11-AS-20220303154749

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 4, 2024

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 by: Based on interviews and record reviews, the facility did not provide supervision necessary for R1 on 03/01/2022 resulting in R1’s injuries, this poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 2, 2024

Plan of correction: Licensee will ensure there is sufficient staff at all times. As plan of correction, licensee will come up with a plan to address when there is not sufficient staff available. Proof of correction will be email to LPA Richards before POC due date.

Allegation investigated: Resident lost part of his finger while in care.

On 07/19/2024, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to render findings of the allegations listed above. LPA Richard met with Krystal Adams and the purpose of today’s visit was explained. The investigation consisted of the following: On 03/04/2022, LPA Jose Calderon initiated an unannounced complaint investigation and requested records which included physicians report, needs and service plan, Physician Report, Medical report for the last 3 months, IPP, Kaiser hospital records, SIR reports. On 03/04/2022 the Department’s Investigations Branch (IB) resume the complaint investigation. On 08/16/2022 the investigation was completed by IB. The investigation revealed the following: Substantiated Regarding the allegation: “Resident lost part of his finger while in care.” It is being alleged that staff do not supervise residents resulting to resident getting injured while in care. IB interviews indicate the following: The administrator stated that on 03/01/2022 she was not present at the facility and the incident happened during a short 30-minute period when there were no other caregivers were present at the facility other than S1. Staff (S1) S1 stated that on 03/01/2022 around 2:40 pm S1 just laid R1 to bed for a nap and went to the kitchen to prepare dinner. After 20 minutes S1 heard a bump, she got to R1 room R1 was on the floor by the bed, and S1 discovered R1 left finger was bleeding and pieces of the skin was on the floor. R1 suffers from dementia and does not recall how they lost part their finger. R1 was transported to Kaiser Urgent Care and was treated for an injury sustained on the left hand. Record Reviews indicate the following: R1 Physician’s Report dated 01/18/2022 indicate that R1 is confused, is disoriented, has inappropriate and wandering behaviors. Hospital Medical Records indicate that R1’s injury to the left finger was a tear of the skin from the fingerprint to the tip of finger (tears typically caused by explosions, gunshots, and animal bites and industrial equipment injuries.) The medical records and the explanation provided by the facility staff on how they believe R1 sustained the injury was not consistent with the diagnosis provided by medical staff on how R1 got injured. The preponderance standard has been met, therefore, the allegation “Resident lost part of his left finger while in care” is substantiated. California Code of Regulations, Tittle 22, Division 6, and Chapter 8 are being cited. Please see LIC9099D. Exit interview was conducted and plan of correction was developed with the Administrator. A copy of this report and Appeals Rights was provided . Regarding the allegation: Resident has a laceration under the eye. It is being alleged that residents are being physically abused while in care. IB Interviews indicate the following: Staff S1 stated that on 03/01/2022 around 2:40 pm that S1 just laid resident R1 to bed for a nap and went to the kitchen to prepare dinner. After 20 minutes S1 heard a bump, when S1 got to R1’s room R1 was on the floor by the bed and discovered R1 has a laceration under the left eye. Then S1 contacted the administrator and informed her about what happened, she instructed S1 to take R1 to Kaiser Urgent Care. R1 suffers from dementia and does not recall anything that happened or how R1 sustained a laceration under the left eye. The administrator and staff all stated that they checked for objects that could possibly cause the laceration under R1’s left eye. There were none observed. 2 out of 2 residents did not disclose any physical abuse by staff members or experiencing any abuse themselves. Record reviews indicate the following: Hospital medical records obtained during the investigation; notes that the laceration near left eye is a healing wound. Based on IB, interviews, records reviews, and medical information available there was not enough evidence to support the allegation. Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview was conducted. A copy of the report was provided to the Administrator Krystal Adams.the state’s words, verbatim · CDSS document, Jul 19, 2024 · control 11-AS-20220303154749

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87461(a)(1-2) · Plan of correction due date: Jul 22, 2024

87461(a) (1-2) Mental Condition. The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual:(1) tends to wander; (2) is confused or forgetful; this requirement was not met as evidenced by: Based on interviews and record reviews, the facility did not provide supervision necessary for R1 on 03/01/2022 resulting in R1’s injuries, this poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 19, 2024

Plan of correction: The licensee will create a plan to ensure that amount of supervision is determined and provided based on the residents needs. Proof of correction will be submitted to LPA Richard before POC Due Date. 07/22/24. Antonine.Richard@dss.ca.gov

Allegation investigated: Facility staff did not dispense medication as prescribed. Staff falsified records. Staff did not assist resident with incontinence needs. Staff did not change resident's clothing. Staff serve small portions of food to residents. Facility does not purchase enough food for residents.

On 02/23/24, at 09:00am, Licensing Program Analyst (LPA) Perry Scott conducted a subsequent unannounced visit to the facility and was greeted by Krystal Perkins, Administrator. LPA explained the purpose of this visit is to gather additional information and deliver findings for the allegations mentioned above. The investigation consisted of the following: An initial complaint visit was completed by LPA Martessa Brown on 02/10/23. A subsequent visit was completed by LPA Perry Scott on 02/23/24. LPAs investigated the allegations mentioned in this complaint; and conducted interviews with residents and staff. Staff rosters, Resident rosters, Needs and Service Plan, Physicians Report, Incontinent Records, and Medication list for R1and R2 were obtained from the facility. A tour of the facility was conducted. The investigation revealed the following: Allegation-Facility staff did not dispense medication as prescribed. Report continued on LIC9099-C Unsubstantiated On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility staff members did not dispense residents (R1) medication as prescribed and waited a couple days before giving the medication to the resident. 3 of 3 staff denied the allegation that Facility staff did not dispense medication as prescribed. All staff (S1-S3) stated that they give the residents medication as prescribed. S1 stated that the prescription for R1 was a five-day prescription, and it was given to the resident as prescribed. LPA reviewed the Medication Administration Record and did not observe any discrepancies. LPA interviewed R2-R5 about the allegation that Facility staff did not dispense medication as prescribed. 4 of 4 residents denied the allegation and stated that they do receive their medication as prescribed. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff did not dispense medication as prescribed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 2- Staff falsified records. On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility falsified documents by putting different dates for medication in the Medication Administration Record for R1. 3 of 3 staff denied the allegation that the Staff falsified records. All staff (S1-S3) stated that they do not falsify documents and all medication given to the residents are documented. LPA verified the records and did not find any discrepancies. LPA interviewed R2-R5 about the allegation that the Staff falsified records. 4 of 4 residents denied the allegation and stated that they haven’t had any issues with their personal records. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff falsified records. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Report continued on LIC9099-C Allegation # 3- Staff did not assist resident with incontinence needs. On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility left R1 in soiled clothing overnight and was not changed. 3 of 3 staff denied the allegation that Staff did not assist resident with incontinence needs. All staff (S1-S3) stated that all residents are incontinent and that they are checked on every two hours and are changed if needed. They deny that any resident has been neglected by not changing them when needed. LPA interviewed R2-R5 about the allegation that Staff did not assist resident with incontinence needs. 4 of 4 residents denied the allegation and stated that whenever they need to be changed the staff does indeed change them. Based on interviews, there is insufficient evidence to support the allegation that the Staff did not assist resident with incontinence needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 4- Staff did not change resident's clothing. On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility left R1 in soiled clothing overnight and was not changed. 3 of 3 staff denied the allegation that Staff did not change resident's clothing. All staff (S1-S3) stated that no one has ever told them that they were not changed and remained in soiled clothing. LPA interviewed R2-R5 about the allegation that Staff did not change resident's clothing. 4 of 4 residents denied the allegation and stated that the staff has never left them in soiled clothing. Based on interviews, there is insufficient evidence to support the allegation that the Staff did not change residents’ clothing. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 5 Staff serve small portions of food to residents. On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer at the facility. The details of the complaint alleged that the facility is serving small portions of food to the residents. 3 of 3 staff denied the allegation that Staff serve small portions of food to residents. All staff (S1-S3) stated that they do not serve small portions of food to the residents. They all state that they serve normal sized portions of food. LPA observed during lunchtime that the residents were served normal sized portions of food and seemed to be happy. LPA interviewed R2-R5 about the allegation that Staff serve small portions of food to residents. 4 of 4 residents denied the allegation and stated that they are being served enough food to eat and it is not small portions of food. Report continued on LIC9099-C Based on interviews and observation, there is insufficient evidence to support the allegation that the Staff serve small portions of food to residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 6- Facility does not purchase enough food for residents. On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer at the facility. The details of the complaint alleged that the facility does not purchase enough food to feed the residents in the facility. 3 of 3 staff denied the allegation that Facility does not purchase enough food for residents. All staff (S1-S3) stated that the facility goes shopping weekly for the residents and they purchase enough to serve the residents. LPA toured the facility and observed that the facility has enough food to meet the needs of the residents. LPA interviewed R2-R5 about the allegation that Facility does not purchase enough food for residents. 4 of 4 residents denied the allegation and stated that the facility does have enough food to feed them, and they are satisfied. Based on interviews and observation, there is insufficient evidence to support the allegation that the Facility does not purchase enough food for residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Krystal Perkins, Administrator.the state’s words, verbatim · CDSS document, Feb 23, 2024 · control 11-AS-20230203151839

Type of visit: Required - 1 Year

On 10/06/23, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the Care Inspection Tool. LPA was first greeted by Caregiver Lakisha Whetstone then was joined with administrator Ronic Tatum and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden of elderly residents ages 60 and above. The facility is approved for two (2) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, one (1) staff bathroom, living area, dining area, kitchen, outside covered patio area, and a laundry room. A garage is being used for storage and office space. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.3 in bathroom number one (1) and 114.3.8 F in bathroom number two (2). A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored, yet accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available, maintained properly. A fire extinguisher was charged, six (6) smoke detectors and carbon monoxide were operable. The facility has a working landline telephone and the last fire drill was conducted on September 2023. See LIC809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff residents were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report with CCLD. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided to Ronic Tatum.the state’s words, verbatim · CDSS document, Oct 6, 2023