Oak Place Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA met with facility administrator, Flordeliza “Baby” Hipolito, and explained the reason for today’s visit. At approx 10:10 A.M. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This facility is a two-story building. On the ground floor, this facility has twelve (12) rooms and two full and three half (2 full and 3 ½) bathrooms. The second floor contains eight (8) rooms and two and a one half (2 full and 1 ½) bathrooms. This facility doesn’t have a staff room, facility will provide 24/7 care. The following was observed. At approx 10:30 a.m. LPA observed staff conducting activities with multiple residents. LPA observed (12) randomly selected resident bedrooms, each room was observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in several restrooms between 105 - 120 degrees Fahrenheit. In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating areas and dining room furniture were observed to be in good condition. The LPA observed the required postings in the common hallway. The temperature inside the facility was maintained at a comfortable level throughout today's visit. Pantry is located on the 2nd floor. LPA observed a sufficient supply of non-perishable food properly stored. LPA observed cameras in the common areas. No audio is recorded. A working telephone is present. There is an activity area with sufficient space for resident use. LPA observed additional fridges, freezer and cabinets. LPA observed a sufficient supply of additional perishable food, PPE, decorations, and various supplies for facility use all inaccessible to residents in care. LPA inspected the kitchen/food service area. Kitchen was observed to be inaccessible to residents in care. All knives and cleaning supplies were observed to be locked and stored in compliance with regulation. At 10:50 a.m. LPA observed staff preparing lunch. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. Medications are centrally stored in a med room on the first floor. LPA observed it to be inaccessible to residents in care. The outdoor area has two covered outdoor seating areas equipped with furniture for residents' use. An outdoor space is designated for smoking. There were no bodies of water observed. There were four (4) storage sheds observed outside, each was inaccessible to residents in care. LPA observed sheds to store emergency water, emergency food, cleaning supplies and various tools / items for facility use. There are two (2) laundry areas and both were observed to be inaccessible to residents in care. At 11:03 a.m., LPA observed staff unloading food supply delivery from Sysco. Records review, ten (10) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Ten(10) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time. Medication review, medications for all residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. During today’s visit LPA informed the Administrator removing medication from their original packaging in advance of administration (pre-pouring) is not permitted. Technical Violation (TV) issued. Infection control / Emergency Disaster plan: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are to be conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/29/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. Smoke detectors and carbon monoxide detectors were tested, all alarms were functional at the time of the visit. Fire extinguishers were observed to be fully charged and last serviced on 8/11/2025. Fire inspections are conducted annually by Integrated Fire Safety (IFS). The last inspection was conducted on 06/12/2026 no violations were noted during their inspection. Interviews conducted during the visit. No Evac chairs observed at stairwells, however LPA observed motorized chairs that can transport resident from top of stairs to bottom of stairs to be operational on each stairwell where only ambulatory residents reside. Technical Violation (TV) issued. During today’s visit LPA obtained a copy of the facility’s LIC 500 and resident roster. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 16, 2026

Allegation investigated: Staff did not treat resident with dignity or respect

Licensing Program Analyst (LPA) Valeria Conway conducted a 10-day complaint investigation visit regarding the above noted allegation. LPA met with Administrator Flordeliza "Baby" Hipolito and explained the reason for the visit. Entrance interview. LPA conducted an interview with the administrator at 10:00 a.m., record review at 10:10 a.m., toured the physical plant to ensure there were no health and safety concerns, and interviews with staff and clients from 10:45 a.m. to 2:30 p.m. The following was then determined: It was alleged that “Staff did not treat resident with dignity or respect”. It was reported that the facility driver (S1) observed shouting and speaking to Client #1 (C1) in a rude/aggressive manner. Interview with the administrator revealed that there was an off-site incident in which S1 transported C1 to a doctor’s appointment and became upset during the visit. Continued on LIC 9099-C Substantiated Continued from LIC 9099 The administrator stated that as result of this event, the licensee suspended S1 until further notice. Interviews conducted with multiple clients revealed that caregivers are generally kind, attentive and caring toward clients. However, several clients reported that S1 has displayed rude and impatient behavior when clients are not ready at the scheduled time for their appointments or when appointments take longer than expected. Clients stated that S1 occasionally becomes visibly upset or expresses frustration in these situations. At approximately 1 p.m., LPA conducted a phone interview with S1. During the conversation, S1 admitted to becoming upset at the doctor’s office because staff were taking too long to check in C1. S1 also stated that during this event, they became annoyed with C1 because C1 “wouldn’t stop yapping”. Based on the information obtained and reviewed, the Department has sufficient evidence to say the alleged violation occurred. Therefore, allegation “Staff did not treat resident with dignity or respect” is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 29-AS-20251028223301

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Nov 7, 2025

Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as some residents feel harassed and disrespected by some staff members, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: The Administrator has agreed to have an in-service training conducted by an approved CCL Vendor which focuses on resident’s personal rights and submit proof to CCL no later than POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted a Case Management - Deficiencies visit in conjunction with complaint visit (Complaint Control # 29-AS-20251028223301). LPA met with Administrator Flordeliza "Baby" Hipolito. The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation. Entrance interview. According to the SOC341 form filed with Community Care Licensing (CCL) on 10/29. and information obtained through the complaint investigation, the administrator acknowledged awareness that the facility driver (S1) suffers from PTSD and may become agitated displaying rude or inappropriate behavior at times. During today’s visit, it was also disclosed that S1 is related to administrator. Based on the information obtained from the SOC341 and interviews conducted, it appears that the administrators Baby and Becky Spring were aware of S1’s behavioral issues but failed to take proactive measures to ensure that residents were treated with dignity and respect, and that their personal rights and safety were protected. Interviews conducted with clients revealed that several clients have experienced rude and impatient behavior from S1. As a precaution, LPA review the Guardian background system, which confirmed that S1 is associated with the facility and eligible to work in a licensed RCFE. However, the administrator did not meet the requirements under Title 22 regulations to ensure that all employees demonstrator appropriate behavior and do not pose a risk to the residents in care. During today’s visit, at approximately 1 p.m., LPA conducted a phone interview with S1. During the conversation, S1 admitted that during an off-site visit with Client #1 (C1), they became very upset with the medical office staff and annoyed by C1. When confronted by the supervisor at the doctor’s office regarding their behavior, S1 reportedly cursed at the supervisor. Continued on LIC 809-C Continued from LIC 809 The supervisor then asked S1 to leave the premises. S1, the sole staff attending for C1, departed the location abandoning C1, leaving them unsupervised. Upon returning to the facility without C1, the administrator had to arrange for another staff member to retrieve and transport C1 to the facility safely. The administrator stated that as result of this event, the licensee suspended S1 until further notice. The following deficiencies were cited from the California Code of Regulations, Title 22 and California Health & Safety Code. (See LIC 809-D). The Administrator was informed that failure to correct deficiencies may result in future civil penalties. Civil penalties of $500 are assessed for a zero-tolerance violation. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Nov 7, 2025

87411(a) Personnel Requirements - General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by. Based on a telephone call with S1 there was an absence of supervision of C1 when S1 abandoned client at the medical facility during an appoinment resulting in an immediate threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Staff #1 was immediately removed from their position and placed on suspension pending further administrative review. The administrator agreed to submit a written statement to the Dept. outlining corrective measures to prevent recurrence of similar incidents. Also, Administrator will notify the LPA of the final employment action taken regarding Staff #1 (rehire, reassignment, or termination) before POC due date .

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(h)(2) · Plan of correction due date: Nov 7, 2025

87405(h)(2) Administrator Qualifications and Duties (h) The administrator shall have the responsibility to:(2) ...report to the licensee on the operation of the facility, and provide the licensee...standards of care and supervision. This requirement was not met as evidenced by. Based on statements the administrator did not comply with the regulation cited above by not protecting the client's personal rights resulting in an immediate threat to the health and safety of residents in carethe state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Administrator agreed to submit a written statement of understanding acknowledging the regulation cited and the importance to protect resident's personal right and report incident and ensure continued compliance to LPA before POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit. LPA met with facility administrator, Flordeliza “Baby” Hipolito, and explained the reason for today’s visit. Entrance interview conducted. At 10:00 A.M. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This facility is a two-story building. On the ground floor, this facility has twelve (12) rooms and two full and three half (2 full and 3 ½) bathrooms. The second floor contains eight (8) rooms and two and a one half (2 full and 1 ½) bathrooms. This facility doesn’t have a staff room, facility will provide 24/7 care. The following was observed. BEDROOMS: Resident bedrooms appeared to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are twenty total bedrooms, all of which were observed during the facility tour; four are private resident rooms and sixteen are shared resident rooms. Carbon monoxide detectors were observed in each room; randomly chosen detectors were tested and functioned properly. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPA observed sufficient amounts of soap and paper products in each restroom. Between 10:10 A.M. and 10:45 A.M. hot water temperature was tested in a sampling of resident restrooms, which was measured at 112.2 – 117.4 degrees Fahrenheit, which is within the required range. Continued on LIC 809-C Continued from LIC 809 COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating areas and dining room furniture were observed to be in good condition. The LPA observed the required postings in the common hallway. The temperature inside the facility was maintained at a comfortable level throughout today's visit. The LPA observed cameras in the common areas. A working telephone is present. Fire extinguishers were observed to be fully charged and last serviced on 8/27/2024. Fire inspections are conducted annually by Integrated Fire Safety (IFS). The last inspection was conducted on 7/17/2024. IFS also conducted the facility's five-year inspection of the fire sprinkler system on 2/9/2023 with no concerns noted. KITCHEN: LPA observed the kitchen/dining area. Kitchen appliances appear to be in operable condition. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods, including emergency supply and water. Cook stated that the facility uses Sysco for their food supply and delivery takes place every Tuesday. All knives and cleaning supplies were observed to be locked and stored in compliance with regulation. OUTDOOR SPACE: The outdoor area has two covered outdoor seating areas equipped with furniture for residents' use. An outdoor space is designated for smoking. There were no bodies of water observed. RECORD REVIEW: Between 11:30 A.M. and 1:35 P.M. LPA reviewed staff and resident records for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisals, and admission agreements. The seven (7) staff files reviewed contained all documents. Separate training binder is maintained for all staff training. All nine (9) residents' files reviewed were missing consent for emergency medical treatment form (LIC627C), technical violation issued (TV). All other necessary forms were in compliance. Additionally, LPA observed that the Emergency Disaster Plan and the Infection Control Plan had not been updated with the required annual signatures. The Administrator reviewed and updated both plans during today’s visit. Technical violation issued. Last emergency drill was conducted on 04/30/2025. Continued on LIC 809-C Continued from LIC 809-C MEDICATION REVIEW: Medication is kept locked in the medication room on the ground floor. At 1:50 P.M. LPA reviewed medications for five (5) randomly chosen residents. All medications appeared to be given as prescribed, however, three (3) resident’s medication list with current centrally stored medication were missing. INTERVIEWS: LPA interviewed two (2) staff and two (2) residents; no concerns were noted. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit. LPA met with Program Manager/Administrator Becky Spring and facility Designee Flordeliza (Baby) Hipolito and explained the reason for today’s visit. Entrance interview conducted. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. BEDROOMS: Resident bedrooms appeared to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are twenty total bedrooms, all of which were observed during the facility tour; four are private resident rooms and sixteen are shared resident rooms. Carbon monoxide detectors were observed in each room; randomly chosen detectors were tested and functioned properly. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPA observed sufficient amounts of soap and paper products in each restroom. Water temperature was tested in a sampling of resident restrooms, which was measured at 108 - 108.5 degrees Fahrenheit, which is within the required range. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating areas and dining room furniture were observed to be in good condition. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be fully charged and last serviced on 9/1/2023. Fire inspections are conducted annually by Integrated Fire Safety (IFS). The last inspection was conducted on 2/9/2023. A Continued on LIC 809-C (continued from LIC809) defective smoke/heat detector was replaced at that time; no other concerns were noted. IFS also conducted the facility's five-year inspection of the fire sprinkler system on 2/9/2023 with no concerns noted. An annual fire inspection by IFS for 2024 is scheduled for 6/27/2024. The fire department will be coming next week to conduct their required inspection as well. The temperature inside the facility was maintained at a comfortable level throughout today's visit. Cleaning supplies and disinfectants are stored locked per regulation. The LPA observed cameras in the common areas. A working telephone is present. KITCHEN: LPA observed the kitchen/dining area. Kitchen appliances appear to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, including emergency supply and water. Cook stated that the facility uses Sysco for their food supply and delivery takes place every Tuesday. All knives and cleaning supplies were observed to be locked and stored in compliance with regulation. OUTDOOR SPACE: The outdoor area has two covered outdoor seating areas equipped with furniture for residents' use. An outdoor space is designated for smoking. There were no bodies of water observed. RECORD REVIEW: LPA reviewed staff and resident records for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisals, and admission agreements. The five staff files reviewed contained all documents. Separate training binder is maintained for all staff training. All five residents' files reviewed were in compliance. MEDICATION REVIEW: LPA reviewed medications for randomly chosen residents. All medications were properly documented and appeared to be given as prescribed. INTERVIEWS: LPA interviewed three staff and three residents; no concerns were noted. No deficiencies cited. Exit interview conducted with Facility Designee. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 20, 2024

Allegation investigated: Staff intimidates residents Staff blocks residents from coming and going Facility failed to safeguard resident's personal property

Licensing Program Analyst (LPA) Teresa Camara conducted a complaint investigation visit regarding the above noted allegations. LPA met with back-up administrator Flordeliza "Baby" Hipolito and explained the reason for the visit. LPA conducted an interview with the administrator at 9:46 a.m., record review at 10:00 a.m., facility tour at 10:20 a.m., and interviews with staff and clients from 10:38 a.m. to 12:37 p.m. The administrator stated the name of the alleged staff intimidating residents is actually a resident at the facility and not a staff. LPA interviewed the alleged victim, resident 1 (R1), who voiced no complaints or concerns regarding staff or missing items. R1 explained in the past, under previous facility owners, R1 had a roommate who would take their shoes but with the help of the administrator that was worked out. (continued on LIC9099-C) Unsubstantiated (continued from LIC9099) R1 stated there are some other residents with habits R1 would prefer they did not do but R1 understand they must live with roommates and compromise is necessary sometimes. LPA also spoke with the alleged perpetrator resident 2 (R2) who did not wish to talk with LPA for very long. R2 is reasonably happy at the facility. R2 prefers to stay on their own and not participate in activities or go out. LPA initially observed R2 in the backyard smoking area staying in an area away from other residents. Interviews with staff were conducted. Staff have not witnessed any residents or other staff intimidating residents or blocking their path. The administrator and one staff said R2 walks around the facility most of the day and sometimes if R2 is in the hall they may be blocking the hallway so staff just say, "excuse me" and R2 moves. R2 is not aggressive in any way and will politely move. Staff have never received any complaints from residents about missing items. One staff recalled a resident missing their wallet but it was found in that resident's drawer a couple days later. Interviews with other residents were conducted. The residents are happy at the facility. They like the food. They like the quality of the food they get under the facility's new ownership. They have never felt intimidated by other residents or staff and have never had their pathway blocked by others. They have never had any missing items. Based on interviews with staff and residents, the allegations "Staff intimidates residents", "Staff blocks residents from coming and going", and "Facility failed to safeguard resident's personal property" are deemed Unsubstantiated at this time. No deficiencies observed. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, May 8, 2024 · control 29-AS-20240502091135