Park Visalia Assisted Living

Type of visit: Case Management - Annual Continuation

On 9/10/2026, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director, Amanda Kelsey. LPA toured Front Lounge/seating area and Theater area. LPA conducted the rest of the facility tour with Administrator. All pathways, entrances and exits were clear from obstructions. The tour started in the facility common areas which were furnished with sufficient seating. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Bathrooms were properly equipped with non-slip tiles and grab bars. Facility grounds were toured. Memory care toured; delayed egress doors observed. Doors and passageways are unobstructed throughout the facility and to the outside. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health, Fingerprint and First Aid clearance. Due to time constraints LPA will return at a later date to complete the annual inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Sep 10, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct a Case Management for incident which occurred on 09/12/25. LPA met with Administrator Amanda Kelsey. LPA interviewed Administrator and reviewed records. Records and interviews revealed R1 was administered a narcotic medication in error. Refer to 809d A copy of this report was provided along with appeal rights and plan of corrections.the state’s words, verbatim · CDSS document, Nov 10, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 11, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by Licensee administer a narcotic medication to R1 in error which poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 10, 2025

Plan of correction: Licensee agrees to conduct a medication training by POC due date 11/11/25.

Type of visit: Required - 1 Year

On 7/10/2025, Licensing Program Analyst (LPA) J. Leffall arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director (ED) Amanda Kelsey. LPA toured Front Lounge/seating area and Theater area while waiting for Administrator. LPA conducted the rest of the facility tour with Administrator. All pathways, entrances and exits were clear from obstructions. The tour started in the facility common areas which were furnished with sufficient seating. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Bathrooms were properly equipped with non-slip tile and grab bars. The tour continued to the facility dinning and kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Medications are kept locked in the Med Carts in the Medication room. Facility grounds were toured. Memory care toured; delayed egress doors observed. Doors and passageways are unobstructed throughout the facility and to the outside. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least one staff on duty who are CPR certified. No deficiencies issued during this inspection. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/24/2025: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with ED. A copy of this report with 9102 was provided to Executive Director, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 10, 2025

Allegation investigated: Staff do no prevent residents from developing pressure injuries Staff do not assist residents with obtaining medical care Staff are not distributing residents' medications as prescribed Staff do not prevent resident from smoking inside of the facility Staff do not observe resident for change in condition Staff do not provide residents with personal care items Staff do not maintain personal protective equipment at facility

Licensing Program Analysts (LPAs) K. Kaur and M. Yang arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Executive Director/ Administrator Amanda Kelsey and explained the purpose of the visit and reviewed the elements of the allegations. LPAs delivered the following complaint investigation findings. During the course of the investigation, the department conducted interviews, reviewed records, and toured the facility. The Department investigated the allegations listed above. Based on interviews conducted and observations residents R1, R4 were observed with heal cushion/support pillows to prevent pressure injuries. Residents R1, R3, R4 were observed with no open wounds. Based on records reviewed and interviews conducted a wound specialist conducts visits once a week with R2 and resident is under home health care. R2 smokes in the designated smoking area in the back parking lot. Medication is administered as prescribed. Adequate PPE supplies and Personal care items were observed in the facility. Based on records reviewed there was insignificant evidence to prove or disprove that staff did not observe residents for change in condition. Unsubstantiated Based interviews conducted, observations, and record reviewed the above allegations were investigated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 24-AS-20250320080931

Type of visit: Case Management - Deficiencies

On 4/11/25, Licensing Program Analysts (LPAs) K. Kaur and M. Yang conducted an unannounced case management-deficiency visit to follow up from case management visit on 8/20/2024 to address failure to provide care and supervision. LPAs met Executive Director, Amanda Kelsey. On 6/11/2024 the Department received a written incident report from the facility, facility reported on 06/10/24 at 1:30AM Resident R1 was found by Visalia Police Department down the street. At 1:31 AM police notified the facility. Based on interviews conducted; Administrator confirmed the building egress alarm did go off however the two staff working were occupied by other residents. When staff responded to the alarm, resident R1 was not observed. Staff failed to conduct residents checks to ensure no residents were left unassisted. Records reviewed indicated R1 had dementia and physician’s report recorded resident is unable to leave unassisted and needs supervision due to wondering. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. An immediate Civil Penalty of $500 is assessed, see attached LIC421IM. Exit interview was conducted. A copy of this report was provided to Administrator via email, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Apr 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 12, 2025

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.... the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by: Based on interviews conducted and records reviewed R1 left the facility on 6/10/2024. Facility was unaware of residents absence until Visalia Police Department found the resident and notified the facility at 1:31 AM, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: Administrator agrees to complete in-service training with all staff to cover the processes the staff should follow regarding Egress Alarms and Residents checks and submit document of training to CCLD. Facility submitted training records ***POC Cleared**

Allegation investigated: Resident sustained pressure ulcer due to neglect

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Amanda Kelsey and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on interviews conducted and records reviewed the facility followed the following plan of care for Resident’s (R1) Care. Resident was bedbound and already getting frequent checks and rotation due to incontinence. Despite frequent rotation the resident developed pressure ulcer sometime around 11/2024 at which point Home Health was initiated by doctor’s orders. Home Health provided wound care while facility continued medication administration for wound and continued checks and rotation. Based on observation and interview of staff, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 21, 2025 · control 24-AS-20250108093803

Type of visit: Case Management - Other

On 3/21/2025, Licensing Program Analyst (LPA) K.Kaur conducted an unannounced Case Management visit. LPA introduced self and explained the reason for the visit to Executive Director/ Administrator Amanda Kelsey. LPA arrived at the facility to conduct case management visit for death report for Resident (R1) dated 01/29/2025. LPA interviewed Memory Care Director Laureano Sanchez who stated death was unexpected. Ambulance and PD were contacted. Resident was admitted to the hospital on 01/26/2025 and discharged on 01/27/2025 with several Diagnosis and change to medication which was not implemented due to not receiving discharge papers in a timely manner. Primary doctor conducted a visit on 01/28/2025 and ordered medications however resident passed before they were received from pharmacy. No deficiencies sited during this Case Management visit. An exit interview was conducted with Administrator. LPA will review the gathered documents and return at a later time if necessary. Report signed on-site and a copy of report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Case Management - Incident

On 08/20/24, Licensing Program Analysts (LPAs) K. Kaur and J. Leffall conducted an unannounced case management visit to the facility. The purpose of the case management visit is to follow up on Special Incident Report (SIR) submitted to CCL Office. LPA met Executive Director, Amanda Kelsey. Facility reported on 06/10/24, Resident # 1 went AWOL and police located resident and returned to the facility. LPAs gathered documents and conducted interviews. The information provided will be reviewed; a follow up case management will be conducted if necessary. Exit interview was conducted. A copy of this report was provided to Administrator via email, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Aug 20, 2024

Type of visit: Required - 1 Year

On 8/2/2024, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director, Amanda Kelsey. LPA toured Front Lounge/seating area and Theater area while waiting for Administrator. LPA conducted the rest of the facility tour with Administrator. All pathways, entrances and exits were clear from obstructions. The tour started in the facility common areas which were furnished with sufficient seating. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Bathrooms were properly equipped with non-slip tile and grab bars. At 12:43 PM LPA observed 2 out of 8 rooms had knives. The tour continued to the facility dinning and kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Medications are kept locked in the Med Carts in the Medication room. Facility grounds were toured. Memory care toured; delayed egress doors observed. Doors and passageways are unobstructed throughout the facility and to the outside. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least one staff on duty who are CPR certified. LPA conducted a sample medication audit and observed Resident (R1) had one extra pill in bubble pack that was not given. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 8/9/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided. Immediate Civil penalties were assessed due to repeat violations.the state’s words, verbatim · CDSS document, Aug 2, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff are not following resident's care plan

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit and reviewed records. LPA met with Administrator Amanda Kelsey and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on observations, interviews and record review the Staff did not have sufficient training to provide and follow residents care plan. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Feb 13, 2024 · control 24-AS-20231103113620

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d)(3) · Plan of correction due date: Feb 14, 2024

87411 Personnel Requirements – General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (3) Skill and knowledge required to provide necessary resident care and supervision… This requirement was not met as evidenced by: Based on interviews and record review; facility staff are not following residents care plan for 2-person assist when transferring/ assisting resident with toileting needs.the state’s words, verbatim · CDSS document, Feb 13, 2024

Plan of correction: Administrator to provide in service training to staff to ensure staff are following care plan for residents transferring needs and provide proof of training to CCLD by due date. Administrator to ensure proper training is provided to staff before working with residents in care.

Allegation investigated: Resident sustained severe injury due to staff neglect Staff did not administer resident's medication Staff did not assist resident with eating Staff did not provide adequate food service to resident Staff did not meet resident's laundry needs Facility is malodorous

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Amanda Kelsey and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on interviews and record review no incidents were documented that resulted in resident abuse or injury. Medication audit was conducted but was inclusive due to resident relocation. Resident weight records were reviewed which indicated although resident weight was at an incline recently at the time of resident admission the resident had put on weight. Facility tour was conducted and did not reveal any facility physical plant issues. . Based on observation and interview of staff and residents, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 26, 2023 · control 24-AS-20230619145953

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 10/26/2023, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct a case management inspection regarding incident report that was received in the CCL office. Incident Report occurred on 7/30/2023 regarding medication errors. LPA explained the reason for inspection and met with Executive Director/ Administrator, Amanda Kelsey LPA conducted a medication audit and reviewed R1’s records and observed residents PRN medication was not documented when given. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. An exit interview was conducted with the Administrator. Report signed on-site and printed copy provided with appeal rights.the state’s words, verbatim · CDSS document, Oct 26, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(b)(3) · Plan of correction due date: Oct 27, 2023

87465 Incidental Medical and Dental Care (b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Review of residents medication and MARs revealed PRN medication was given without proper documentation.the state’s words, verbatim · CDSS document, Oct 26, 2023

Plan of correction: Licnesee to ensure a record of each PRN dose is maintained in the resident's record.

Type of visit: Case Management - Annual Continuation

On 10/26/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Continuation Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director, Amanda Kelsey. LPA reviewed staff training records and discussed with Activities coordinator the activities calendar. LPA checked residents’ locked medications and completed a medication audit of a sample pull. Fire drill conducted on 10/25/2023. Service records reviewed for annual Sprinkler Service and Fire alarm system. Carbon monoxide tested and operational. No deficiencies were issued during this inspection. An exit interview was conducted with the Administrator. Report signed on-site and printed copy provided.the state’s words, verbatim · CDSS document, Oct 26, 2023

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/24/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director, Amanda Kelsey. LPA toured Front Lounge/seating area and Theater while waiting for Administrator. LPA conducted the rest of the facility tour with Administrator. All pathways, entrances and exits were clear from obstructions. The tour started in the facility common areas which were furnished with sufficient seating. The tour continued to the facility dinning and kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Ice Machine was clean and serviced on 8/2023. At 12:02 PM LPA observed unlocked chemicals in the resident laundry room. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Bathrooms were properly equipped with non-slip tile and grab bars. Hot water temperature was tested between 112.5 degrees F and 120 degrees F in several resident bathrooms. Medications are kept locked in the Med Carts in the Medication room. Facility grounds were toured. Memory care toured; delayed egress doors observed. At 1:25 PM LPA observed an odor in Memory Care room 120. LPA questioned Memory Care Director who informed LPA resident was recently changed after a bowel movement. LPA removed resident’s comforter and observed brown stains on the inside of the comforter. Doors and passageways are unobstructed throughout the facility and to the outside. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least two staff on duty who are CPR certified. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Continued to next page. LPA is requesting the following documents be submitted to the Fresno CCL office by 10/31/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. Due to time constraints, LPA will return at a later date for an annual continuation. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided.the state’s words, verbatim · CDSS document, Oct 24, 2023