Parkside Manor

Allegation investigated: -Personal Rights.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Ruby Alinio, administrator via phone who gave authorization for staff Lina Pascual to sign the report. The Department received an allegation of personal rights. According to the Reporting Party, resident (R1) has bowel impairment condition that benefits from drinking coffee every day to help with constipation, but the facility regularly runs out of coffee resulting in R1 experiencing pain and not able to eat. On 7/13/26, LPA conducted 10-day visit to the facility, made observations, reviewed records and conducted confidential interviews with staff and residents in care. During the visit, LPA toured the kitchen and observed four jars of 10.5 ounces of Nescafe Clasico 150-cup, sugar and coffee creamer available for residents in care. Based on interviews conducted with residents (R1, R2, R3, R4 & R5) determined that they don’t have any issues when they want to drink coffee and some of them prefer not to drink coffee at all. Continue on LIC9099C... Unsubstantiated Continued from LIC9099... Per R1, there are days that facility staff provided them with two cups of coffee, and at times they only gave them one cup of coffee, R1 disclosed that through the course of years the facility has been providing them with coffee when they want to get coffee, which it could be any brand, they don't have a brand preference as far as they gave them coffee when they request it. According to S1, they have coffee available for residents in care, but there is one resident who wants to go buy coffee whenever they want to go and the facility goes grocery shopping on Tuesdays when staff available will go and get items listed in the grocery list, but resident at times doesn't request to buy their coffee timely to be included to the weekly grocery list. However, it was confirmed through interviews that R1 doesn't have a preference of any specific brand and will drink any coffee that its available at the facility. Based on records review of R1’ physician report dated 6/30/22 revealed that R1 doesn’t have a special diet, but they do have a bowel impairment that results in constipation, which it’s being treated with a prescribed medication named polyethylene glycol 17 grams which is instructed to be taken one packet by mouth daily as needed for constipation to be dissolved in 4-8 ounces of beverage, but there is no indication that beverage has to be coffee. Based on LPA’s observations, records review and interviews conducted with involved parties doesn’t indicate that the facility is not providing residents with coffee to support above allegation. A finding that the complaint allegation of personal rights is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jul 13, 2026 · control 21-AS-20260709161548

Allegation investigated: -Personal Rights.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Rosella Kuhn, staff. Administrator Ruby Alinio was not able to come to the facility but they were available over the phone and gave authorization for designated staff to sign the report. The Department received an allegation of personal rights. The Reporting party has concerns that staff (S1) are verbally abusing resident (R1) after inquiring about bruising noticed in R1’s arms and hands. During the course of investigation, LPA conducted 10-day visit on 04/24/26, made observations, reviewed records and conducted interviews. Upon administrator’s arrival, Administrator approached R1 to inquire about R1’s debit card missing, R1 stated that S1 stole the debit card where they receive their income from government benefits. Administrator called S1 to inquire about R1’s verbal statement, S1 raised their tone of voice to ask R1 why they were under the impression that they had the card missing. Continued on LIC9099C... Substantiated Continued from LIC9099... LPA witnessed this incident and administrator touched S1 kindly indicating that they could not talk to R1 in that manner. Per administrator, S1 reacted like that due to R1 accusing them of stealing their debit card. Also, during visit, Administrator told LPA about R1's bruising in their arms due to skin condition. However, there was no LIC602 physician report on file because R1 doesn’t have health insurance at this moment. Based on review of R1’s records, the facility has been in constant communication with pertinent agencies to resolve this issue. Based on interviews conducted with residents (R1, R2 & R3) it was confirmed that S1 raises their voice to residents and frequently ignores their requests for assistance. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. The Administrator was informed that additional civil penalties are under review by the Department by the Health and Safety Code 1569.49 (f). Continued from LIC9099A... The county recently lowered R1’s monthly payment from $3500 to $1939, which goes directly to Parkside Manor through Adobe Services, which is R1’s payee services. LPA was provided with paystubs confirming above information and the existence of debit card. Interviews conducted by LPA with S1 stated that R1’s male friend who comes to visit R1 and stays outside could have taken it from them, but it is unclear if this statement is true or not. Upon learning of stolen debit card, administrator called the social security office to stop any payments been made through that debit card. On 5/15/2026, LPA received written confirmation from the facility that R1 has in their possession a new debit card after they instructed them to never share it or their password with anybody else. Currently, the facility is processing their medical insurance using their government benefits as proof of income. Based on records review and interviews conducted LPA is unable to determine if facility staff could have been financially abusing R1. A finding that the complaint allegation financial abuse is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jun 3, 2026 · control 21-AS-20260421104844

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(1) · Plan of correction due date: Jun 4, 2026

Type A: §1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidence by: Based on LPA’s/Administrator’s observations and interviews with residents in care, S1 did not ensure that residents’ personal rights were not violated by raising their voice to residents in care, which poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 3, 2026

Plan of correction: The administrator agrees to contact the Ombudsman or outside agency to schedule personal rights training for all staff including S1. The administrator will ensure residents’ rights are not violated, then submit proof of enrollment to a personal rights training provider to clear the citation by POC due date 6/4/2026.

Type of visit: Required - 1 Year

At approximately 9:15 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit. Administrator Cecilia Ganzon was not at the facility during the inspection. Parkside Manor is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a multi-level complex with residents living on the ground level. The upper level is staff quarters.. The facility has an approved fire clearance for seventeen (17) residents, sixteen (16) of whom may be non-ambulatory. One (1) resident may be bedridden. The facility has a Hospice Waiver for four (4) residents. Upon arrival, LPA was informed that there were eleven (11) residents in care and two (2) staff members on-site. At approximately 9:30 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:35 AM, LPA toured the facility. All exits were clear and unobstructed. All three (3) fire extinguishers were last serviced and tagged on 2/3/2026. The Vallejo Fire Department conducted a Fire & Life Safety Inspection on 11/20/2025 and found no violations. The facility was sufficiently lighted. LPA inspected six (6) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. In the kitchen LPA observed two (2) large containers of eggs that were not refrigerated. Facility staff stated they were not refrigerated for the past 24 hours. Eggs are required to be refrigerated. This deficiency will be cited. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills every six (6) months with the last disaster drill having been conducted on 1/1/2026. Regulations require disaster drills be held quarterly. This deficiency will be cited. Continued on 809-C... ...Continued from 809 The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. At approximately 10:40 AM, LPA reviewed five (5) resident files. Four (4) of five (5) resident files (for residents R1, R2, R3 & R4) were observed not to have current appraisals. Per regulations, resident appraisals are to be completed with a change of condition or annually if there is no change of condition. This deficiency will be cited. LPA reviewed five (5) staff files. Five (5) of five (5) staff files (for staff members S1 through S5) were observed not to contain proof of annual training for 2025. Two (2) of five (5) staff files (for staff members S1 & S3) were observed to have expired First Aid certification. Two (2) of five (5) staff files (for staff members S4 & S5) were observed not to have a medical assessment and proof of a negative tuberculosis test. These deficiencies will be cited. LPA audited Medication for four (4) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Cecilia Ganzon’s Administrator Certification 7034418740 is current with an expiration date of 7/28/2026. Aurelia Renta’s Administrator Certification 7007148740 is current with an expiration date of 1/5/2027. LPA requested the following documents be submitted to Community Care Licensing by 3/10/2026: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance LPA discussed the Departments Technical Support Program (TSP) with back-up Administrator Renta. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809Ds, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to back-up Administrator Renta. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management inspection. LPA arrived to the facility and was greeted by staff. Licensees Cecilia Ganzon and Aurelia Renta were contacted and arrived later to the facility to conduct today's inspection. The purpose of this case management inspection is to follow up on a self report incident report submit to Community Care Licensing (CCL). CCL received a self reported incident report on 8/18/2025 reporting an incident of AWOL that occurred on 8/17/25 when resident (R1), AWOL'd the facility during a big group of visitors that came to visit another resident. At approximate 2:45 pm staff (S1) noted that R1 was gone, staff went outside to look around the neighborhood. At 3:53pm Kaiser ambulance called the facility to notify them that resident was brought to ER. Honda Vallejo observed resident and called the ambulance. At 4:30pm resident was discharged back to the facility. After resident was located an identification bracelet was provided to resident and responsible parties were notified. After learning of the incident, LPA contacted the facility on 8/18/2025 and spoke to Administrator to request additional documentation including R1's physician report (LIC 602), care plan and AWOL policy. During today's inspection, LPA reviewed records and conducted interviews with Licensee and staff. Facilities Polices and Procedure regarding AWOL/Elopement were not followed. R1 does not have a medical assessment since 9/29/23, R1 has a diagnosis of dementia and is not allowed to leave the facility unassisted. Also, needs or service plan dated 8/17/25 needs to be reviewed and updated. LPA learned after reviewing LIC500 Personnel Report that S1 started working at 3pm and there was another staff (S2) who was working from 6am-3pm to care and supervise 12 residents in care, which conflicts with incident report data. Based on interviews with the Licensee and records review, It is unclear the time when R1 left the facility, but facility visitor's log for the date of 8/17/25 indicates that big group of visitors arrived at 1:10pm. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Licensees and copy of report given.the state’s words, verbatim · CDSS document, Aug 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Aug 22, 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. This requirement has not been met as evidenced by: Based on record review and interviews conducted the facility failed to ensure adequate staffing to meet clients needs resulting in R1 AWOL the facility without staff knowledge, which poses an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Aug 21, 2025

Plan of correction: Licensee agrees to submit a plan and updated LIC500 Personnel Report to ensure adequate staffing at the facility at all times. Submit plan to CCL by POC 8/22/2025. Facility to train all staff regarding Care and Supervision, AWOL procedures and staff training to be submitted to Community Care Licensing (CCL) by POC due date 8/22/2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with licensee/administrator Cecilia Ganzon and Aurelia Renta. This facility has 2 levels, the upper level is used for staff and a gate on the bottom of the stairs prevents access to residents. LPA toured facility and grounds and observed all required signs posted in common areas. Facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days supply of perishable and one week of non-perishable foods and items are stored properly. Kitchen area is gated and residents do not have access to any sharp objects. Fire Extinguishers were fully charged, and have proof of service on 2/13/2025. Smoke detectors and carbon monoxide detectors are operational. Fire drills are conducted and the last one was documented on 1/5/2025. Water temperature in the resident bathroom was tested and found to be within the required temperature regulation of 105-120 degrees. Exit doors have auditory alarms to alert staff. The bedrooms are all furnished as required. Bathrooms were clean and sanitary with non-skid mats/floors and grab bars. Residents have call bells to alert staff if needed. Resident and staff files are located and locked in cabinets in office area. LPA reviewed resident files and were found complete and organized. Staff files were reviewed and had proof of training and CPR/1st aid expire on 2026. Continue report see LIC809-C Administrator certificate for Cecilia Ganzon #7034418740 is active and expires 7/28/2026. During todays visit LPA observed residents watching television in the living room, some residents seating in the dining area and conversing and other residents in their rooms, sleeping or doing activities such as puzzles. Staff were also observed assisting residents and engaging with them. Licensee/Administrator to submit the below documents to LPA by 3/10/2025. · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report- · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Copy of Liability Insurance- Copy of Administrator Certificate No deficiencies cited during todays inspectionthe state’s words, verbatim · CDSS document, Feb 14, 2025

Allegation investigated: Staff are not assisting resident with transfers

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. It has been alleged that staff have not assisted R1 with transfers. Title Twenty-Two requires, in part, the facility to assess a person's need for assistance with transferring and in meeting the needs identified in the appraisal. R1 requires assistance with transfers. This investigation has included a review of documents, unannounced site visits to the facility as well as interviews with staff and witnesses. Based upon the documents and statements, the following determinations are made: Staff state that efforts have consistently been made to assist R1 with transfers and that R1 has been periodically uncooperative with transfer efforts by staff; R1's behavior has deteriorated in the recent past and R1 refuses prescribed medications and routine hygiene care attempted by staff as well as other auxiliary services designed to assist in R1's rehabilitation. Based upon interviews, documents, and observations, staff have made reasonable efforts to assist R1 with transfers. Although the allegation may be true, or valid, there is not a preponderance of evidence to prove or, disprove, the allegation. Therefore, the allegation is UNSUBSTANTIATED. No citations issued today. Report left. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 17, 2024 · control 21-AS-20240815150548

Allegation investigated: Failure to seek timely medical resulting in death

Licensing Program Analyst (LPA) Araceli Canela arrived at this facility unannounced, to deliver findings regarding the above allegation. LPA met with both licensees, Cecilia Ganzon & Aurelia Renta. It was alleged facility failed to seek timely medical resulting in death of a resident. LPA requested & received records; including Community Care Licensing (CCL) Investigations Branch report. Investigation included review of Vallejo Police Department report #24-5069, in which there was no indication of foul play and R1's death was due to natural causes. The Medic Ambulance Patient Care Report indicated R1 had a DO Not Resuscitate (DNR) form in file. Per R1's Certificate of death, R1's cause of death was noted as Dementia with Lewy Bodies with onset notes as years. There was no indication that facility staff failed to seek timely medical attention resulting in death. Based on the information gathered, the above complaint allegation is UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. No citations issued. Unfoundedthe state’s words, verbatim · CDSS document, Jul 15, 2024 · control 21-AS-20240529102118

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced regarding another matter and to conduct a Case Management visit and enquire about a possible eviction the facility may have issued to resident R1. LPA went over information received regarding the eviction for R1 and eviction procedure requirements with both Aurelia Renta(S1) and Cecilia Ganzon (S2). S2 explained that they issued a 60 day eviction for R1 for a higher level of care due to R1 refusing medications and some care from staff. In review of the 60 day eviction that was issued for R1, the eviction issued was not a legal eviction, meaning that it did not meet Licensing requirements. LPA discussed information needed in the letter and documentation when submitting the eviction to CCL within 5 days for review and approval. Facility will follow up with resident getting a new medical assessment and facility stated they recently met with R1's family to go over R1's care needs. Facility was advised that they will need to reissue the eviction in they wish to proceed. LPA also went over mandated reporter requirements and reporting requirements. LPA provided regulation for eviction procedures 87224. No citations issued at this time.the state’s words, verbatim · CDSS document, Jul 15, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Araceli Canela arrived announced to conduct a Case Management Inspection and to go over a recent Fire clearance that was requested for a bedroom to be used for bedridden. LPA met with licensee, Cecilia Ganzon and toured the home. On January 5, 2024 this facility submitted a request for 1 bedridden and 16 non-ambulatory residents and a new fire clearance was approved by the Vallejo Fire department on 2/5/2024. The fire clearance is for room #9 to be used for one (1) bedridden resident. The home was observed clean and at a comfortable temperature with all exits free from obstruction. The facility will be issued an updated license for total capacity of 17 of which one may be bedridden and 16 non-ambulatory. No citations were issued.the state’s words, verbatim · CDSS document, Mar 26, 2024

Type of visit: Required - 1 Year

LPA Hiratsuka conducted this unannounced annual visit. Administrator arrived during visit. LPA observed three staff on duty. This building has two floors. The first floor are for residents and the second floor are for staff. LPA toured both inside and outside of the facility. All exits have audio alerts on the doors. Four resident files were reviewed Staff files were reviewed. LPA observed that annual staff training appears to be due starting this month through March and reminded administrator to work on annual staff training. Emergency drills are conducted quarterly. The follow was observed and cited during today's visit: -The backdoor of the building had a small metal rod that was stuck into the frame to the door on the bottom right side of the door frame that prevented the door from opening. This is a violation because it prevents the residents from leaving the facility. The caregiver removed the small metal rod and was instructed by LPA that it cannot be used to prevent the door from being opened. Only locks approved by the fire inspector are allowed on doors. -A gardening machete was found in the backyard on a bench. This was accessible to residents. It was removed and locked in a shed during visit. -There are two storage sheds in the backyard. One stored chairs and other facility items and is where the gardening machete was place and the other stored paint and other items. Both were found with no locks on them. This poses an immediate hazard to residents. LPA was shown that locks were found and placed on the doors for the sheds during visit. The following shall be updated and submitted to Community Care Licensing by 02/10/2024: -LIC 500 facility personnel or staff schedule -a copy of current liability insurance -LIC 308 designation of administrative responsibility. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights leftthe state’s words, verbatim · CDSS document, Jan 14, 2024

Allegation investigated: Staff inappropriately touches resident in care. Staff is not providing residents’ medication as prescribed. Neglect and Lack of Supervision resulting in resident not being provided adequate food service.

At approximately 1:00PM, Licensing Program Analyst (LPA) Araceli Canela arrived at this facility unannounced, to continue investigation and deliver findings regarding the above allegations. LPA met with Administrator and both licensees, Cecilia Ganzon & Aurelia Renta. It was alleged staff inappropriately touches resident in care; staff is not providing residents’ medication as prescribed and neglect and lack of supervision resulting in resident not being provided adequate food service. LPA conducted resident and staff interviews, reviewed records and requested more information from the reporting party. Based on information gathered, it was determined the staff in question for inappropriately touching resident and not providing adequate food service, has never worked or been employed at the facility. Complaint allegation only reported a first name of the staff and resident and staff interviewed did not know anyone by that name. Continue report see LIC9099-C Unfounded continue report from LIC9099 In addition, the allegation for staff is not providing residents’ medication as prescribed in that staff would crush medication and place it in the residents coffee cup. Staff member reported on complaint allegation to have done this, was also never an employee of this facility and the facility has not had a staff with that first name employed or working. Facility denies all allegations and expressed if they crush medication, they have a doctors order and this would not be placed in someone's coffee. Facility also expressed they provide adequate food service and their cook provides a large variety of options and residents are encouraged to eat. LPA has also observed on every inspection that has been conducted by LPA, the facility has a cook that is always cooking fresh food and food is adequate, in good condition and stored properly. LPA did not receive any additional information from reporting party and was unable to interview complainant. Based on information gathered and information that both names of staff identified in complaint allegation have never been employed or worked at this facility, all the above complaint allegations are UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. No citations issued for this complaintthe state’s words, verbatim · CDSS document, Jan 3, 2024 · control 21-AS-20231009140411

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to this facility to follow up regarding a previous inspection visit of 10/10/23, where LPA requested facility have resident R1 medically assessed to determine ambulatory status. Resident R1's Physician Report in file, dated, 6/15/2023 does not indicate R1s ambulatory status. Prior Physician report for R1 dated 2/23/2022 indicates R1 as Non-ambulatory, but there is a question regarding R1s current ambulatory status and LPA had requested facility to have R1 medically assessed with a medical report completed in full. LPA once again went over requirements for facility to submit paperwork to Community Licensing regarding a request for bedridden room review. In addition LPA found staff present in the facility S1, who was fingerprinted but has not received proper clearance to the facility. LPA went over requirements and a civil penalty was assessed for $100.00 for staff S1. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Jan 3, 2024

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

87355(e)(1)Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health & 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 exemption as required by the Department. This requirement was not met as evidenced by: LPA found staff S1 who was fingerprinted but has not received clearance. S1 was in the facility today. This is an immediate risk to the Health & Safety of residents in care.the state’s words, verbatim · CDSS document, Jan 3, 2024

Plan of correction: Facility to send in a written plan that they understand regulation and how they will meet it. Facility understands S1 may not be inside the facility or around any residents until proper clearance is received. POC due date 1/4/2024 Facility was issued a $100.00 civil penalty for failure to have proper clearance prior to working, residing or volunteering in a facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(c) · Plan of correction due date: Jan 22, 2024

87458(c) Medical Assessment (c)The licensee shall obtain an updated medical assessment when required by the Department. This requirement was not met, As evidenced by: On 10/10/2023 LPA conducted a facility visit and requested facility to obtain a medical assessment, fully completed for R1 and as of today 1/3/2024 the facility failed to comply with needed request. This is a potential risk to the health & Safety of residents in care.the state’s words, verbatim · CDSS document, Jan 3, 2024

Plan of correction: Facility agrees obtain a current and fully completed Medical assessment for resident R1. Facility to send in written plan on how facility will meet this requirement and stay in compliance. POC due date 1/22/2024 attention LPA A Canela.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to this facility regarding another matter and observed the facility has replaced the flooring of the facility and informed LPA they will also be replacing or doing repairs to the backyard deck. LPA reminded facility, any work on the facility must be reported to Community Care Licensing(CCL) in writing prior to starting. The notification should include the type of work being performed, when it will start and be completed, permit requirements and how the residents of the home will be protected and not be affected by the work being done. LPA also requested facility to remove stored items covered by a tarp from the side of the home, failure to remove may result in citations being issued. LPA also went over resident R1 who has a Physician Report in file, dated, 6/15/2023 but report does not indicate R1s ambulatory status. Prior Physician report for R1 dated 2/23/2022 indicates R1 as Non-ambulatory, but there is a question regarding R1s current ambulatory status and LPA requested facility to have the 6/15/2023 medical report completed in full. Facility understands, they do not have approval for bedridden residents at this time. LPA went over requirements and items needed for the facility to request approval for bedridden residents from the fire department and CCL LPA consulted regarding vaccinations. No citations issued during today's visit.the state’s words, verbatim · CDSS document, Oct 10, 2023