Pendar's Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with administrator (ADM) Marie Pendar and stated the purpose of the visit. The facility is licensed to serve adults 60 and over all may be non-ambulatory and granted hospice waiver for two. LPA observed 3 residents and 2 staff present. LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. Indoor temperature was within acceptable range of 70°F. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Kitchen water temperature measured at 108.6°F. Bathroom water temperature ranged from 105°F to 108.8°F. Bathrooms had grab bars and non-skid mats; resident rooms had adequate storage Medications were locked and inaccessible to residents; first aid kit was complete. Outdoor areas were free of hazards; laundry appliances were functional, and cleaning supplies were secured. Fire, smoke, and carbon monoxide systems were operational; hallways were clear and well-lit. LPA reviewed resident and staff records, including medication logs, admission agreements, care plans, personal and incidentals, health screenings, and training. All staff have required clearances and certifications. page 1 of 2 The facility conducts fire and earthquake drill quarterly for each shift. Last drill practice training was on 05/26/2026. The facility is equipped with 4 fire extinguisher were inspected on 06/28/2026. No deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with ADM Marie Pendar and a copy of the report was provided. page 2 of 2 end of reportthe state’s words, verbatim · CDSS document, Jul 16, 2026

Type of visit: POC

On 08/04/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Plan of Correction (POC) visit. LPA announced the purpose of the visit and met with Marie Pendar, Administrator. LPA observed 4 resident 2 staff. On 07/24/25 the facility was cited for Type A 87307(d)(6), Personnel Accommodation and Services and Type A 87309(a) Storage Space and Access, Type B 87458(a) Medical Assessment On 08/04/25, LPA conducted a POC visit to clear the Type A and Type B POC's. LPA received a copy of the facility's plan of corrections and in-service training. During visit LPA observed locked drawer with knives, and observed gate unlocked and clear of obstruction. A copy of the Letter of Deficiencies Cleared letter was provided. No deficiencies cited during today's visit. This report was reviewed with Administrator, Marie Pendar and a copy of the signed report was providedthe state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Marie Pendar, Administrator/Licensee. LPA announced the purpose of the visit. LPA observed 4 residents and 3 staff. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, During inspection LPA observed the facility kitchen drawer with knives unlocked and accessible to residents in care. LPA observed toxics under kitchen sink unlocked and accessible to residents in care. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature measured with thermometer was 40 degrees F. LPA toured 4 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detector in the hallway and found the smoke detector to function properly when tested. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperature in the bathroom sink measured with thermometer at 111 degrees F. The Kitchen sink measured with thermometer at 113 degrees F. page 1 of 1 page 2 of 2 LPA toured the outside area and found the backyard exit was locked with a pad lock to prevent resident wandering behavior which poses an immediate health, safety or personal rights risk to persons in care. During visit ADM removed the pad lock. LPA observed fire extinguisher was last serviced on 06/25/25 LPA reviewed Fire and Earthquake log last fire drill was conducted on 05/25/25. The facility has a pull down station fire alarm and was last inspected on 06/25/25. LPA reviewed resident records for 3 residents. R1 did not have an updated physicians report last report dated 05/25/2023, and Centrally Stored Medication was reviewed with ADM. LPA reviewed 3 staff records. Deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Marie Pendar, Administrator/licensee and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 24, 2025

Allegation investigated: Staff did not adequately supervise resident resulting in resident wandering away from the facility

Licensing Program Analyst (LPA) Christine Kabariti arrived to the facility unannounced to deliver the finding for the above allegation. LPA met with Desginated Administrator, Mario Lagan. On 01/24/2025, the Department received the complaint. On 01/30/2025, the initial complaint investigation was conducted. The following documents were obtained to include: LIC500 and R1's physician's report, appraisal/needs and services plan, face sheet, identification and emergency contact information, admission agreement, and police report. Page 1 of 3. Substantiated It was alleged that the staff did not adequately supervise resident resulting in resident (R1) wandering away from the facility. Based on review of the police report records, it’s noted that R1 was found about 0.2 miles away from the facility running through the parking lot of the shopping center. On 01/30/2025, staff members and the Licensee were interviewed. Based on staff interview 2 staff were working during the time of the incident. It was stated that on 01/23/2025 R1 left the facility from his/her side door and jumped the fence to go to a sandwich shop across the street of the facility. 2 out of 2 staff stated that they were cleaning and assisting other residents when R1 exited the facility. When staff noticed R1 was missing, staff went to look outside and saw an employee of the sandwich shop waving them down to come there. The Licensee stated that R1’s new behavior of leaving the facility began in the beginning of January 2025. Licensee states that they were addressing the behavior by talking to the doctor, following up with R1’s case manager, and they were waiting for R1’s insurance to approve a 1:1 staff. Licensee states that R1’s bedroom door does not have door alarms but stated a plan to buy door alarms for his/her room due to his/her exit-seeking behavior. Licensee also stated a plan to replace the battery for the door alarm at the front door to help notify staff when someone opens the doors. Based on interview with resident (R1), it was stated that he/she likes to leave the facility at least twice a week to go across the street by him/herself, without staff supervision. The review of R1’s records indicates that R1 is not able to leave the facility unassisted. On 01/30/2025, LPA observed that R1’s bedroom is located right next to the front door entrance of the facility. The front door alarm was not operable. R1’s private bedroom has a sliding door which leads to the side of the facility. R1’s sliding door had a door alarm, but the door alarm was not operable. Page 2 of 3. The Department has investigated the above allegation. Based on interview, record review and observation the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. A deficiency was cited per California Code of Regulation, Title 22. This report was reviewed with Licensee Marie Pendar and a copy of the report and appeal rights were provided. Page 3 of 3. Based on review of the police report, 2 witnesses stated to have observed staff hit R1. Witness (W1) stated to have observed one of the staff swing at R1 but was not sure which of the staff hit R1. It was stated that the incident happened in front of the facility. Witness (W2) stated to have observed of the staff hit R1 multiple times to get into the facility. Resident (R1) was interviewed. Based on interview, R1 denied staff pushing and hitting him/her. R1 did not have any complaints about staff’s treatment towards him/her. The 2 staff members who were part of alleged incident were interviewed. Based on staff interview, 2 out of 2 staff denied pushing and hitting R1. Staff stated a moment while walking back to the facility where the staff was yelling at R1 to “stop” before crossing the crosswalk as there was a bus coming. Staff denied touching R1 while walking back to the facility and before entering the facility. Based on review of the police report, on 01/23/2025, there were no bruises or marks on R1’s body. It was noted that R1 did not seem fearful of the staff. Based on LPA’s observation on 01/30/2025, there were no bruises or marks on R1’s body. R1 did not observe to seem fearful of the staff. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated, meaning that although the allegation is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Marie Pendar and a copy of the report was provided. Page 2 of 2.the state’s words, verbatim · CDSS document, May 19, 2025 · control 26-AS-20250124153302

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: May 20, 2025

(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 is not met as evidenced by: Based on observation, interview, and record review the licensee did not ensure resident (R1) was provided supervision to meet R1’s exit seeking behavior resulting in R1 leaving the facility unassisted which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee will complete training with all staff regarding resident rights and supervision / safety. Licensee will submit the staff training record to LPA Kabariti via email by POC due date of 05/20/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a case management – deficiencies visit. LPA met with Designated Administrator, Mario Lagan and Licensee, Marie Pendar. The purpose of the visit is to address Title 22 violations observed during a complaint investigation (Control Number 26-AS-20250124153302). During the investigation, staff stated that on 01/23/2025 the only 2 staff working at the facility both left the facility to walk about 200 feet away (0.2 miles) to pick up R1, after R1 eloped from the facility. The staff instructed 1 resident to supervise 3 other residents for about 5-10 minutes while the staff went to get R1. Staff stated that the 1 resident who was asked to supervise the other resident was the most “reliable” to watch the remainder of the residents, as the resident had the most cognition. During the investigation, it was stated that R1’s elopement behavior began in the beginning of January 2025. Based on review of R1’s appraisal/needs and services plan it was last updated in year 2023. R1’s appraisal/needs and services plan was not updated to address R1’s new elopement behavior. During today's visit, LPA observed a pad lock device located at the bottom left side of the front entrance door. It was stated that the pad lock was installed to help reduce R1's elopement behavior. LPA observed an audible door alarm located at the top left of the front door, however, the door alarm was not working. Page 1 of 2. During today's visit, staff removed the pad lock located at the bottom left side of the front door. Licensee states a plan to replace the door alarm at the front door. Licensee states to be currently working with R1's insurance company to help implement a 1:1 staff for R1. It was also stated that on 04/25/2025, R1 eloped from the facility and was found by staff about 300 feet away from the facility. Based on review of the facility's incident reports, the facility did not report R1's elopement to the Department. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. An immediate $500 civil penalty was assessed due to absence of supervision on 01/23/2025. This report was reviewed with Licensee, Marie Pendar and a copy of the report and appeal rights were provided. Page 2 of 2.the state’s words, verbatim · CDSS document, May 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(1) · Plan of correction due date: May 19, 2025

(a) In each facility: (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure that a staff member was present with 4 residents, when 2 out of 2 staff members left to pick up R1 after R1 eloped from the facility which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee will conduct staff training on the facility's elopement policies and procedures and ensuring proper supervision at all times. Licensee will submit training document to LPA Kabariti via email by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87307(d)(6) · Plan of correction due date: May 20, 2025

(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure the front door was not free of obstruction as the front door contained a pad lock at the bottom left side of the front door which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee removed the pad lock on the front door during visit. Licensee will conduct a staff training regarding ensuring exit doors are free of obstruction. Licensee will submit training document to LPA Kabariti via email by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: May 26, 2025

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure to update R1’s reappraisal to document R1’s new behavior of elopement which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee corrected the deficiency prior to visit by updating R1's appraisal/needs and services plan on 03/27/2025. LPA obtained a copy of the updated appraisal/needs and services plan.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: May 26, 2025

(a) ... : (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. … (D) Any incident which threatens the welfare, safety or health of any resident, ... or unexplained absence of any resident. Based on interview, record review and observation the licensee did not ensure to report R1's elopement incidnet on 04/25/2025 to the Department which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Licensee will complete training with staff regarding reporting requirements. Licensee will submit the training document to LPA Kabariti via email by POC due date.

Allegation investigated: Facility staff intimidated resident by not providing basic services/meal services. Facility staff made false information on a resident's record.

Unannounced complaint visit made out to this facility on 03/08/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Maria Pendar, who was briefly interviewed at this time. Current census was (6) residents. The purpose of this visit was to deliver the findings of this investigation to this facility, and it's designated Administrator, at this time. Based on interviews and a review of the forms and documents that were retrieved during this investigation, it was learned that resident, R1, initially moved into this facility several years ago dating back to 2015. Based on interviews conducted, it was learned that facility staff approached R1 and requested that R1 sign certain forms and documents without thoroughly explaining the nature of the documents and the need for why R1 had to sign them right away. It was learned that R1 refused to sign the forms and documents and requested that the facility staff provide R1 blank versions of these documents so that R1 could entrust R1's licensed medical professional to Substantiated As a result, R1 pulled out the catheter, without any warning, causing severe bodily harm to R1. It was learned that facility staff who were present did go ahead and contact 911 who responded and took R1 to the hospital for medical treatment. Based on a review of the facility forms and documents for R1, it was observed that a recent Physician's Report, LIC 602, was updated by R1's responsible licensed medical professional on 09/19/2024 addressing R1's current diagnosis and care needs. Based on a review of the file for R1, it was learned that R1 had a history of sustaining bladder infections due to R1's inability to urinate on a regular basis. This was one of the issues that was targeted with the surgery so that R1 could have regular visits to the restroom in order to prevent future bladder complications. It was learned that R1 was then equipped with a catheter to facilitate urination and the healing process as well. Based on a review of the forms and documents submitted by this facility, it was learned that R1 has been a resident at this facility for almost 10 years. During this span of time, all of R1's finances have been handled and paid by a trust that was set up to meet R1's care needs and maintain R1's financial capabilities to remain in an assisted living environment. It was learned that all invoices for basic services, medications, and ancillary needs were initially paid up front by this facility. This facility would then generate an invoice at the end of the month and submit them to the party responsible for handling and maintaining R1's finances which was done so through R1's trust. It was observed that receipts and all services rendered for each individual month were captured and submitted to the trust in order to receive payment. It was noted that this facility, and it's representative, finally initiated an increase in the monthly basic services fee, back in the latter part of 2023, which then went into effect in February of 2024. All letters notifying the resident and their responsible parties of the rate increase were observed to be present and served with the adequate time frame in mind as well. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred. There were no deficiencies observed or cited at this time. Exit Interview complete them upon R1's next scheduled appointment. It was learned that this was met with disdain from the facility staff person who did not pursue the matter any further after R1 refused to comply with their request. It was learned that these documents were already filled out by the facility staff person assessing R1's capabilities and care needs at that time. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegations were valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 8, 2025 · control 26-AS-20240910134450

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Mar 9, 2025

Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This facility was found to be deficient as evidenced by lack of dignity and respect shown towards R1 when attempting update forms and documents without resident consent which posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2025

Plan of correction: The facility designated Administrator stated that all facility staff will undergo training, for no less than one hour in duration, on the subject matter of facility residents rights and how to properly maintain them at all times. A statement of correction, along with copies of the updated training, will be completed and submitted into CCL by the due date. Proof of completed training will involve the topic of training, name of the vendorized trainer, and list of attendee(s).

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Mar 9, 2025

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This facility was found to be deficient as evidenced by lack of professionalism, dignity and respect shown towards R1 after R1's refusal to comply with staff's demands to update R1's forms and documents which posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2025

Plan of correction: The facility designated Administrator stated that all facility staff will undergo training, for no less than one hour in duration, on the subject matter of maintaing professionalism and upholding facility residents rights at all times. A statement of correction, along with copies of the updated training, will be completed and submitted into CCL by the due date. Proof of completed training will involve the topic of training, name of the vendorized trainer, and list of attendee(s).

Type of visit: Collateral

On 12/10/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced collateral visit to deliver findings regarding a complaint from the licensees closed facility Pendar's Residential Care #435294025. LPA met with staff Mario Lagan and explained the purpose of today's visit. LPA spoke to the licensee Marie Pendar to discuss findings over the phone. While at the facility LPA spoke to staff Mario Lagan to discuss the findings and inform that this is to deliver the findings regarding the closed facility. He confirmed with Marie LPAs presence and discussion and receipt of the complaint findings. Report is reviewed with Mario and a copy is provided.the state’s words, verbatim · CDSS document, Dec 10, 2024

Type of visit: Required - 1 Year

On 7/16/2024 at 1:00 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived and conducted an unannounced required 1 year inspection visit and met with Administrator (ADM), Mila Valisto. ADM contacted licensee, Marie Pendar, due to previous commitment was not able to stay in the facility. Licensee/ADM was in constant contact via phone with ADM. Licensee Marie Pendar arrived at the facility at around 6:20 p.m. LPA observed a ramp leading to the front door free from obstruction. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over 6 non-ambulatory, and a waiver for 2 hospice care. The facility's has 5 residents (R1 to R5) that have mild to advanced neurocognitive impairment. 4 staff were present including the ADM at the time of the visit. 5 residents were present at the facility. LPA observed 5 of 5 residents are in the bedroom. 2 of 5 are non-ambulatory and 3 of 5 are ambulatory. The facility has 5 resident room (BR2 to BR6) and 1 staff room (BR1). At 1:05 p.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents rooms, staff room, backyard and walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 73 degrees F. LPA and ADM toured the 5 bedrooms and LPA observed the rooms to be organized and free from debris and has sufficient storage for resident's personal belongings. 5 of 5 resident bedrooms have exit doors and are free from obstruction. 1 of 5 bedroom is shared by 2 residents. LPA observed 5 of 5 residents' bed are sanitary and free from debris. page 1 of 3 see LIC 809C LPA with ADM toured 3 full bathrooms (B1, B2 and B3). B1 is located at the hallway and shared by two resident. LPA observed B1 have non skid mats and grab bars and a bath seat with a broken leg that was tied together by a rope. B2 is used by one resident and has non-skid mats and grab bars. LPA observed that the trash bin inside B2 did not have a lid. B3 is located in a shared bedroom at the end of the hallway towards the back of the property. LPA observed that bath seat has water residue and soap residue. LPA observed that the facility has a wall pull fire alarm system, a smoke alarm and a carbon monoxide alert system that is in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. The sliding door going out to the back deck/patio slides easily and free from obstruction. LPA observed ramps and walkways are free from obstruction. LPA observed the backyard area to be free from debris and is maintained. LPA tested the water temperature for kitchen and bathrooms, water temperature was measured at 105.9 degrees F. Dining and kitchen area and living room area were observed to be sanitary and organized. The facility has sufficient supply of perishable food for 2 days. The facility's non-perishable food for 7 days was not sufficient. The fire extinguisher located in the kitchen was last inspected on 1/12/2024. LPA with ADM inspected the back exterior area of the facility. LPA observed that the ramps are free from obstruction, however wooden plank by BR2 sliding door entry way was frayed. LPA observed the screen door for BR3 was frayed. LPA observed the wooden plank on the ramp by BR6 was frayed and dipping when stepped on. LPA observed bed protectors on the clotheslines. The ramps rail were observed to be in good repair and sturdy. LPA reviewed the following documents 3 of 5 resident record and 3 of 4 staff record. 1 of 3 resident have dementia, 1 of 3 has mild cognitive impairment. LPA observed that the following needs and services plan needs to be updated, 3 of 3 are missing signed consent form, 1 of 3 is missing the personal rights form. LPA reviewed staff record and observed the following 3 of 3 staff record. 3 of 3 medical training is up to date 2 of 3 have the updated 1st aid cpr, 3 of 3 did not have a signed Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders (SOC 341A). page 2 of 3 LIC 809C LPA reviewed 3 of 3 resident centrally stored medication record. Medications are properly labeled. LPA and ADM conducted medication review and observed that 3 of 3 resident have missing medication. LPA requested the copy LIC 500, LIC 400, Updated Policy and Procedure, copy of the surety bond. Deficiencies were cited during today's visit per California Code of Regulation Title 22. See LIC 809D. An Exit interview was conducted with administrator Mila Valisto and Licensee Marie Pendar.the state’s words, verbatim · CDSS document, Jul 16, 2024

Allegation investigated: Resident in care is not being fed.

Licensing Program Analysts (LPAs) David Marrufo and Mita Partoza conducted an unannounced complaint investigation visit and met with Administrator Mila Valisto and Licensee Marie Pendar. During visit, LPA Marrufo interviewed 5 out of 5 residents, interviewed Administrator Valisto, Licensee Pendar, and staff S1. LPAs observed the lunch meal service and observed facility food storage areas. LPAs observed resident records during visit. During interview, resident R1 stated that R1 sometimes refuses meals because R1 does not want to gain weight. LPAs observed staff assist R1 with feeding during visit. See LIC9099-C for more information. Page 1 of 2. Unsubstantiated Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22 This report was reviewed with Mila Valisto and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 13, 2023 · control 26-AS-20231005210200

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) David Marrufo and Mita Partoza conducted a Case Management visit and met with Mila Valisto. LPAs visited the facility to conduct a complaint investigation visit. During visit, LPAs observed that resident R1's latest Physician's Report was completed on 12/05/2019. The Physician's Report stated R1 has a diagnosis of dementia. LPAs also observed resident R2 did not have a Functional Capabilities Form in R2's resident records. LPAs observed that a plank on one of the exterior wooden hand rails was loose during visit. An Advisory Note was issued. See LIC9102 for more information. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D for more information. This report was reviewed with Administrator Mila Valisto and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 13, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Oct 20, 2023

Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: Licensee did not ensure that resident R1 had a medical assessment that was updated annualy, which poses a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2023

Plan of correction: Licensee agrees to update R1's LIC602A Physician's Report by POC date and submit a copy of the report to licensing once completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b)(17)(B) · Plan of correction due date: Oct 20, 2023

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (17) Documents and information required by the following: (B) Section 87459, Functional Capabilities. This requirement was not met as evidenced by: Licensee did not ensure that resident R2's resident record included a Functional Capabilities form, which poses a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2023

Plan of correction: Licensee agrees to complete a Functional Capabiliities form for resident R2 and submit a copy of the completed form by POC date.