Platinum Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 05/19/26 at approximately 3:00pm, and met with Lorena Madriga-Back-up Administrator. Administrator Mera Shaughnessey arrived to meet with the LPA. There currently are six (6) residents in care. LPA observed two caregivers on duty. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Emergency disaster drills are being conducted as required. Last emergency disaster drill. was conducted on 4/5/26, wild fire drill, and the previous one was conducted on 1/10/26, power outage drill. LPA reviewed six (6) resident files. All medication records were complete and medications were stored and locked up as required. LPA reviewed five (5) staff files. Staff reviewed all had current required first aid certification and CPR certification. All staff had required criminal record clearance. LPA reviewed staff annual training, and medication training for those staff that assist residents' with medications. The LPA toured the home with the Administrator Mera Shaughnessey. The exits were all free and clear of obstructions. The fire extinguishers were serviced and tagged as required. All medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. Continued on LIC809C.. The facility had a sufficient supply of food. Sufficient supply of hygiene products, linens, soaps/cleaners/disinfectants, furnishings, paper products, and personal protective equipment (PPE) supplies. All bathrooms had non-slip mats/non-slip flooring for resident use. All bathrooms had grab bars for residents use. All common areas, resident rooms, hallways, and bathrooms had sufficient lighting for resident's use. Hot water was measured at 109.6 degrees Fahrenheit. LPA is requesting the following documents be updated and submitted to CCL by 6/19/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 (9 page)- Emergency Disaster Plan- update if needed- submit copy Copy of Current Liability Insurance Copy of Infection Control Plan- update if needed- submit copy LIC400- Affidavit of Client Cash Resources Copy of Bond if handling cash, per LIC400 LPA observed the following deficiencies: During the facility tour, the LPA observed the laundry room door ajar, this is where all cleaners, soaps, and disinfectants are stored. The door has a keypad lock which locks the door when fully closing it.The laundry room was unattended by the staff while unlocked. This deficiency will be cited, 87309(a)(1) Storage Space and Access- Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements, see LIC9099D. Deficiencies 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 with Licensee/Administrator Mera Shaughnessey. Appeal Rights provided to the Licensee/Administrator.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Alviso conducted a case management annual continuation inspection, on 4/9/25 at approximately 9:45am, and met with caregivers Jordan and Lorena, both Lead staff. The annual was opened and started on 4/1/2025, see report LIC809. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has a required emergency and disaster plan. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. LPA reviewed fire drills and emergency disaster drills, and these are conducted as required. Fire extinguishers are serviced and tagged. Facility has working smoke alarms and carbon monoxide detectors. LPA reviewed six (6) resident files. Files were complete. LPA discussed the updated/changes in regulations with the lead staff Lorena. LPA emailed the Departments PIN ASC- #24-09, regarding the regulation updates, to the Licensee/Administrator. LPA reviewed five (5) staff files. LPA reviewed staff training. All staff have first aid certification and CPR certification as required. No deficiencies cited during today's inspection. LPA conducted an exit interview by phone with Administrator Mera Shaughnessey. Exit interview conducted with Lead taff Lorena Madrigal. Report LIC809 left for the Administrator.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Alviso and Contreras conducted a Required- 1 Year visit, on 4/1/25 at approximately 2:09pm, and met with Licensee/Administrator Mera Shaughnessey. There currently are six (6) residents in care. LPAs observed two caregivers on duty. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. LPA's toured the facility with administrator Mera Shaughnessey.All postings were visible to all entering facility. Hot water was measured at 116.9 and 120.5 degrees Fahrenheit. Fire extinguishers were dated December 2024. All exits were clear and free from obstruction. All bathrooms had grab bars, and shower mats for resident use. Backyard was free and clear of any hazards. Fire exit was clear and free of obstruction. Exit doors had auditory alarms. Food supply was sufficient. Facility had sufficient supply of cleaners, paper products, and personal protective equipment (PPE). LPA are requesting the following documents be updated and submitted to CCL by 5/1//2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report Continued on LIC809C... LIC610 - Emergency Disaster Plan-update if needed-submit if changes Copy of Current Liability Insurance Copy of current Administrator Certificate Copy of updated Infection Control Plan- update if needed- submit if changes LPAs will continue this annual inspection at a later date. LPAs observed medication deficiencies which will be cited, see LIC809D. Deficiencies 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 with Licensee/Administrator Mera Shaughnessey. Appeal Rights provided to the Licensee/Administrator.the state’s words, verbatim · CDSS document, Apr 1, 2025

Allegation investigated: Facility food supply is not sufficient to meet residents needs Facility is violating residents rights

Licensing Program Analyst (LPA) Alviso conducted an unannounced complaint inspection, on 12/30/24 at approximately 9:30am, and met with caregiver Litiana Tuioga. Caregiver contacted the facility Administrator, Mera Shaughnessey, who arrived shortly after to meet with the LPA. The reporting party (RP) alleges that "facility food supply is not sufficient to meet residents needs, and facility is violating residents rights". LPA toured the facility, including looking at the food supply, perishable and non-perishable. LPA observed a sufficient supply of frozen meats, frozen vegetables, fresh perishables, lunch meats, cheese, fruits, vegetables, grains, noodles, and miscellaneous canned food supply. Interviews conducted with staff (S2, S3),stated that their is always enough food supply, and if anything is needed, staff notify the Administrator. The Administrator will get the food items to the facility that day. S3 stated that they may go borrow milk or some lettuce from their sister facility, if wanting it for something specific while waiting for the Administrator to bring the purchase of the requested items that day. S1 stated that staff notify them when perishable items are needed, due to shopping for these more often than the non-perishable items; Administrator stated the non-perishables will go bad faster then non-perishables, so we have to shop for these every week to two weeks as needed. Continued on LIC9099C... Unsubstantiated S1 stated they have never told the facility staff to go borrow food supply items from their next door licensed facility. S1 stated there is a sufficient supply of food to feed the residents in care. S1 stated they buy groceries in bulk and many perishables every few weeks as needed. S1 stated that no staff have provided any personal food items as this is not required of them and/or expected. S1 stated the staff are not to purchase and/or provide any food items to the facility, S1 stated they purchase food items from Costco, and local grocery stores, as needed and required to meet residents needs. In review of pictures of residents when they have had a fall and/or some sort of injury or reaction to something, there was no information obtained and/or found that are violating residents rights. This information is shared between caregivers on duty and coming on shift regarding residents in care. S1 stated they have a staff only group message for information updates for staff on shift and coming on shift. Pictures are taken to send to the resident Physician if requested by the Doctor; One of the POAs of a resident wants all pictures of R1 when anything happens. There is never any facial pictures and/or any personal private area (s) pictures of residents that would violate personal privacy. S1 stated that residents are always treated with respect in all ways, the facility is not to violate personal rights of residents in care. There was no information obtained and/or observed, from LPAs facility food inspection, and all conducted interviews, to support violations had occurred. Based on the LPAs observations, conducted interviews, and related information obtained during the investigation, the allegations of "facility food supply is not sufficient to meet residents needs, and facility is violating residents rights". are Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator Mera Shaughnessey.the state’s words, verbatim · CDSS document, Dec 30, 2024 · control 21-AS-20241227145208

Allegation investigated: Medications are accessible to residents in care Staff force residents to shower Staff did not safeguard residents' personal belongings

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 7/3/2024 at approximately 9:45am, and met with Lead Caregiver, has a current Administrator certificate. Caregivers, Jordan and Chris were on duty at the facility. LPA reviewed facility record of all facility residents in care.The LPA conducted interviews with staff, and other related parties. LPA conducted an interview with the Licensee/Administrator who confirmed that residents, R1 and R2, are not residents who reside at the facility, Platinum Residential. LPA obtained copies of facility records. Investigation revealed that residents, R1 and R2, are not residents of the facility, and this investigation/complaint is not regarding resident care at Platinum Residential Care Home. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations "medications are accessible to residents in care, staff force residents to shower, staff did not safeguard residents' personal belongings" are Unfounded.We have found that the complaint allegation(s) were Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Nothe state’s words, verbatim · CDSS document, Jul 3, 2024 · control 21-AS-20240626114916

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 3/28/24 at approximately 12:40pm, and met with Licensee/Administrator Mera Shaughnessey. There currently are five (5) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. The facility conducted a fire drill and earthquake drill on 1/5/24. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. LPA reviewed five (5) resident files. All files were complete. The LPA reviewed five (5) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. The LPA toured the facility with the Administrator Mera. The hot water was checked at 117. degrees Fahrenheit , which is within regulation. The fire extinguishers were tagged and serviced as required-expires 12/28/24. All exits were unobstructed. Food supply was sufficient. All bathrooms have grab bars, and the large shower room and private shower bathrooms have mats for resident use. The facility is well lighted, including all resident rooms and bathrooms. The facility was observed to be warm and at a comfortable temperature. Cleaners/toxins were locked and inaccessible to residents in care. All medications were locked up and not accessible to residents in care. Facility had sufficient furnishings for client use. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 4/28/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate. The following deficiencies were observed during staff file reviews: Four (4) out of five (5) staff lacked annual required training hours, per LPA's file reviews. This deficiency will be cited, HSC 1569.696(b)(2) 2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training, see LIC809D. Four (4) out of five (5) staff lacked required Health and Safety Code annual medication training, per LPA's file reviews. This deficiency will be cited, 1569.69(b)Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period, see LIC809D. Deficiencies 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 with Administrator/Licensee Mera Shaughnessey. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 28, 2024