Plc 7117 Main

Allegation investigated: Illegal eviction

On 6/17/26, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to do complaint investgation for allegation listed above. LPA met with administrator, Sevrena Miller during today's visit and explained the purpose of the visit. The Department record review and interviewed staff and resident regarding this allegation. Record review reflected that resident, R1 and the department and R1 was provided copy of Eviction Notice (dated -6/10/26) which was issued per department's guidelines. R1 interview indicated that eviction notice was issued due to non payment and other issues and there were no reference of any monthly rate increase as it was mentioned during complaint filing. R1 stated that they were looking for another place to move out at this time. Staff interview reflected that R1 was given eviction notice for non payment and other issues and there was never a discussion to increase R1s monthly charges for basic services. Based on this information, this allegation was UNFOUNDED. A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. No citations were issued. Exit interview conducted. A copy of this report has been provided to facility. Unfoundedthe state’s words, verbatim · CDSS document, Jun 17, 2026 · control 59-AS-20260612144045

Allegation investigated: Staff improperly transferred resident resulting in staff dropping resident.

On 3/30/26, Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA and LPM met with administrator, Sevrena Miller during today's visit and explained the purpose of the visit. The department conducted record review and interviewed residents and staff regarding the allegation. The investigation revealed that on 01/14/2026 resident, R1 sustained a fall during a transfer by staff, S1. A review of R1’s needs and service plan documents R1 requires a 2-person physical assist and notes “always use gait belt”. S1 attempted to transfer R1 without another staff or using a gait belt resulting in R1 falling and causing pain and injury. Based on the information gathered, the preponderance of evidence standards has been met.Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached LIC 9099-D page. Exit interview conducted. Appeal rights and a copy of this report were provided. Substantiatedthe state’s words, verbatim · CDSS document, Mar 30, 2026 · control 59-AS-20260213101436

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Mar 31, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities -(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities..... (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 was not met as evidenced by; The investigation revealed that on 01/14/2026, resident, R1 sustained a fall during a transfer by staff , S1. A review of R1’s needs and service plan documents R1 requires a 2-person physical assist and notes “always use gait belt”, which poses a immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: Licensee/Administrator shall send a letter of understanding of this Regulation and shall conduct all staff training. All POC documents are due by 3/31/26.

Type of visit: Case Management - Other

On 02/18/26, LPA Bains conducted an unannounced case management visit to the facility while conducting complaint visit for complaint # 59-AS-20260213101436. LPA met with administrator, Sevrena Miller and explained the purpose of today’s visit. From record review, residents and staff interviews , it was evaluated that resident, R1 had a fall incident around 01/14/26 while staff was transferring R1 to thier commode. It was noted that staff were aware about the fall incident but facility did not report that fall incident to department as required. From today's visit, LPA observed that staff left residents medications unattended and accessible to residents (R1,R2,R3) in dining room, R1s and R2s room which was not permitted per RCFE Regulation. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 809-D page. Exit interview conducted. Appeal Rights and copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Mar 4, 2026

87211(a)(1)(D) -Reporting Requirement- Any incident which threatens the welfare, safety or health of any resident, such as..... This requirement is not met as evidenced by; Based on the records review and interviews, it has been determined that the facility did not report an incident where resident R1 had a fall incident while staff transfer around 01/14/26 which poses an potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee /Administrator shall send a written statement to CCL of understanding of regulation for 87211 for reporting requirements and shall do training with staff. POC documents should be sent to CCL by POC date-3/4/26.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 19, 2026

87465- (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.This requirement is not met as evidenced by: Based on observation ,medications were left unattended and accessible to residents (R1,R2,R3) without staff's supervision which poses a immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee/ Administrator shall send a letter of understanding of this regulation and conduct staff training. All POC documents are due by 02/19/26.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 09/15/25 to conduct the annual inspection. LPA met with staff, Sevrena Miller (S1) and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA checked the medications for two (2) residents and no errors were identified. LPA reviewed two (2) residents files and two (2) staff files and found them to be complete. LPA and S1 toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. LPA checked the kitchen area for the ability to prepare and store food. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire Extinguisher was last serviced on 03/06/25 and was ready for emergency use. Inside temperature was 76 degree F during visit. Facility was conducting fire and disaster drills per requirement. Several topics were discussed. LPA requested a copy of the LIC308, LIC 500, LIC610E and current liability insurance to be sent to the Department by 09/30/25. No deficiencies were observed and cited per Title 22 Regulations from this visit. Exit interview conducted. Copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: POC

On 09/24/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a Plan of Correction (POC) case management and met with Staff, Sevrena Miller and explained the purpose of the visit. On 09/05/24, LPA cited the facility on CCR regulation, 80061(b) -Reporting Requirements -and facility should have submitted all required documents to clear Plan Of Correction ( POC) by POC Due Date of 09/19/24. Licensee/administrator did not ensure that the POC was corrected upon Due Date of 09/19/24. On today's date, LPA will be assessing a Civil Penalty of $100/day from 09/20/24-09/23/24 (Total - $400.00) for this violation and will continue to accrue until POC is corrected. Civil Penalties were assessed during this visit for failure to correct the above violations by POC Due Date. Exit Interview was conducted, Appeal rights were provided, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 24, 2024

Type of visit: POC

On 09/17/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a Plan of Correction (POC) case management and met with Staff, Sevrena Miller and explained the purpose of the visit. On 08/20/24, LPA cited the facility on CCR regulation, 87303(e)(2) -Maintenance and Operation for hot water temperature measured above 120 degree F. During today's visit, LPA checked the water temperature in kitchen sink and the reading was 106 degree F which was in required range from 105-120 degree F. At this point, facility comply with POC requirement and this citation has been cleared. Exit Interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 17, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 09/05/24 to do case management visit and met with Staff, Sevrena Miller and explained the purpose of the visit. Based on Incident Report (LIC624) dated 08/29/24 sent by facility to Department, it was indicated that Resident, R1, was found missing by staff around 6:45PM during routine checks. It was learnt that R1 had returned from hospital the same day around 1:30PM, where R1 was treated for mental disorder. Per staff, R1 was doing fine after returning from hospital and took their medications and meals till R1 was found missing around 6:45PM. Staff searched R1 on facility’s property and surrounding areas but could not find R1. Administrator was notified and staff called 9-1-1 and sheriff around 7pm. Per facility records, missing person report was filed under case number, 24-78100. It was also learnt that R1 use to leave facility in the past and R1s LIC602 signed by thier physician indicated that R1 can leave Unassisted, but Authorities made the Alarm for missing person due to R1s mental health issues. During today’s visit, LPA was informed by staff that R1 was found uninjured on 08/30/24 by law enforcement and currently was at mental health care facility and getting the medical treatment with unknown discharge plan. Facility was in touch with R1s responsible party, social worker and other required parties per regulations regarding R1s health updates. During record review and staff’s interviews, LPA found that R1 was hospitalized one week prior to this incident where R1 received the treatment for their mental disorder and was in hospital for seven days and returned on 08/29/24. This incident should have been reported to Department per requirement, but facility did not report this incident. Based on this information, per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached LIC809-D page. Exit interview was conducted, copy of this report and appeal rights were provided. Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today.the state’s words, verbatim · CDSS document, Sep 5, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80061(b) · Plan of correction due date: Sep 19, 2024

80061-(b) Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report .... (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event…. This requirement is not met as evidenced by; Based on documents reviewed, the facility did not meet reporting requirements for incidents that occurred around 08/22/24 for resident, R1 which poses potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Sep 5, 2024

Plan of correction: Administrator shall send a letter of understanding of this regulation and shall conduct all staff training and will send proof to department within 15 days. Additionally, Administrator shall ensure to send all incidents to department in timely manner and shall keep records for sending those reports. All POC documents are due by 09/19/24.

Type of visit: POC

On 09/05/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a Plan of Correction (POC) case management and met with Staff, Sevrena Miller and explained the purpose of the visit. On 08/20/24, LPA cited the facility on CCR regulation, 87303(e)(2) -Maintenance and Operation -and facility should have submitted all required documents to clear POC by POC Due Date of 09/04/24. Licensee/administrator did not ensure that the POC was corrected upon Due Date of 09/04/24. Furthermore, LPA checked water temperature in the kitchen during today's visit and the reading was 145.8 degree F which is not within required range ( 105-120 degre F ). On today's date, LPA will be assessing a Civil Penalty of $100/day from 09/04/24-09/05/24 (Total - $200.00) for this violation and will continue to accrue until POC is corrected. Civil Penalties were assessed during this visit for failure to correct the above violations by POC Due Date. Exit Interview was conducted, Appeal rights were provided, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 08/20/24 to conduct the annual inspection. LPA met with staff, Sevrena Miller (S1) and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed medications of two (2) residents comparing with physician orders. LPA reviewed two (2) residents files and two (2) staff files. LPA and S1 toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire Extinguisher was last serviced on 03/15/24 and was ready for emergency use. Inside temperature was 74 degree F during visit. Following issues were observed during today's visit: Issues with medications management and hot water reading was above 120 degree and citations were issued as listed on LIC809-D. LPA requested a copy of the LIC308, LIC 500, LIC610E and current liability insurance to be sent to the Department by 08/31/24. Deficiencies were observed and cited per Title 22, CCR Regulations as listed on LIC 809-D. Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today. Exit interview conducted. Copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 20, 2024

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.