Pld Family Home Care

Allegation investigated: Facility does not provide resident paperwork.

On August 12, 2026, Licensing Program Analyst (LPA) Antonine Richard initiated a visit regarding the above allegation. LPA Richard met with Precious Dennis, Administrator, explained the purpose of the visit, and was granted entry to the facility. The investigation consisted of the following: On August 12, 2026, LPA Richard reviewed and obtained the following documents as part of the investigation: Personnel Report and Resident Roster, and requested documents for resident #1 (R1), including Admission Agreement, Identification and Emergency Information, Physician’s Report, Durable Power of Attorney, and Healthcare Agent. LPA reviewed and obtained text message communications from POA and A1. LPA also interviewed the Administrator (A1), one staff member (S1), and five residents (R1-R5). Report continued on LIC9099C. Unsubstantiated Allegation #1: Facility does not provide resident paperwork. The complaint alleged that the power of attorney (POA) requested the facility file for resident #1 (R1) on July 22, 2026, and asked to collect the documents within a couple of weeks. However, when the POA attempted to pick up the documents on August 1, 2026, they were not ready. On August 12, 2026, LPA Richard interviewed the Administrator (A1), who denied the allegation. A1 stated that they received the POA's request for R1's file, and it was agreed that the POA would pick it up in the next couple of weeks. However, on August 1, 2026, at 1:22 PM, A1 received a text message from the POA indicating they would be visiting R1 and would pick up the documents that day. A1 responded, welcoming the visit but informing the POA that the documents would be ready on Tuesday, August 4, 2026, which was earlier than the date originally agreed upon. On August 12, 2026, the LPA conducted interviews with one staff member (S1) and five residents (R1-R5). S1 stated that they do not access resident personnel records to protect privacy. The residents (R1-R5) expressed satisfaction with their living conditions, noting that staff treat them well. They also mentioned that if they need assistance, A1 would print documents if they asked. Report continued on LIC9099C Additionally, the LPA reviewed text communications between the POA and A1, which indicated that certain documents would be picked up within the next couple of weeks. During today's visit, the LPA also observed a sealed envelope addressed to the POA, dated August 4, 2026. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. No deficiencies were cited. An exit interview conducted. A copy of this report was provided to the Administrator Precious Dennis.the state’s words, verbatim · CDSS document, Aug 12, 2026 · control 11-AS-20260807135649

Allegation investigated: Resident is being restrained. Facility is limiting visitation. Resident was not allowed to leave facility.

On 07/31/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator Precious Dennis as the purpose of today’s visit was explained. The investigation consisted of the following: On 07/31/26 LPA Villegas obtained copies of the staff and resident roster, visitation policy, facility sign in/out sheets, and copies of the following documents for Resident #1 (R1) Emergency ID form, pre-appraisal dated: 07/01/24, Functional capability assessment dated: 12/29/25, Admission agreement dated: 07/01/24, Physicians report dated: 12/16/25, needs and service plan dated: 12/11/25, Power of attorney, and Dual power of attorney documents. On 07/31/26 LPA conducted interviews with Resident #1-6 (R1-R6), and interviews with Unsubstantiated staff #1-2 (S1-S2). On 07/31/26 LPA conducted a review of R1's file. The investigation revealed the following: Allegation: Resident is being restrained. It is alleged that a resident in care was restrained in a wheelchair with a belt around body and the chair. On 07/31/26 LPA conducted interviews with R1-R6 regarding the allegation above. 5 of 6 residents interviewed denied the allegation above. 1 of 6 residents interviewed confirmed the allegation above and reported being informed by staff that it is being done to ensure safety. Furthermore, 6 of 6 residents reported feeling safe when assisted by staff. On 07/31/26 LPA conducted interviews with S1-S2 regarding the allegation above. 2 of 2 staff interviewed denied the allegation above. On 07/31/26 LPA conducted a review of R1's file, LPA observed that there is a physicians order for a seat belt for R1. Allegation: Facility is limiting visitation. It is alleged that a resident family not allowed to visits without any explanation. On 07/31/26 LPA conducted interviews with R1-R6 regarding the allegation above. 6 of 6 residents interviewed denied the allegation above, and reported that facility staff has not denied them of any visitations. On 07/31/26 LPA conducted interviews with S1-S2 regarding the allegation above. 2 of 2 staff interviewed denied the allegation above and reported that visiting hours are 11am-7pm daily. On 07/31/26 LPA conducted a review of Admission agreement dated: 07/01/24. Per Admission agreement page 24 under family visits, the following is documented: Visitation is daily from 11 am-7 pm, if other times are needed please contact facility in advance for arrangements. On 07/31/26 LPA conducted a review of visitors sign in sheets from 11/2025 to 07/2026, LPA observed that R1 is actively having visitors at the facility and there are no documented refused visits. Allegation: Resident was not allowed to leave facility. it is alleged that a resident in care was not allowed to attend a family event. 07/31/26 LPA conducted interviews with R1-R6 regarding the allegation above. 6 of 6 residents interviewed denied the allegation above, and reported that facility staff has not refused to let them leave the facility with family. On 07/31/26 LPA conducted interviews with S1-S2 regarding the allegation above. 2 of 2 staff interviewed denied the allegation above, 1 of the 2 staff interviewed reported that it is encouraged that residents spend time out of the facility with family. Additionally, 2 of 2 staff stated that it is recommended but not mandatory that visitors notify the facility ahead of time if they will be taking a resident out in to the community so that staff ensures the resident is ready to go at the time of pick up. 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. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 31, 2026 · control 11-AS-20260724155120

Allegation investigated: Staff prevented the resident from being assessed by their healthcare provider. Staff prevented the resident from receiving a visitation.

On April 28, 2026, at 8:00 a.m., Licensing Program Analyst (LPA) Pamela Bunker conducted a subsequent visit to gather information regarding the above allegations. LPA met with Precious Dennis, Administrator, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of the following: On December 30, 2025 and January 23, 2026, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 12/30/2025), Resident Roster (dated 12/30/2025), Admission Agreement (dated 07/01/2024), Identification and Emergency Information (dated 07/01/2024), Physician’s Report (dated 06/27/2024), Medical Assessment (dated 06/27/2024), Medication Administration Records (MARs) (dated 12/01/2025-12/31/2025), Resident Appraisal & Needs and Services Plan (dated 07/01/2024), Functional Capability Assessment (dated 08/01/2025 & 12/29/2025), Preplacement Appraisal Information (dated 07/01/2024), Personal Rights (dated 07/01/2024), Consent Forms (dated 07/01/2024), Durable Power of Attorney (dated 08/15/2023, 08/16/2023, and 08/18/2023) Healthcare Agent and Notary Public (dated 07/10/2023), See continued LIC9099-C page 2. Unsubstantiated Continued LIC9099-C page 2. Ring Doorbell Video Camera (dated 12/05/2025), Text Messages (12/01/2025--12/03/2025), and Sign-In and Sign-Out Sheet (dated 12/01/2025-12/31/2025). On 12/29/2025, between 9:00 a.m. and 3:15 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#2 (S1–S2) and residents #1–#4 (R1–R4). The investigation revealed the following: Allegation: Staff prevented the resident from being assessed by their healthcare provider. LPA interviewed S1-S2. Both staff members (2 out of 2) stated that the staff did not prevent the resident from being assessed by their healthcare provider. S1-S2 stated that Resident 1 (R1) has a durable Power of Attorney (POA), with one individual responsible for financial decisions and another responsible for medical decisions. S1-S2 stated that the facility has no authority or control over the resident’s healthcare or the selection of healthcare providers. Decisions regarding medical assessments are solely determined by the POA for medical decisions, not the facility. R1-R2 stated that the facility has a visitors logs, that show a nurse comes to the facility every week. Both staff members, S1 and S2, denied the allegation. LPA Bunker interviewed Residents #1–#4 (R1–R4), 4 out of 4 residents stated that staff do not prevent residents from being assessed by their healthcare provider. Resident #1 (R1) stated that they have a durable power of attorney that makes decisions on their behalf because they are unable to make decisions independently. R1-R4 denied the allegation. LPA Bunker interviewed Witness #1 (W1), who confirmed that they are the Power of Attorney (POA) for Resident #1 (R1) and make all healthcare decisions, not the facility. W1 stated that they arranged for a nurse to visit the facility twice a week and for the physician to visit every two months to provide care for R1. W1 denied the allegation. See continued LIC9099-C page 3. Continued LIC9099-C page 3. Allegation: Staff prevented the resident from receiving a visitation. LPA Bunker interviewed staff members #1 and #2 (S1–S2). Both staff members (2 out of 2) stated that residents are not prevented from receiving visitations. 2 out of 2 staff members stated that visiting hours are scheduled daily from 11:00 a.m. to 7:00 p.m., and reported that all residents are allowed visitors during these hours and confirmed that staff do not restrict or interfere with visitations. 2 out of 2 staff members stated that the facility maintains a Visitor Sign-In and Sign-Out sheet to document all visits, and the logs confirm that R1 is receiving visitors. Staff reported that they have never denied visitors access to the residents. S1-S2 denied the allegation. LPA Bunker interviewed Residents #1–#4 (R1–R4). All four residents (4 out of 4) stated that staff do not prevent residents from receiving visitors and confirmed that their family members visit regularly during designated visiting hours. R1–R4 denied the allegation. LPA Bunker also interviewed Witness #1 (W1), who stated that they were the Power of Attorney (POA) for medical decisions. W1 stated that R1 is not denied visitation and can receive visitors at the facility. W1 also stated that R1 is permitted to leave the facility for outings and off-site visits with family. W1 denied the allegation. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough evidence to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. There were no deficiencies cited. LPA Bunker provided Administrator Precious Dennis with copies of the Complaint Investigation Reports LIC-9099 and LIC-9099Cs. An exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 11-AS-20251224093938

Allegation investigated: Staff prevented the resident from being assessed by their healthcare provider. Staff prevented the resident from receiving a visitation.

On January 23, 2026, at 8:00 a.m., Licensing Program Analyst (LPA) Pamela Bunker conducted a subsequent visit to gather information regarding the above allegations. LPA met with Precious Dennis, Administrator, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of the following: On December 30, 2025 and January 23, 2026, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 12/30/2025), Resident Roster (dated 12/30/2025), Admission Agreement (dated 07/01/2024), Identification and Emergency Information (dated 07/01/2024), Physician’s Report (dated 06/27/2024), Medical Assessment (dated 06/27/2024), Medication Administration Records (MARs) (dated 12/01/2025-12/31/2025), Resident Appraisal & Needs and Services Plan (dated 07/01/2024), Functional Capability Assessment (dated 08/01/2025 & 12/29/2025), Preplacement Appraisal Information (dated 07/01/2024), Personal Rights (dated 07/01/2024), Consent Forms (dated 07/01/2024), Durable Power of Attorney (dated 08/15/2023, 08/16/2023, and 08/18/2023) Healthcare Agent and Notary Public (dated 07/10/2023), See continued LIC9099-C page 2. Unsubstantiated Continued LIC9099-C page 2. Ring Doorbell Video Camera (dated 12/05/2025), Text Messages (12/01/2025--12/03/2025), and Sign-In and Sign-Out Sheet (dated 12/01/2025-12/31/2025). On 12/29/2025, between 9:00 a.m. and 3:15 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#2 (S1–S2) and residents #1–#4 (R1–R4). The investigation revealed the following: Allegation: Staff prevented the resident from being assessed by their healthcare provider. LPA interviewed S1-S2. Both staff members (2 out of 2) consistently stated that the staff did not prevent the resident from being assessed by their healthcare provider. S1-S2 stated that Resident 1 (R1) has a durable Power of Attorney (POA), with one individual responsible for financial decisions and another responsible for medical decisions. S1-S2 stated that the facility has no authority or control over the resident’s healthcare or the selection of healthcare providers. Decisions regarding medical assessments are solely determined by the POA for medical decisions, not the facility. 2 out of 2 staff members stated that the R1 is able to hear and communicate. R1 has arthritis and occasionally experiences pain in her knees and legs. She is able to ambulate with the assistance of a walker. Both staff members, S1 and S2, denied the allegation. S1 clarified that no one had hung up the telephone on anyone. Due to HIPAA regulations, S1 explained that the facility is not the Medical Power of Attorney (POA) for the resident and therefore could not discuss the resident’s medical needs. S1 stated that she advised that inquiries would need to speak with the individual holding the Medical POA and provided the appropriate contact number. S1-S2 stated that the resident has been diagnosed with dementia and is currently receiving palliative care under the hospice program. In compliance with HIPAA, they reiterated that they are not permitted to share personal or medical information regarding the resident. S1 stated that the payment for room and board in September 2024 was 17 days late. The POA inquired whether the facility would consider working with the family to revise the late fee charges for that month. S1 stated that the late fee amount was reduced. S1 agreed to provide a one-time discount, charging $600.00 instead of the regular price of $3,000.00. The POAs accepted the adjustment and received confirmation via email dated October 29, 2024. The admission agreement specifies that room and board must be paid in advance, beginning on the first of each month and due on the same date thereafter. If the basic monthly fee is not received within three days of the due date, a late fee of $500 per day will be assessed for each day the payment remains unpaid. Payments may be made by check or cash. See continued LIC9099-C page 2. Continued LIC9099-C page 3. In the event the facility receives a returned check from the bank, an $80 charge will be assessed to cover bank fees and special handling costs, in addition to a $150 fee. R1’s admission agreement was originally signed and initialed on July 01, 2024. LPA Bunker interviewed Residents #1–#4 (R1–R4), 4 out of 4 residents stated that staff do not prevent residents from being assessed by their healthcare provider. Resident #1 (R1) stated that they have a durable power of attorney that makes decisions on their behalf because they are unable to make decisions independently. During the visit, LPA observed R1 ambulating with the assistance of a walker. R1-R4 denied the allegation. LPA Bunker interviewed Witness #1 (W1), who confirmed that they are the Power of Attorney (POA) for Resident #1 (R1) and make all healthcare decisions, not the facility. W1 stated that they arranged for a nurse to visit the facility twice a week and for the physician to visit every two months to provide care for R1. W1 denied the allegation. Allegation: Staff prevented the resident from receiving a visitation. LPA interviewed staff members #1 and #2 (S1–S2). Both staff members (2 out of 2) consistently stated that residents are not prevented from receiving visitations. 2 out of 2 staff members stated that visiting hours are scheduled daily from 11:00 a.m. to 7:00 p.m., and reported that all residents are allowed visitors during these hours and confirmed that staff do not restrict or interfere with visitations. 2 out of 2 staff members stated that the facility maintains a visitor Sign-In and Sign-Out sheet to document all visits. S1-S2 denied the allegation. LPA Bunker interviewed Residents #1–#4 (R1–R4), 4 out of 4 residents stated that staff do not prevent residents from receiving visitors and confirmed that their family members visit the facility regularly during visiting hours. R1-R4 denied the allegation. LPA Bunker also interviewed Witness #1 (W1), who stated that they are the Power of Attorney (POA) for Resident #1 (R1) and confirmed that staff did not prevent R1 from receiving a visitation. W1 stated that R1 is not permitted to leave the facility for any outings or off-site visits with family or others unless W1 has given prior approval. All such arrangements must be discussed with W1 to obtain consent. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. There were no deficiencies cited. LPA Bunker provided Administrator Precious Dennis with copies of the Complaint Investigation Reports LIC-9099 and LIC-9099Cs. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jan 23, 2026 · control 11-AS-20251224093938

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Required - 1 Year Annual visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the evaluation, the facility is clear of COVID-19 infection. LPA Bunker met with Administrator Precious Dennis and explained the purpose of today's annual inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There are currently six (6), Residential Care Facility for the Elderly (RCFE) residents in placement. The facility's annual fees are up to date. The following 12 Domains will be observed and reviewed: Infection Control, Operational Requirements, Physical Plant & Environmental Safety, Staffing, Personnel Records-Training/Staff Training, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical and Dental, Resident Records/Incident Reports, Disaster Preparedness, and Resident with Special Health Needs. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." The facility is a single-story family home located in a residential neighborhood. Administrator Precious and LPA Bunker toured the facility, which consisted of the following: a living room, four bedrooms, two bathrooms, one half-bathroom, a dining room, a kitchen, a laundry area, an office, a detached garage, and an indoor/outdoor activity area. There is a shaded outdoor space furnished with patio furniture, including tables and chairs. Bedrooms #1-4, and bathrooms #1-2 are designated for the residents. See continued LIC809-C page 2. Continued LIC809-C page 2 LPA Bunker observed the facility’s infection control practices, which included screening protocols for residents and visitors, the availability of hand sanitizer, a visitor log, and the use of thermometers at the facility entrance. Logs documenting daily COVID-19 screenings and temperature checks for both residents and staff were available and up to date. Personal Protective Equipment (PPE) supplies were readily accessible to staff, and an additional supply of PPE was also observed. Additionally, sufficient liquid soap, paper products, cleaning supplies, and disinfectants were available. Documents are posted as required on the bulletin board located in the kitchen and hallway. The following Title 22-regulated areas were audited and found to be in compliance: • Telephones: Facility telephones are operational. • Bedrooms: All bedrooms meet the required standards for furniture, safety, privacy, and comfort. An adequate supply of linens is available. • Bathrooms: Bathrooms are clean, fully operational, and equipped with non-skid surface mats to ensure safety and privacy. • Kitchen and Food Service: The kitchen is adequately equipped for food preparation and service. A review of food supplies confirmed an ample stock of both perishable and nonperishable items, stored appropriately. • Medication Storage and Management: Medications are centrally stored in a locked cabinet in the kitchen. Records are current, ensuring proper documentation and secure storage. • Common Areas: The living room, dining room, and other shared spaces are well-maintained, free of hazards, and meet cleanliness standards essential for resident safety and well-being. • Safety Equipment and Measures: The facility is equipped with a fully stocked first aid kit and manual, functional smoke and carbon monoxide detectors, and properly charged fire extinguishers. Hot water temperature was measured at 110°F, within the acceptable range of 105–120°F. • Emergency Preparedness: All exit doors are in compliance. Bedroom windows are fitted with sliding locks that do not use thumbscrews. A fire drill was conducted on January 04, 2026. • Environmental Safety: The yard is free of debris and hazards. Trash cans are covered, and there are no firearms or bodies of water on the premises. Hazardous items are stored securely and remain inaccessible to clients. See continued LIC809-C page 3. Continued LIC809-C page 3. • Staff Training: Staff have received training on dependent adult and elder abuse reporting. • Administrative Compliance: The Administrator’s Certificate is current, with an expiration date of January 03, 2028. Compliance with HIV/TB requirements has been verified. LPA Bunker provided Administrator Precious Dennis with a copy of the facility evaluation report. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 14, 2026

Allegation investigated: Facility staff neglect resulted in resident developing stage 4 pressure injuries. Facility staff neglect resulted in resident requiring emergency surgery. Facility staff did not assist resident with medical appointments as needed. Facility staff admitted resident into the facility without the consent of the authorized representative.

On 09/06/2024, at 9:00am, the department made an unannounced initial visit to the facility and was greeted by Precious Dennis, Administrator. The purpose for today’s visit was to obtain facility files pertaining to the above-mentioned allegations. The investigation consisted of the following: On 09/06/24 the department conducted an initial visit and met with Administrator, Precious Dennis (S1). A subsequent visit was completed by the department on 06/12/2025. During the initial visit, the department conducted a tour of the facility’s physical plant and observed residents in care. The department obtained copies of the following documents: Resident Roster (Dated: 01/18/2020), Staff Roster (Dated: January 2024), ID/Emergency Information (Dated: 06/27/2019), Kaiser Permanente Face Sheet ( Dated: 06/26/2019) (Physicians Report (Dated: 06/27/2019), Resident Appraisal Information (Dated: 06/27/2019), Resident Appraisal (Dated: 06/27/2019), Power of Attorney (Dated: 07/19/2019), Resident Referral Email (Dated: 06/27/2019), Kaiser Permanente Doctor Letter (Dated: 02/01/2022 & 07/15/2022) from the facility for R1. Report Continued On LIC9099-C Unsubstantiated This complaint was referred to the California Department of Social Services Investigation Bureau for an investigation on 09/05/24. As a part of the investigation, the department subpoenaed medical records, including imaging records and other writings, referring, or relating to the medical history, mental or physical condition, diagnoses, and/or treatment from Kaiser Permanente for resident (R1). Additionally, the department requested medical records from All Care Home Health, Comcare Home Health, and Omnicare Home Health agencies. The department interviewed staff (S1-S2), resident (R2), and witnesses (W1-W4). The investigation revealed the following: Allegation#1 - Facility staff neglect resulted in resident developing stage 4 pressure injuries The details of the complaint alleged that the resident (R1) while under the care and supervision of facility staff, the resident developed stage 4 pressure injuries. On 09/26/2024, from 04:05pm-6:00pm, the department interviewed staff (S1) and resident (R2) regarding the allegation. R1 could not be interviewed because R1 has passed away on 8/01/2022 of natural cause: Cardiopulmonary arrest due to Atherosclerosis. 1 of 1 staff denied the allegation. Staff (S1) stated that R1 resided at the facility from June 27, 2019, to August 01, 2022. S1 stated that when R1 first arrived at the facility on June 27, 2019, the pressure injuries were small scabs. S1 stated that R1 was treated by several health agencies during R1s stay at the facility. While at the facility, S1 took R1 to the hospital as R1 sustained a stage four pressure injury to R1s coccyx and ankle while R1 was at the facility. S1 stated R1 was being repositioned every 2 hours as instructed by the home health agency. The department reviewed the medical records from Comcare Home Health and All Care Home Health Medical Records for R1 and observed that on 12/02/2021 R1 was diagnosed with three pressure injuries: Wound 1, Location: Rt ankle, Type: Pressure Ulcer/Injury, Stage: DTPI (Deep Tissue Pressure Injury). Wound 2, Location: Lt heel, Type: Pressure Ulcer/Injury, Stage: DTPI. Wound 3, Location: Lt buttock, Type: Pressure Ulcer/Injury, Stage: Stage 3. Additionally, on 02/17/2022 R1 was diagnosed with two pressure injuries: Wound 1, Location: coccyx, Type: Pressure Ulcer/Injury, Stage: Stage 3. Wound 2, Location: Rt ankle, Type: Pressure Ulcer/Injury, Stage: Stage 3. R1 was consistently under the care of All Care and Comcare Home Health to treat the wounds. Based on the records reviewed, there is no sufficient evidence to prove the facility’s failure of providing appropriate care to the resident by seeking timely medical intervention for stage 2 pressure injury development that led to its progression to stage 4 pressure injuries. With the resident’s health conditions, the development and progression of pressure injuries could not have been avoided even when appropriate treatments were being rendered. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff neglect resulted in resident developing stage 4 pressure injuries. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Report Continued On LIC9099-C Allegation #2- Facility staff neglect resulted in resident requiring emergency surgery. The details of the complaint alleged that the resident (R1) required emergency surgery after being at the facility for the first six weeks due to dehydration and severely impacted bowels. On 9/13/24, 9/26/24, 11/26/24, and 12/10/24 the department interviewed staff (S1-S2), and witnesses (W1-W4) regarding the allegation. R1 could not be interviewed because R1 has passed away. 2 of 2 staff denied the allegation. S1 stated that they informed witness (W2) that R1 was bleeding from R1s private area; and S1 also alerted R1s primary care physician. S1 stated that the PCP told them to monitor the resident for now. S1 stated that later that night R1s bleeding stopped and S1 alerted (W2) about it. Subsequently, the next day, S1 took R1 to the hospital for an examination. R1 was then diagnosed with three polyps and had to have emergency surgery to remove them. Witness (W1) contends it was staff neglect, witness (W4) stated that polyps take on average several years to develop (primary care physician), while witness (W3) had no knowledge of the incident. The department reviewed Kaiser Permanente’s medical records for R1 and based on records reviewed there was insufficient evidence to prove that the facility was responsible for Neglect/ Lack of supervision leading to R1 having to have emergency surgery. Per R1s medical records, there was a telephone call placed to Kaiser on August 09, 2019, regarding a concern that R1 sustained vaginal bleeding earlier in the same morning. R1 was then taken to the Emergency Department (ED) at Kaiser on August 10, 2019. R1 was diagnosed with polyps while R1 was in care at the facility and underwent surgery. Based on the evidence and interviews conducted; the facility acted timely to address R1s bleeding as they contacted the hospital and brought R1 into the ED for treatment. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff neglect resulted in resident requiring emergency surgery. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation #3- Facility staff admitted resident into the facility without the consent of the authorized representative. The details of the complaint alleged that the facility admitted the resident into the facility without the consent of R1s appointed power of attorney. On 09/06/24, the department interviewed staff (S1) regarding the allegation. 1 of 1 staff denied the allegation that the Facility staff admitted resident into the facility without the consent of the authorized representative. Staff stated that the resident was admitted to the facility on 06/27/2019 by a family member. Subsequently, the family member produced a document showing they had power of attorney and could act on behalf of the resident. S1 stated the resident was admitted to the facility on good faith and remained in the facility based on the documents received. Report Continued On LIC9099-C The department reviewed the Power of Attorney (Dated: 07/19/2019), Resident Appraisal (Dated: 06/27/2019), and Physicians Report (Dated: 06/27/2019) and observed that the facility had the required documents to admit the resident to the facility. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff admitted resident into the facility without the consent of the authorized representative. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation #4- Facility staff did not assist resident with medical appointments as needed. The details of the complaint alleged that the facility failed to follow through on medical appointments for the resident. It was reported that Kaiser physicians ordered home health care services for the resident, however facility staff never followed through and made the appointments for the resident to receive home health care as needed. On 09/26/2024, from 04:05pm-6:00pm, the department interviewed staff (S1) regarding the allegation. Staff (S1) stated that R1 only missed one or two appointments during their stay at the facility and it would be due to R1 feeling too tired to attend the appointments. S1 also stated that when appointments were missed, they would reschedule it. The department reviewed medical records from Kaiser Permanente, and all appointments for the resident. The department also reviewed records for the health agencies that were working with the facility. The facility administrator (S1) stated that there were three home health agencies who worked with R1 while R1 resided at the facility: Omnicare, Comcare, and All Care Home Health, and that they were all working together to help the resident. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff did not assist resident with medical appointments as needed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No citations were issued for this complaint. An exit interview was conducted with Precious Dennis, Administrator, and a hard copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 12, 2025 · control 11-AS-20240905100546

Type of visit: Case Management - Other

On 06/12/25 Licensing Program Analyst Perry Scott conducted a case management visit to this facility and met with Precious Dennis, Administrator. LPA was delivering findings in the complaint investigation for 11-AS-20240905100546 which was received on 09/05/2024. The purpose of today’s visit is to issue deficiencies that were observed in that complaint investigation. LPA explained the purpose of today’s visit. An investigation conducted by the California Department of Social Services determined that the facility failed to do a reappraisal of resident (R1) when they noticed a change in the skin integrity of the resident and failed to develop a plan to address the significant change. Additionally, the facility retained R1 with a stage 3 pressure injury and failed to obtain an exception from licensing. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies, therefore the following citations are issued: Section 87463(a) Reappraisals and Section 87615(a)(1) Prohibited Health Conditions. Plans of corrections were discussed. Plan of corrections are to be submitted on or before 06/20/25, to avoid monetary penalties. An exit interview was conducted with Precious Dennis, Administrator, and a hard copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 12, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Jun 20, 2025

87463(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Based on interviews and records reviewed, the administrator noticed a change in R1s skin integrity and failed to ensure a reappraisal was conducted to develop a plan to address the significant change.the state’s words, verbatim · CDSS document, Jun 12, 2025

Plan of correction: Licensee/Administrator shall read Title 22 Section 87463(a) Reappraisals. Licensee to do in-service training with staff on reappraisals of residents and send proof of the in-service with signatures of staff. Plan of Correction (POC) is due to the CCLD/El Segundo ASC Regional Office by 06/20/25. Email to LPA Perry Scott at perry.scott@dss.ca.gov to avoid monetary penalties.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87615(a)(1) · Plan of correction due date: Jun 20, 2025

87615(a)(1) Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidence by: Based on interviews conducted and records reviewed, the facility retained R1 with a stage 3 pressure injury and failed to obtain an exception from licensing.the state’s words, verbatim · CDSS document, Jun 12, 2025

Plan of correction: Licensee/Administrator shall read Title 22 Section 87615(a)(1) Prohibited Health Condition. Licensee/Administrator to do in-service training with staff on prohibited health conditions and send proof of the in-service with signatures of staff. Plan of Correction (POC) is due to the CCLD/El Segundo ASC Regional Office by 06/20/25. Email to LPA Perry Scott at perry.scott@dss.ca.gov to avoid monetary penalties.

Allegation investigated: Licensee does not ensure that facility maintains a working telephone on the premises at all times

On 05/12/2025 at 9:30 a.m., the Department conducted an initial visit to gather information regarding the above allegations. The Department met with Administrator Precious Dennis and explained the purpose of today's visit. LPA was granted entry to the facility. The investigation consisted of the following: On 05/12/2025, at 9:30 a.m., the Department requested, reviewed, and obtained copies of the Residents Roster (dated 05/12/2025) and Personnel Report (Dated 05/12/2025), Special Incident Report (dated 12/27/2025), and Ring Camera video footage (May 2025). The Department conducted interviews with Staff Members #1-2 (S1-S2), Witness #1 (W1), and Residents #1-2 (R1-R2). Resident #3-5 have dementia, spoke only limited words, and were unable to recall or respond to the questions asked. S1 and S2 stated that the telephone is operable and that they are currently using AT&T-provided cellphone associated with the facility's landline number. The landline is temporarily down due to a neighborhood outage; however, the cellphone is functioning properly. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 S1 and S2 stated that visitors are not required to call the facility in advance to notify staff of their visit. They also stated that visitors are not made to wait outside the facility door for extended periods of time before being allowed to enter the facility. Investigation Reveals the following: It was reported that the facility's phone has not been in working order for some time, and that one of the staff members has been providing their personal cell phone number as a means of contact. However, the staff member with the cell phone is not always present at the facility, and when that staff member is present at the facility, they do not always answer their cell phone. It was also reported that staff require visitors to call ahead before arriving at the facility to inform staff that they are coming to visit a resident. Upon arrival, visitors are made to wait outside the facility door for an extended period of time before being allowed inside. Staff Members #1-2 (S1-S2), when interviewed, confirmed that the landline is temporarily down due to a neighborhood outage. S1-S2 stated that all residents, responsible parties, visitors, Community Care Licensing, and the appropriate agencies have been notified of the outage. S1 stated on 05/05/2025, a visitor came to the facility at 3:19 p.m. to visit a resident, and staff opened the door in 16 seconds. The visitor was at the front door for less than 20 seconds before being allowed inside. S1 also provided supporting evidence through Ring camera video footage, which captured the visitor entering through the facility's door. Allegation: Licensee does not ensure that the facility maintains a working telephone on the premises at all times. It was alleged that the licensee does not ensure the facility maintains a working telephone on the premises at all times. Staff Members #1–2 (S1–S2) reported that the facility’s AT&T landline has been down due to theft of equipment, including copper wires and pipes, from the main utility pole. This incident caused an outage of landline and internet services throughout the neighborhood. S1 stated that this issue was reported to Community Care Licensing in December 2024, and that AT&T responded by providing the facility with a cellphone that carries the same number as the original landline. AT&T explained that they are in the process of installing a new system, which has been a target for theft. S1 and S2 confirmed that AT&T provided the facility with a cellphone that is fully functional and allows them to receive and make calls without delay. When the Department called the facility’s phone number, the call was answered immediately by staff using an AT&T cellphone. See continued LIC9099-C page 3 Continued LIC9099-C page 3 S1 stated that staff use the Nextdoor app to stay informed about neighborhood issues, including the ongoing power and service outages. Staff Members #1–2 (S1–S2) and Residents #1–2 (R1–R2) stated that the cellphone is available for use by residents, responsible parties, visitors, and others needing to contact the facility. The phone was found to be in good working order, properly maintained, and fully operable at the time of the visit. 2 out of 2 staff members confirmed that the facility maintains a working cellphone on the premises and that visitors do not experience extended wait times at the door. 2 out of 2 residents interviewed agreed that the phones are working properly and that visitors are not made to wait before entering the facility. Witness 1 (W1) stated they visit the facility frequently, and that their visits are unannounced. W1 stated they have never had to wait outside for an extended period, as staff consistently allow them entry promptly. W1 also confirmed they were made aware of the AT&T outage affecting the neighborhood, and have no issues contacting facility staff by telephone. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. There were no deficiencies cited. LPA Bunker provided Administrator Precious Dennis with copies of the Complaint Investigation Reports LIC-9099 and LIC-9099Cs. An exit interview was conducted.the state’s words, verbatim · CDSS document, May 12, 2025 · control 11-AS-20250505115849

Type of visit: Case Management - Annual Continuation

On February 6, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced Case Management Annual Continuation to complete inspection conducted on January 31, 2025 using the CARE Inspection Tool. LPA met with Precious Dennis and explained the purpose of this visit. The facility is licensed for (6) 60-year-old or older adults. May retain 1 hospice resident. Currently, there are 6 residents in the facility. The facility is a single-story home located in a residential neighborhood which consists of the following: A living room, four (4) bedrooms, two (2) bathrooms, one (1) half-bathroom, dining room, kitchen, laundry area, detached garage, shaded area, indoor/outdoor activity areas. Safety LPA observed and tested smoke/carbon monoxide combo detectors to be fully operable. LPA observed (2 ) fully charged fire extinguishers that was last serviced on 01/18/2025. The last emergency drill was conducted on 1/12/25. LPA inspected the First Aid kit and found it contained an ample supply of required items: Scissors, tweezers, gauze, disinfectant wipes, band aids. LPA observed all exits to be clear and easily accessible. All toxins locked and inaccessible to residents in care. Page 1 of 2 Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet that is inaccessible to Residents in care. Files LPA reviewed ( 4 ) resident files and found that (4) out of (4) contained all the necessary documentation. LPA reviewed (4) staff files and found that (4) out of (4) contained the required documentation, certification, and training. Liability Insurance expires on 06/24/25 Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff. Outside area: During visit LPA observed the outside grounds (front and back) to be free of clutter, debris, and passage ways were free of obstruction. There were no deficiencies cited during today’s visit. Exit interview conduct and copy of report provided to Administrator Precious Dennis.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Required - 1 Year

On January 31, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced required annual visit using the CARE Inspection Tools. LPAs met with Precious Dennis and explained the purpose of this visit. The facility is licensed for (6) 60-year-old or older adults. May retain 1 hospice resident . Currently, there are 6 residents in the facility. The facility is a single-story home located in a residential neighborhood. LPA Lee and Administrator Ms. Dennis toured the facility which consisted of the following: A living room, four (4) bedrooms, two (2) bathrooms, one (1) half-bathroom, dining room, kitchen, laundry area, detached garage, shaded area, indoor/outdoor activity areas. Physical Plant LPA and Administrator Louretta Dennis toured the facility inside and outside. LPA observed There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. LPA observed that facility had required postings: Facility license, personal rights, ombudsman information poster, facility sketch, exit signs, infectious disease postings, Administrator certificates, an emergency disaster plan. Page 1 of 2 Bedrooms LPA inspected all (4) bedrooms (2 private 2 shared) All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. Resident’s toiletries and incontinent supplies observed in resident rooms. The water temperature measured 110 degrees Fahrenheit. All bathrooms were observed to be clean, in good repair and within Title 22 regulations. Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in hall closet. . Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet in the kitchen and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. There is a laundry room where the washer and dryer are located. The detergent and other cleaning supplies are locked in a cabinet inaccessible to residents in care. Due to time restraint, LPA to complete inspection on subsequent visit. There were no deficiencies cited during this visit. Exit interviewed conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Annual/Required visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Administrator Precious Dennis and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There are currently six (6), Residential Care Facility for the Elderly (RCFE) residents in placement. The facility's annual fees are current. The facility is a single-story family home located in a residential neighborhood. Administrator Ms. Dennis and LPA Bunker toured the facility which consisted of the following: A living room, 4 bedrooms, 2 bathrooms, dining room, kitchen, laundry area, detached garage, shaded area, and indoor/outdoor activity areas. Bedrooms #1-4, and bathrooms #1-2 are designated for the residents. LPA Bunker observed the facility’s infection control practices, screening protocols for residents and visitors, sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of residents and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of Personal Protective Equipment (PPE) was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. Documents were posted as mandated. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. The resident's bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, bathrooms are clean and operational. The first aid kit is fully stocked with a manual, the hot water temperature was measured at 110 degrees Fahrenheit, the telephones are working, the smoke and carbon monoxide detectors are in compliance, the fire extinguishers are fully charged, The resident’s medications were locked reviewed for proper storage, documentation, and system implementation, there is an ample supply of perishable and nonperishable food and adequate linen supply. No firearms on the premises, the resident's bedroom windows had no sliding window lock with thumbscrew, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to residents, the yard is free of debris and hazards. LPA Bunker will return at a later date to complete the annual visit. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 18, 2024