Prestige Environs for the Ages

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a health and safety check. LPA met with Teresita Heard during today's inspection. LPA toured the facility with licensee and observed common living spaces, kitchen, bedrooms and bathrooms. LPA observed there are no residents in care. Licensee stated herself, husband and son are staying at the house. No deficiencies cited during today's inspection. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Jul 23, 2026

Type of visit: Required - 1 Year

On 02/09/2026, Licensing Program Analyst (LPA) Graham Gunby arrived at the facility to conduct an annual continuation visit. LPA met with Administrator and explained the purpose of the visit. During this annual inspection, LPA observed there are no residents in care. Additionally, LPA was informed facility is planning on accepting residents once they return from their trip. A tour was conducted, areas toured included but not limited to five bedrooms, kitchen, laundry room, bathrooms and the common areas. Areas toured no immediate health, safety and personal rights violations were observed. As a result of today's visit, no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 9, 2026

Allegation investigated: Resident was not administered medications as prescribed.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver (2) additional findings to a complaint received on February 28, 2025. LPA met with Teresita "Tess" Heard, Administrator, stating the reason for today's inspection. Also present was staff, Treylon Heard. (1) resident was resting in her room. During the course of the investigation, LPA reviewed documentation related to prior resident (R1), including, but not limited to, the physician's report and medication documentation. LPA interviewed (2) family members of (R1), (3) faciility staff and (1) hospice nurse, who attended to (R1) regularly. The results of the investigation are as follows: Resident (R1) moved to the care home on November 14, 2024, under the care of hospice. The physician's report notes (R1) had a diagnosis of Mild Cognitive Impairment (MCI), fall weakness, motor impairment paralysis and incontinence. Additionally the report notes that (R1) could be confused, was able to communicate and follow directions at times, and needed help with all Activites of Daily Living (ADL's). *cont on 9099C-1.. Substantiated 9099C-1.. Allegation: Resident was not administered medications as prescribed. The allegation states that resident (R1), who was under hospice care, was observed by visitors to be alert and talkative one day and the next day would be barely speaking, and almost in a coma state. The administrator stated (R1had a stroke and was paralyzed on the left side, would sometimes eat and drink lightly, "was fully aware of what's going on and did not have Dementia"The Administrator stated (R1) took "pre-filled meds" from their hospice company and was "very cooperative, and never refused medications. Additionally, the administrator stated that "two cousins visited everyday for 2-3 hours, there were a total of about ten different visitors, adding "the visitors never said anything that (R1) seemed over-medicated". The administrator confirmed the facility uses a Medication Administration Record (MAR), documents all PRN medications administered, and that (R1) took Ativan every (2) hours as well as Halidol. Staff (S1) confirmed that he helped with hospice medications, set up the medications per (R1's) chart, and (R1) "took her medications". (S1) stated (R1) was "normal, always sleepy", he assisted with pain medications and there were no problems. Staff (S2) confirmed that (R1) took Ativan and Halidol and there were no issues with medications being administered, asserting (R1) "surprised me at her age- she was in and out of lucid moments and at times didn't make sense". A family member who visited (R1) regularly stated (R1) did not like taking some of the medications- it was a challenge- (R1) did not like them". The family member explained "there were days where (R1) was adamant and didn't know who I was, and there were days when I called my cousin and said (R1) is not going to make it, and the next day (R1) was chipper". The family member stated "Some days (R1) seemed to be more heavily medicated than the other days- it was a roller coaster" and asked the nurse about the medications, who said she would follow up with facility staff to ensure the medications were being given at the proper time. The hospice nurse confirmed she spoke with the Administrator, at least twice, about how to correctly administer (R1's) medications by following the prescribed dosages. The nurse explained how the hospice Medical Director provided additional training on following the prescribed dosages, mainly with the medication, Ativan. The nurse indicated that the facility was administering medications correctly according to the prescribed frequency, but the mg/dosage was sometimes more or less than what was prescribed. *cont on 9099C-2.. 9099C-2 LPA reviewed medication documentation from November 2024- January 2025. The Centrally Stored Medication Record (LIC622) notes a prescription was filled on November 13, 2024 Lorazapem (Ativan) 0.5 mg tablet- One tablet to be given by mouth, every (6) hours as needed. On November 14, 2024, a new prescription of Ativan 1mg tablet (30 tablets) was logged for resident to take 1 tablet every (4) hours, as needed, for anxiety and agitation. On December 2, 2024, a refill bottle of Ativan 1mg (60) tablets was logged. The PRN log for November 2024 shows Ativan (quantity not listed) was administered once a day from November 14, 2024 through November 22, 2024 and was given again on November 26, 2024, once at 8:00 am and again at 9:00 pm. The PRN log for December 2024 notes 1 tablet of medication, Ativan was administered at least daily from December 1-5. LPA reviewed a hospice physician's order, dated December 6, 2024, where the order for Lorazapem (Ativan) 1 mg, every (4) hours was discontinued and an order for Ativan .5 mg, every 4 hours was started. The next administered doses were documented as follows: Dec 10- 9:00 am- 0.5 mg for restlessness Dec 11- 8:00 am- 1/2 tablet for restlessness and Dec 11- 5:00 pm- 1/2 tablet for restlessness Dec 12 7:30 am- 1/2 tablet for restlessness and Dec 12 5:30 pm- 1 tablet for restlessness Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 9099-D page. Exit interview with the Administrator. Copy of report and appeal rights provided 9099A-C-1.. The administrator explained that the catheter was changed "three times by the hospice nurse due to leaking and that due to (R1's) bone structure" the nurse put tape to secure the catheter on the left side to secure it. The administrator stated (R1) "was very cognizant about what was going on and midnight was the last time she was checked until the morning". The hospice nurse stated (R1) definitely had Dementia and (R1) would tell stories that were not always credible. The hospice nurse indicated she did not believe (R1) was inappropriately touched by staff. Based on information obtained, LPA finds the allegation to be UNFOUNDED--meaning that the allegation was false, could not have happened and/or is without reasonable basis. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, May 8, 2025 · control 59-AS-20250228150820

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: May 9, 2025

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on interviews conducted and documenation reviewed, the Licensee did not ensure the PRN medication Ativan .5 mg was administered, per doctor's orders, on December 12, 2024 (5:30 pm), which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: Licensee/Administrator agree to ensure all staff have completed medication training on following prescription orders for PRN medications. Ensure hospice is counting the medications at least weekly, making sure the facilty's records match the hospice's records. Documentation due to the Deparment, by 5/22/25, by email or fax.

Allegation investigated: Facility did not abide by the admission agreement.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a 10-day inspection and met with Teresita Heard, Administrator, stating the reason for today's inspection. LPA observed staff, Treylon Heard, present also and (1) resident in their room at the start of the inspection. During today's inspection, LPA discussed the allegation pertaining to resident (R1), reviewed the admission agreement, and observed (2) attempted delivery notices regarding a letter that was sent by registered mail and regular USPS nmail to the faciliy on February 18, 2025. The Department was provided with a copy of the letter. The findings are as follows: The allegation states that resident (R1) passed on January 10, 2025, and (R1's) personal belongs were removed on January 11, 2025. According to the facilities contract, a refund is given for the days remaining in the month if it was paid in advance. A full month of January rent was paid on January 1, 2025 for (R1). *cont on 9099C-1.. Substantiated 9099C-1.. LPA and Administrator reviewed the admission agreement where it states that "Advance Notice to Terminate the Admission Agreement upon death is not required". Additionally, the following is stated in the Admission Agreement, "Within fifteen (15) days after your personal property is removed from the facility, your estate or other person or entity responsible for payment of fees and charges, under this agreement, will receive a refund of any fees paid in advance covering the period after your personal property has been removed." The Administrator indicated she spoke to (R1's) responsible person by telephone on February 17,2025 when she was out of the country and indicated she would have to review the admissions agreement before issuing a refund. In addition, the Administrator agreed with the agency and (R1's) responsible person that the monthly rent would be reduced by $1,300 because there a room vacancy at the time, and the agency could not locate another facility with a vacancy. The Administrator stated to LPA that during the signing of the admission agreement with (R1's) responsible person, it was agreed that since a Pre-Admission fee was not being charged, and the facility was paying placement agency fees, there would no refunds of any pre-paid rent monies, after (R1) passed, who was on hospice. The Administrator stated to LPA that her understanding was that prepaid fees referred to a Pre-Admission fee, which she does not charge. The Administrator confirmed she returned to the facility on Monday, March 3, 2025 and had not received a letter from (R1's) responsible person, by regular USPS mail, while she was away. LPA observed the Administrator look through a small pile of mail during today's inspection and did not locate the letter from (R1's) responsible person. The Administrator provided LPA with (2) attempted delivery receipts left inside the mailbox, across the street. One was dated February 19, 2025 (noted as a First Attempt) and a second one was dated February 24, 2025 (noted as a final attempt) and that the letter would be returned to sender on March 6, 2025, if not picked up before then.The Administrator confirmed that (R1) passed on January 11, 2025, their belongings were removed on January 12, 2025 and January rent was paid on January 1, 2025 to cover the entire month, thru January 31, 2025. Health and Safety Code section 1569.652(c) states the following: (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 9099-D page. Exit interview with the Administrator. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Mar 6, 2025 · control 59-AS-20250228150820

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Mar 20, 2025

§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on documentation reviewed and interviews conducted, the Licensee did not issue a refund due to (R1's) responsible person, for rent monies paid from January 13, 2025- January 31, 2025, after (R1's) belongings were removed on January 12, 2025, following their passing on January 11, 2025, which posed a health and safety risk or personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: Licensee/Administrator agree to contact (R1's) responsible person to discuss payment to be made within the next (2) weeks, by 3/20/25. Documentation to be submitted to the Department showing the refund has been made. LPA provided a copy of the letter mailed on February 18, 2025 to the Administrator today.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Teresita Heard, Administrator, and explained purpose of inspection. The facility is licensed for (6) non-ambulatory residents, (1) of whom may be bedridden, and has a hospice waiver approved for (6) residents. Currently there are (3) residents and there are no residents under hospice. During today's inspection, a home health nurse arrived to speak with a newly admitted resident, who was visiting with their family. LPA observed (1) other resident in the common area and (1) in her resident room. LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, and laundry area. The Administrator and staff live in the facility. LPA observed the home to be clean, safe, odor free, in good repair. Sharps, toxins and medications are locked in the kitchen. There is sufficient 2+day perishable food, including much fresh produce, and 7+day non-perishable supply of food. There are additional toxins locked in the laundry room and sufficient paper/incontinent supplies as well as linens/blankets/towels. There is a complete First Aid kit. Inside temperature was observed to be 72* F. The fire extinguisher was last serviced 4/29/24, and the smoke/monoxide alarms are in working order. Hot water temperature measured 120*F in the kitchen and in a resident bathroom. LPA advised the allowed range is 105*F-120*F. There are games/activities on site and sufficient indoor and outdoor space, including covered seating. There is (1) unlocked exit gate and exit doors have alarms. There is a garden in the back area. LPA reviewed (2) resident files and (3) staff files. Files were organized and contained current documentation. Medications were reviewed for (1) resident. Orders match medications being given and documentation is current. There is documentation for completed initial and ongoing staff training, including current First Aid/CPR certifications. All staff are cleared and associated. Administrator certificate #6003786740- exp 7/7/25. The facility just obtained an updated Dementia Care Compliance plan from an approved vendor. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Jan 30, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Teresita Heard, Administrator, and explained purpose of inspection. Administrator had a question about when her annual fees were due. LPA then discovered that the annual inspection is not due until 2/28/25. There are currently (2) residents and neither resident is under hospice care. LPA and Administrator toured the inside of the facility and observed (1) resident present. A second resident was currently out of the facility. LPA observed the facility to be clean, in good repair and odor free. LPA observed sufficient 2+ day perishable and 7+day non-perishable food on hand. The inside temperature measured 72*F, and the fire extinguisher was last serviced 4/29/24. Administrator confirmed that all contact information on file is current. LPA observed multiple postings to be in the common area. Administrator certificate #6003786740- exp 7/7/25. There are no deficiencies issued in today's report. Exit interview. Copy of report emailed, as requested, to the Administrator.the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Teresita Heard, Administrator, and explained purpose of inspection. The facility is licensed for (6) non-ambulatory residents, (1) resident may be bedridden, and has a hospice waiver approved for (6) residents. This location has been operating as a care home for many years. Currently, there is (1) resident in care and (0) residents under hospice. LPA observed staff Trey Heard, present and (1) resident to be resting in her room. LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, and laundry area. The Administrator and staff live in the facility. LPA observed the home to be clean, safe, odor free, in good repair and to not pose any health and safety risk or personal rights violation. Inside temperature was observed to be 76* F. Facility conducts quarterly fire drills and the smoke/monoxide alarms are in working order. The facility has a back yard area with covered seating and there is (1) unlocked exit gate. The grounds are well maintained and pest control regularly provides treatment. Hot water measured 105* F in the kitchen. Each resident room has an exit door to the backyard. LPA observed toxins, sharps and medications to be locked in a separate areas. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable food. There are sufficient linens/towels and PPE on hand. LPA observed paper towels, soap, sanitizer in the bathrooms. LPA observed various Covid posters and required postings throughout. LPA reviewed (1) resident file and found it to be organized and contain current documentation. Medications were organized and locked. Staff files are organized and also contain current documentation. Staff has current First Aid/CPR certification, and the Administrator has a medical background. All staff are cleared and associated. LPA observed the current Administrator certificate #6003786740- exp 7/7/25 to be posted. Infection Control Plan and Emergency Disaster Pans were reviewed. Copy of current liability insurance obtained along with current email address. There are no deficiencies cited. Exit interview. Report left.the state’s words, verbatim · CDSS document, Apr 19, 2024

Type of visit: Prelicensing

On 01/24/2024, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Administrator, Teresita Heard, and explained the purpose of the visit. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed at 112 degrees F. LPA checked the kitchen area for the ability to prepare and store food. LPA observed at least a 2-day perishable and 7-day nonperishable food supply on hand. LPA observed sharps/ knives to be locked away and inaccessible to residents in care. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed the perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards. The care home has smoke detectors and carbon monoxide detectors that are operable. Licensing complaint poster are posted as required. Fire extinguishers was last serviced on 01/06/2023. First aid kit are maintained and ready for emergency use. Component III presentation conducted with administrator. LPA observed that the facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Exit Interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jan 24, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Capacity: 6 Census (if any clients in care): 2 COMP II Participants: Teresita Heard Interview Method: Telephone interview On November 07, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 7, 2023