Primrose Residental Care

Allegation investigated: Staff abused resident in care. Staff denied resident access to their personal funds. The licensee did not provide proper notice of increase in rate. Staff are unqualified to meet residents needs. Residents are not allowed to choose their physician. Staff denied resident's room and roommate choice.

On July 28, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation and delivering findings into the above allegations. LPA was greeted and granted entry after stating the purpose of the visit. During the course of the investigation, a walkthrough of the physical plant and four residents, five staff, one witness interivews were conducted. A record review and copies of the following documentation were obtained: Resident Rosters, Personnel Report Summary, Face Sheets, Admission Agreements, Physician's Reports, Personal Rights, Inividual Program Plans (IPPs), ledgers, and resident check. Also obtained are personnel records consisting of Face Sheets and training certificates. The investigation is as follows: Regarding the allegation, Staff abused resident in care, it is alleged Staff #1 (S1) would isolate, berate, insult resident(s) due to their mental faculties, appearance, and weight. Also alleged, S1 would ignore and verbally/physically abuse resident(s). Unsubstantiated The admission agreements and IPPs do not indicate S1 as the designated agent for the power of attorney (POA) for any of the five current residents registered to this time. The admission agreements were signed by the resident or the responsible person other than S1. Therefore, this agency has investigated the complaint and based on interviews which were conducted and the records that were reviewed, the allegation is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with House Manager Miriam Esquivel, and a copy of this report was provided at exit. Based on observations conducted on August 22-23, 2023, April 7, 2026, and April 16, 2023, residents were treated with respect and dignity. Staff were observed to be courteous, kind, and professional during the visits. Based on the interviews, one out of four residents indicated S1 would "beat up" and "slap" their friend but had not provided further context to corroborate the abuse had occurred towards self. Four of four staff denied the allegation indicating residents are not discriminated against, treated with respect, and dignity. The Individual Program Plan dated January 17, 2023, and Resident Rosters dated May 12, 2022, and November 15, 2025, indicate Resident #1 (R1) is/was not a resident of this facility. LPAs were unable to interview Resident #2 (R2) as contact information and records were unavailable due to R2 moving out in 2016. Regarding the allegation, Staff denied resident access to their personal funds, it is alleged R2 was denied access to their funds. R2 was not interviewed as contact information, and records were unavailable due to R2 moving out in 2016. Additionally, R1's Individual Program Plan (IPP) dated January 17, 2023, and Resident Rosters dated May 12, 2022, and November 15, 2025, indicate R1 is/was not a resident of this facility. LPAs observed the Personal and Incidental (P&I) funds secured in a locked safe in the living room. Based on the review of the available P&I funds, LPA verified the amount available was accurate according to the ledger. Based on the interviews, three out of four residents denied the allegation as the residents indicated trusting and relying on S1, with their finances and being able to access their funds as needed. One resident could not be interviewed due to their medical condition. Based on the review of the IPPs and Admission Agreements of current residents, the licensee is the designated payee to handle three of four residents’ cash resources which includes incidental expense monies (P&I) while one resident independently manages their own finances. S1 denied the public guardian receiving commission for resident referrals. Three out of four interviewed staff did not corroborate with the allegation. Regarding the allegation, the licensee did not provide proper notice of increase in rate, it is alleged there was an unexplainable, significant rate hike, and depletion of resident's finances once residents were referred to the facility. None of the residents were able to provide details about their shared cost and notice of increase during the interviews. Three of the four staff were also unable to provide information. S1 indicated an increase of their shared cost was on January 1st of each year when the Social Security (SSI) rate increased. The increase would then be discussed during the annual or quarterly meetings with the regional center, resident, and their representative per S1. S1 indicated the regional center would reimburse the facility for the cost of living. In review of the signed admission agreements, the admission agreement states that the facility would provide a "60 day written notice to the resident or the person responsible." Residents were not informed within the 60 day period because the regional center provides the information during the annual/quarterly meetings at the time S1 would be notified as well. R2 was not interviewed as contact information, and records were unavailable due to R2 moving out in 2016. Additionally, R1's Individual Program Plan (IPP) dated January 17, 2023, and Resident Rosters dated May 12, 2022, and November 15, 2025, indicate R1 is/was not a resident of this facility. Regarding the allegation, Staff are unqualified to meet the resident’s needs, it is alleged staff do not have adequate training or the ability to communicate in English to understand the resident’s needs. Based on the review of three staff files, fingerprint/background clearance transfers, annual training requirements, CPR/First Aid, and health clearances were met. Interviews revealed two of three staff did present to have some challenges understanding and communicating in English. However, both staff indicated their level of understanding and speaking does not impact the care and supervision of the residents and their needs. Four of four residents indicated that their needs had been met so far and did not experience much trouble communicating with staff. Regarding the allegation, Residents are not allowed to choose their physician, it is alleged the facility had a “preferred” physician for all the residents including R1. R1 is/was not a registered resident. Based on the interviews, two of four staff denied the allegation while the remaining two staff did not have information to provide. Three of the four current residents were not aware who their current doctor is while one of the residents expressed satisfaction with S1 selecting their doctor. Regarding the allegation, Staff denied resident’s room and roommate choice, it is alleged Resident #3 (R3) had shared a room with R2. R2 had requested a different room in the facility due to R2 sleeping nude at the time. R2 and R3 are former residents, and LPA was unable to obtain their records as it had been over 3 years since the residents had not resided at the facility. Based on the walk through of the physical plant, there is one private bedroom and two shared bedrooms. Interviews revealed one of four residents being unsatisfied with their living arrangement but indicated getting along with their current roommate. Based on observations, the private bedroom is occupied by another resident, and the interviewed resident had already moved back from the other shared bedroom which they had already occupied before. Based on observation, interviews, and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with House Manager Miriam Esquivel, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Jul 28, 2026 · control 22-AS-20230320140108

Type of visit: Case Management - Deficiencies

On July 28, 2027, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of issuing a deficiency in connection to a complaint investigation for Control Number 22-AS-20230320140108. LPA met with House Manager Miriam Esquivel and stated the reason for the visit. On April 7, 2026, LPAs Jessica Cho and Eboni Bentley observed Nest cameras in the following areas: one in the living room coffee table, one in the back patio, and one in the front patio. The interviews also confirmed and also by the administrator that all Nest cameras were equipped with audio recording capabilities which LPAs verified through the Nest app on the administrator’s mobile phone. A violation exists; therefore, a deficiency is being cited today. An exit interview is being conducted with House Manager Miriam Esquivel, and a copy of this report including the LIC809-D, and the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Jul 28, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Aug 7, 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, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups." This requirement was not met as evidenced by: Based on observation, residents are not afforded privacy as the 3 cameras in the living room, back/front patios are equipped with audio recording features which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 28, 2026

Plan of correction: The living room camera was removed today. The back patio and front patio cameras will be removed by POC due date. Should the administrator choose to purchase a camera that is not equipped with audio features, please submit photographs of the camera brand/model number as well as a facility sketch showing the areas the cameras are installed by POC due date.

Allegation investigated: Staff yells at residents

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Staff #1 (S1) Miriam Esquivel, discussed the purpose of the inspection, and explained the allegation. Administrator (AD) Lacy Faddoul appeared via telephone. The investigation into the allegation that staff yells at residents revealed the following: During the course of the investigation, LPA inspected the facility, interviewed residents and staff, and obtained and reviewed copies of the resident roster and staff roster. It was alleged that staff yell at residents. LPA inspected the facility, conducted health and safety checks, and observed no health and safety issues. LPA interviewed the three staff present who denied the allegation. LPA interviewed all four clients and obtained information corroborating that staff yell at residents but that it is a minor issue. Substantiated During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 18, 2026 · control 22-AS-20260513153352

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Jun 1, 2026

87468.1 Personal Rights … (a) … (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature… This requirement was not met as evidenced by: Based on interviews, the licensee did not ensure staff did not yell at residents which residents described as a minor issue, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: Licensee stated they will conduct staff training on personal rights and interacting with residents and submit proof to LPA by POC due date.

Allegation investigated: Staff did not provide telephone service to residents in care. Staff denied resident access to their personal wheelchair. Staff monitors residents via hidden cameras. Staff did not permit resident to open their mail. Staff is denying residents' access to make and receive confidential calls. Staff denied residents' right to leave the facility.

On April 16, 2026, Licensing Program Analysts (LPAs) Jessica Cho and Eboni Bentley made an unannounced visit for the purpose of continuing the investigation into the above allegations. LPAs were greeted and granted entry after stating the purpose of the visit. During the course of the investigation, a walkthrough of the physical plant and four resident/five staff/one witness interivews were conducted. A record review and copies of the following documentation were obtained: Resident Rosters, Personnel Report Summary, Face Sheets, Admission Agreements, Physician's Reports, Personal Rights, for all Inividual Program Plan (IPP). Also obtained are personnel records consisting of Face Sheets and training certificates. The investigation revealed the following: Regarding the allegation, Staff did not provide telephone service to residents in care, it is alleged that staff does not provide residents access to a facility telephone. Based on observation, LPAs observed a working telephone above the kitchen sink. LPA Bentley tested the facility phone at (657) 220-4368 and was deemed operational. Unsubstantiated Four out of four staff denied the allegation stating the facility phone is available to residents in care. Two out of four residents denied the allegation as they utilize their own cell phones and is permitted to use the facility phone if needed. The third resident provided conflicting statements, and LPAs were unable to qualify the fourth resident due to their medical condition. Regarding the allegation, Staff denied resident access to their personal wheelchair, it is alleged that Resident #3 (R3) was denied access to their wheelchair, and the wheelchair was refused to be repaired, making it impossible for R3 to leave the facility. Based on observations, LPAs observed R3 using a walker. LPA Bentley observed the manual and electric wheelchairs in the garage designated for R3 also confirmed by R3. R3 stated during the interview that the new wheelchair is working and the old wheelchair is not working due to a broken joystick. R3 indicated there was a one year delay in receiving the new electric wheelchair due to pending insurance approvals, however, was able to utilize a manual wheelchair while waiting for the new electric version. Four out of four staff reported that R3 is the only resident that uses a wheelchair and uses the wheelchair on the weekends and when they travel longer distances. Three out of four staff confirmed that the wheelchair has been in disrepair in the past. Two out of four staff interviewed denied the allegation while one staff was not employed at the time and the last staff did not provide a clear response. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016. Regarding the allegation, Staff monitors residents via hidden cameras, it is alleged that the licensee placed hidden cameras in the public rooms and bedrooms without the knowledge and consent of the residents or their families. It is also alleged that the cameras can be found hidden in faux alarm clocks. During the investigation, LPA Bentley observed clocks in all residents’ bedrooms but did not find any evidence of hidden cameras as well as around the room. LPAs observed four visible surveillance cameras. There are three Google Nest cameras. One is present in the living room, the second is mounted on the exterior roof in the front entryway, and the third is also mounted on the back patio roof. There is an additional Ring camera on the exterior front gate. All cameras have an audio component evidenced by the administrator’s Google Nest and Ring app accounts. Three of four residents confirmed the presence of these cameras in the common areas and denied there being any hidden cameras in their bedrooms. Four out of four staff denied the allegation. A record review of each resident’s admission agreements revealed that each resident signed and acknowledged that the facility is “under 24 hour surveillance.” Four out of four staff denied the allegation stating the facility phone is available to residents in care. Two out of four residents denied the allegation as they utilize their own cell phones and is permitted to use the facility phone if needed. The third resident provided conflicting statements and LPAs were unable to qualify the four resident due to their medical condition. Regarding the allegation, Staff denied resident access to their personal wheelchair, it is alleged that Resident #3 (R3) was denied access to their wheelchair and the wheelchair was refused to be repaired, making it impossible for R3 to leave the facility. Based on LPAs Cho and Bentley's observation, all four residents are ambulatory. LPAs’ observed R3 utilizes a walker. LPA Bentley observed the manual and electric wheelchairs in the garage designated for R3 also confirmed by R3. R3 stated during the interview that the new wheelchair is working and the old wheelchair is not working due to broken joystick. R3 indicated there was a one-year delay in receiving the new electric wheelchair due to pending insurance approvals, however, were able to utilize a manual wheelchair while waiting for the new electric version. Four out of four staff reported that R3 is the only resident that uses a wheelchair and uses the wheelchair on the weekends and when they travel longer distances. Three out of four staff confirmed that the wheelchair has been in disrepair in the past. Two out of four staff interviewed denied the allegation while one staff was not employed at the time and the last staff did not provide a clear response. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016. Regarding the allegation, Staff monitors residents via hidden cameras, it is alleged that in the licensee placed hidden cameras in the public rooms and bedrooms without the knowledge and consent of the residents or their families. It is also alleged that the cameras can be found hidden in faux alarm clocks. During the investigation, LPA Bentley observed clocks in all residents’ bedrooms but did not find any evidence of hidden cameras as well as around the room. LPAs observed four visible surveillance cameras. There are three Google Nest cameras. One is present in the living room, the second is mounted on the exterior roof in the front entryway, and the third is also mounted on the back patio roof. There is an additional Ring camera on the exterior front gate. All cameras have an audio component evidenced by the administrator’s Google Nest and Ring app accounts. Three of four residents confirmed the presence of these cameras in the common areas and denied there being any hidden cameras in their bedrooms. Three out of four staff denied the allegation while one confirmed the presence of visible cameras in two out of the three bedrooms in 2023. A record review of each resident’s admission agreements revealed that each resident signed and acknowledged that the facility is “under 24 hour surveillance.” The facility submitted a waiver dated March 23, 2020, requesting to utilize a video surveillance in both public and private areas. dated March 23, 2020, however, approval was not confirmed. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016. Regarding the allegation, Staff did not permit resident to open their mail, it is alleged that staff open residents’ mail received from their family. Four out of four staff denied the allegation, stating residents receive their unopened mail on a weekly basis, as the mailbox is locked to prevent theft from individuals outside of the facility. Two of four residents interviewed stated they receive unopened mail and have never been prevented from opening their own mail. One resident stated their mail is delivered to their family home. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016. Regarding the allegation, Staff is denying residents' access to make and receive confidential calls, it is alleged that the incoming calls would be directed to Staff #1 (S1)’s cell phone and S1 would transfer, connect the call, listen in, and record the telephone calls. It is also alleged that S1 denied resident’s family members and friends access to the residents by phone if they feel that the family member or friend would convince the resident to file a complaint or leave the facility. Based on observation, there is a working facility telephone and three of four residents were observed to have their personal cellular phone during the visit. Four out of four staff denied the allegation, stating the facility phone is always available for resident use, residents are able to receive and make calls, and staff always provide residents privacy and do not listen in on resident phone calls. Three out of four residents denied the allegation indicating that staff do not listen to their phone calls and always give them privacy. Two of the four residents interviewed stated they have their own cell phones but know that they could use the facility phone to make and receive calls if needed to. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016. Regarding the allegation, Staff denied residents' right to leave the facility, it is alleged that staff are not permitting R5 to leave the facility. Four out of four staff denied the allegation, stating residents are allowed to leave the facility whenever they like as long as it is safe for them to do so and residents are able to leave with family. Three out of four residents corroborated this by stating they can leave the facility whenever they want. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016. Based on the observations made, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the aforementioned allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with House Manager Miriam Esquivel, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Apr 16, 2026 · control 22-AS-20230320140108

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) at 8am LPA met with House Manager Miriam Esquivel and explained the purpose of the visit. The facility is a four bedroom, three bathroom single story residence in which one bedroom and one bathroom is used by live-in staff. The facility has an approved fire clearance of four ambulatory; of which two are approved for hospice. The facility currently has a census of four residents in care and none receive hospice services. During the visit LPA toured the kitchen and all appliances were in working order. The refrigerator had two-days of perishable items and seven-days of non-perishable food on-hand. Emergency water and supplies were observed in the garage with the washer and dryer. Sharps and knives were secured in a locked toolbox and cleaning supplies were stored in a locked storage closet. The facility was clean and there were no odors detected. LPA observed resident rooms had all of the required furnishings and were clean. LPA measured the hot water temperature in two of two resident bathrooms and hot water measured between 107.0-108.5 degrees Fahrenheit. All bathrooms had non-skid mats and grab bars. The smoke and carbon monoxide detectors were inspected and detectors were operational. The fire extinguisher was charged and inspected on April 1, 2026. The facility's last fire drill was documented on March 12, 2026 on the fire log. LPA requested the Emergency Disaster Plan which was not posted. A Technical Violation will be given for LIC 610E to be posted and updated. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the facility and there is ample space for activities and a shaded seating area was observed. There were no obstructions in pathways. A patio screen needed repair and a work order has been requested to repair the patio screen. Cameras are outdoors and in main living room facing front door. Audio is disabled at this time. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The facility has a First Aid Kit with the required elements and a First Aid Manual. LPA confirmed the facility has current liability insurance and surety bond. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. Resident P&I records were reviewed and were accurate. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 9, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. A Technical Violation was provided for the Emergency Disaster Plan (LIC 610E) to be reviewed and updated. A fact sheet of Legionnaire's Disease was also left with the facility for review, An exit interview was conducted with Miriam Esquivel, House Manager and a copy of the report, LIC 9102-TV and files reviewed (LIC 858 & LIC 859), were given at the time of the visit.the state’s words, verbatim · CDSS document, Apr 15, 2026

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) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 1:45pm. During today’s visit, LPA met with Miriam Esquivel, Administrative Designee. At time of entry two residents were at Day Program and two were present in the facility. The facility is a three bedroom, two bathroom single story residence with an approved fire clearance of four ambulatory; two non-ambulatory residents of which two are approved for hospice. The facility currently has a census of four residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 111.2 and 117.0 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on March 7, 2025. The facility’s fire drill is scheduled for April 10, 2025 and was last done in December 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. Emergency supplies are stored in the living room LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit has all the required elements and facility has a First Aid book. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. One of four resident files did not have an Admissions Agreement for this facility and had transferred (Continued on LIC 809-C) (Continued from LIC 809) from another facility under the same Licensee. An LIC 9102-TV will be given to update the Admissions Agreement for this resident to this location. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires May 9, 2026. LPA toured the exterior as the last resident returned home from Day Program. LPA noted there is only one gated entryway so residents can freely walk around the perimeter of the home. There are no hazards blocking exterior passageways and LPA observed a shaded patio area. The washer and dryer were located in the garage. LPA noted disinfectants were locked in a toxic chemicals cabinet. All sharps were secured in a locked box in the kitchen. All three resident bedrooms had the required furnishings. Two shared a bedroom, two have a private bedroom and there is an additional bedroom for staff with an exterior entrance. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Miriam Esquivel, Administrator Designee and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Apr 7, 2025

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: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Jerome Haley arrived to complete the required one-year annual visit that was started May 1, 2024. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. A phone call was placed to Licensee/Administrator Lacy Faddoul who could not attend with today's visit. LPA Haley and Administrator Faddoul briefly spoke on the phone regarding the citation that will be issued for Staff 1 (S1). During the visit, LPA Haley completed the inspection tool, conducted interviews with staff and resident 1 (R1). As a result of the annual inspection, deficiencies will be cited and a Technical Violation will be issued. An exit interview was conducted, and a copy of this report and appeal rights were provided to staff.the state’s words, verbatim · CDSS document, May 3, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jerome Haley and Edward Kim conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPAs were greeted and granted entry by staff and explained the reason for the visit. Staff contacted Administrator (AD) Lacy Faddoul was unable to attend todays visit. During the inspection, LPA Haley observed all client bedrooms and bathrooms. All client bedrooms had the necessary elements and were in compliance with regulation guidelines. Hot water temperatures were measured at 145.5 degrees Fahrenheit and 134.4 degrees Fahrenheit. No hazardous items were observed in the client bathrooms. In the kitchen, knives and sharp objects are kept locked in a toolbox in a kitchen cabinet. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. The garage had a clear walkway free of obstruction. Hazardous cleaning materials are stored in the locked garage along with several other facility items like adult diapers, walker, wheelchair, and a bike. A washer and dryer was observed. The backyard was clean, organized, and walkways were free of obstruction. A shaded area with a table and chairs was observed. A fully charged fire extinguisher was observed mounted on the wall above the locked cabinets in the living room used to store medication, staff, and resident files. Due to time constraints, the annual inspection was ended today and will be continued. Deficiencies observed and photographed during the tour of the physical plant and review of the staff roster will be cited at the conclusion of the annual inspection. An exit interview conducted, and a copy of this report was provided to staff.the state’s words, verbatim · CDSS document, May 1, 2024