Pruneridge Residential Care Home #3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Caregiver, Cynthia Gacias and stated the purpose of today's visit. LPA Rai spoke with Licensee/Administrator Leliani Cortes over the phone and obtained verbal permission for Caregiver, Cynthia Gacias to sign today's report on her behalf. LPA Rai observed 3 staff and 6 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed screen doors in good repair. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include resident rooms, staff room, living room, dining room, kitchen and bathroom. Resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids, including mounted dish soap. Fire extinguisher was observed and inspected on 12/29/2024. The facility staff could not provide disaster drill log for 2025. LPA Rai reviewed facility records for 2 staff and 2 residents. 2 Out of 2 staff files did not contain training documentation for 2025. Resident R1's medication #1 was not written on the Centrally Stored Medication Log. Staff S1-S2 stated R1 was administered the medication per physician's orders. LPA Rai reviewed resident medications and central stored medication records. Continuation on LIC 809-D, Page 1 of 2. Page 2 of 2. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. A civil penalty is being assessed for the amount of $250 for a repeat violation for HSC 1569.695(c). A previous licensing report issued on 12/21/2024 cited the same deficiency. Please see LIC421FC. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report, including today's cited deficiencies, was reviewed with Licensee/Administrator Lelani Cortes and a copy of the report was provided. Licensee/Administrator agreed and understood the POC. Appeal Rights was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Dec 4, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Dec 11, 2025

87465(h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year... This requirement is not met as evidenced by: Based on record review and observation of resident R1's file and R1's centrally stored medication log, facility staff are assisting resident R1 in administration of medication #1 and medication #1 is not recorded on the Centrally Stored Medication log which poses/posed a potential health, safety orthe state’s words, verbatim · CDSS document, Dec 4, 2025

Plan of correction: (con't) personal rights risk to persons in care.

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Dec 11, 2025

1569.625(b)(2)...training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision... This requirement is not met as evidenced by: Based on record review, staff S1 & S2's facility file did not contain the training records and S1 & S2 stated they are not sure if they have received training which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Dec 11, 2025

1569.695(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. This requirement is not met as evidenced by: Based on record review, Licensee and facility staff were not able to provide a copy of the disaster drill record at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Staff (S1), Concordia Casabar. During the visit, LPA observed 5 residents and 2 staff. LPA explained the purpose of the visit. Staff S1 contacted ADM and informed her about LPA's visit. ADM stated she could not come to the facility and Staff S1 could sign on her behalf. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring bedroom #3, LPA observed wheel chairs obstructing Exit#2. LPA also observed a stick, in the pathway of the sliding screen door, preventing the sliding screen door from opening. (Photographs were taken.) ADM stated the staff may have put the stick there for safety and forgot to remove it. Staff S1 removed the obstructions during LPA's visit. While touring the backyard, LPA observed the fence near exit #2 was partially leaning. LPA also observed the fence next to exit #2 had a section, leading to the front of the home, that had sections of the fence that had wooden planks missing. (Photographs were taken.) LPA also observed the hand rails of the wooden deck had sections that were splintering and had sections that had moss growing. (Photographs were taken.) LPA also observed the metal white sections of the wooden deck was rusting. LPA also observed the wall next to the hose, directly next to exit number 4 has an orange color on the wall. (Photographs were taken.) While touring bathroom #3, LPA observed the shower's wall mount soap dish fixture had tape covering, which was being used to cover the damaged. (Photograph was taken.) Page 1 Out of 2. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 116 degrees F. Fire extinguisher was serviced in January 5, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit. The facility's last fire/earthquake drill conducted was on May 14, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA requested to review R1 and R2's needs and services Plans. ADM stated if the forms are not in the file, then she didn't do them. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 residents. LPA requested copies of the following updated documents; 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. LIC200, please update (i.e., new phone numbers etc), if necessary. 6. Qualifications of Administrator (Certificate) 7. Please review your facility program for updates (incorporating new laws and/or regulations) LPA provided ADM with CDSS Flyer, "Important updates to Dementia Care and Miscellaneous Changes, effective January 1, 2025." Deficiencies are being cited during today's visit. This report was reviewed with Staff Concordia Casabar and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Dec 21, 2024