Pruneridge Residential Care Home

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Rose Calungcagin. The purpose of the visit was to follow up on a deficiency cited during the visit on 09/22/2025 for a bathroom sink that was clogged. LPA Marrufo observed today that the sink was no longer clogged. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Rose Calungcagin and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Concordia Casabar. During visit, LPA toured the facility inside and out. LPA toured the kitchen area and observed locked cabinets for sharp objects and cleaning supplies. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete. LPA toured four out of four resident bedrooms. Each bedroom had working lights and available clothing and storage areas. LPA toured two out of two bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperature in one of the two bathroom sinks was 107 F. The sink in the other bathroom was clogged during visit. LPA tested the carbon monoxide and smoke detectors in the hallways and resident rooms during visit. All detectors functioned properly when tested. LPA toured the outside area and observed the exits to be clear of obstructions. See LIC809-C page for more information. Page 1 of 2. LPA reviewed five out of five Centrally Stored Medication and Destruction Records (CSMDR). 4 out of 5 resident CSMDRs were complete. Resident R1's CSMDR was missing 7 medications. LPA reviewed 5 out of 5 resident records and found them to be complete. LPA reviewed 4 staff records. 3 out of 4 staff records were complete. Staff S1 did not have a staff record maintained at the facility, and was missing an LIC501 Personnel Record, LIC503 Health Screening, and current First Aid Certification. LPA reviewed the emergency disaster drill log and found the last drill was recorded on 08/01/2025. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D pages for more information. LPA Marrufo requests updated copies of the following records be submitted to the department within seven calendar days: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility Liability Insurance LIC610E Emergency Disaster Plan This report was reviewed with Concordia Casabar and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Sep 22, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Type A and Type B deficiencies cited on 9/24/2024. LPA Rai met with Lead Caregiver (S1), Rose (Rosalia) Calungcagin and stated the purpose of today's visit. S1 notified Licensee/Administrator Leilani Cortes of LPAs' visit and S1 stated Licensee/Administrator was busy at the time and unable to be present during today's visit. LPA Rai observed 2 staff and 6 residents in the facility. During visit, LPA Rai inspected the kitchen area. LPA Rai observed at random canned foods in the cabinet and 10 out of 10 canned foods were not expired. LPA Rai observed sharps, such as knives, and toxic chemicals locked in cabinet and inaccessible to residents. LPA Rai observed medications were in the locked cabinet and inaccessible to residents. During visit, LPA Rai inspected the backyard and garage. LPA Rai observed the gardening tools and toxic chemicals were locked and inaccessible to residents in care. During visit, LPA Rai inspected the designated office. 2 Out of 2 staff stated the office is not being used as a bedroom and is currently being used as a storage space. During visit, LPA Rai reviewed staff S1's Statement of Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. During visit, LPA Rai provided letter of the Deficiency Citations cleared. No deficiencies were cited at this time as per California Code of Regulations, Title 22. This report was reviewed with Lead Caregiver, Rose (Rosalia) Calungcagin and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 20, 2024

Allegation investigated: Staff are not ensuring resident's oral hygiene needs are met Staff are not ensuring resident is repositioned every two hours

Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Lead Caregiver, Rose (Rosalia) Calungcagin and stated the purpose of today’s visit. On 2/6/2024, the Department received a complaint with the above allegations. It was alleged that R1 was admitted to the hospital on 2/3/2024 and resident had not received any oral care and resident had a pressure injury stage 1 from not being repositioned every 2 hours. On 2/15/2024, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 3. Unsubstantiated Page 2 of 3. Staff are not ensuring resident’s oral hygiene needs are met. On 2/15/2024, LPA Rai interviewed 3 staff, including staff (S1) who was the primary caregiver for R1. One staff (S3) did not provide direct care to R1. Two out of two staff stated the facility staff provided oral care to resident every morning and R1 did not have any issues, pain or redness related to R1’s mouth, gums, or jaws. Two out of two staff stated R1’s responsible party would make arrangements for dentist appointments. Based on review of R1’s Physician’s Report dated 4/12/2023, R1 does not wear dentures and does not have special diet. R1 is able to feed himself/herself. R1 is not able to groom himself/herself. Based on review of R1’s Progress Note on 2/1/2023, staff did not note any issues related to oral care or resident refusing oral care. Staff are not ensuring resident is repositioned every two hours. On 2/15/2024, LPA Rai interviewed 3 staff, including staff (S1) who was the primary caregiver for R1. One staff (S3) did not have direct care experience with R1. Two out of two staff stated R1 was observed in the morning of 2/3/2024 before going to the hospital and R1 did not have any bruising or wounds on the buttocks. Two out of two staff stated R1 was able to reposition himself/herself and needed assistance to transfer. Two out of two staff stated the facility staff would assist R1 in sitting in the dining room or living room. S1 stated R1 would be repositioned every two hours or even sooner depending on if R1 wanted to go to dining room or living room. Page 3 of 3. Based on review of R1’s Physician’s Report dated 4/12/2023, R1 does not require continuous bed care. R1 does not have a history of skin condition or breakdown. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Lead Caregiver Rosalia (Rose) Calungcagin and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2024 · control 26-AS-20240206092923

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Marcela Yanez and Simi Rai conducted an unannounced Required 1 Year visit. LPAs met with Lead Caregiver (S1), Rose (Rosalia) Calungcagin and stated the purpose of today's visit. S1 notified Licensee/Administrator Leilani Cortes of LPAs' visit and S1 stated Licensee/Administrator was busy at the time and unable to be present during today's visit. LPAs observed 2 staff in the facility, 5 residents at the facility and 1 resident out of the facility. LPAs observed 3 cameras in common areas of the facility. S1 stated the cameras only record video and no audio. LPAs observed 1 staff bedroom where in the door does not have locking capabilities. Staff S1 stated she resides in the staff room by herself. LPAs observed 7 day pill box on top of a table in staff room which was unlocked and accessible to residents in care . S1 stated the pill box belongs to her and the pill box contains prescription medication and vitamins. S1 removed the medication pill box and placed it in locked facility closet. LPAs observed office area which was converted to a living space for staff S2. LPAs observed a foldable mattress and S2's medication in a paper bag which were not locked and accessible to residents. S1 and S2 confirmed S2 is a live-in staff and sleeps at night in the office area 7 days out of the week. LPAs toured the facility kitchen and observed food supply of at least 2 days of perishable food and 7 days of nonperishable food. LPAs at random inspected 10 canned foods and observed 2 cans of food and 2 yogurts cups that had expired. While touring the kitchen LPAs observed a small pill cup contained 2 medication tablets which was left unattended in the kitchen cabinet which did not have locking capabilities. LPAs also observed 2 knives and 1 multi-purpose scissors on the kitchen counter, hidden underneath a kitchen towel by S1, which was unlocked and accessible to residents in care. Fire extinguisher located in the kitchen was observed last serviced on 01/20/2024. Continuation on LIC 809-C, Page 1 of 3. Page 2 of 3. LPAs observed 4 resident bedrooms. LPAs observed resident R1 was laying in bed and LPAs observed the bed was attached with full bed rails. S1 stated R1 was not under Hospice Services at this time. LPAs observed 1 bottle of hydrogen peroxide in resident R3's bathroom cabinet unlocked and accessible located in R3's bedroom. LPAs toured the garage and noted the door to the garage was unlocked during inspection. LPAs observed drawers in the garage, drawer which contained toxic chemicals such as Disinfecting wipes, Dishwasher Detergent and Spackle and tools such as Box Cutter Razor Blade, Hammer and Wrench. LPAs observed the garage drawer was unlocked and accessible to residents in care. Laundry area was observed laundry detergent was locked and inaccessible to residents. During visit, LPAs toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPAs observed 1 shed which contained tools that were accessible to residents in care. The shed door was not locked and staff had placed a round brick to stop the door from opening. LPAs observed 1 locked shed used for storage space. Both sheds were used as storage space and not habitual space. LPAs observed a pool in the backyard with two gates door which were locked and inaccessible to residents. LPAs observed Chlorine tablets near the pool filter in an unlocked gated area. LPAs observed all windows and screens in good repair and working condition. During inspection LPAs observed facility disaster drill which was conducted on 09/01/2024. LPAs inspected 3 bathrooms which all had non slip surface and grab bars in the showers. LPAs observed hot water temperature measured by thermometer which ranged from 108.9 - 109.2 degrees F. LPAs observed 1 prescription lotion, 3 ointment bottles and 1 multi-purpose scissors in the cabinet in Bathroom #1 which were unlocked and accessible to resident in care. LPA Yanez reviewed and inspected resident files and medication at random for two residents and all medications were recorded on the Centrally Stored Medication Record. LPAs reviewed 2 staff files. LPAs observed staff S2 did not have Statement of Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. Staff S1 confirmed S2 did not have the document in S2's file. Page 3 of 3. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Violation was provided during today's visit. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Licensee/Administrator was not present during exit interview. This report was reviewed with Lead Caregiver (S1), Rose (Rosalia) Calungcagin and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Sep 24, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(8) · Plan of correction due date: Sep 25, 2024

87555 (b)(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, Licensee did not ensure food stored at the facility were not expired wherein LPA Rai observed 4 out of 10 canned foods and packaged food were expired which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/Administrator was not present during today's visit. Licensee/ Administrator to submit a written plan of action understanding regulation and will ensure all food stored at the facility is not expired and in-service training is scheduled by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(f)(1) · Plan of correction due date: Sep 25, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on observation, Licensee did not ensure multiple knives were stored inaccessible to residents which LPAs observed in the kitchen, bathroom, garage and backyard which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Administrator to submit a written plan of action understanding regulation and will ensure knives are stored inaccessible to residents and in-service training is scheduled by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Sep 25, 2024

87705(f)(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol ... and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, Licensee did not ensure over-the-counter medication, supplements/vitamins, toxic substances, gardening supplies were stored inaccessible to residents with Dementia in staff room, backyard, office and bathroom which poses/posed an immediate Health, Safety,the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Administrator to submit a written plan of action understanding regulation and will ensure over-the-counter medication, supplements/vitamins, toxic substances, gardening supplies were stored inaccessible to residents and in-service training is scheduled by POC due date. (con't) or Personal Rights risk to persons in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Sep 25, 2024

87465 (h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, LPAs observed R1's medication was placed in small container in a cabinet which did not have locking capability which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Administrator was not present during today's visit. Administrator to submit a written plan of action understanding regulation and will ensure centrally stored medicines shall be kept in a safe and locked place and in-service training is scheduled by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Sep 25, 2024

87202 (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: Based on observation, LPAs observed a mattress and S2's medications in the office area. S1 and S2 stated S2 is a live-in staff and uses the office area as a bedroom which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Administrator to submit a written plan of action understanding regulation and will ensure facility maintains fire clearance and create a plan to occupy the office as a living space for S2 by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Sep 25, 2024

87608 Postural Supports (a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, LPAs observed resident R2 using a full bed rail and S1 confirmed R2 was not on hospice services which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Administrator to submit a written plan of action understanding regulation and to submit an exception request if R2 will continue to use a full bed rail by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Oct 1, 2024

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement was not met as evidenced by: Based on record review, 1 out of 2 staff files was incomplete and did not contain Statement of Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders which poses/posed an potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2024

Plan of correction: Licensee/ Administrator was not present during today's visit. Administrator to submit a written plan of action understanding regulation and will ensure staff files are complete by POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conduced an unannounced case management visit and met with Lead Caregiver, Rose (Rosalia) Calungcagin. LPA Rai stated the purpose of today's visit to assess the facility's request for an exception for R1's prohibited condition. The licensee has submitted an exception request for R1 who is depend on others to perform all activities of daily living. Staff were interviewed concerning R1's care and the requirement of the exception. R1 is not receiving Hospice services at this time. At approximately 8:32pm, LPA Rai observed R1 in a reclined position in bed. R1 was awake and LPA Rai attempted to conduct an interview but R1 did not respond to questions. R1 was not able to move arms, legs or hands. R1 was observed with contractures in the hands and R1 was unable to grab items such as a glass of water or hairbrush. S1 stated the facility staff provide assistance to R1 in all areas of activity of daily living. At this time, the Department is reviewing Licensee's request for the exception for R1. No deficiencies were cited. Exit interview conducted with Lead Caregiver, Rose (Rosalia) Calungcagin. A copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 23, 2023