Purple Pasta Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Leticia Manuel. LPA then met with Licensee/Administrator Penelope Pankey, who arrived shortly after. LPA performed a welfare check on residents in care and interviewed facility staff. LPA reviewed the care records for all residents in care, and the personnel files of all active staff. LPA, accompanied by Licensee’s staff, also toured the interior and exterior of the facility, and inspected all common areas and resident rooms. According to the facility’s license: The facility has a maximum capacity for six (6) residents, of whom up to one (1) may be non-ambulatory and up to one (1) more may be either non-ambulatory or bedridden. Only shared Bedroom #5, per the facility sketch, is approved to house non-ambulatory or bedridden residents. Up to two (2) residents may be under hospice care at any given time. Per LPA observation and manager interview and informed by LIC602 Physician’s Reports: During today’s inspection, there were a total of five (5) residents in care, of whom two (2) residents [Resident #1 (R1) and Resident #2 (R2)] were bedridden, which exceeds the bedridden capacity specified in the facility’s prior approved fire clearance and facility license. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] Additionally, upon LPA’s arrival at the facility, neither R1 nor R2 were occupying Bedroom #5. Only one (1) resident, R2, was under hospice care. During today’s visit, Licensee communicated with and secured consent from R1’s responsible person (RP), then moved R1 to Bedroom #5, as required. [CONTINUED ON LIC 809-C, 2 of 3] [CONTINUED FROM LIC 809] (Licensee explained that they believe R2 can turn and reposition themselves in bed; as part of the Plan of Correction, Licensee will contact R2’s physician to see if they would be willing to change R2’s status from bedridden to non-ambulatory. If the doctor does not concur, then Licensee will take legal steps to relocate R2 from the facility, which would bring the facility back in compliance with its prior approved fire clearance and facility license.) The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present. R2 had a gastronomy tube, which is a Prohibited Health Condition in the RCFE setting. Although Licensee is themselves a Registered Nurse (RN), and although Licensee had documentation that facility direct care staff had received hands-on training from a licensed professional on on gastronomy care, Licensee had not yet applied for and received an approved Exception Request from CCLD to retain R2, with this Prohibited Health Condition. Per available LIC602 Physician’s Reports and manager interview: At least four (4) of the five (5) residents in care had either Dementia or Mild Cognitive Impairment (MCI), and their doctors determined that they should not have direct access to cleaning chemicals; all five (5) residents also required facility staff to store and administer their medications, for safety. LPA observed multiple prescription medications, belonging to two residents, left unsecured/unlocked on top of the kitchen counter. Additionally, there were cold-storage medications for a third resident in the facility’s refrigerator which were left unlocked. LPA was able to touch and move said medications without the staff’s awareness, before handing said medications to staff to immediately lock up. During today’s visit, Licensee produced a locking box for those medications which must be stored in the refrigerator. Beneath the facility’s kitchen sink was an unlocked cabinet containing multiple cleaning chemicals. In the facility's laundry room, LPA observed cleaning chemicals stored next to non-perishable food; for example, a bottle of laundry detergent with a push-button spout was positioned directly above and inches away from some canned goods. During today’s visit, LPA directed staff to lock away all chemicals and to move the food to a separate storage area. The facility’s fire extinguisher was not serviced within the last twelve (12) months, as required. The smoke alarm device in Bedroom #4, which was present during the facility’s earlier fire clearance inspection, was removed/missing. During today’s visit, facility staff installed a replacement smoke alarm device in Bedroom #4. All other smoke alarms and the facility’s carbon monoxide detector were working. [CONTINUED ON LIC 809-C, 2 of 3] [CONTINUED FROM LIC 809-C, 1 of 3] In the facility’s backyard: LPA observed two (2) gardening hand spades with metal blades and one (1) container of fertilizer, left out in the open, which LPA handed to staff to lock away. There was a collection of unused medical equipment (i.e., walkers, wheelchairs, and shower chairs) that had accumulated in the facility’s backyard, which LPA directed Licensee to relocate/discard, so to not interfere with residents'/visitors’ enjoyment of the premises. Beyond this, the facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present. Night lights, flashlights, and facility telephone were all working. The First Aid Kit was complete with the required contents. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There were no active fireplaces or open-faced heaters accessible to residents. No pools or bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Required licensing postings were observed in visible areas of the facility. Licensee presented proof of current business liability insurance. The facility’s ambient internal temperature was complaint at 70 F. Hot water temperature at taps used by residents for grooming were initially too hot: Bathroom #1 Sink was 125.4 F and Bathroom #2 Sink was 128.1 F. (Regulation requires them to be between 105 F and 120 F). During today’s visit, adjustments were made to the facility’s water heater settings to bring these taps back into the complaint temperature range. Refrigerators and freezers used to preserve perishable food were compliant in temperature. There was at least two (2) days of perishable food, at least seven (7) days non-perishable food present, along with cooking/dining equipment and utensils. LPA observed the following food items (which ordinarily require cold-storage) being stored outside of the refrigerator: Celery, cabbage, eggs, and a prior-opened jar of mayonnaise. LPA provided corrective education to staff during today’s visit. During a review of resident records, LPA observed, and manager interview confirmed: While R2 had a LIC602 Physician’s Report (“Medical Assessment”) that was filled out, it was not signed by R2’s physician, as required. Licensee did not have a completed LIC602 Physician’s Report for Resident #3 (R3), either. For R1, R3, and Resident #4 (R4), Licensee did not have written proof of a negative Tuberculosis (TB) test result or chest x-ray screening for the resident, which was required before move-in. [CONTINUED ON LIC 809-C, 3 of 3] [CONTINUED FROM LIC 809-C, 2 of 3] For R1, R2, R3, R4, and Resident #5 (R5), Licensee did not have the name, address, and telephone number of the residents’ dentist to be called in the event of an emergency, as required. R3 had Diabetes (a “Restricted Health Condition” in the RCFE setting, per regulation), for which staff provided support and oversight of R3’s blood sugar testing (glucometer) and Insulin administration (flex pen). However, Licensee did not have written proof that five (5) of five (5) direct care staff [Staff #1 (S1) through Staff #5 (S5)] had received hands-on training from a licensed professional on Diabetes/Glucometer/Insulin, as was required before this care for R3 began. Licensee also did not have proof/documentation that they held a meeting/conference with the responsible person and other appropriate parties for R1, R3 and R4, for the purpose of reviewing and updating the resident’s written record of care / care plan within the last twelve (12) months, as was required. Durning a review of staff records, LPA observed, and manager interview confirmed: For five (5) of five (5) direct care staff (S1 through S5) plus themselves [Staff #6 (S6)], Licensee did not maintain written proof of a completed LIC503 Health Screening (or equivalent job-related physical examination) with negative TB test result, signed by a doctor, as required before employment. S4 and S5 did not have proof of current First Aid Training, as required. Licensee did not have an employee file/record for S5, as required. Although Licensee performed two (2) disaster drills within the last year, this fell short of the frequency and variety of disaster drills described in regulation. Licensee also did not have written proof that they provided PPE training within the last twelve (12) months to S1 through S5, as required. Eighteen (18) deficiencies were cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. Since one of the deficiencies represents a violation of the facility’s prior approved fire clearance, an Immediate Civil Penalty of $500 was charged/assessed (refer to the LIC421-IM page). Since one of the deficiencies is a repeat violation within the last twelve (12) months, a repeat violation civil penalty of $250 was also charged/assessed (refer to the LIC421-FC page). LPA also issued Technical Assistance (TA) regarding periodically measuring and recording residents’ body weights and regarding refresher training for staff on California Mandated Reporting requirements (refer to the LIC9102-TA pages). An exit interview was conducted with Licensee/Administrator Penelope Pankey, to whom a copy of this report, the LIC809-D pages, the LIC9102-TA pages, the LIC421-IM page, the LIC421-FC page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Apr 13, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced case management visit for a Plan of Correction (POC) clearance. LPA A. Rodgers identified herself and was granted entry by Care Giver Rossana Pinote. LPA met with Administrator Penelope Pankey and discussed the purpose of today’s visit. During today’s visit, LPA reviewed resident files including Admissions agreements, Medical Assessments, and pre-admission appraisal. LPA also reviewed staff files including training documents and criminal clearance background checks. LPA also reviewed the facility binder that included information needed during an emergency such as: A resident roster with the date of birth for each resident, appraisal of resident needs and services plan for each resident, A resident medication list for residents with centrally stored medications, Contact information for the responsible party and physician for each resident. An exit interview was conducted with Administrator/Licensee Administrator Penelope Pankey and a copy of this report, along with Licensee Rights (LIC 9058 03/22). The signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 16, 2025

Allegation investigated: Licensee accepted a resident requiring a higher level of care Staff are not adequately trained Staff left resident in wet diapers for an extended period of time

Licensing Program Analyst (LPA) Amy Rodgers made an unannounced visit to deliver finding of an investigation on the above-mentioned allegation. LPA met with Licensee/Administrator Penelope Pankey and discussed the basic elements of the complaint. The Department’s investigation consisted of interviews with staff, residents, and outside sources and a facility tour. On May 30, 2025, Community Care Licensing (CCL) received a complaint alleging that the Licensee accepted a resident requiring a higher level of care, Staff are not adequately trained, and staff left the resident in wet diapers for an extended period of time. More specifically, Licensee staff did not remove leg braces as part of physical therapy guidelines for Resident #1(R1) , R1 was not getting briefs changed at night, and staff needed resident care training. (CONTINUED ON LIC 9099C) Unsubstantiated (CONTINUED FROM LIC 9099) A records review of R1’s physician's report, hospital records, and pre-placement agreement revealed that R1 is not incontinent but does require temporary, continuous bed care due to leg surgeries and injuries. R1 requires staff assistance with bathing, dressing, grooming, and toileting. During interviews, R1 stated that staff were assisting with care needs; however, it was noted that two caregivers are needed to assist with incontinence care. R1's interview confirmed that a home health care provider is responsible for managing the leg brace and skin care. Interview with R1's home health care provider, as well as the licensee revealed that physical therapy and removing leg braces for skin cleaning will be addressed through R1's home health care providers. Staff Records and staff interviews revealed that one staff member is designated to cook and clean, and is not responsible for direct care duties. Further review of training documents confirmed that staff have completed the required CCL training. Interviews with care staff demonstrate an understanding of resident care training protocols. Based upon the information obtained during the investigation it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the violation occurred and is therefore UNSUBSTANTIATED. An exit interview was conducted with Licensee/Administrator Penelope Pankey A copy of this report was provided and their signature on this report confirms receipt.the state’s words, verbatim · CDSS document, Jul 15, 2025 · control 08-AS-20250522153659

Type of visit: Post Licensing

Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced post annual visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified themselves to, and explained the purpose of the visit Care giver Eduadro Hernandez. Administrator Penelope Pankey later joined the visit. LPA toured the facility and inspected each room of the facility, including resident rooms, bathrooms for resident and staff use, kitchen, common areas, and outside space. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for resident medications and resident and staff files. Medications were stored in their original container and locked, made inaccessible to clients. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. LPA reviewed multiple resident records. There were documents missing for all four resident: Resident #1, Resident #2, Resident #3 and Resident #4 and citations were issued during todays visit. (Continued on page 809-C) During the visit, LPA determined that Staff 1(S1) and Staff 2 (S2) was not associated to the facility and did not have an active fingerprint clearance. [Administrator was provided with an LIC811 Confidential Names List to identify S1 and S2 ] Interviews with S1 and S2 and the Administrator revealed that S1 and S2 had been working at the facility for more than 5 calendar days. LPA notified Administrator that S1 could not be present or working at the facility until all was associated to the facility. LPA observed S1 and S2 leave the facility during the visit. The following deficiencies were cited for missing medical assessments, missing admissions agreements, missing pre-placement agreements and for staff without criminal background clearance and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for staff without a criminal background clearance and noted on the attached LIC421BG form. An exit interview was conducted with Administrator Penelope Pankey , whose signature below confirms receipt of a copy of this report, the LIC811, LIC 809-D's and the LIC421BG and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, May 23, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit. LPA was met by Applicant Penelope Pankey and was granted entry into the facility. The purpose of today's visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 10/17/2024 and the facility is approved for 6(six) residents, 4(four) of which are ambulatory, one(1) non-amblatory and one (1) bedridden. During today's visit, LPA toured the facility and inspected all common areas, outside spaces, and a sampling of resident rooms across the facility. The facility was found to be clean, safe, and in good repair with no pathway obstructions. Private and common resident bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature in a sampling of resident bathrooms and kitchen were measured at 107 degrees Fahrenheit. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for resident medications and files. Fire extinguishers were observed throughout the facility and found to be in compliance. A functioning carbon monoxide detector and smoke detectors were observed in the facility. No bodies of water were observed near or on the premises. LPA observed 7-day supply of non-perishable food. Required postings were observed in a common area of the facility. LPA reviewed the applicant's Infection Control Plan and Emergency Disaster Plan. LPA conducted Component III with the applicant. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance. Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the Applicant Pankey, whose signature below confirms receipt of a copy of this report.the state’s words, verbatim · CDSS document, Mar 4, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): N/A COMP II Participants: Licensee/Administrator Penelope Pankey Interview Method: Telephone interview On 2/6/2025, 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 that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. 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. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 6, 2025