Quality Care Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility Staff, Nancy Cudal,and Licensee Kristine Juarez Continual Administrator's Certification for Administrator Oscar Chavez expires 02/18/2027. There are currently 41 residents who reside at this home and there is 1 resident on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested in multiple resident bedrooms between 105 and 113 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA reviewed a sample of staff and resident files, Emergency Disaster Plan, Plan of Operation, Infection Control Plan, and Disaster drills. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with, Facility Staff, Nancy Cudal, and Licensee Kristine Juarez, copy of report left at facilitythe state’s words, verbatim · CDSS document, Jun 30, 2026

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.

Allegation investigated: Licensee does not ensure staff have the ability to communicate clearly with the residents

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to investigate the above allegations. LPA met with facility Licensee, Kristine Juarez, and explained the purpose of today's visit. Regarding the allegation that the licensee does not ensure staff have the ability to communicate clearly with residents, interviews were conducted with multiple residents. Residents reported that staff are able to communicate with them and assist them with their needs. Several residents stated that staff occasionally use hand gestures, translation applications, or assistance from other staff members when language barriers arise. However, residents consistently reported that staff ultimately understand their requests and provide assistance with meals, medications, housekeeping, personal care, and other needs. No residents interviewed identified specific incidents in which communication barriers resulted in unmet needs, lack of care, or resident harm. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted with Licensee, Kristine Juarez , and copy of report provided Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 16, 2026 · control 24-AS-20260609174536

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management / Health Checks. LPA met with facility Administrator Oscar Chavez, and explained the purpose of today's visit. LPA conducted a Health/Safety check on Resident 1. Resident 1 was in their bedroom watching sleeping but woke for long enough have a short conversation. LPA interviewed Resident in their room privately. Resident 1 appeared to be safe and communicated openly. LPA asked Resident 1 multiple questions, documented on separate 812. Resident 2 left the facility walking on 04/11/2026 and was hit by a car when walking to a nearby store. Facility administrator stated when resident 2 did not return to the facility on 04/11/2026 they went to search for them in Kern hospital. Resident 1 was located at Kern hospital on 04/13/2026. The facility did call Kern hospital on 04/11/2026 attempting to locate Resident 2 but they changed their name upon admission. Resident 2 will need multiple surgeries and will remain at Kern hospital. Facility administrator is not able to contact resident 2's relatives as they did not provide contact information. Exit interview conducted with facility Administrator Oscar Chavez and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management / Health Checks. LPA met with facility Administrator Oscar Chavez, and explained the purpose of today's visit. LPA conducted a Health/Safety check on Resident 1. Resident 1 was in their bedroom watching television. LPA interviewed Resident in their room privately. Resident 1 appeared to be safe and communicated openly. Exit interview conducted with facility Administrator Oscar Chavez and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Allegation investigated: Facility staff did not arrange, or assist in arranging, for medical care for a resident in care Residents are not accorded safe, healthful and comfortable accommodations Facility staff did not ensure supplies necessary for personal care was readily available to each resident Facility staff are administering medications that have not been authorized by the person's physician. Facility staff did not receive appropriate training

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to investigate the above allegations. LPA met with facility facility staff Nancy Cudal, and explained the purpose of today's visit. Regarding the allegation Facility staff did not arrange, or assist in arranging, for medical care for a resident in care. Resident 1 was refusing physical therapy in the past. Resident 1 is now receving physical therapy. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiated Regarding the allegation Residents are not accorded safe, healthful and comfortable accommodations. Resident 1 communicated during two visits to the facility one on 12/29/2025, and 01/31/2026 that they are doing ok, and safe at the facility. LPA observed during a visit to the facility on 01/31/2026 Resident 1's room appears clean, they were watching television and appeared to have clean clothing. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Facility staff did not ensure supplies necessary for personal care was readily available to each resident. During visits to the facility on 12/29/2026, and 01/31/2026, Resident 1 does have personal care items including deodorant, toothbrush, and lotion readily available. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Facility staff are administering medications that have not been authorized by the person's physician. LPA reviewed resident 1's prescribed medication list. LPA observed staff 1 assisting facility residents with medications. LPA reviewed Resident 1's Centrally Stored Medication record provided to the facility by pharmacy. Resident 1 is being given all prescribed medication.Staff 1 has required training to assist residents with prescribed medications. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation Facility staff did not receive appropriate training. LPA reviewed resident 1's prescribed medication list. LPA observed staff 1 assisting facility residents with medications. LPA reviewed Resident 1's Centrally Stored Medication record provided to the facility by pharmacy. Resident 1 is being given all prescribed medication. Staff 1 has required training to assist residents with prescribed medications. Staff 1 has all required training to provide care to residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted with facility staff Nancy Cudal, and copy of report providedthe state’s words, verbatim · CDSS document, Jan 31, 2026 · control 24-AS-20251211100546

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(g)(1) · Plan of correction due date: Feb 14, 2026

87217 Safeguards for Resident Cash, Personal Property, and Valuables (g) Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care, including, but not limited to the following:(1) Records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. The following requirement has not been met as evidenced by: Based on observation the facility staff was not keeping accurate record on a ledger documenting resident 1's purchases, which poses a potential, health, safety, or personalm rights risk to residents in carethe state’s words, verbatim · CDSS document, Jan 31, 2026

Plan of correction: Facility Administrator will provide receipts and updated purchase ledger to LPA by POC date of 02/14/2026.

Type of visit: Office

On 01/13/2026, the Non-Compliance Conference was changed to an Informal Office Meeting. The purpose of the informal meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during the meeting. The following were in attendance: Kristine Juarez, Licensee Representative Alma Espinal, Administrator Nieva Ruiz, Operations Manager Alexandria Walton, Licensing Program Manager Shawna Doucette, Licensing Program Analyst The following concerns were addressed: Fingerprint Clearance Control of Property Safeguards to client cash resources Facility Records A copy of this report was discussedthe state’s words, verbatim · CDSS document, Jan 13, 2026

Allegation investigated: Staff withheld resident’s personal property

On 12/29/25, Licensing Program Analyst (LPA) J. Duarte and Licensing Program Manager (LPM) A. Walton, arrived unannounced to conduct a complaint investigation. LPA introduced self, stated the purpose of the visit. LPA and LPM met with Administrator, Oscar Chavez The Department has investigated the complaint alleging: Staff withheld resident's personal property. During the course of the investigation, LPA and LPM interviewed the Administrator and reviewed records. LPA and LPM verifed that R1's ID is on file. Based on interviews, it was determined that facility staff will provide R1's ID to R1 when requested. Facility staff will not provide R1's ID to a third party unless the facility receives approval from R1. 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. No deficiencies issued during this inspection. Exit interview conducted. A copy of this report was provided to Administrator, Oscar Chavez, whose signature on this form confirms receipt of this document. Unfoundedthe state’s words, verbatim · CDSS document, Dec 29, 2025 · control 24-AS-20251219164446

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette and Jimmy Duarte arrived at the facility unannounced to conduct a complaint investigation. During the course of the investigation LPA's observed additional deficiencies. LPA met with Administrator Nancy Cudal. Due to technical issues LPA had to reissue the 809D. The purpose of the report is to add the missing 809D page and civil penalty. LPA reviewed records and observed discrepancies in S1's file. After checking LIS, it was found S1 was not listed to be fingerprint cleared. S1's clearance shows pending. LPA obtained copies of facility records and staff schedule. During the records review of S1's file, LPA observed S1 to not have a current TB test. S1 took her file and marked the positive box and wrote a date of 8/17/25, altering the health screening. Additionally, facility Administrator resigned 11/12/25. Facility does not have a current Administrator. Administrator Nancy Cudal is assisting until facility finds an Administrator. Refer to 809D A copy of this report was provided along with plans of correction and appeal rights. A Civil Penalty was issued.the state’s words, verbatim · CDSS document, Dec 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 16, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Licensee had S1 at the facility who was not fingerprint cleared according to LIS and Guardian which poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Licensee agrees to remove S1 from the facility and not return until fingerprint cleared. Licensee agrees to conduct an investigation and submit findings by POC due date 12/16/25. S1 was removed. Civil Penalty was issued.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Jan 14, 2026

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by Licensee did not have a current Administrator due to Administrator resigning 11/12/25 which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette and Jimmy Duarte arrived at the facility unannounced to conduct a complaint investigation. During the course of the investigation LPA's observed additional deficiencies. LPA met with Administrator Nancy Cudal. LPA reviewed records and observed discrepancies in S1's file. After checking LIS, it was found S1 was not listed to be fingerprint cleared. S1's clearance shows pending. LPA obtained copies of facility records and staff schedule. During the records review of S1's file, LPA observed S1 to not have a current TB test. S1 took her file and marked the positive box and wrote a date of 8/17/25, altering the health screening. Additionally, facility Administrator resigned 11/12/25. Facility does not have a current Administrator. Administrator Nancy Cudal is assisting until facility finds an Administrator. Refer to 809D A copy of this report was provided along with plans of correction and appeal rights. A Civil Penalty was issued.the state’s words, verbatim · CDSS document, Dec 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Dec 26, 2025

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement was not met as evidenced by Licensee did not obtain a TB test for S1 and LPA observed S1 alter the health screening, writing in a date of 8/17/25 and marking the positive box which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 15, 2025

Plan of correction: Licensee agrees to submit a current health screening for S1 by POC due date 12/26/25

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.

Allegation investigated: Staff administered a medicaton to a resident without authorization

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to investigate the allegation above. LPA met with facility Facility staff, Nancy Cudal, and explained the purpose of today's visit. Regarding the allegation staff administered a medication to a resident without authorization. LPA conducted an interview with the resident, reviewed medication documentation, interviewed facility staff, and medical office staff. The resident is responsible for his own care and admission decisions and is not conserved. Record review showed documentation indicating that the resident declined the medication in September and October 2025. During the LPA’s interview, the resident—who is nonverbal but communicates effectively confirmed that they did not receive the injection and that they continue to refuse it. Staff interviews and documentation confirmed that the resident’s decision was respected and that no injection was administered without consent. This agency has investigated the complaint alleging staff administered a medication to resident without authorization. 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. No deficincies cited Per title 22 Regulations. Ext interview conducted with facility staff Nancy Cudal, and a copy of this report provided. Unfoundedthe state’s words, verbatim · CDSS document, Nov 5, 2025 · control 24-AS-20251028154925

Allegation investigated: Staff do not allow resident to access own funds

Licensing Program Analysts (LPA)'s Shawna Doucette and Daiquiri Boyd conducted an unannounced complaint visit and was granted entry by Staff Jennifer Hernandez. LPA met with Administrator Nancy Cudal. LPA explained the purpose of the visit. LPA reviewed records and conducted interviews. Based on records review and interviews, facility staff has possession of R1's bank card and are withdrawing rent for R1 out of R1's account. Administrator stated facility has had possession of R1's card since 12/24. R1's physicians report states R1 is unable to handle R1's own cash resources. Faciltiy did not obtain a payee for R1. Substantiated Based on interviews, R1 is receiving showers 2 times per week. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided. Based on the interviews, records review submitted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. A copy of this report with appeal rights and plan of correction was provided.the state’s words, verbatim · CDSS document, Oct 8, 2025 · control 24-AS-20250822143856

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Oct 9, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Licensee did not obtain a payee for R1's SSI money for rent and P&I money for R1 which poses an immediate health, safety and or personal rights risk to resident care.the state’s words, verbatim · CDSS document, Oct 8, 2025

Plan of correction: Licensee agrees to obtain a payee for R1 and will submit proof of payee by POC due date 10/9/25

Allegation investigated: Facility staff are not meeting resident diapering needs.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit. LPA interviewed staff and obtained copies of R1's file. Based on interviews and records review, R1 is not normally incontinent per LIC 602 and staff interviews. Staff interviews indicated R1 became ill and was soiling diapers more than every two hours. Facility staff then sent R1 to the hospital to be evaluated. Staff interviews indicated R1 was changed right before sending R1 to the hospital. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 22, 2025 · control 24-AS-20250722112548

Allegation investigated: Staff do not serve residents adequate amounts of food. Staff yell at residents. Staff withhold resident's funds.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit. Administrator Nancy Cudal contacted Administrator Alma Espinal via telephone who gave permission for Administrator Nancy Cudal to assist with this report. LPA interviewed residents and staff. LPA obtained a copy of this weeks menu. LPA observed leftovers from breakfast served from this morning. Facility served french toast, eggs and sausage. LPA observed kitchen staff starting to prep for lunch. Facility staff advised lunch will be a fish filet, rice, fruit and green beans. LPA reviewed and obtained copies of P & I records. Based on resident interviews and observation, Staff are serving adequeate amounts of food. Three out of three residents stated they are getting enough food. Unsubstantiated Based on interviews of 3 out of 3 residents, staff do not yell at the residents. Based on interview with Administrator there are not reports of staff yelling at residents. Based on interviews, 1 out of 3 residents state they receive their money when they ask for it and it is not withheld. 1 out of 3 residents money is handled by family. 1 out of 3 residents are waiting on a debit card that was ordered because the resident lost their ID and debit card. Based on interviews with Administrator, resident money is distributed every Monday. If a resident does not want money on Monday or requests money another day during the week then it is distributed if the resident has available money. Based on records review, residents are receiving P & I. Administrator is assisting resident in obtaining a new ID and debit card. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 27, 2025 · control 24-AS-20250625154604

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA)'s Shawna Doucette and Sarah Hurt arrived at the facility unannounced to conduct the Required Annual Inspection. LPA's met with Administrator Alma Espinal. LPAs toured the facility inside and out. LPAs observed adequate food supply. Smoke detectors and carbon monoxide detector were tested and are in working order. Facility has pull station fire alarm with sprinkler system. Fire extinguishers were serviced 2/10/25. Water temperature measured at 120 F. LPAs observed the following deficiencies: Sample of resident files were reviewed- R1 did not have a completed LIC 602. LPA's viewed several required boxes missing required information. R2 did not have a current needs and service plan. R3's physician report was not complete and was missing diagnosis. R3 did not have a current LIC602 for change in condition R3 went on hospice. Facility did not have a hospice care plan for R3. LPA observed a sample of resident's medication and medication records. R3's medication 1 started on 5/1/25. Pill bottle originally contained 30 pills. R3 has 8 pills left. R3 is missing a pill or it was administer twice in a day. Prescription indicates it should be administered once daily. R3's medication 2 started on 5/1/25. Pill bottle originally contained 30 pills. R3 has 7 pills left. Facility is missing or administered 2 of R3's pills. Facility staff did not properly log medication 3 starting on 5/16/25 which was hand written on the pill bottle for R3. Centrally stored log states medication 3 started 5/1/25. Medication is in a pill bottle containing 30 pills out of 45 pills. Med tech states it started PM but there is no documentation showing the medication started AM or PM for R3. R3's medication started on 5/1/25 AM per facility staff and is supposed to be administered 2 times per day. Facility staff later stated it started PM. Centrally stored log does not indicate if pill bottle was started AM or PM. Bottle contains 60 pills started 5/1/25 and has remaining of 40 pills. During the facility tour LPA Hurt observed resident room screens screwed into the wall. A copy of this report was provided to the Administrator with plan of corrections and appeal rights.the state’s words, verbatim · CDSS document, May 21, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Staff are not meeting resident's hygiene needs

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit. LPA toured the facility. LPA checked resident's room. Resident was not at the facility during visit. On 1/17/24, LPA attempted to interview R1 via telephone however R1 is unable to communicate verbally due to a medical condition. Investigated on 24-AS-20241101104516 Based on interviews and records review, it is undetermined whether or not the facility is meeting the residents hygiene needs. LPA reviewed resident records, indicating resident is receiving prescribed medications. LPA reviewed shower schedule indicating resident is receiving showers weekly. LPA reviewed LIC602 indicating resident can leave the facility unassisted. Unsubstantiated Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 20, 2025 · control 24-AS-20250107084538

Allegation investigated: Resident's hygiene needs are not being met Residents bed sheets are not being changed Transportation for appointments not provided

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit. LPA toured the facility. LPA checked resident's room. Resident was not at the facility during visit. On 1/17/24, LPA attempted to interview R1 via telephone however R1 is unable to communicate verbally due to a medical condition. Based on interviews and records review, it is undetermined whether or not the facility is meeting the residents needs. LPA reviewed resident records, indicating resident is receiving prescribed medications. LPA reviewed shower schedule indicating resident is receiving showers weekly. LPA reviewed LIC602 indicating resident can leave the facility unassisted. Unsubstantiated Based on observatoin and interviews, LPA toured the faciliity on 1/16/24, and observed bedding on R1's bed. LPA toured the facility today and room was in the process of be cleaned and sheets were being changed. Based on records review and interviews, R1 has a current LIC 602. Facility doctors schedule visits to see resident's at the facility. R1 saw the Psychiatrist on December 18, 2024 and will see the Psychiatrist today. R1 was not at the facility during the visit and was out in the community. Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 20, 2025 · control 24-AS-20241101104516

Allegation investigated: Staff is over medicating a resident while in care Staff is not meeting a resident's medical needs while in care

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit. LPA reviewed R1's medications. Medications are being administered as prescribed. LPA reviewed R1's file and obtained copies. LPA interviewed resident and staff. LPA intervirewed R1's emergency contact. LPA toured the facility. Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 16, 2025 · control 24-AS-20250108084254

Allegation investigated: Staff do not prevent resident from leaving the facility unassisted

Licensing Program Analyst (LPA) Shawna Doucette (LPA) conducted a visit to deliver findings. LPA discussed the purpose of the visit and the elements of the allegations with Caregiver/Office Staff Jan Krizia Adajar. Administrator Nancy Cudal gave permission for Caregiver/Office Staff Jan Krizia Adajar to sign for this report. LPA reviewed records and interviewed staff. LPA obtained copies of residents file, which was incomplete. Facility did not have a completed LIC 602 signed by a doctor. Facility has LIC 601 completed but not signed. Admissions agreement was signed, but was incomplete Pre Placement Appraisal was blank and Needs and Service Plan was blank. Centrally stored log was complete. Due to lack of documentation, LPA was unable to determine if R1 can leave facility unassisted. Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 10, 2024 · control 24-AS-20241016102317

Allegation investigated: Staff did not provide adequate supervision resulting in resident eloping from facility. Staff did not file report in a timely manner.

Licensing Program Analyst (LPA) Shawna Doucette (LPA) conducted a visit to commence a complaint investigation. LPA discussed the purpose of the visit and the elements of the allegations with Caregiver/Office Staff Jan Krizia Adajar. Administrator Nancy Cudal gave permission for Caregiver/Office Staff Jan Krizia Adajar to sign for this report. LPA reviewed and obtained copies of R1's file. Based on interviews and records review R1 can leave facility unassisted per LIC602. Based on records review and interviews, facility reported to Bakersfield Police Department report number 2024-00146406 on 12/3/24. Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 10, 2024 · control 24-AS-20241204234223

Type of visit: Office

On 10/22/24 Licensee Kristine Juarez arrived at the Fresno Regional Office and requested to meet with Licensing Program Analyst Shawna Doucette. Licensing Program Analyst Shawna Doucette and Licensing Program Manager See Moua met with Licensee Kristine Juarez and Alma Espinol. The purpose of the meeting was to discuss the complaint received on 10/16/24 and the documents that were requested from the complaint inspection. During today’s meeting, copies of all utility bills that was requested were provided to the LPA. POC for the substantiated complaint was provided during the meeting. LPA and LPM also followed up on R1 for the complaint received on 10/16/24. The complaint alleges that R1 AWOL from the facility and was missing. Information was provided that R1 was found at the hospital. R1 was reassessed and requires a higher level of care. Hospital case worker is working on discharging R1 to a nursing facility. During the meeting, facility roster was provided. A copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2024

Allegation investigated: Facility failed to pay electrical bill

Licensing Program Analyst (LPA) Shawna Doucette (LPA) conducted a visit to commence a complaint investigation. LPA discussed the purpose of the visit and the elements of the allegations with Administrator Nancy Cudal. LPA interviewed Administrator. LPA obtained a copy of the electric bill showing a past due balance of $13,878.18. LPA received a photo of the PG & E Final notice posted at facility. Facility did not report to Licensing electric was going to be shut off. LPA requested copies of utility bills (water, garbage, electric, gas, phone) for July 2024, August 2024, September 2024 and October 2024 (or most current) submitted by 10/15/2024. LPA toured the facility and observed the power to be on and water was running. The facility was set at a comfortable temperature. Substantiated Based on the Departments interviews, records review, and photos submitted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Oct 12, 2024 · control 24-AS-20241011073600

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d)(5) · Plan of correction due date: Oct 16, 2024

87211 Reporting Requirements (d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their representatives, in writing within two business days of any of the following specified events, or knowledge thereof: (5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. This requirement was not met as evidenced by: Licensee did not report to Licensing Final Notice from PG & E that the electric was going to be shut off which poses an immediate health safety and or personal rights risk.the state’s words, verbatim · CDSS document, Oct 12, 2024

Plan of correction: LIcensee agrees to submit copies of all utilities for the months listed on this report and licensee agrees to submit a written understanding of how this regulation will be met by POC due date 10/15/24.

Allegation investigated: Facility is not safeguard resident’s property Resident is not getting is P & I funds Facility uses intimidation to violate residents personal rights

Licensing Program Analysts (LPA)'s Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA's explained the purpose of the visit. LPA requested a copy of and reviewed the resident roster. LPA interviewed Administrator. Facility does not have a client by the name listed in this complaint. Based on LPA's interviews and record review, this agency has investigated the complaint alleging, Facility is not safeguard resident’s property, Resident is not getting is P & I funds and Facility uses intimidation to violate residents personal rights. We have found that the complaint was UNFOUNDED, which means it could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint. An exit interview was conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Oct 7, 2024 · control 24-AS-20241003164659

Allegation investigated: Facility is not administering residents medications Facility is not meeting the residents needs

Licensing Program Analysts (LPA)'s Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA's explained the purpose of the visit. LPA requested copies of R1's file. LPA toured the facility. LPA interviewed resident and staff. Based on record reviews and interviews, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 7, 2024 · control 24-AS-20241003163936

Allegation investigated: Staff mismanaged resident's medication

Licensing Program Analyst (LPA) Shawna Doucette (LPA) conducted a visit to commence a complaint investigation. LPA discussed the purpose of the visit and the elements of the allegations with Administrator Nancy Cudal. LPA reviewed records and interviewed staff and residents. Based on records review and interviews, there is missing documentation for pain medication (PRN) being administered for R1. R1's June 2024 MARS log shows Olanzapine twice but does not show why one of the medications was not being administered. It is unknown if the medication was discontinued due to lack of documentation or missed for June 2024. Based on the Departments interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. Civil Penalty issued for repeat violation. Substantiatedthe state’s words, verbatim · CDSS document, Sep 10, 2024 · control 24-AS-20240627092941

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 11, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by Licensee had two loggings of the same medication by different doctors which was not logged as to why it was not administered and PRN's were not properly documented for the month of June.2024 which poses an immediate health safety and or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Sep 10, 2024

Plan of correction: Plan of Correction Licensee agrees to develop a plan for logging PRN and prescription medication and submit by POC due date 09/11/24. Civil Penalty issued for repeat violation

Allegation investigated: Staff does not ensure resident is provided clean clothing. Staff does not ensure resident attends scheduled appointments. Staff does not ensure resident is provided shoes. Staff shaved resident's hair without resident's consent. Staff does not allow resident to receive personal calls.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Nancy Cudal. LPA explained the purpose of the visit. LPA interviewed staff. LPA obtained copies of residents file. LPA interviewed R1's family. LPA toured the facility and checked R1's room. LPA observed clean clothing for R1. Based on observation and interviews LPA was unable to determine if there was a time R1 did not have clean clothing. During the course of the visit, LPA observed clean clothing in R1's closet and drawers. Based on record review and interviews, LPA was unable to determine if staff ensures resident attends scheduled appointments. After records review, staff notes show R1 refused a medical appointment on May 7, 2024 which was rescheduled for May 31, 2024. After conducting interviews, it was found R1 does refuse medical appointments sometimes. During today's visit, R1 was at a medical appointment. Unsubstantiated Based on interviews, it is undetermined if R1 did not have shoes. After conducting interviews, it was found R1's shoes were misplaced and found in the laundry room. Based on interviews with staff and R1's family, it is undetermined if staff shaved R1's hair without R1's consent. Based on interviews, it is undetermined if staff do not allow resident to receive personal phone calls. After conducting interviews, it was found R1 sometimes denies phone calls. Based on interviews, observations and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 9, 2024 · control 24-AS-20240508153114

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA)'s Shawna Doucette and Brianna Miranda arrived at the facility unannounced to conduct the Required Annual Inspection. LPA's were granted entry by Staff Krizia Adajar. S LPA's met with Administrator Nancy Cudal. Licensee Representative Kristine Juarez responded to the facility to assist with the visit. LPAs toured the facility inside and out. LPAs observed adequate food supply. When entering the facility there was an urine odor. Carbon monoxide detector were tested and are in working order. Facility has pull station fire alarm with sprinkler system. Fire extinguishers were serviced 2/29/24, LPAs observed one extinguisher to not have charge. Water temperature in R3 (128.1) & R5 (139.9) were over the allowed temperature. LPAs observed the following deficiencies: Sample of resident files were reviewed- R3's physician report was not complete and was missing DX. Resident files did not have PRN orders from physician, no plan of care for residents with restricted. LPAs observed hospice records which were not complete. LPAs observed room 38 to have buildup in the shower. LPAs observed broken window, screens missing from windows, and screen torn. LPAs observed ice machine to have mold, on the side of the facility was broken furniture and other items. Sample of staff files were reviewed and LPAs observed staff training to not be current or documented properly. Licensee did not have documentation for staff training for resident on hospice. LPA observed a sample of resident's medication which were not recorded on centrally stored log and were not stored properly (R1). R1 did not receive medication from 11/2023 through 4/2024, facility does not have document records for this time period. LPA's observed cleaning supplies to be in unlocked closets and outdoors on side of facility accessible to residents. LPAs observed Administrator working in facility without being associated to the facility since May 2024. LPA's observed R6 to have full bed rails with no physician's order. Hospice order states R6 is approved for half bed rails. Deficiencies were cited on LIC809D and civil penalties were issued. Exit interview was completed, a copy of this report LIC809, LIC809D, and appeal rights were provided to Licensee Representative Kristine Juarez.the state’s words, verbatim · CDSS document, Jun 19, 2024

Type of visit: Office

An informal meeting was held on 04/30/2024 at the Fresno Regional Office. The purpose of the informal meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during this meeting. The following were in attendance: Kristine Juarez, Licensee Representative Ria Loria, Administrator Nieva Ruiz, Operations Manager Sergiy Pidgirny, Licensing Program Manager Shawna Doucette, Licensing Program Analyst The following concerns were addressed: Responsibility of Licensing Governing Body, Administrator Qualifications and Duties, Care and Supervision, Medications, Food, and Reporting Requirements. TSP was offered to Licensee. Licensee was provided with copies of all applicable regulations and/or Health and Safety Code and a copy of this report.the state’s words, verbatim · CDSS document, Apr 30, 2024

Allegation investigated: Unqualified staff providing care and supervision.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. LPA contacted Administrator Ria Loria via telephone who gave permission for Staff Paula Maribel Brizuela to sign for the report. LPA interviewed staff and residents. LPA toured the facility. LPA reviewed staff file for S1. LPA obtained a copy of the staff schedule and the resident roster. LPA reviewed staff schedule and found S1 is working in the facility on 4/17/24, 4/19/24 and 4/20/24 and is not associated to the facility. LPA reviewed S1's file, which only consisted of the LIC 501. Facility did not have any other information for S1. Substantiated Based on interviews, observations and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided. Based on the Departments interviews and records review S1 worked in the facility on 4/17/24, 04/19/24 and 4/20/24, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. Civil Penalty was issued. Refer to 809 and 809D for additional deficiencies observed during visit. A copy of the this report was provided to the Administrator with appeal rights and plan of correction.the state’s words, verbatim · CDSS document, Apr 22, 2024 · control 24-AS-20240417130037

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1522(C) · Plan of correction due date: Apr 23, 2024

1522 Fingerprints and criminal records; exemptions; criminal record clearances (C) Any person who provides client assistance in dressing, grooming, bathing, or personal hygiene. Any nurse assistant or home health aide meeting the requirements of Section 1338.5 or 1736.6, respectively, who is not employed, retained, or contracted by the licensee, and who has been certified or recertified on or after July 1, 1998, shall be deemed to meet the criminal record clearance requirements of this section. A certified nurse assistant and certified home health aide who will be providing client assistance and who falls under this exemption shall provide one copy of their current certification, prior to providing care, to the community care facility. The facility shall maintain the copy of the certification on file as long as care is being provided by the certified nurse assistant or certified home health aide at the facility or in a certified family home or resource family home of a foster family agency. This paragraph does not restrict the right of the department to exclude a certified nurse assistant or certified home health aide from a licensed community care facility or certified family home or resource family home of a foster family agency pursuant to Section 1558.the state’s words, verbatim · CDSS document, Apr 22, 2024

Plan of correction: Plan of Correction POC Licensee agrees to associate S1 to the facility by POC due date 04/23/24. Licensee will submit proof of association. Civil Penalty issued

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. During the course of the investigation, a Case Management was conducted to address additional deficiencies. LPA contacted Administrator Ria Loria via telephone who gave permission for Staff Paula Maribel Brizuela to sign for the report. During the course of the investigation, LPA reviewed S1's file. S1 only had an LIC 501 in the staff file. LPA also observed no activities or Activities Director for residents at the facility. A copy of the this report was provided to the Administrator with appeal rights and plan of correction.the state’s words, verbatim · CDSS document, Apr 22, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Apr 26, 2024

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidenced by Licensee did not have a complete personnel file for S1 which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2024

Plan of correction: Plan of Correction Plan of Correction Licensee agrees to submit a copy of S1's entire file including all Licensing requirements by POC due date 4/26/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87219(f) · Plan of correction due date: May 17, 2024

87219 Planned Activities (f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities, and shall be given such staff assistance as necessary in order for all residents to participate in accordance with their interests and abilities. The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents. The responsible employee shall have had at least one year of experience in conducting group activities and be knowledgeable in evaluating resident needs, supervising other employees, and in training volunteers. This requirement was not met as evidenced by Licensee does not have a full time staff for activities or planned activities for residents in care which poses an immediate health safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2024

Plan of correction: Plan of Correction Licensee agrees to hire a full time activities staff designated to create activities for residents and submit the staff hired information and a copy of a planned activities calendar by POC due date 5/17/24.

Allegation investigated: Staff are not providing adequate food service for residents Staff are not meeting resident's dietary needs

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. LPA explained the purpose of the visit. Staff Paula Maribel Brizuela advised the Administrator is currently out of the country. LPA toured the facilty. LPA checked the food and took photos. LPA took photos of the menu. LPA requested staff training for kitchen staff. Facility could not provide staff training documents for food service. LPA interviewed staff. Facility does not have a 2 day pershiable and a 7 day non pershiable food supply. LPA took photos. Facility is serving won ton soup and eggrolls with jello for lunch during visit. LPA oberved a small bowl of soup with 3 wontons in each bowl, 3 egg rolls and 2 small slices of oranges. The menu states liver an onions, mashed potatoes, sweet green peas, dinner rolls, cake and an alternative of roasted chicken. For dinner the menu states chili dog with cheese diced onions, french fries, pickle spear and cinnamon apple sauce. Facility is serving ground beef, boxed mashed potatoes and oranges. Substantiated Facility does not have qualified personnel creating the menu for residents. The menu is not being followed. Facility does not have the ingredients to cook what is on the menu. Facility does not have a menu for residents who require special diets. LPA found 5-7 pounds of hamburger meat not refrigerated that felt warm to touch and is planned to be served for dinner. Facility put warm meat back in freezer. Based on the Departments interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. Refer to 809 and 809D for additional deficiencies observed during visit. A copy of the this report was provided to the Administrator with appeal rights and plan of correction.the state’s words, verbatim · CDSS document, Apr 3, 2024 · control 24-AS-20240116151446

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(a) · Plan of correction due date: Apr 12, 2024

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Licensee did not have a sufficient amout of meat planned to cook for dinner. Facility had 5 to 7 pounds of meat out for dinner for 43 residents which poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 3, 2024

Plan of correction: Plan of Correction Licensee agrees to provide a written statement of quality and quanity of food that will meet the needs of the residents. by POC due date 04/9/24. Facility staff took out an additional 6.82 pounds of hamburger meat during visit to serve for dinner and stated facility would add canned green beans to the meal.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(7) · Plan of correction due date: Apr 9, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply:(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. Licensee did not provide a modfied diet menu for residents R1 thru R6 that require doctor order modified diets which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 3, 2024

Plan of correction: Plan of Correction POC Licensee agrees to create and submit a menu from a licensed professional or qualified person to meet the needs of residents requiring a special diet by POC due date 4/9/24.

Allegation investigated: Staff did not ensure that resident's toileting needs are met Staff did not safeguard resident’s personal belongings

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. LPA explained the purpose of the visit. Staff Paula Maribel Brizuela advised the Administrator is currently out of the country. LPA toured the facilty. LPA interviewed staff. Facility staff stated R1 did not have a roommate. Resident no longer resides at the facility. LPA requested a copy of R1's file. LPA reviewed the property list. Based on interviews and records review, it is not determined whether or not Staff did not ensure that resident's toileting needs are met and if Staff did not safeguard resident’s personal belongings. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided to Administrator via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 3, 2024 · control 24-AS-20240129151358

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. During the course of the Complaint 24-AS-20240116151446 visit, LPA observed additional deficiencies. LPA was unable to view staff training for kitchen staff. Facility does not have a nutritionist or dietician or a qualified person as a full time employee. Facility does not have a qualified staff assisting with creating menus. Facility does not have copies monthly menus. Facility has a generic menu posted, which is not being followed. LPA took photos. Facility does not have a 2 day perishable and a 7 day non perishable food supply. Facility had hamburger meat out on kitchen table in a metal pan which felt warm to touch. Facility staff placed meat back in freezer. LPA took photos. Refer to 809D. Civil penalty was issued for a repeat violation. A copy of the this report was provided to the Administrator with appeal rights and plan of correction.the state’s words, verbatim · CDSS document, Apr 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(28) · Plan of correction due date: Apr 26, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement was not met as evidenced by Licensee did not properly store uncooked hamburger meat which was left out and felt warm to touch. Facility staff placed meat back in the freezer which poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 3, 2024

Plan of correction: Plan of Correction POC Licensee agrees to properly store food and conduct a staff training on food storage and submit a copy of agenda and trained staff by POC due date 4/26/24 .

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(26) · Plan of correction due date: Apr 9, 2024

87555 General Food Service Requirements(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by Licensee did not have nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises, which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 3, 2024

Plan of correction: Plan of Correction POC Licensee agree to submit a plan on how this regulation will be met in the future and have sufficient food at the facility to meet the requirements of this regulation by POC due 0412/24. LPA will return to clear POC during a visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(17) · Plan of correction due date: Apr 26, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. This requirement was not met as evidenced by Licensee could not provide copies of trained staff that will meet this regulation which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 3, 2024

Plan of correction: Plan of Correction POC Licensee agrees to submit copies of a qualified person responsible for food service that will meet this regulation by POC due date 4/46/24.

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.

Allegation investigated: Staff do not afford residents privacy during phone calls

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Ria Loria. LPA explained the purpose of the visit. LPA interviewed staff and residents. After conducting interviews, it was found facility phone calls for residents are being transferred to staff's personal cell phones. Based on the Departments interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. A copy of the this report was provided to the Administrator with appeal rights and plan of correction. Substantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2024 · control 24-AS-20240111220531

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Mar 15, 2024

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 was not met as evidenced by Licensee sends calls to staff's personal cell phones for residents which does not allow privacy which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 6, 2024

Plan of correction: Plan of Correction POC Licensee agrees to submit in writing how this regulation will be met without using staff's personal cellphones for residents by POC due date 3/15/24

Allegation investigated: Unlawful evicted.

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Ria Loria. LPA explained the purpose of the visit. LPA interviewed staff. LPA obtained copies of R1 file and medical records showing R1 was in the hospital and then transferred to a higher level of care. Based on LPA's interviews, this agency has investigated the complaint alleging, Unlawful eviction. We have found that the complaint was UNFOUNDED, which means it could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint. A copy of this report was provided to Administrator via email. Unfoundedthe state’s words, verbatim · CDSS document, Mar 6, 2024 · control 24-AS-20231222111549

Type of visit: Case Management - Incident

LPA Shawna Doucette arrived at the facility unannounced to conduct a case management regarding a death that occurred on with R1. LPA was granted entry into the facility by Administrator Ria Loria. LPA met with Administrator Ria Loria. LPA interviewed Staff. LPA obtained copies of R1's records. LPA requested a copy of the death report which will be provided once received. LPA will review records and return if deficiencies are found once records are reviewed. An exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 6, 2024

Allegation investigated: Staff are hiding medications in other substances without the resident's knowledge

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced 10 day complaint visit and was granted entry by Staff Paula Maribel Brizula. LPA discussed the purpose of the visit. Staff Paola Maribel Brizula contacted Administrator Ria Loria via telephone who gave permission for Staff Paula Maribel Brizula to sign for this report. LPA interviewed both medication technicians. Based on interviews, it is not determined whether or not Staff are hiding medications in other substances without the resident's knowledge. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided to Administrator via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 23, 2024 · control 24-AS-20240214153005

Allegation investigated: Staff mismanaged resident's medication

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Staff Paula Maribel Brizuela. LPA explained the purpose of the visit. Staff Paula Maribel Brizuela contacted Administrator Ria Loria who gave permission for Staff to sign for this report. LPA interviewed Staff. LPA reviewed medication log and centrally stored log. Centrally stored log was missing medications for R1. Based on interviews, R1 missed the medication for 4 days, 1/1/24 - 1/4/24. Based on the Departments interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. Civil penalty was issued. Substantiated The Department found additional deficiencies during the course of the investigation, which will be addressed and cited on a separate 809 and 809D. A copy of this report was provided with plans of correction and appeal rights.the state’s words, verbatim · CDSS document, Jan 9, 2024 · control 24-AS-20240105154108

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 10, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evicdenced by: Licensee did not ensure R1's medication was administered from 1/1/24 to 1/4/24 which poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: Plan of Correction POC Licensee agrees to conduct training by the pharmacist to ensure this regulation is met and agrees to submit agenda, with pharmacist information and staff roster by POC due date 1/19/24.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Shawna Doucette arrived at the facility unannounced to conduct a complaint investigation. During the course of the investigation LPA observed additional deficiencies. LPA met with Staff Paula Maribel Brizuela. LPA interviewed staff. LPA reviewed records for R1. Facility did not have all of R1's medications listed on the centrally stored log that are currently being administered. LPA took a photo of R1's centrally stored log. Refer to 809d A copy of this report with plan of correction and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 9, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(6) · Plan of correction due date: Jan 19, 2024

87465 Incidental Medical and Dental Care(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 and includes: Licensee did not comply with this section by not having a centrally stored log for some of R1's medications which poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: POC Plan of Correction Licensee agrees to do a written statement on how this regulation will be met in the future. Licensee agrees to submit updated Centrally stored log to licensing by POC due date 1/19/24 Civil Penalty issued

Allegation investigated: Resident's dietary needs are not being met

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Ria Loria. LPA explained the purpose of the visit. LPA toured the facility and took photos of the food and the menu. LPA observed lettuce and 1 bag carrots only. LPA did not observe any fresh fruit. Administrator could not provide staff training or qualified staff to create a special diet menu for LPA to view. Facility menu had an old facility name on it "Golden Castle". LPA reviewed resident files. C1 did not have a diagnosis on C1's LIC602. C2 did not have a LIC 602 for this facility. See 9099C Substantiated Based on the Departments interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. The Department found additional deficiencies during the course of the investigation, which will be addressed and cited on a separate 809 and 809D. A copy of this report was provided to staff with plans of correction and appeal rights.the state’s words, verbatim · CDSS document, Oct 18, 2023 · control 24-AS-20231017081313

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(7) · Plan of correction due date: Oct 20, 2023

87555 General Food Service Requirements (b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidenced by: Licensee did not provide a special diet for C2 who requires a special diet on LIC602. Based on observation and interview, C2 had cereal for breakfast and raviolis, peaches and potato chips for lunch which poses a potential health safety and or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Oct 18, 2023

Plan of correction: Plan of Correction POC Licensee agrees to provide a menu of a special diet to meet the needs of C2 by POC due date 11/3/23.

Allegation investigated: Staff member mismanages residents' medication

Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit and was granted entry by Administrator Ria Loria. LPA explained the purpose of the visit. LPA reviewed C1 and C2's medications and medication records. Facility had a centrally stored log for all medications that came from the Medicine Shoppe pharmacy, however did not have centrally stored log for medications that came from other pharmacys. LPA was unable to determine a start date or review centrally stored logs from the previous month. LPA reviewed the MARS log which was not current. LPA reviewed the medications which were in bubble packs and were administered up until todays date. Based on the Departments interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. A copy of this report was provided to staff with plans of correction and appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Oct 18, 2023 · control 24-AS-20231004164333

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(6) · Plan of correction due date: Nov 3, 2023

87465 Incidental Medical and Dental Care (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by Licensee did not have a centrally stored log for some of C1's and C2's medications which poses a health safety and personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Oct 18, 2023

Plan of correction: Plan of Correction POC Licensee agrees to submit a written plan on how this regulation will be met and a copy of C1 and C2's centrally stored log listing all medications by POC due date 11/03/23

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Shawna Doucette arrived at the facility unannounced to conduct a complaint investigation. During the course of the investigation LPA observed additional deficiencies. LPA met with Administrator Ria Loria. Kitchen staff do not have training and facility does not have qualified staff to create a special diet for clients requiring a special diet per clients LIC602. C1's LIC602 are not current and do not list a diagnosis. C2's LIC602 is from another facility. During the visit, Administrator contacted C2's doctor and obtained an updated LIC602. Facility is not following special diet requirements in LIC602. See 809D A copy of this report with plan of correction and appeal rights were provided to Administrator.the state’s words, verbatim · CDSS document, Oct 18, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(17) · Plan of correction due date: Nov 3, 2023

87555 General Food Service Requirements (b) The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. This regulation was not met as evidenced by Licensee does not had trained kitchen staff or a consultation with a qualified person which poses a potential health safety and or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Oct 18, 2023

Plan of correction: Plan Of Correction POC Licensee agrees to provide staff training and provide proof of how this regulation was met by POC due date of 11/3/23.