Raya's Paradise

Type of visit: Required - 1 Year

On Tuesday, 5/19/26, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual inspection visit at the facility. LPA met with the Administrator, and reason for the visit was discussed. Facility is licensed as a single-story residence, fire clearance for ten (10) non-ambulatory, and one (1) bedridden. Hospice waiver for eleven (11). Facility has eight (8) total bedrooms. Facility has two (2) bathrooms. At 10:20 am, LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Auditory alarm sensors are present on all exits. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 76.0°F., within the required range. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted in April 2026. Kitchen area is clean and free of clutter. LPA observed refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Knives/Sharps are stored in a locked kitchen drawer which is inaccessible to residents. Plates, cups, utensils, and two day supply of perishable food is properly stored and labeled. A seven day supply of nonperishable food is kept in detached garage and properly stored. Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet underneath the kitchen sink. [LIC 9099C]-Continued Fire Detection/Protection system is present in the facility. Multiple dual smoke\carbon monoxide detectors are installed, hardwired, and interconnected. Detectors were tested and function properly. LPA observed four (4) fire extinguishers located by the kitchen area, the front entrance, the rear of the facility hallway, and inside the garage. Extinguishers indicate full charge and display service date: 02/16/2026. Medications are stored in a secured medication cart in kitchen area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored inside living room cabinet. Laundry is located in the hallway, secured by an electric rolling shutter activated by a key switch accessible by staff only. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Hallway area storage cabinets were observed to contain fresh towels, linens and blankets, sufficient for residents. Commons: LPA observed living room, dining area, and all other common areas finding them as clean, organized and clear of obstruction. Furnishings observed as in good condition and provides adequate seating for residents. Multiple televisions observed in common areas, and resident bedrooms. Activities were observed as stored in a cupboard section of the living room, along with arts and crafts, board games, puzzles etc. Bedrooms are observed as clean with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 117.0°F. Within the required range. Garage is detached from the house and observed as locked and inaccessible to residents. Garage is also used as storage for emergency food supplies, resident related equipment, bottled water and PPE supplies. Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for residents. Outdoor furniture observed to be in good condition. There are no bodies of water in the facility. All trash cans were observed to be covered. [LIC 9099C]-Continued Resident records: At 12:35 pm, LPA observed records stored in a locked and secured office area, inaccessible to residents. Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be current and complete. Staff records: LPA observed records stored in a locked and secured office area, inaccessible to residents. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current. There were no health and safety hazards observed during the inspection. Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Case Management - Health Checks

At approximately 10:30 a.m. on 04/08/26 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with the assistant administrator and disclosed the reason for the visit. Today’s case management visit was conducted to ensure the health and safety of all residents. LPA toured the facility inside and out at 10:30 a.m. today, interviewed five (05) out of seven (07) residents between 10:35 a.m. and 11:00 a.m., and requested pertinent records, including but not limited to admission agreements, medical assessments, care plans, and staff and client rosters at 3:00 p.m. No immediate health or safety concerns were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 8, 2026

Type of visit: Case Management - Health Checks

On Thursday, 12/11/25, 1:25 pm, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct health and safety observations. LPA met with Administrator, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster During this visit, LPA conducted a tour of the facility, and interviewed resident and staff. Two (2) staff were observed providing care and supervision to residents. Residents were observed to be comfortable watching television, in conversation with other residents/staff, or resting in their rooms. No health and safety issues observed. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 11, 2025

Type of visit: Case Management - Health Checks

On Tuesday, 11/04/25, 10:05 am, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct health and safety observations. LPA met with Administrator, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster During this visit, LPA conducted a tour of the facility, and observed staff providing care and supervision to residents. Residents were observed to be comfortable watching television in the living room, in conversation with other residents/staff, or resting in their rooms. No health and safety issues observed. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Case Management - Health Checks

On Friday, 10/17/25, 9:10 am, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct health and safety observations. LPA met with Administrator, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster During this visit, LPA conducted a tour of the facility, and interviewed resident and staff. Two (2) staff were observed providing care and supervision to residents. Residents were observed to be comfortable watching television in the living room, in conversation with other residents/staff, or resting in their rooms. No health and safety issues observed. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 17, 2025

Type of visit: Case Management - Health Checks

On Friday, 10/10/25, 10:00 am, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct health and safety observations. LPA met with Administrator, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster During this visit, LPA conducted a tour of the facility, and interviewed resident and staff. Two (2) staff were observed providing care and supervision to residents. Residents were observed to be comfortable watching television in the living room, in conversation with other residents/staff, or resting in their rooms. No health and safety issues observed. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Case Management - Health Checks

On 10/03/25, at 10:55 am, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct a facility health and safety observation. LPA met with the Administrator, and reason for the visit was discussed. During this visit, LPA conducted a tour of the facility. Two (2) facility caregiver staff were observed working in the facility. One caregiver was assisting a resident in their room. The other caregiver was observed providing care and supervision to residents gathered in the living room. No health and safety issues observed. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Case Management - Health Checks

On 09/25/25, at 9:45 am, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct a facility health and safety observation. LPA met with the Administrator, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster During this visit, LPA conducted a tour of the facility, and spoke with residents and staff. Two (2) staff were observed providing care and supervision to residents. Residents were observed to be comfortable watching television, or resting in their room. No health and safety issues observed. Exit interview conducted and a copy of this report was provided to Admin.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Case Management - Health Checks

On Friday, 09/19/25, 10:30 am, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct health and safety observations. LPA met with Administrator designee, Kevin Moscoso, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster During this visit, LPA conducted a tour of the facility, and interviewed residents and staff. Two (2) staff were observed providing care and supervision to residents. Residents were observed to be comfortable watching television in the living room, in conversation with other residents/staff, or resting in their rooms. No health and safety issues observed. Exit interview conducted and a copy of this report was provided to Admin designee.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Health Checks

On 09/04/25, at 12:40 pm, Licensing Program Analyst, (LPA) Ray Comer, arrived for an unannounced case management visit to conduct a facility health and safety observation. LPA met with the Administrator, and reason for the visit was discussed. During the visit, LPA received the following documentation: 1. LIC 500 (Personal Roster) 2. Resident Roster 3. Resident POA /Conservator contact Information 4. Resident Admission Agreements (which include rent payment source information) Physical plant inspection: Facility is licensed as a single-story residence, fire clearance for ten (10) non-ambulatory, and one (1) bedridden. Hospice waiver for eleven (11). Facility has eight (8) total bedrooms. Facility has two (2) bathrooms. All rooms were observed as appropriately furnished, clean, and clear of obstruction. Common areas were observed as clean with shaded patio and seating sufficient for residents. All entrances\exits are equipped with a functioning delayed signaling system. Kitchen area observed with sufficient perishable and non-perishable food. Two (2) residents are receiving hospice services at this time. [LIC 9099 C]- Continued During this visit, LPA conducted a tour of the facility, and completed interviews with staff and residents. LPA also observed the facility's medication cart, and conducted an audit of resident medications, and associated records; Facility uses "Yardi EHR" software system. No health and safety issues observed. Exit interview conducted and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Required - 1 Year

On Friday, 06/27/25, 8:30 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual inspection visit at the facility. LPA met with the Administrator, and reason for the visit was discussed. Facility is licensed as a single-story residence, fire clearance for ten (10) non-ambulatory, and one (1) bedridden. Hospice waiver for eleven (11). Facility has eight (8) total bedrooms. Facility has two (2) bathrooms. At 8:50 am, LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Auditory alarm sensors are present on all exits. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F., within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted in April 2025. [LIC 9099-C]-Continued Kitchen area is clean and free of clutter. LPA observed refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Knives/Sharps are stored in a locked kitchen drawer which is inaccessible to residents. Plates, cups, utensils, and two day supply of perishable food is properly stored and labeled. A seven day supply of nonperishable food is kept in detached garage and properly stored. Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet underneath the kitchen sink. Fire Detection/Protection system is present in the facility. Multiple dual smoke\ carbon monoxide detectors are installed, hardwired, and interconnected. Detectors were tested and function properly. LPA observed four (4) fire extinguishers located by the kitchen area, the front entrance, the rear of the facility hallway, and inside the garage. Extinguishers indicate full charge and display service date: 02/20/2025. Medications are stored in a secured medication cart in kitchen area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored inside living room cabinet. Laundry is located in the hallway, secured by an electric rolling shutter activated by a key switch accessible by staff only. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Hallway area storage cabinets were observed to contain fresh towels, linens and blankets, sufficient for residents. Commons: LPA observed living room, dining area, and all other common areas finding them as clean, organized and clear of obstruction. Furnishings observed as in good condition and provide adequate seating for residents. Multiple large television monitors were observed in common areas and resident bedrooms. Activities were observed as stored in a cupboard section of the living room, along with arts and crafts, board games, puzzles etc. Bedrooms are observed as clean with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, at least one chair, and night stand. [LIC 9099C]-Continued Bathrooms were observed to be clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 108.0°F. Within the required range. Garage is detached from the house and observed as locked and inaccessible to residents. Garage is also used as storage for emergency food supplies, resident related equipment, bottled water and PPE supplies. Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for residents. Outdoor furniture observed to be in good condition. There are no bodies of water in the facility. All trash cans were observed to be covered. Resident records: LPA observed records stored in a locked and secured office area, inaccessible to residents. Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be current and complete. Staff records: LPA observed records stored in a locked and secured office area, inaccessible to residents. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current. There were no health and safety hazards observed during the inspection. Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Case Management - Other

On 06/11/25, at 08:50AM, Licensing Program Analyst Gina Saucedo conducted an unannounced site visit at this facility for the purpose of obtaining records. LPA met with Caregiver, Tiphanie Moreno and explained the purpose of the visit. The administrator was called and arrived five (5) minutes after. During this visit, LPA obtained the following information: 1. Census 2. LIC 601 3. LIC 500 4. Resident Roster 5. POA or Conservator (Contact Information) 6. Physician Report 7. Admission Agreement 8. Rent Payment Source Exit interview conducted and a copy of this report was issued.the state’s words, verbatim · CDSS document, Jun 11, 2025

Allegation investigated: Facility does not have adequate staffing to meet resident's needs. Staff does not follow up on resident's doctor's appointments. Staff is mismanaging resident's medications. Facility handrail is in disrepair.

At 10:30 AM, Licensing Program Analysts (LPAs) Huma Rahimi and Raymond Comer, conducted a subsequent complaint visit in response to the above-mentioned allegations. LPAs met with the Administrator, Brian Rosales, and explained the reason for the visit. An initial visit was conducted on 07/10/2023 by LPA LaQueena Lacy. During today's visit, at 10:45 AM, LPAs conducted physical plant tour. At 11:00 AM, LPAs requested resident and staff roster. At 11:15 AM, LPAs requested copies of pertinent information, which includes, but is not limited, to Maintanance Repair Log, Medication Log, Transportation Log, etc., relevant to the investigation. Between 11:30 AM – 12:45 PM, the team conducted an interview with the Administrator, two (2) Staff, a Licensed Vocational Nurse, one (1) out of seven (7) residents who were able to communicate, and two (2) out of six (6) family members. Continue on LIC 9099 Unsubstantiated Facility does not have adequate staffing to meet resident's needs: It was alleged that the facility is chronically understaffed. To investigate the above allegation, LPAs conducted records review and inspected the facility’s staff schedule. The schedule indicates that there are three shifts. During the day shift there are two (2) staff scheduled. During the night shift, there is only one staff available. Additionally, interviews with the Administrator and two staff revealed that they always have MedTech as a backup staff to cover for any shift, or during an emergency. Interview with a resident and two (2) out of six (6) family members did not express any concerns with the facility being understaffed. Furthermore, during today’s visit LPAs observed enough staff available to provide care and supervision to residents in care. Based on the record review, interviews and LPAs observation, this allegation is deemed Unsubstantiated at this time. Staff does not follow up on resident's doctor's appointments: Regarding the allegation that Staff do not follow up on resident's doctor's appointments, it was alleged that Staff do not consistently follow up on after care, nor medications directives from doctor/hospital visits. LPAs’ Huma Rahimi, and Raymond Comer, conducted a facility records review and observed that Resident#1 (R1)’s appointments were both scheduled and noted as completed with the assistance facility Staff. LPAs’ interview with the Administrator, two (2) Staff caregivers, and Staff Licensed Vocational Nurse (LVN) revealed that the staff drove residents regularly to complete resident doctor's appointments. Additionally, Staff interviews revealed that in the event of any scheduling conflicts, Staff contacted both physicians and resident’s families that appointment rescheduling was necessary. Based on LPAs’ records review, interview with staff and residents, this allegation is deemed Unsubstantiated at this time. Staff is mismanaging resident's medications: It was alleged that the facility has not followed on after care and/or medications for residents. To investigate the above allegation, LPAs reviewed medication log for Resident #1 (R1) and did not observe any discrepancy or missed medication. Additionally, LPAs reviewed the monthly transportation log of R1’s doctor’s appointments and did not observe any missed appointments. Furthermore, interviews with the Administrator, Licensed Vocational Nurse, and two (2) staff revealed that all scheduled doctor’s appointments are completed with the assistance of the staff or family members. LPAs were informed that the facility also provide third party transportation in case of unavailability of the facility’s transportation. Interviews with a resident and two (2) out of six (6) family members revealed that they never missed any medication or follow up doctor’s appointments. Based on the record review, interviews and LPAs observation, this allegation is deemed Unsubstantiated at this time. Continue on LIC 9099C Facility handrail is in disrepair: With regards to the allegation of facility handrails being in disrepair, it is alleged that handrails along ramp leading from kitchen to the outside courtyard area are broken and have been in disrepair for several months. LPAs’ Huma Rahimi, and Raymond Comer, conducted a physical tour of the facility and found handrails secure and in good repair. A review of the facility’s maintenance repair ticketing system shows that on July 10, 2023, a ticket was generated with high priority to repair handguard rails; documentation indicates the repair was completed the same day. Interviews conducted with residents and their conservators evidence a consensus opinion that the facility is safe, and that facility plant issues are resolved in a timely basis. Based on LPA observation, records review and interviews with residents, LPAs has determined that this allegation is deemed to be Unsubstantiated at this time. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Sep 10, 2024 · control 31-AS-20230705081809

Type of visit: Required - 1 Year

On 08/20/24, 10:15 AM, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced Annual visit to this facility. LPA met with Facility Administrator, Brian Rosales, and reason for the visit was discussed. Facility is licensed as a single-story residence, fire clearance for ten (10) non-ambulatory, and one (1) bedridden. Hospice waiver for eleven (11). Facility has eight (8) total bedrooms; seven shared and one private, and two (2) bathrooms. At 10:30 AM, LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Auditory alarm sensors are present on all exits. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F., within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted in March, 2024. Fire Detection/Protection system is present in the facility. Multiple dual smoke alarm and carbon monoxide detectors are installed, hardwired, and interconnected. Detectors were tested and function properly. LPA observed Three (3) fire extinguishers located on the wall between the dining room and kitchen, behind the front door, and at the end of the hallway near rooms bedroom#7 and bedroom #8. Extinguishers display service date: 02/16/2024. [LIC 809C-continued] Kitchen: At 10:50AM, LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with an adequate supply of perishables and non-perishable food. Storage cabinets were observed to contain emergency dry food, condiments, and can goods. Food is observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are secured in a locked drawer and inaccessible to residents. Medications are stored in a secured medication cart in kitchen area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored inside living room cabinet. Laundry At 11:15 AM, LPA observed the hallway area. The laundry is located in the hallway, across from bedroom #3, and is secured by an electric rolling shutter activated by a key switch only accessible to staff. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Hallway area storage cabinets were observed to contain fresh towels, linens and blankets, sufficient for residents. Commons: LPA observed all common areas of the facility, including the living room and resident dining area. Common areas were clean and organized. Furnishings provide adequate seating for residents and are in good condition. Activities were observed as stored in a cupboard section of the living room, along with arts and crafts, board games, puzzles etc. Bedrooms are observed as clean with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 111.0°F. Within the required range. [LIC 809C-continued] Garage is detached from the house; observed to be locked by keypad-only entry, and inaccessible to residents. Garage is also used as storage for PPE supplies, incontinence supplies, wheelchairs, bedframes, emergency food, and other supplies for resident needs. Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. A locked shed in the backyard stores tools and maintenance supplies. All trash cans were observed to be covered. There are no bodies of water in the facility. Resident records: Secured cabinet in the kitchen area is locked and inaccessible to residents. A total of six (6) Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current. Staff records: Secured cabinet in the kitchen area is locked and inaccessible to residents. A total of six (6) Staff files were reviewed. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility representative, Administrator Brain Rosales.the state’s words, verbatim · CDSS document, Aug 20, 2024

Allegation investigated: Staff do not treat residents with dignity or respect Staff speak inappropriately to residents Staff did not seek timely medical attention for a resident Staff handled resident roughly

At 12:30 p.m. on 02/01/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Administrator and disclosed the reason for the visit. To investigate the allegations above, LPA conducted an initial visit on 08/24/2023 and toured the facility at 11:50 a.m. and reviewed records at 1:00 p.m. including but not limited to admission agreements, physician’s reports, care plans, and care notes. LPA conducted a subsequent visit on 11/16/2023 and interviewed a family member (F1) at 11:45 a.m., Staff #1 (S1) at 12:30 p.m., Staff #2 (S2) at 12:50 p.m., Staff #3 (S3) at 1:00 p.m., Staff #4 (S4) at 2:30 p.m., Staff #5 (S5) at 2:45 p.m., and Staff #6 (S6) at 3:00 p.m., and five (05) out of eight (08) residents between 1:30 p.m. and 2:30 p.m., and toured the facility at 2:30 p.m. Unsubstantiated Regarding the allegation “Staff do not treat residents with dignity or respect” it was alleged staff mistreat residents based on their financial status or race. Interviews with the seven (07) out of seven (07) staff revealed no staff have mistreated residents based on their status. Interviews with five (05) out of five (05) residents interviewed revealed they felt respected by staff and had no concerns about staff disrespect. LPA did not observe any mistreatment of residents during today’s visit or the two previous visits. Based on interviews and observations, facility staff treat residents with respect. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff speak inappropriately to residents” it was alleged Staff #7 (S7) used derogatory language towards residents. S7 was unavailable for interview. Interviews with the staff and residents revealed they had never heard S7 or any other staff using derogatory language. S4 described S7 as a “calm and level” individual. The facility terminated S7 due to attendance issues. Based on interviews, staff do not speak inappropriately to residents. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not seek timely medical attention for a resident” it was alleged staff ignored an open sore on the nose of Resident #1 (R1) and do not attempt to treat it. Interview with F1 revealed R1’s nose sore had been an ongoing issue for several months. The facility scheduled several appointments to address the sore. Interview with S1 revealed the sore was first noticed in July 2023 by a physician. The facility scheduled a biopsy in September 2023. Staff have treated the sore with ointment and bandaids, but R1 often picks off the bandaid and picks at the sore. Due to the insurance authorization process taking longer than expected, R1's treatment also has taken longer than expected. Record review of R1’s care plan noted they receive ointment twice daily for the sore. Medical notes revealed R1 had an initial physician’s appointment on 07/05/2023 and was offered a referral to a dermatologist. R1 refused the referral. A biopsy was performed on 09/11/2023 and a follow-up appointment was attended on 09/13/2023. Appointment notes confirmed the facility is treating R1’s lesion with Mupirocin ointment. S3, S4, and S6 confirmed that it has been an ongoing issue treated by ointment and bandaids as well as medical appointments. Interview with R1 revealed it does not hurt, though the bandaid does get itchy, so they take it off occasionally. R1 was observed on 11/16/2023 wearing a bandaid on their nose. LPA conducted a follow-up interview with S1 at 3:30 p.m. on 01/30/2024 who confirmed the facility has worked with F1 to fully heal R1’s sore, and the sore is almost healed. Based on interviews and record review, the facility sought timely medical attention for R1’s sore. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff handled resident roughly” it was alleged S2 yanks down Resident #2 (R2) to transfer them to their wheelchair. Interview with S2 revealed they worked in the facility only temporarily, but they never yanked or mishandled any residents. S2 used the assistance of another staff to transfer R2 for safety which was the protocol. Interviews with staff revealed they had never seen S2 or any other staff handle R2 or other residents in a rough manner. Interview with R2 at 2:20 p.m. on 11/16/2023 revealed they felt respected by staff and have never been treated roughly. R2 further stated they enjoyed living at the facility. R2 did not iterate further on how they are transferred from their wheelchair. At approximately 2:30 p.m. on 11/16/2023 LPA observed two staff assisting R2 in transferring from their wheelchair. Based on interviews and observations, facility staff do not handle residents roughly. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health and safety hazards were observed during this visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 1, 2024 · control 31-AS-20230816104132