Real Elderly Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) David Marrufo arrived on 07/31/2026 for an unannounced inspection to follow up on a substantiated allegation of complaint investigation. LPA met with Licensee Jocelyn Real and stated the purpose of this visit. On October 23, 2025, the Department concluded a complaint investigation regarding the following allegation - resident sustained an unexplained fracture due to staff neglect. The licensee was cited for California Code of Regulations (CCR) Title 22, § 87468.2(a)(4). At the time of the complaint visit on October 23, 2025, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code 1569.49(f). See LIC9099-C page for more information. Page 1 of 2. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code § 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including, but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the resident (R1) who is immobile and requires two-person assist for all ADL’s sustaining an unexplained shoulder fracture. Based on interview with R1’s primary care physician it was stated that the displaced “comminuted” or fragmented bone injuries typically occur due to impact trauma, such as a fall of considerable height from a bed or during a shower and such injuries are not generally caused by mishandling or pulling of an arm. Today, 07/31/2026, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 (f) for a violation that the Department constitutes as a serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500.00 was previously issued on October 23, 2025, the amount of the civil penalty issued today will be $9,500. An Exit interview was conducted. A copy of the report was issued. Appeal rights were provided. Licensee Jocelyn Real and her signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Jul 31, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Jocelyn Real, Licensee. The purpose of the visit was to issue a citation for a deficiency found as part of a complaint investigation that the department received on 08/04/2025. On 07/19/2025, at approximately 0900 hours, a small purple bruise was found on resident R1’s right upper arm and reported to all staff via a group chat. It was not until 07/22/2025 that staff contacted R1’s home health nurse to report R1’s bruise. R1’s home health nurse advised staff to address the bruise at R1’s existing appointment on 07/24/2025 and to apply a cold compress for the time being. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Jocelyn Real, Licensee, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 31, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Nov 1, 2025

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: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Licensee did not ensure that facility staff arranged for medical care for R1’s upper right arm injury, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agrees to submit a plan of correction to the department by 11/01/2025 stating how the licensee will conduct in-service training with staff on arranging, or assisting in arranging, for medical and dental care appropriate to the conditions and needs of the residents. Once training is completed, the licensee shall submit training records to the department, including names of staff trained, training dates, training topics, and names and qualifications of trainers.

Allegation investigated: Resident sustained an unexplained fracture due to staff neglect

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Jocelyn Real, Licensee. On 08/04/2025, the department received a complaint with the above allegation. On 08/05/2025, LPA Marrufo conducted an initial complaint investigation visit. Resident R1 is non-ambulatory, does not attend a day program, and requires complete assistance with all activities of daily living (ADLs). R1 requires two-person assist when transferring between wheelchair and bed and has a history of minor bruising on his/her arms due to his/her fragile skin and arthritis. On 07/19/2025, at approximately 0900 hours, a small purple bruise was found on R1’s right upper arm and reported to all staff via a group chat. It was not until 07/22/2025 that staff contacted R1’s home health nurse to report R1’s bruise. R1’s home health nurse advised staff to address the bruise at R1’s existing appointment on 07/24/2025 and to apply a cold compress for the time being. See LIC9099-C page for more information. Page 1 of 2. Substantiated Staff were instructed not to provide care to R1 alone and that two staff were required to assist R1 with all his/her ADLs. On 07/24/2025, R1’s Primary Care Physician (PCP) examined R1 and noted a resolving ecchymosis/edema on R1’s right upper arm. An X-ray was ordered and showed a displaced comminuted proximal right humeral fracture. R1 was treated with an arm sling. During interview, R1’s PCP stated displaced “comminuted” or fragmented bone injuries typically occur due to impact trauma, such as a car crash or a fall “of considerable height” from a “bed or during a shower.” Such injuries are not generally caused by mishandling or pulling of the arm. Staff interviewed said that an unwitnessed fall would have been unlikely given R1 was immobile and the right side of R1’s bed was against the wall. Staff did not know how R1 sustained a shoulder fracture. Interviewed staff stated that there was no change to R1’s behavior or baseline in the days prior to when the bruise was discovered. Interviewed staff stated R1 always cried when he/she moved, changed, or was in pain due to the contractures of his/her arms and legs. Based on records review and interviews, there is preponderance of evidence to prove the alleged violation did occur; therefore, the allegation is substantiated. An immediate civil penalty of $500 is being assessed today for serious bodily injury or death. See LIC421IM for more information. See 9099-D for deficiencies cited per the California Code of Regulations, Title 22. Failure to correct the deficiency may result in a civil penalty. At the time of the inspection report on 10/23/2025, Licensee was informed that the incident is under review and future civil penalties may apply based on Health and Safety Code 1569.49. This report was reviewed with Licensee Jocelyn Real and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORT.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 26-AS-20250804131913

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Oct 24, 2025

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: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Licensee did not ensure that staff provided care, supervision, and services that meet the individual needs of resident R1 and that staff were sufficient in numbers, qualifications, and competency to meet R1’s needs to prevent R1 from sustaining an unexplained fracture, which poses an immediate health and safety risk to residents in care. *An immediate civil penalty of $500 is being assessed today.*the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee agrees to submit a plan of correction by Plan of Correction Due Date of 10/24/2025 stating how the licensee plans on conducting in-service training with staff on ensuring that the personal rights of residents are upheld, including the right to care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Once training is completed, Licensee shall submit copies of training records, including names of staff trained, dates of training, training topics, and names and qualifications of trainers to the department.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Geronimo Aries, Administrator. LPA announced the purpose of the visit. LPA observed 3 residents in the common area watching television. Room temperature measured at 70 degrees F. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature measured with thermometer a 40 degrees and 0 degrees F. LPA observed the facility monitors refrigerator temperature and water temperature measured daily and keeps a log of measurements. LPA toured 4 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. ADM tested the smoke detectors in the living room and found the smoke detector to function properly when tested. LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 116 to 116.8 degrees F. Page 1 of 2 Page 2 of 2 LPA toured the outside area and found the exits to be clear of obstructions. During tour LPA observed 2 locked storage shed used for storage and not living quarters. LPA observed a hand rail in backyard surrounding the whole back yard walking area. LPA observed a shaded area with chairs for residents to use. LPA observed fire extinguisher was last serviced on 08/06/25. LPA reviewed Fire and Earthquake log. Last disaster drill was conducted on 08/30/25 LPA reviewed resident records for 3 out of 5 residents. LPA reviewed 3 staff records. ADM and LPA reviewed Centrally Stored Medication Record and P & I money for 3 residents. No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Geronimo Aries and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 8, 2025

Type of visit: Case Management - Other

The purpose of this visit was to amend the Case Management -Incident issued on 11/5/2024 wherein the Department inadvertently did not issue a deficiency on the medication error reported on 10/30/2024. Please see LIC809-D for the deficiency. Appeal Rights attached. Exit interview was conducted with House Manager (HM). the report was provided to HM for review. A copy of the report was provided to HM.the state’s words, verbatim · CDSS document, Nov 26, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 27, 2024

87465 Incidental Medical and Dental Care. (a) ...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: Based on the interview and record reviewed, the facility staff were lack of supervision and resulted in resident R1 took resident R2's medications which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 26, 2024

Plan of correction: Licensee stated to submit a plan of correction by the POC due date to ensure staff to provide necessary supervision when administering medication to residents, and provide the staff training log of medication care training and providing care and supervision training.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management - incident visit and met house manager Janet Salvador (HM). This is an amended report due to new information from 11/5/24. On 10/30/24, the Department received an incident report reporting that a resident (R1) accidentally took other resident's medication. LPA interviewed Licensee (LCN), ADM, 1 staff, and 2 residents. During interview, LCN stated on 10/29/2024, he/she received a report from staff S1 that resident R1 had a medication error incident. LCN stated this was the first incident of medication error occurred in the facility. Staff S2 stated he/she found resident R1 took resident R2's medications while he/she was going to administer medication to resident R2. LPA obtained a copy of the incident report and LCN stated that they had notified R1 doctor regarding the incident. A copy of R1's doctor's instruction was obtained during visit. LPA reviewed/checked R1's 6 medications with R1's November 2024 centrally stored medication form/log, and they were all matched by counting the amount or number of medication in the bottle and cross referencing log. During visit on 11/5/24, the Department inadvertently did not issue a citation on the medication error. Therefore, a citation under Title 22, section 87465(a)(4) is being cited for today. Please see LIC809 and LIC809-D for deficiency. Exit interview was conducted with HM. The report was provided to HM for signature. A copy of the report was provided to HM.the state’s words, verbatim · CDSS document, Nov 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Jocelyn Real. LPA observed 4 staff and 2 residents in the facility. 2 residents went to day program. LPA reviewed 2 resident files and 2 staff files. LPA toured the facility inside out with ADM. License, ADM Certificate, and Personal Rights posters were observed in the facility. Family room, kitchen, dinning room and two restrooms were inspected. Bar and non skid mats were observed in the restrooms. 2 shared resident bedrooms, 2 single resident rooms, laundry room, and garage were inspected. Staff break area was observed in the garage. Three half rail beds were observed in the bedroom. ADM stated the facility has the document for that but was unable to provide during the inspection. ADM stated to provide later. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, knives closet, and cleaning product closet were observed locked. Room temperature was at 72 degree F, and hot water temperature was at 114 degree F in the facility. The temperature of the freezer was observed at -16 degree F and the temperature of the refrigerator was observed at 43 degree F. ADM tested the call button system, and it works fine. Fire extinguisher was serviced on 08/15/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were working fine. Front yard and backyard were inspected. Two storage rooms were observed at the backyard. There was no obstruction to block the walkways. Door alarm was observed installed at the main door. Flash lights, first aid box, and night light were observed in the facility. the last time the facility conducted the fire drill was on 8/18/2024. No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Sep 10, 2024