Regency Park Oak Knoll

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility. LPA met with Business Services Director Jacqueline Hernandez and Administrator Annabelle Argenal. The purpose of the visit was explained to them. Annual fees are current. The facility is licensed to serve 206 elderly residents who are ambulatory and non-ambulatory, age 60 and above. Non-ambulatory rooms are rooms #101-#140 (excludes room # 110) and rooms #201-#267 (excludes room# 221, 222, 243). The facility is a two-story building located in a residential neighborhood. It consist of several resident bedrooms in both floors, a lobby seating area, offices, a dining room, a coffee bar, a studio dining room, a commercial kitchen, a medication room, a common shower, an activity room, a family room, a parlor, a courtyard in the first floor, a conference room, a TV room, a library, a laundry room, and patio in the second floor. Today’s inspection consisted of applying CARE tool, conducting physical plant tour, reviewing staff/residents records, checking residents’ food supply/medication, and interviewing staff/residents. Infection Control: The facility maintains current infection control plan, dated 4/1/26. Hand sanitizer and proper sanitation were observed during the visit throughout the facility. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Staff have TB test clearances on file. (CONTINUED ON LIC 809C) Operational Requirements: A plan of operation is maintained. Facility has a current liability insurance policy which covers from 08/01/2025 to 08/01/2026. Facility is operating within the license. Physical Plant/Environmental Safety: Physical plant was conducted with Jacqueline Hernandez and observed the following: Facility was observed clean and in good repair indoors and outdoors. First Floor: Main entrance, lobby, family room, TV room, dining room, coffee bar, beauty parlor, outdoor areas were clean and in good repair. Fireplaces were adequately screened. Carbon monoxide detectors were tested and operable. Fire extinguishers were mounted on the wall in the kitchen and last checked was on 07/08/2025. Smoke detectors were monitored by ADR Security System, which was a fire prevention company and the recent service was done today 04/06/26. Ramps, exit doors, and passageways are free of debris and obstructions. Kitchen was observed clean. Storage rooms, Med room, laundry room and maintenance office were inaccessible to residents. Common shower across from the elevator has skid flooring. Five (5) resident rooms were randomly selected for a physical plant tour. Call system was tested and the response time was in a range of 5 – 10 minutes. Resident bedrooms were observed clean, tidy and in compliance. The residents’ bathrooms were clean and in working condition with grab bars, and skid mats. Hot water temperatures were measured in a range from 108.1 degree F to 111.6 degree F, which was in compliance within the required 105-120 degrees F. The courtyard or outdoor area had a small bodily of water which was secured with fence and inaccessible to the residents. Shaded seating area was provided to residents. Delay egress exits and auditory devices were operable. Second Floor: Library's fireplace is adequately screened. Library, conference room, and sensory room were observed clean and in good repair. Five (5) resident rooms were randomly selected for a physical plant tour. Call system was tested and the response time was in a range of 5 – 10 minutes. Resident bedrooms were observed clean, tidy and in compliance. (CONTINUED ON LIC 809C) The residents’ bathrooms were in compliance. Hot water temperatures were measured in a range from 106.5 degree F to 116.6 degree F, which was in compliance. Delay egress exits were operable. Staffing: Current CPR/First Aid training were on file. There were four (4) available night staff, whom have been provided emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate for Annabelle Argenal is current and the expiration date is 04/21/2027. Staff records were available for review. Six (6) staff files were reviewed. Staff records and in service training were current. Resident Rights/Information: Adequate signage including Personal Rights, Let Us No poster (PUB 475), and Local Ombudsman posters were observed in the lobby. Planned Activities: LPA observed residents were doing activities/exercises after breakfast. Activity materials were observed. The facility has a library and a sensory area to stimulate neurological skills. Food Service: Sufficient food supplies were observed of perishables for at least two (2) days and non-perishables for at least seven (7) days. Residents’ dietary list was posted in the kitchen near the food tray preparation area. Pest was not observed. Staff were observed using hygiene and contamination prevention methods. Incidental Medical and Dental: Wellness room and medication carts were locked. Wellness room / med room stored in house medications, refrigerated medications, and surplus medications. Medication carts were located in the studio dining room. Medications were kept in their original containers. (CONTINUED ON LIC 809C) Resident Records/Incident Reports: Residents records were available for review. Six (6) resident files were reviewed which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610E 3/19), it has been reviewed within a year. The last emergency drill was conducted on 03/20/26 which was done quarterly. Emergency evacuation chairs were observed at the top of each exit door. Residents with Special Health Needs: Postural support/bed rails were observed and physician's requests were observed in residents files who are under hospice. Facility followed dementia regulations. All delay egress exit doors were tested and operable. Facility keeps hospice plan on file. Exit: No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator and LIC 809s were provided.the state’s words, verbatim · CDSS document, Apr 6, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Galarza initiated an unannounced Case Management- Deficiencies visit to issue a citation regarding observations made on April 15, 2025. The purpose of the visit was explained telephonically to Executive Director Anabelle Argenal. Environmental Services Director Mary Chavira assisted with the visit. Ms. Argenal arrived at the end of the visit. On 4/15/2025, it was observed that resident in room # 118 had a three-quarter length rails. Resident (R1) did not have a physician order on file. Pictures were taken. A physical plant inspection was conducted today. Resident (R1's) bed does not have any bed rails Per Title 22, a deficiency is being cited. Exit interview was conducted with Mary Chavira. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Jul 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(A) · Plan of correction due date: Jul 15, 2025

Postural Supports. A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement was not met evidenced by: Based on observation during visit conducted on 4/15/25, the bed in room 118 had a three-quarter rail. No physician order was on file or provided to LPA.This posed a potential health, safety or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: Executive Director submitted picture evidence that the bed rail was removed. Per R1's physician, no bed rail order was approved by the residents doctor. *Citation is cleared. .

Allegation investigated: Staff are not mitigating the spread of infectious outbreaks in the facility. Staff are not keeping the facility clean and orderly. Staff are not meeting residents' personal hygiene needs.

Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit regarding the above allegations. LPA discussed the purpose of the visit with Business Services Director. Executive Director arrived shortly after and assisted with the physical plant inspection. The investigation consisted of: A physical plant tour was conducted, with special focus on all common areas and inspection of 18 resident rooms. Records pertaining to resident (R1) were reviewed and collected. Staff (S1-S7), family (F1), and residents (R1-R6) were interviewed. *Narrative continues next page. Unsubstantiated Allegation: Staff are not mitigating the spread of infectious outbreaks in the facility. The complaint alleges resident (R1) has a skin rash that is spreading throughout the body. According to interviews conducted, the resident developed a rash late December 2024, and on March 24, 2025 staff reported the rash to R1's Nurse Practioner whom orderded permethrin medication. The resident began treatment on March 26, 2025. On March 28, 2025, medication Ivermectin was initiated because Permethrin irritated the resident's skin. Both medications are used to confirmed scabies, and in some instances as a precautionary plan to mitigate contagion to others. However, medical professionals never ordered a skin scrape to confirm scabies in R1. All staff interviewed denied there was a recent outbreak in the building, but did acknowledge R1's room was cleaned as if there was scabies and the resident was isolated and treated. Based on record review, none of the documents state R1 had confirmed scabies. Family reported that the resident has been experiencing rashes since late December, but the rashes have not been officially diagnosed. Therefore, there is insufficient evidence to corroborate the allegation. Allegation: Staff are not keeping the facility clean and orderly. It is alleged the facility is not clean. A total of 6 residents were interviewed. None reported the facility is not clean. A total of seven (7) staff were interviewed. All staff denied the allegation. Housekeeping staff stated the building and rooms are cleaned daily and resident rooms are thoroughly cleaned once a week and/or as needed. Staff stated that some residents tell housekeepers they do not like they way their room is cleaned. Executive Director stated that housekeeping staff clean daily, and deep cleaning of resident rooms is done once a week and/or as needed. Incontinent residents get their linens washed daily or every other day, common area sofas are power washed once a month, and all areas of the facility are disinfected everyday. A total of 18 rooms and all common areas were inspected. All rooms and common areas were observed to be very clean. During the visit, plenty of housekeeping staff was observed cleaning rooms and common areas. Therefore, there is insufficient evidence to corroborate the allegation. Allegation: Staff are not meeting residents' personal hygiene needs. It is alleged that facility staff are not providing proper hygiene care for resident (R1) because the resident developed rashes throughout their body. All staff and residents interviewed denied the allegation. Staff stated residents receive daily hygiene assistance and/or several times a day if needed. The facility specializes in caring for cognitively impaired residents that require extensive hygiene assistance. Based on observation, all residents looked well groomed and clean during the visit. Therefore, the allegation cannot be supported. Based on interviews conducted and document review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted with Anabelle Argenal. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 15, 2025 · control 28-AS-20250409144507

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Galarza generated this Case Management - Deficiencies report in conjunction with complaint control # 28-AS-20250409144507 pertaining to observations made during the physical plant inspection of resident rooms. The purpose of the report was explained to Executive Director Annabelle Argenal. Observations: Room # 118's bed has full bed rails. Resident (R1) is not enrolled in hospice care. Pictures were taken. Deficiency was cited. An exit interview was conducted and a copy of the report and appeal rights were issued to Annabelle Argenal.the state’s words, verbatim · CDSS document, Apr 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Apr 16, 2025

Postural Supports. Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, the bed in room 118 had a quarter/full bed rail. Resident (R1) is not presently receiving hospice care. This poses an iimmediate health, safety or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Apr 15, 2025

Plan of correction: Staff shall remove R1's quarter/full bed rail. Submit self-certification and picture evidence that the rail was removed. If a half rail physician ordered is obtained submit a copy. Licensee agreed to remove a half rail from R2's bed and will submit picture proof by tomorrow that the half rail was removed.

Allegation investigated: Staff failed to protect a resident from being sexually abused.

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with and explained the reason for the visit. The investigation consisted of the following: On 3/25/25 LPA Flores conducted a health and safety check at the facility and requested physician’s report, needs and care plan, pre-appraisal, and facility notes for Resident #1(R1). On 3/28/25 LPA received documents requested for R1. On 4/9/25 LPA conducted interviews over the phone with staff and requested the following documents for Resident #2(R2) physician’s report, needs and care plan, pre-appraisal. On 4/10/25 LPA conducted interviews with residents and delivered findings. The investigation revealed the following: Regarding allegation: Staff failed to protect a resident from being sexually abused. It is alleged there was a resident who was harassing another resident and responsible party suspects resident was sexual abuse by that resident. (CONTINUED ON LIC 9099C) Unsubstantiated Interviews with residents revealed residents do not have concerns regarding other residents. Per residents’ staff ensure that they are providing care and supervision. Interview with Administrator revealed that due to the cognitive condition of many of the residents at the facility, situations in which residents seek to have a romantic relationship have come about. However, in the case of R1 there was no observations of R1 being engaged by other residents. Administrator remembers a resident that had tendency to initiate intimate relationships with residents. However, R1 was not approach in that sense by that resident. Interviews with staff revealed R1 was most of the time in the common areas, was never found alone in room with any residents or exiting other resident’s rooms. Caregivers who provided care do not recall R1 showing fear when providing showers or care. Documents reviewed revealed the following: per physician’s report dated: 4/5/24 R1 has dementia, is ambulatory, and can be confused and disoriented. Documents reviewed do not note concerns or behaviors noticed by staff. Communication log with R1's responsible party between 4/7/24 to 6/4/24 notes communication between staff and responsible party regarding behaviors not related to the allegation. Physician Report dated: 12/22/24 for R2, notes R2 has dementia and that R2 may have inappropriate behaviors. Physician’s report does not detail what type of inappropriate behaviors R2 has. Needs and care plan dated: 3/11/24 does not note inappropriate behaviors with other residents. Per interviews and documents reviewed there is no evidence that inappropriate behaviors or sexual abuse took place among the residents. Therefore, this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Anabelle Argenal Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 28-AS-20250324111638

Type of visit: Required - 1 Year

Licensing Program Analyst(s) (LPA)s Mary Flores and Blanca Gonzalez conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jacqueline Hernandez Business Services Director and explained the reason for the visit. Facility is licensed to served 206 elderly residents age 60 and over, ambulatory and non-ambulatory. Rooms excluded from non-ambulatory status are #110, 221, 222, 243. The facility is a two story building located in a residential neighborhood. It consist of several resident bedrooms in both floors, a lobby seating area, offices, a dining room, a coffee bar, a studio dining room, a commercial kitchen, a medication room, a common shower, an activity room, a family room, a parlor, a courtyard in the first floor, a conference room, a TV room, a library, a laundry room, and patio in the second floor. LPA reviewed the following CARE inspection tool domains during this visit: Infection Control: Infection control plan was reviewed which meets current regulations and was last revised on 5/12/24. Hand sanitizer and proper sanitation were observed during the visit throughout the facility. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Staff have a TB test clearance on file. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: LPAs conducted a tour of the facility with Jacqueline Hernandez and observed the following: Facility was observed clean and in good repair indoors and outdoors. (CONTINUED ON LIC 809C) First Floor: Lobby, family room, TV room, dining room, coffee bar, beauty parlor are clean and in good repair. Fireplace was observed in the lobby and it was adequately screened. Kitchen was observed clean, with hot water temperature warning sign. Emergency food supplies were observed in a closet by the kitchen. Wellness room was observed inaccessible to the residents. Common shower across from the elevator has skid flooring. Four resident bedrooms were observed in the first floor, each with sufficient lighting, required furniture and bedding supplies. The residents bathrooms were clean and in working condition with grab bars, and skid mats. Water temperature was tested between 108.8-112.4 degrees F. Second Floor: Library's fireplace is adequately screened. Library, conference room, and sensory room were observed clean and in good repair. Five resident bedrooms were observed in the second floor, each with sufficient lighting, required furniture and bedding supplies. The residents bathrooms were clean and in working condition with grab bars, and skid mats. Water temperature was tested between 105.0 - 113.5 degrees F., which is within the required 105-120 degrees F. Passageways were clear of obstructions. Courtyard has shaded seating area for residents. Staffing: Administrator Anabelle Argenal arrived at the facility shortly after. At least one person on shift has current CPR/First Aid training on file. There are 4 available night staff, whom have been provided emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate for Anabelle Argenal #6034626740 was observed exp. date: 4/21/25. All staff records were available for review. LPA reviewed a total of 4 staff files which included medical assessment, TB clearance, background clearance, and training. Staff training files were reviewed, training has been provided on Hospice, Restricted Health Conditions, and Postural. As well as dementia, emergency, and activities of daily living. Resident Rights/Information: Personal Rights, Let Us No poster (PUB 475), and Local Ombudsman posters were observed in the lobby. Planned Activities: Activity materials were observed, for activities such as religious, clubs, exercises, and gardening. Outdoor area has a seating area to promote outdoor activities. The facility has a library and a sensory area to stimulate neurological skills. Food Service: Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. Commercial food supplies were observed. The list of residents with special diets was posted in the kitchen. Pest was not observed. Staff were observed using hygiene and contamination prevention methods. (CONTINUED ON LIC 809C) Incidental Medical and Dental: Wellness room is used to stored in house medications, refrigerated medications, and surplus medications. Medication carts are located in the studio dining room and were observed locked. Medications are label and in their original containers. LPAs reviewed medications for 5 residents. Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 5 resident files which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610E 3/19), it has been reviewed within a year. Last Emergency drill was conducted on 3/5/25, quarterly emergency drills are being conducted. Emergency evacuation chairs were observed at the top of each exit door. Residents with Special Health Needs: Postural support/bed rails were observed and physician's request were observed in residents files who are under hospice. Facility is following dementia regulations. Facility has a fenced pond/water feature in the courtyard. Medical assessments for residents with dementia were observed within the last 12 months. All egress exit doors were tested and are in working condition. Facility keeps hospice plan on file. No deficiencies were noted during this visit. Exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 10, 2025

Allegation investigated: Staff did not arrange medical care for a resident Staff did not ensure that facility was maintained sanitary Staff did not safeguard a resident's ambulatory devices

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Jacqueline Hernandez and explained the reason for the visit. The investigation consisted of the following: LPA requested a copy of resident and staff roster. LPA conducted a tour resident #1’s room. LPA conducted interviews with 4 residents and 6 staff. LPA requested the following copies for resident #1 (R1); admission’s agreement, physician’s report, personal property and valuables, identification and emergency information sheet, incident report, notice to physician, preplacement appraisal information, and work orders. Copies of in-service training provided on 6/13/24 were obtained. The investigation revealed the following: Regarding allegation: Staff did not arrange medial care for a resident. It is alleged R1 fell and sustained injuries however, staff did not call 911 for the resident. Per incident report, on 6/3/24 R1 was found in R1’s room in the floor around 6:45pm. Med Aide notified family member of fall and action taken. (CONTINUED ON LIC 9099C) Substantiated However, did not contact emergency respond until family member arrived at around 9:00pm and requested to arrange ambulance transport for R1. Interviews conducted revealed the following, per administrator it is protocol to contact 911 after a resident sustains a fall and complaints of pain. Administrator and wellness director had a corrective action conversation with Med-Aide on duty the day of the incident as med-aide should have called 911 after assessing, checking, and observing resident was in continuous and severe pain. Per staff interview it was reported and observed that R1 was complaining of a lot of pain after the fall and 30 minutes after when checked. Med Aide failed to call 911 or arrange emergency transport after checking the resident self and observing R1 was still in pain. On 6/13/24, Administrator provided an in-service training on “procedure review/medical emergencies/criteria/conditions when to call 911.” Per one of the criteria listed in the in-service training pamphlet provided, “The community summons emergency medical services by calling 911 when the resident exhibits signs and systems of distress… fall with… severe pain…” Per administration a write up will be provided to Med Aide upon returning to work. Per the interviews with staff R1 was demonstrating severe pain and Med Aide fail to contact 911. Therefore, the allegation is substantiated. Based on LPAs interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Regarding allegation: Staff did not ensure that facility was maintained sanitary. It is alleged there was fecal matter on the resident's bedroom furniture and on carpet. LPA observed R1’s room and observed the room was empty, the carpet looked cleaned with three brown half a dollar coin size stains and strong odor of what could be feces or urine. Per interviews conducted with staff R1 was assisted to clean self after toileting due to cognitive skills. Staff stated to find feces in the floor and/or wall in the morning constantly which were cleaned by staff during the day. Per records reviewed a work order was placed to clean the carpet on 4/16/24 and was completed on 5/13/24. Although the staff stated to clean the stains during the day. Due to interviews, LPAs observation and work order to clean the carpet completed in almost a month the allegation is substantiated. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. (CONTINUED ON LIC 9099C) Regarding allegation: Staff did not safeguard a resident’s ambulatory devices. It is alleged resident's wheelchair become lost on 6/3/2024 and found on 6/11/2024. Interviews conducted reveal the following: Per administrator, the wheelchair was place at storage and wellness director was aware of the location of the wheelchair. Per Wellness director, once the family inquired about R1’s wheelchair, staff began to search for the wheelchair. Family provided serial number and wellness director searched throughout the facility until it was found in the facility’s weight room. Wellness director was not aware of the family bringing in the wheelchair or of its where about and it is not certain how the wheelchair was place in that room. Document review revealed resident personal property and valuables was blank and had no items listed for R1. Per interviews conducted the facility staff were not aware that R1 had a wheelchair and were only aware of its location once wellness director search for the wheelchair. Therefore, this allegation is substantiated. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview was conducted with Anabelle Argenal and a copy of this report, LIC 9099D, and appeal rights were provided. However, staff will follow R1 or prompt R1 to use the walker right away. Staff stated that as soon as they will notice R1 was up, a staff will follow right after to provide the walker, while in the common areas. Interviews with residents did not provide information regarding the allegation due to residents’ cognitive skills. Documents review revealed R1’s preplacement appraisal information sheet dated 4/10/24 notes R1 uses a walker and is ambulatory. Per appraisal needs and service plan dated 4/19/24, R1 needs constant reminders to use walker. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Anabelle Argenal and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 17, 2024 · control 28-AS-20240612113615

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Jun 18, 2024

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis... This requirement is not met as evidence by: Based on interviews conducted licensee did not ensure that staff would call 911 for R1 after sustaining a fall and complaining of pain which poses an immediate risk to the health, safety, or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Jun 17, 2024

Plan of correction: Administrator provided in service training regarding Emergency procedures on 6/13/24 to staff. Deficiency cleared as of 6/17/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Jul 2, 2024

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on observations and interviews conducted licensee did not ensure R1's room was sanitary at all times which poses a potential health, safety, or personal rights risk to the persons in care.the state’s words, verbatim · CDSS document, Jun 17, 2024

Plan of correction: Administrator will provide an in-service training to maintenance and housekeeping staff regarding proper cleaning and disinfecting and response time to fecal/urine carpet cleaning by POC due date 7/2/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Jul 2, 2024

87217 Safeguards for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents'..., personal property... which have been entrusted to the licensee or facility staff. This requirement is not met as evidence by: Based on interviews and documents reviewed the licensee did not ensure that R1's wheelchair was properly listed and safe keep at the facility which poses a potential risk to the health, safety, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Jun 17, 2024

Plan of correction: Administrator will certify in writing that upon admission all items will be listed, staff will be responsible to report items that may be found around the facility, and family will be notify of storage of such items by POC due date 7/2/24.

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA)s Mary Flores and Daniel Konishi conducted an unannounced annual visit at the facility to conclude annual visit started on 5/9/24. LPAs met with Annabelle Argenal and explained the reason for the visit. During this visit LPAs concluded the following CARE inspection tool domains: Infection Control, Operational Requirements, Staffing, Personnel Records/Staff Training, Disaster Preparedness, Residents with Special Health Needs. LPAs reviewed the following during today's visit. Eight (8) staff files. Training was reviewed and staff #3 - #8 do have a total of 20 hours which include hours on hospice, postural support, restricted health conditions, and dementia care. Except for staff #6. Infection Control plan last updated on 5/1/24. Emergency Disaster plan last updated on 6/2/23. A copy of Liability Insurance was provided during the visit of 5/9/24. Hospice plans and files were reviewed during the visit of 5/9/24. Last Fire Drill was conducted on 3/26/24. Administrator certificate was observed for Annabelle Argenal #6034626740 exp. date: 4/21/25. Interviews with 4 staff and 4 residents were conducted. Deficiencies were noted during this visit per Title 22 Regulations. Technical Violations were noted. Exit interview was conducted with Annabelle Argenal and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 16, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jacqueline Hernandez and explained the reason for the visit. Facility is licensed to served 206 elderly residents age 60 and over, ambulatory and non-ambulatory. Rooms excluded from non-ambulatory status are #110, 221, 222, 243. The facility is a two story building located in a residential neighborhood. It consist of several resident bedrooms in both floors, a lobby seating area, offices, a dining room, a coffee bar, a studio dining room, a commercial kitchen, a medication room, a common shower, an activity room, a family room, a parlor, a courtyard in the first floor, a conference room, a TV room, a library, and patio in the second floor. LPA toured the facility with Jacqueline Hernandez and observed the following: First Floor: Lobby and family room are clean in good repair, fireplace is covered. Dining room has an uncovered rectangle shape hole of about 4ft x 3ft. Per maintenance a leak was noticed this morning and the hole was cut to prevent leaking. Kitchen was observed clean, sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. List of special diets posted. Egress exit doors were checked down stairs and in working condition. Passageway from the exit door of the laundry was tested. LPA observed a food tray cart, trash cans, and laundry moving cart blocking the exit at the end of the passageway by the parking lot. Local Ombudsman and PUB 745 are posted in the hallway to the parlor. Parlor is clean and in good repair. Medication room and carts located in the studio dining room were observed locked. Emergency food supplies were observed in a closet by the kitchen. Common shower across from the elevator does not have skid strips/mats. Second Floor: Library's fireplace is covered, TV room, conference room were observed clean and in good repair. Three (3) egress exit doors were tested and are in working condition. Emergency evacuation chairs were observed at the top of each exit door. (CONTINUED ON LIC 809C) A total of 9 randomly picked resident bedrooms were observed and each have the required furniture, bedding supplies, and sufficient lighting. Each room has a private bathroom, LPA tested water temperature in each and tested between 110.1 - 122.1 degrees F., which is not within the required 105-120 degrees F. Facility has a fire sprinkle system throughout the building. Fire extinguishers were observed and last checked on 7/10/23. Courtyard is enclosed and has sufficient seating shaded area. Upstairs patio is fenced and has a sufficient seating area. Water feature pond is fence around. This facility serves as a dementia building, LPA reviewed medication with Med-Tech staff for 9 residents. LPA reviewed files for 8 residents. During today's visit LPA completed the following domains: Physical Plant and Environment Safety Resident Right - Information Food Services Incidental Medical and Dental Resident Record - Incident Reports Planned Activities LPA will return at a later time to conclude the annual visit and finish additional CARE tool inspection domains. Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Annabelle Argenal and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, May 9, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.