Renaissance Care Home

Allegation investigated: Staff are mismanaging resident's medication Staff did not ensure resident's incontinence needs were being met

Licensing Program Administrator, LPA Noel Wolf Petersen, arrived unnanounced to the facility to conduct a complaint investigation into the above allegations. LPA met with administrator, Teresita Ranin to explain the purpose of the visit. As to the allegation that Staff are mismanaging resident's medication, record review of the Centrally stored Medication Administrative record shows that Morphine should be given every 8 hours routine AND as needed, and record review on the MARs that the medication was only given as needed was filled out. one hospice nurse gave a statement that the client was often expressing pain/agitation, via grimace, moans before debraiding the wound, and morphine would need to be given by the medtech and a waiting period for it to take effect before the care could begin. LPA gave guidance, morphine is a schedule 2 narcotic and additional precautionary measures: i.e. a controlled substances log reflecting a more limited and controlled access to the drug are necessasary. Continued on c page. Substantiated As to the allegation that Staff did not ensure resident's incontinence needs were being met, in interview it was learned two home health nurses and a home health aid agree residents were often found wet, (more frequently after night shift). 1 of 4 Hospice nurses described the facility as on average worse than other care homes with regard to incontinence care. The Administrator made a statement to the LPA that S4 was not competent in basic duties of ther job and was fired as a result of poor performance. 4 of 4 hospice nurses described a recent improvement in the care at the facility in general, coinciding with the hiring of 2 additional staff. Based on LPAs observations and 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. California Code of Regulations, , are being cited on the attached LIC 9099D.) A copy of the appeal rights was provided, a copy of the report was read and given to the administrator. exit interview was conducted. As to the allegation that a resident was not repositioned as needed A log of the checks for rotation care, showed 1 check per 2 hours, and refusal happening 2-4 times per day, by reason of r1 being asleep. S2 staff provided a statement that r1 was heavily contracted and in pain, which presented a challenge when it came to rotating the client and doing incontinence care like changing briefs, while the care could be done with one often the care needed 2 persons to quickly address the incontinance. a record review of the night shift on the LIC 500 for this period, showed a single staff, s5, on duty for Sunday-Tuesday shifts 8pm to 7am. That staff, S5, does not have any signed entries on the rotation log for may. The rotation log shows that S4 and S5 normally assume the days when S2 and S3 are off duty. 2 home health aids and 4 nurses could not reach a consensus that rotation services were or were not being provided as described by the care plans. As to the Allegation that Staff did not prevent resident from developing a pressure injury, there is not a consensus of neutral third parties (hospice nurses) that would characterize care by the facility as a definitive cause of the development of a pressure injury. 2 of 4 nurses interviewed have concerns about the facility not properly shielding a barrier dressing from being dry as related to bathing/incontinence, and belive based on thier observations that the care at the facility probably did contribute to the development of a pressure injury, but would not support the characterization that the facility caused the development of a pressure injury. 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 is unsubstantiated. A copy of the report was read and given to the administrator. exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 6, 2026 · control 27-AS-20260506104525

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1,2) · Plan of correction due date: Aug 7, 2026

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. (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This requirement was not met as evidenced by: record review of centrally stored log pain managment medication(Morphine) perscribed as routine and prn, and record review of MAR showing PRN distribution only, per interview with administrator there is no controlled substances log for the morphine, per hospice nurse, client r1 was frequently discovered expressing pain symptoms prior to services. Not following this requirement poses a risk to the health safety or personal rights to clients in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: LPA is suggestign that a inventrory of controlled substances currently in the facility be taken and logged, by the poc date 8/7/2026. The administrator should send a copy of the Centrally Stored Administration record, MARs, and Controlled Substances log for all to the LPA clients at the end of every week(fridays) for the next six weeks. licensee agrees.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(b)(3) · Plan of correction due date: Aug 7, 2026

87465 Incidental Medical and Dental Care (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not being followed as evidenced by: in interview with 2 hospice nurses who identified clients r1 and r3 and characterized their observations as discovered wet frequently. Not following this requirement poses a risk to health safety or personal rights of clients in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: LPA suggested the facility begin an incontinance care log recording time of checks and the clients status to be updated and signed every time care is provided for the clients with identified incontinance needs. LPA gave guidance that incontinance care checks frequency should increase as need is discovered. a plan to address the current incontinance care needs of the clients should be sent to the lpa by end of day 8/07/2026. licensee agrees.

Allegation investigated: Licensee did not provide resident with required notice of fee increase

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to conduct a complaint investigation into the above allegations, LPA met with administrator Teresita Ranin to explain the purpose of the visit. LPA was given a copy of the admission agreement, it does include modification conditions requiring 60 days notice for a rate change for basic services. The Administrator explained in interview a client had a increase in Febuary of 2026 (resident moved to a privite room) without written notice, and a rate increase from september of 2025 (resident had increases in care) without a written notice. The notice was given and agreed to verbally, and signed on the admission agreement but not 60 days in advance of the change and not written. Based on LPAs observations and 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. California Code of Regulations, is being cited on the attached LIC 9099D. A copy of the report was read and given to the administrator. appeal rights were provided, exit interview was conducted Substantiatedthe state’s words, verbatim · CDSS document, Jul 23, 2026 · control 27-AS-20260506104525

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(4) · Plan of correction due date: Aug 6, 2026

87507 Admission Agreements (g) Admission agreements shall specify the following:(4) Modification conditions, including the requirement for the provision of at least 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified, This requirement was not followed as evidniced by: Record review of admission agreement were 60 days written notice prior to rate change terms are present, Interview with administrator where she is saying the notice is verbal and not 60 days in advance. not following this requirement poses a health, saftey, personal rights risk to clients in carethe state’s words, verbatim · CDSS document, Jul 23, 2026

Plan of correction: LPA is suggesting those terms are added if they are not there, to the admission agreement in a modification conditions ammendium by the poc date, 8.06.26

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.

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unanounced to the facility to conduct an annual inspection 1:30pm on 4/30/26. LPA met with administrator Teresita Ranin, to explain the purpose of the visit. renaissance care home is a 6 bed facility with a current capacity of 6. theres 5 adults aged 60+ residing in the facility with 3 on hospice. LPA gave guidance that current fire clearance(6 nonambulatory, 6 hopice) would have to be updated to include bedridden should any of the clients present with the ability to not rotate themselves independently, unless the facility is assisting the resident with finding alternate housing. Physical inspection was conducted, including but not limited to kitchen, bedrooms, bathrooms, common areas, evacuation route and exterior. The facility is clean, traffic areas are well lit and unobstructed. kitchen has adequate lockable storage for sharps. there is food storage adequate for 2 days perishable, 7 days non perishable for 5 residents eating 3 meals and 3 snacks a day. The LPA asked for foods being stored without a label of expiration(i.e. leftovers) to be dated. freezer stored items should be inspected quarterly for frost damage. Bedrooms have the required furniture and furnishings. Bathrooms have functional hardware, and have temperature measured between 105 and 120*F. Common areas and exteriors are free of tripping hazards and have furniture in good repair. The evacuation route gate is not able to swing freely and latch closed. LPA gave guidance the gate should be shaved down or rehung. The Fire extinguishers are dated January 2026, the first aid kit has all required items, and the smoke/co detector is functional. 2 staff and 2 clients were interviewed. continued on c page 5 of 5 Staff files including health screening, continuing and initial trainings, cpr/first aid certification and backround checks are present and up to date. 2 of 2 Client files including the signed admission agreements, addendums to the admission agreement, recent 602 medical asseessment and needs and services plans were up to date and present. Administrator files, including but not limited to facilitiy posters, insurances, control of the property, evacuation plan, and infection control plan were reviewed, and found to be present and up to date. PRN documentation is not being filled out completely as described in regulation and cold storage medication was not locked, LPA gave guidance for the administrator that her 20 hours per week should have some time devoted to assessing each of the staff on the policies and procedures of their regular duties. No citations given as part of this visit, a copy of the report was read and given to the administrator. exit interview conducted. LPA asked for a updated LIC 500 and LIC 9020 to be emailed to the LPA, noel.wolfpetersen@dss.ca.govthe state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct one year annual/required inspection. LPA Lund met with Administrator Teresita Ranin and explained the purpose of the visit. Census 5. LPA Lund and Administrator Teresita Ranin toured/inspected the physical plant including the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, activity room, and outside courtyards. LPA Lund observed sufficient furniture and lighting throughout the facility. LPA Lund observed sufficient 7-day non-perishable and 2- day perishable food supplies. Hot water temperature was measured at 109 degrees Fahrenheit in kitchen sink, which is within the required range of 105 to 120 degrees. Fire extinguishers expire on 1/10/2026 and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 2 resident and 2 staff files and are in compliance. All staff are Fingerprint cleared and associated to the facility. First aid kit was checked and is complete. No Deficiencies were during the inspection. Exit interview and report left.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to Post Licensing inspection. LPA Lund met with Administrator Teresita Ranin and explained the purpose of the visit. Census 6. LPA Lund and Administrator Teresita Ranin toured/inspected the physical plant including the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, activity room, and outside courtyards. LPA Lund observed sufficient furniture and lighting throughout the facility. LPA Lund observed sufficient 7-day non-perishable and 2- day perishable food supplies. Hot water temperature was measured at 110 degrees Fahrenheit in kitchen sink, which is within the required range of 105 to 120 degrees. Fire extinguishers expire 1/15/2025 and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 3 resident and 2 staff files. Fire drill was completed on 4/1/2024. All staff are Fingerprint cleared and associated to the facility. First aid kit was checked and is complete. No Deficiencies were during the inspection. Exit interview and report left.the state’s words, verbatim · CDSS document, May 13, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a pre-licensing inspection. LPA Lund met with Administrator Teresita Ranin and explained the purpose of the visit. Administrator Certificate Expires 11/29/2025. Census 5. LPA Lund and Administrator Teresita Ranin toured/inspected the physical plant including the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, activity room, and outside courtyards. LPA Lund observed sufficient furniture and lighting throughout the facility. LPA Lund observed sufficient seven-day non-perishable and two- day perishable food supplies. Hot water temperature was measured at 108 degrees Fahrenheit in kitchen sink, which is within the required range of 105 to 120 degrees. Fire extinguishers expire 1/15/2025 and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 2 resident and 2 staff files and were in compliance. Fire drill was completed on 4/1/2024. All staff are Fingerprint cleared and associated to the facility. First aid kit was checked and is complete. No Deficiencies were during the visit. Exit interview with licensee and copy of the report left. LPA Lund conducted Component 111.the state’s words, verbatim · CDSS document, Apr 29, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 Interview Method: Telephone interview On 4/5/2024, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 5, 2024