Rest Haven Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Licensee Nelfa Reeder, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6), a current census of (4). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility does not have a swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities. The facility is equipped with operating smoke detectors/carbon monoxide alarms, working laundry equipment and telephone service. Resident’s shower, toilet, and hand washing areas were operating properly. The hot water temperature in the resident’s bathroom measured 116.8 degrees F. Three (3) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, facility sketch, emergency telephone numbers, CCLD complaint poster, and Ombudsman poster. Food Service: Facility kitchen and dining area are maintained clean, however the kitchen is under a remodel. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training and are background cleared. Medical Related Services: Resident’s medications are labeled and centrally stored, however not in a locked cabinet, deficiency issued. Medication had discrepancies, deficiency issued. Record Review: Two (2) Staff files reviewed were observed to be complete. Four (4) Resident files reviewed were observed to be complete, however R2 was missing a needs and service plan, deficiency issued. Facilities last fire and earthquake drill was conducted on 04/05/26. Facility has an updated liability insurance expiring 02/13/27. Licensee was notified annual fees are due by 08/31/26. Based on observations and record review deficiencies and technical violations were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC 809/C) along with (LIC 809D & LIC 9102) and appeal right were discussed and provided to Licensee Nelfa Reeder at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 30, 2026

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Licensee Nelfa Reeder, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6), a current census of (3). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility does not have a swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities The facility is not equipped with operating smoke detectors/carbon monoxide alarms, deficiency issued. Facility has working laundry equipment and telephone service. Resident’s shower, toilet, and hand washing areas were operating properly. The hot water temperature in the resident’s bathroom measured 111.5 degrees F. Three (3) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, administrator certificate, facility sketch, emergency disaster plan and telephone numbers, CCLD complaint poster, and Ombudsman poster. Food Service: Facility kitchen and dining area are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Three (3) Staff files reviewed were observed to be complete. Three (3) Resident files reviewed were observed to be complete. Facilities last fire and earthquake drill was conducted on 8/04/25. Based on observations and record review deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report along with LIC 809-D and appeal right were discussed and provided to Licensee Nelfa Reeder.the state’s words, verbatim · CDSS document, Oct 14, 2025

Allegation investigated: Staff are chemically restraining residents in care. Neglect resulting in UTI.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Nelfa Reeder, and discussed the purpose of the visit. During today’s visit, LPA conducted observations, interviewed staff, residents, outside parties and obtained facility records. It is alleged that staff are chemically restraining residents in care. R1 no longer resides at the facility and was unable to be interviewed. LPA conducted 2 resident interviews, 1 out of 2 residents stated they do not take any medication. 1 out of 2 residents informed LPA they are not being over medication nor have they seen other residents being over medicated. LPA interviewed 2 staff members. 2 out of 2 staff informed LPA residents are not being chemically Unsubstantiated restrained. Based on LPA's observation and medication review, residents are receiving medication as prescribed by physician and are not being chemically restrained. Regarding allegation #2, based on observation, record review, and interviews LPA Ramirez was unable to corroborate the allegation of Resident(s) developed UTI due to neglect. No current residents have UTI(s) that resulted from neglect. Based on the information above, the allegation is unsubstantiated. A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report LIC 9099 and LIC9099C was discussed, and a copy was provided to Administrator Nelfa Reeder.the state’s words, verbatim · CDSS document, Feb 3, 2025 · control 56-AS-20250127145545

Allegation investigated: Facility staff do not administer resident medication as prescribed. Facility staff do not provide adequate activities for residents in care.

Licensing Program Analyst (LPA) Bernadette Allen met with Licensee/Administrator Nelfa Reeder- Administrator at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office on 12/24/2024 at 11:30 AM to deliver the findings of the above allegation. LPA Allen explained the purpose of the requested office visit. The investigation involved a review of records, and interviews with staff and responsible parties of Resident 1 (R1). During the interview with Administrator Nelfa Reeder- Administrator, it was revealed that the facility does not maintain the MARS Medication Administration Record Schedule to show that residents' medications are being administered as prescribed by their physicians. The administrator stated that she does not keep records of when medications are given. Additionally, when asked about activities for the clients in care, the administrator mentioned that there is no schedule for activities and that residents simply watch TV or engage in activities of their choice. Substantiated The licensee was informed of her responsibility to ensure that a record is always kept to confirm that medications are dispensed as prescribed by physicians. She was also advised that daily activity schedule should be arranged for the clients in care. The absence of both the MARS schedule and organized daily activities presents a potential health and safety risk for those in care. A citation has been issued for not having a MARS available for review and for not having a schedule for planned activities. The licensee has agreed to provide training of regulations 87465(c)(3) and 87219(a)-(i)(1) and provide training by the POC date. Based on the evidence gathered during the investigation, the above allegation is found to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and provided to Nelfa Reeder- Administrator at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Dec 24, 2024 · control 56-AS-20241003155326

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(c)(3) · Plan of correction due date: Jan 3, 2025

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the....(3)A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.This requirement was not met as evidenced by: The administrator stated and could not provide records of medications being given to residents in care which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 24, 2024

Plan of correction: The administrator/licensee will provide LPA a copy of the MARS documenting medications administered by staff that will be used. She will also conduct training and submit a written statement of understanding of the cited regulation, signed by all staff members by January 3, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a)-(i)(1) · Plan of correction due date: Jan 3, 2025

(a) -(i) (1)Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include:..This requirement was not met as evidenced by: LPA asked to review a schedule of activities that could not be provided. She said residents simply watch TV or engage in activities of their choice. The licensee has agreed to provide a written schedule of activites and will encourange residents to engage in activites daily.the state’s words, verbatim · CDSS document, Dec 24, 2024

Plan of correction: The administrator/licensee will provide a copy of the monthly planned activities for residents. She will also train all staff on the cited regulation and submit a written statement of understanding, signed by all staff members assisting with activities, by January 3, 2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Nelfa Reeder and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6), a current census of (5). LPA Ramirez conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pool or similar bodies of water. Outdoor shaded area is sufficient for resident activities. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility is equipped with operating smoke detectors/carbon monoxide alarms and telephone service. Resident’s showers and toilets were operating properly. The hot water temperature in (2) residents bathrooms measured at 109.7 and 108 degrees F. Three (3) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, CCLD complaint poster, Ombudsman poster, facility license, disaster facility sketch, emergency telephone numbers, and disaster plan. Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C Care & Supervision: Facility has 24-hour/7days a week care staff. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Three (3) Staff files reviewed, staff #2 has an expired CPR certificate, deficiency will be cited. Five (5) Resident files reviewed were observed to be complete. Based on observations and record review deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where reports (LIC809 & LIC809-D) were discussed and copies were provided with appeal rights to Administrator Nelfa Reeder.the state’s words, verbatim · CDSS document, Sep 18, 2024