Revere Court

Type of visit: Required - 1 Year

On 11/7/25 at 1:00pm Licensing Program Analyst (LPA) Kevin Gould arrived at Revere Court for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Marina Smetyukh and together conducted a tour of the facility. The facility is divided into five (5) buildings, one (1) administrative building and four (4) residential cottages each with a capacity for eighteen (18) residents. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchens, resident bedrooms; resident bathrooms, living and dining rooms and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed facility staff are not disposing of used syringes in accordance with regulations, LPA observed two syringe disposal locations without the appropriate container. Per staff statements the location has not been utilized for some time and staff are disposing in correct location. LPA observed the facility training plan is in need of revision as it does not meet requirements for 8 hours of training dedicated to dementia. LPA and administrator discussed the facility signal system. LPA measured the water temperature in each building, which met the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies in an commercial level kitchen. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Nov 7, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: ) Questionable death. 2) Staff did not ensure resident received adequate nutrition while in care. 3) Staff did not ensure adequate care and supervision was provided to resident.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Revere Court RCFE on 10/29/25 at 1:05pm to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with Administrator Marina Smetyukh and together discussed the investigation details. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. The department obtained and reviewed R1's death certificate which did not indicate any cause that was determined to be questionable. LPA Gould conducted interviews with nine (9) staff members. All interviews conducted did not corroborate the allegations listed inthe complaint. Per staff statements, hospice notes reviewed and staff communications and daily notes all indicated that as R1 was declining and on hospice care, as part of R1's decline R1 was reported to have had a decline in appetite and would not consume as much food as prior to being placed on hospice. Report Continued on LIC 9099-C. Unsubstantiated Additionally, The department has received statements by interviewed staff that R1 only had one significant fall prior to their death. Per staff statements R1 only had one fall which resulted in injury, the department received notification and documentation of fall and selected treatments that did not meet department requirements for further investigation. Staff interviewed provided statements that R1's decline and instability was addressed by increased checks and supervision and the implementation of a bed alarm that would alert staff members if/when R1 would attempt to get out of bed without staff assistance. All staff statements received were consistent with a resident on hospice and declining prior to death. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of (Questionable Death, Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 29, 2025 · control 27-AS-20250303114503

Allegation investigated: Staff do not ensure residents are spoken to in an appropriate manner Staff do not ensure residents are handled in an appropriate manner

On 12-31-2024 at 1:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to deliver and discuss findings for the allegations noted above. LPA met with Executive Director Irene Charnell and explained the purpose of the visit. During this investigation, LPA conducted interviews with six staff members, three additional witnesses, and reviewed facility file documentation including caregiver schedule, and employee records. Additionally, LPA conducted facility observations on 10/24/2024 and 12/4/2024. Allegation: Staff do not ensure residents are spoken to in an appropriate manner. LPA conducted interviews and observation as noted above. Based on interviews and observation conducted, it was determined that facility is exclusive to memory care. Interviews did not reveal any corroborated statements of staff speaking inappropriately to residents in care. Observations were conducted by LPA in all four cottages serving memory care residents and consisted of various residents in rooms, common areas, and during activity events. {Cont. on 9099C} Unsubstantiated LPA’s observations did not reveal staff speaking to residents in an inappropriate manner. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. Allegation: Staff do not ensure residents are handled in an appropriate manner. LPA conducted interviews and observation as noted above. Interviews conducted did not reveal any corroborated statements of staff inappropriately handling residents physically. Observations were conducted by LPA in all four cottages serving memory care residents and consisted of various residents in rooms, common areas, and during activity events. LPA’s observations did not reveal staff physically handling residents in an inappropriate manner. LPA did not observe rough handling in care techniques or redirection attempts. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, Dec 31, 2024 · control 27-AS-20241015084008

Allegation investigated: Licensee does not ensure facility is kept free of pests Licensee does not ensure staff are in good health to perform assigned tasks Licensee does not ensure equipment is maintained and in good repair

On 12-4-24 at 1:35pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced at facility to deliver and discuss findings for the allegations noted above. LPA met with Executive Director Irene Charnell and explained the purpose of the visit. During this investigation, LPA conducted interviews with six staff members and reviewed facility file documentation including caregiver schedule, employee records, and pest control agreement. Additionally, LPA conducted facility observations on 10/24/2024 and 12/4/2024. Allegation: Licensee does not ensure facility is kept free of pests. LPA conducted interview and observation as noted above. Observation conducted did not reveal the presence or evidence of pests within the facility. Interviews conducted revealed that although facility has a history of presence of pests, a pest control service is conducted regularly since 4/19/2022 with most recent service conducted 12/4/2024. {Cont. on 9099C} Unsubstantiated LPA observed and reviewed facility’s pest control agreement to confirm the above. As a result, there is not a preponderance of evidence to conclude licensee does not ensure facility is kept free of pests, therefore, this allegation is UNSUBSTANTIATED. Allegation: Licensee does not ensure staff are in good health to perform assigned tasks. LPA conducted interviews, record reviews, and observation as noted above. Interviews conducted did not reveal staff attempting to perform assigned duties while exhibiting poor health symptoms. Interviews further revealed staff are not being requested to work while ill. LPA’s review of various staff records revealed that staff can physically perform duties and are in adequate health. LPA’s observation revealed staff interacting appropriately with residents in care and able to perform various care techniques appropriately and without physical difficulty. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. Allegation: Licensee does not ensure equipment is maintained and in good repair. LPA conducted interviews and observation as noted above. Interviews conducted revealed no corroborated statement of disrepair items in facility currently or in the recent past. LPA’s observation revealed no disrepair items within facility. LPA observed the proper functionality of devices in kitchen and all four cottages including dishwashers, refrigerators, and lighting fixtures. As a result, there is not a preponderance of evidence to conclude facility’s equipment is in poor condition or disrepair, therefore, this allegation is UNSUBSTANTIATED. An allegation of unsubstantiated means that the allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Executive Director and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 27-AS-20241015084008

The state marks this report as 3 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

On 10/10/24 at 9:15am Licensing Program Analyst (LPA) Kevin Gould arrived at Revere Court for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Irene Charnell and together conducted a tour of the facility. The facility is divided into five (5) buildings, one (1) administrative building and four (4) residential cottages each with a capacity for eighteen (18) residents. . LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchens, resident bedrooms; resident bathrooms, living and dining rooms and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature in each building, which met the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies in an commercial level kitchen. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 10, 2024

Type of visit: Case Management - Incident

On 6/20/24 at 11:00am Licensing Program analyst (LPA) Kevin Gould conducted an unannounced case management inspection to address concerns of recent falls within the last week at the facility. LPA met with RSC Nicole Hemenover, LVN to discuss recent falls and to determine if there are any connections or issues present and to provide support. LPA reviewed recent falls and incident reports and observed the residents. LPA met with one resident who provided statements regarding their most recent fall at the facility. LPA observed all recently reported falls have varying circumstances and occurred at different times and locations at the facility. No deficiencies were observed during today's inspection. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 20, 2024

Allegation investigated: ) Staff did not prevent resident from pushing another resident in care. 2) Resident in care was locked out of the facility. 3) Staff did not follow proper reporting requirements. 4) Staff did not prevent resident from having an indecent exposure incident at the facility.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Revere Court RCFE on 5/9/24 at 1:30pm to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Administrator, Irene Charnell and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA Gould conducted interviews with five (5) staff members and three (3) residents in building 1. Per the staff interviews, LPA could not corroborate that an altercation occurred between R2 and R3. Both residents interviewed could not recall or describe the alleged incident. Per R2, she has had only one fall at the facility and it occurred in the bathroom when sick. R2 could not recall if staff were aware of this fall. LPA was unable to corroborate the fall as a result of one resident pushing another. All staff interviewed denied any knowledge of the described incident. The allegations that staff did not prevent a resident from pushing another resident and not reporting the incident are both determined to be unsubstantiated. Unsubstantiated Additionally, in regards to alleged indecent exposure allegation and resident being locked out of facility, LPA again conducted 5 staff interviews and three residents interviews. No residents interviewed could recall such an incident and staff denied ever witnessing a resident expose themselves to other residents. LPA also interviewed staff and residents regarding being locked out of the facility. Facility staff did provide statements that while the facility had a COVID outbreak, individual units were locked to prevent residents from going to other cottages and spreading disease. Facility staff also explained different procedures for visitors and residents to gain access to locations during COVID outbreaks. No residents interviewed could corroborate being locked outside the facility. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of neglect/lack of supervision and reporting requirements are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 9, 2024 · control 27-AS-20240402081017

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jamie Ivey Canady visited the facility unannounced and met with Administrator Irene Charnell and explained the reason for today's visit. According to Incident Report received by the Department from the facility on 1/15/2024, R1 is a member of facility Day Club. R1 was reported AWOL from the facility day club program at approximately 4:45 pm on 1/10/2024. According to facility document review, R1 had last been seen on the facility grounds by facility staff at 4:30pm. R1 was located on the same road as the facility, but outside the grounds next to a busy street at approximately 4:50pm by facility staff. According to facility incident report R1 was missing from facility grounds for less than 10 minutes. Based on facility resident file review, on page 2 of R1 Preplacement Appraisal Form LIC603, under services needed "Needs special observation/night supervision (due to confusion, forgetfulness, wandering), Yes is checked with a handwritten note "Yes to all. Constant Wandering". According to facility file document review, and facility invoice, facility had construction and repairs performed on the facility on 1/10/2024. Based on incident report, facility gate had been left slightly ajar by construction staff. It was learned that R1 accessed the outside of the facility grounds via the open section in the gate that had been left open by construction staff. However, based on Title 22 regulations, licensee responsibility for health and safety of R1 based on facility service agreement was not fulfilled. Therefore, based on Title 22 regulations, deficiencies cited. Exit interview held and copy of report given to Administrator Irene Charnell.the state’s words, verbatim · CDSS document, Jan 18, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(a)(h) · Plan of correction due date: Jan 18, 2024

87705 Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia...(h)Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents.This was not met as evidenced by: Based on facility incident report and documentation, the licensee did not ensure the facility gates stayed locked during construction services. This posed an immediate health and safety issue to persons in care.the state’s words, verbatim · CDSS document, Jan 18, 2024

Plan of correction: Licensee states as a plan of correction no keys will be given to outside vendors. A training withthe maintenance team that this is the new protocol going forward will be conducted no later than (NLT) 1/19/2024 and proof of training will be forwared to LPA via email.