Robert Creek Villa I

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Mariana "Mimi" Musca, Administrator Designee/caregiver, and stated the reason for the inspection. Also present was staff, Beata Kratschmer. The administrator was out of town and unable to attend. There are (5) residents currently. (1) resident is under hospice care. Residents were resting in their rooms. LPA and Administrator toured the interior/exterior of the facility including the common areas, (6) private resident bedrooms, (4) of which have a private bath, (1) additional full bathroom, kitchen, and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, slip-resistant flooring, and hygiene supplies. There is sufficient 2+day perishable, including lots of fresh produce, and 7+day non-perishable supply of food. The facility prepares fresh food daily. Sharps and medications are locked in a cabinet near the kitchen and toxins are locked in the garage. Hot water temperature measured 116.6*F in the kitchen. The fire extinguisher was last serviced 6/1/2026, and the smoke/monoxide alarms are working. Inside temperature measured 78*F. All required postings are visible in the common area- an updated SOC341 was provided. There are (2) unlocked exits and no pools. There is a small table and chairs by the front door. All exit doors have an auditory alert and exit signs. There are non-audio cameras in the common areas. LPA reviewed (2) resident files and (3) staff files. Files are organized and contain current paperwork, including care plans. Medications were reviewed for (2) residents are being administered per orders. Documentation (MAR) is also current. Staff are completing the required training each year and have current First Aid/CPR certifications. RCFE Admin cert #7035965740 (exp 11/2/2027). There are no deficiencies observed during today's inspection, and no citations are being issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 26, 2026

The state marks this report as 4 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) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Mariana "Mimi" Musca, caregiver, and stated the reason for the inspection. At the start of the inspection, (5) residents were present. The sixth resident returned at 1:50 pm after attending their day/health care program. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). LPA was advised there are currently (0) residents under hospice care. LPA and Administrator toured the interior/exterior of the facility including the common areas, (6) resident bedrooms with private bath, (2) full bathrooms, kitchen, (3) staff rooms and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, slip-resistant flooring, and hygiene supplies. There is sufficient 2+day perishable and 7+day non-perishable supply of food. Sharps and medications are locked in a cabinet near the kitchen and toxins are locked in the garage. Hot water temperature measured 114*F in a resident bathroom. Fire extinguisher last serviced 6/24/25, and the smoke/monoxide alarm was tested/working. Inside temperature measured 80*F. There is a First Aid kit on site and sufficient paper/incontinent products. All required postings are visible in the common area. There is a covered patio table outside, (1) unlocked exit and no pools. Updated land line contact obtained as well as an updated copy of LIC500, LIC308 and current liability insurance. (2) resident files and (5) staff files were reviewed. Files were organized and contained current/complete documentation. Staff has completed the initial/continuing required training and has current First Aid/CPR. The administrator's certificate is pending renewal. The Plan of Operation contains documentation related to updated Dementia care regulations. Medications were reviewed for (1) residents- orders match medications administered and documentation is current. There are no deficiencies observed during today's inspection, and no citations are being issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Mariana "Mimi" Musca, caregiver, and stated reason for the inspection. At the start of the inspection, (5) residents were present. The sixth resident returned at 1:50 pm after attending their day/health care program. This report is being created to clear the Post-Licensing inspection in the system. There are no deficiencies issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: Questionable death. Staff did not seek timely medical care for resident.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver investigative findings to a complaint received on May 5, 2025, and met with Mariana Musca, caregiver, who contacted Administrator, Adina Sbingu. LPA stated the reason for today's inspection. The Administrator arrived around 11:05 am. Also present was staff, Beata Kratschmer. LPA was advised (2) residents were attending their day program, (3) were resting in their rooms and (1) was watching television in the common area. During the investigation, the Department interviewed the Administrator, (2) staff, resident (R1's) responsible person, and reviewed documenation related to resident (R1), including the county death certificate. The results of the investigation are as follows: Resident moved in on January 30, 2024, with a diagnosis of Dementia, Coronary Artery Disease, Hypertension, a history of stroke. Additionally, the physician’s report (dated 1/26/2024) notes that resident’s heart was working at 30-35% capacity, resident had Atrial Fibrillation, could be confused but was able to communicate their needs. *cont on 9099C-1.. Unsubstantiated 9099C-1.. The Pre-Appraisal indicates resident had a pacemaker and had memory issues since it was installed in December 2023, was able to ambulate, showed anxiety and depression, was independent with ADL’s, and needed minimal assistance with eating and medications. Allegation: Questionable death. The allegation states that staff indicated they checked on resident (R1) on the morning of April 22, 2025 (0730 hours) to wash and assist resident but (R1) did not want to get up so staff gave (R1) a bed bath. Staff (S1) stated she and staff (S2) later checked in on (R1) again at approximately 0815 hours and observed (R1) was having trouble breathing. Staff (S1) stated that after a minute or two, (R1) stopped breathing entirely and at that point she called 911 and was given instructions for CPR. The Department investigated the above allegation and obtained the county death certificate which lists the following conditions that contributed to (R1’s) death: Cerebrovascular Accident (lasting minutes), Myocardial Infarction (lasting hours), Chronic Kidney Disease and Hypertension (lasting years). (R1’s) death is recorded at 9:08 am on April 22, 2025 There were no other health conditions that contributed to or resulted in the cause of (R1’s) death that was reported to the Sacramento County Coroner’s office, and there was also no biopsy or autopsy performed. The Administrator explained how (R1) had been refusing medications, starting on 4/7/25 through 4/22/25. LPA was provided with documentation showing (R1) refused ordered medications in the morning and evening on: 4/7/25; 4/9/25; 4/11/25, 4/15/25; refused medications in the morning on 4/10/25; 4/12/25, 4/13/25, 4/14/25, 4/16/25, 4/17/25, and 4/20/25; and refused medications in the evening on 4/19/25. The facility submitted an incident report for an incident involving (R1) calling 9-1-1 on 4/17/25. The Administrator and report indicated that it is not certain what (R1) reported to 9-1-1; however, the fire department came out to evaluate (R1), who was cleared and not taken to the hospital at that time. The Administrator stated that 9-1-1 left the home as “(R1) didn't want to go to the hospital", adding that (R1’s) doctor spoke to them later that day and then on Sunday, 4/20/25, advising (R1) they need to be sent out for a "5150", or mental health evaluation. The incident report further states that (R1’s) Psychiatrist communicated with the responsible person that a 5150 may need to be requested if resident’s behavior continues and because resident was refusing medication, contributing to (R1) pretending to "push a pen in the head" of another resident (R2), but no contact was made. *cont on 9099C-2.. 9099C-2 ..The Administrator stated she spoke to the responsible person, on Sunday, April 20, 2025 and confirmed the police arrived at the facility on that day (10:30 am) and took (R1) to a local hospital. LPA reviewed a second incident report for an incident occurring on 4/20/25 (8:00 am). Staff called (R1) for breakfast and found resident in their bathroom filling the garbage can with water, which flooded the room. (R1) was sent to the hospital for a mental health evaluation. On 4/21/25, the administrator received a call from the hospital that (R1) was cleared for discharge, and their responsible person had requested resident be put on the same medication dosages prior to February 3, 2025, which the hospital agreed to. The Administrator stated (R1) was very tired and groggy upon returning to the facility. Hospital discharge papers, dated 4/20/25, note (R1) was admitted with a diagnosis of Agitation or violent behavior, discharged with a Diagnosis of Dementia with Behavioral Disturbance and to follow up with their primary care physician in 3-5 days. The discharge paperwork also notes (R1) is to begin taking (5) new prescribed medications: Aripiprazole 5 mg; Mirtazapine 15 mg; Prazosin 1 mg; Trazodone 100 mg and Valproic Acid 250 mg. The Administrator stated (R1) returned from the hospital on 4/21/25, with (4) of the medications and the medication, Valproic Acid 250 mg was picked up later that day. The Administrator stated that (R1) was "tired and not able to chew very well"and that (R1) went to sleep as usual on 4/21/25 (at 7:30 pm), did not wake up during the night but had a small amount blood in his underwear, which was normal, at times. The Administrator stated (R1) was previously sent to the Emergency Room for spotting and the facility was advised to hold off on administering Xarelto for (3) days and then resume it. LPA observed this documentation. The Administrator stated in February 2025, Kaiser "decreased but then increased the amount of Depakote" and (R1) also "refused to take this medication, which was a mood stabilizer, now and then, and his situation became worse and worse” until Sunday, April 22, 2025. Documentation shows the medication Depakote and Abilify, also a mood stabilizer, was increased and decreased multiple times starting in February 2025. Based on information obtained, LPA finds this allegation to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. *cont on 9099C-3.. 9099C-3- Allegation: Staff did not seek timely medical care for resident. The allegation states that on April 22, 2025, resident (R1) was observed to have blood in their underwear and in the shower. The Administrator stated (R1) went to bed at 7:30 pm on Monday night, 4/21/25 and did not wake up during the night but had a small amount blood in his underwear, which was normal, at times. The Administrator stated (R1) was taking medication for prostate and blood thinner. The Administrator stated (R1) was previously sent to the Emergency Room for spotting and the facility was advised to hold off on administering Xarelto for (3) days and then resume it. LPA observed this documentation. Medication records note (R1) was taking Rivaroxaban (Xarelto) 20 mg oral tablet once daily, which is used to treat AFib (Atrial Fibrillation), and this medication and other anti-coagulants can increase the risk of bleeding. The Administrator stated “often times (R1) was bleeding in the teeth area” and she took (R1) to the dentist where they had a plan to treat the gums and used antibiotic rinse”. The Administrator stated (R1) was taken to many medical appointments, including with specialists, which the responsible person confirmed also. Staff (S1) stated that (R1) would occasionally have a small amount of blood, a couple of drops, and (R1) didn’t ever complain about the medical condition, commenting (R1) used to take blood thinner every day. (S1) stated (R1) was good about taking their medications until April 2025 and would give the reason for refusing medications as they “make (R1) feel sick” every time they’re taken. (S1) confirmed Depakote was initially decreased in February 2025 but later increased and (R1) was good about taking the medications. (S1) stated (R1) was not as happy when they started refusing medications on April 7, 2025. Staff (S2) confirmed the same information. LPA and the Administrator phoned the responsible person on 6/17/25, who expressed she was very happy with the care (R1) received at the facility and confirmed the facility would regularly be in contact with her regarding any medical or medication issues, which she would promptly communicate with (R1's) physician. The responsible person confirmed that (R1) had visited the dentist and there was a treatment plan for the bleeding gums (R1) would experience; however, (R1) would cancel the appointments. The responsible person felt that once (R1's) mental heath was treated, they could then go to the dentist. Based on information obtained, LPA finds this allegation to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview. Copy of report left at facility.the state’s words, verbatim · CDSS document, Jun 17, 2025 · control 59-AS-20250505092228

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Mariana "Mimi" Musca, caregiver, and stated reason for the inspection. Mariana contacted the Administrator, Adina, by phone, who arrived at approximately 10:30 am. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). LPA was advised (2) residents are currently under hospice care. LPA observed all (6) residents to be present the facility. LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with private bath, (2) full bathrooms, kitchen, (3) staff rooms and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. The bathrooms have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. There is sufficient 2+day perishable and 7+day non-perishable supply of food. Sharps and toxins are locked. Hot water temperature measured 113*F in a resident bathroom. Fire extinguisher was last serviced 8/2/24, and the smoke/monoxide alarms are working. Fire doors are kept open with approved device and close automatically when the alarms are activated. Fireplace is used as storage only. There is a locked medication box in the refrigerator, and medications are locked in a separate cabinet. LPA observed the inside temperature to be 79*F. There is a First Aid kit on site as well as sufficient paper/incontinent products, including PPE. All required postings are posted.There is a covered patio table outside and (1) unlocked exit. There are no pools or bodies of water. (2) resident files were reviewed and were found to contain current/complete documentation. Meds were reviewed for (1) resident and orders matched meds being administered. LPA reviewed all staff files and observed current First Aid/CPR certification and documentation of completed annual training. LPA requested an updated copy of LIC500, LIC308 and current liability insurance today by 10/16/24. There are no deficiencies issued during today's inspection. Exit interview with Administrator. Copy of report provided.the state’s words, verbatim · CDSS document, Oct 9, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Mariana "Mimi" Musca, caregiver, and stated reason for the inspection. Mariana contacted the Administrator, Adina, by phone, who arrived at approximately 2:00 pm. LPA was advised that (2) of (6) residents were out of the community; (1) returned during the inspection. (1) resident is currently under hospice care. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms with private bath, (2) full bathrooms, kitchen, staff rooms and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps, toxins and medications in the kitchen. There are locked medications in the refrigerator. LPA observed the inside temperature to be 79*F. Fire extinguisher was last serviced 8/21/23. Hot water temperature measured 110*F in the kitchen. First Aid kit on site as well as sufficient paper products, including PPE. All required postings are posted. LPA reviewed the Infection Control Plan (LIC9282) and additional pages, that were last updated on 5/23/23 and found it to be very comprehensive. LPA observed (1) unlocked gate from the inside back patio with covered patio seating. There are no pools or bodies of water. LPA observed copy of RCFE Administrator certificate # 6004705740- exp 11/2/23- renewal documentation to be submitted this month. LPA reviewed (3) resident files and found them to contain current/complete documentation. Meds were reviewed for (1) resident and orders matched meds being administered. Documentation is current also. LPA reviewed all staff files - all staff have current First Aid/CPR certification and have completed recent annual training for (40) hours. LPA requested an updated copy of LIC500, LIC308 and current liability insurance today by 10/11/23. There are no deficiencies issued during today's inspection. Exit interview with Administrator. Copy of report provided.the state’s words, verbatim · CDSS document, Oct 4, 2023