Sacramento Senior Living II

Allegation investigated: The facility allowed excluded individuals to work in the facility. Staff are forging resident documents.

On 06/23/2026, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with facility staff Netani and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. Allegation: The facility allowed excluded individuals to work in the facility. It was alleged that the facility allowed excluded individuals to work in the facility. This investigation consisted of interviews with facility staff, residents, and records review. On 2/13/2026 LPA Hughes conducted a visit to the facility and spoke with facility staff (S1) who stated that they have not seen excluded individuals (E1) and (E2) inside of the facility. Interview with 3 out of 4 residents stated that they have not observed the excluded individuals inside of the facility. LPA checked LIC 500 Personnel Report, and Guardian Rosters and did not observe excluded individuals (E1) and (E2) on the reports. There is not enough information or evidence present to corroborate the allegation, therefore the allegation is unsubstantiated. Continuation 9099-C Unsubstantiated On 05/29/2026 LPA Hughes requested updated LIC 500 Personnel Reports from the administrator to verify staffing and administrator presence; however, the requested records were not provided. This was observed not in compliance with Title 22 regulation 87405, as the facility did not ensure facility administrator presence in the facility for a sufficient amount of time to effectively manage the facility and carry out duties as required by regulation. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility. Allegation: Staff are forging resident documents. It was alleged that staff are forging resident documents. This investigation consisted of records review. On 2/13/2026 LPA Hughes conducted a visit to the facility and collected resident LIC 602 Physician’s Reports for 5 residents in care. LPA Hughes reviewed the records and verified that 4 out of 5 LIC 602 Physician’s Reports contained physician signatures. LPA contacted the physician’s offices and confirmed that the signatures on the LIC 602 forms were authentic and consistent with the records maintained by the physicians. There is not enough evidence to corroborate that the facility forged or falsified documents. Therefore, this allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.the state’s words, verbatim · CDSS document, Jun 23, 2026 · control 27-AS-20260211145346

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jun 29, 2026

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person… and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility... This requirement was not met as evidenced by: The licensee did not ensure a qualified facility administrator was present at the facility as required. Interviews revealed that the administrator was not present at the facility for the minimum required hours necessary to oversee facility operations.the state’s words, verbatim · CDSS document, Jun 23, 2026

Plan of correction: The licensee will submit a statement of acknowledgement of the regulation cited. Additionally, the licensee will designate a facility administrator approved by CCLD, update the facility LIC 500 Personnel Report, and LIC 308 Designation of Facility Responsibility. Licensee will email administrator.. documents, LIC 308, LIC 500 to LPA by 06/29/2026.

Type of visit: Required - 1 Year

On 2/26/2026 at 9:30am, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with the facility designated administrator Salote. The current census is 5 with 1 facility staff present. This facility is a single story building licensed to serve (6) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 105 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen and was last serviced on 12/30/2025. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 76 degrees Fahrenheit. LPA observed toxins located in the hallway closet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 5 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 5 out of 5 resident files and they were complete. LPA reviewed 3 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 02/27/2026 (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of the LIC 809 reports was provided to the facility.the state’s words, verbatim · CDSS document, Feb 26, 2026

Type of visit: Case Management - Other

On 02/13/2026 at 2:20 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management visit to the facility. LPA met with the facility administrator Charlotte Lewis. The current census is 5 with 1 facility staff present. The purpose of this visit was to amend a complaint report that was created on 2/10/2026, the following changes were made to the complaint report control number: 27-AS-20260105163353, an allegation was changed from substantiated to unsubstantiated. During this visit LPA also conducted a case management regarding a deficiency that was cited during the complaint visit on 2/10/2026 control number: 27-AS-20260105163353. During the complaint investigation it was revealed that the facility did not ensure that Reporting Requirements were met as cited from the California Code of Regulations, Title 22, regulation 87211 Reporting Requirements. The deficiencies can be found on the 809-D page. An exit interview was conducted, and a copy of the 809 report, 809-D page, and appeal rights were given to the facility.the state’s words, verbatim · CDSS document, Feb 13, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a) · Plan of correction due date: Feb 13, 2026

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1)A written report shall be submitted to the licensing agency... for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This requirement was not met as evidenced by: The licensee did not ensure that a written report was provided to the Dept as required after (1)occurrences in which resident (R1) eloped from the facility.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: The licensee will ensure the facility remains in compliance with Title 22 regulations 87211 at all times. The licensee agrees to submit written reports within 7 days for any occurrence in the facility which threatens the health, safety, and welfare of residents in care.

Allegation investigated: Staff did not ensure resident received adequate food service. Staff prevented resident from attending day program services. Staff did not dispense medication to resident as prescribed. Staff did not communicate in a timely manner to coordinate resident’s care. Staff did not ensure resident received timely medical care.

On 2/10/2026 at 12:00 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility staff Netani and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The facility administrator was not present during today's visit. The current census is 6. Allegation: Staff did not ensure resident received adequate food service. It was alleged that staff did not ensure resident received adequate food service. This investigation consisted of interviews with residents, and facility observation. On 01/13/2026, LPA Hughes conducted a visit to the facility. LPA spoke with 3 out of 5 residents who stated they have no concern about not being provided with an adequate amount of food in the facility. LPA toured the facility and observed the facilities 2-day and 7-day supply of food with a sufficient supply of food for residents in care. There was not enough evidence present to corroborate this allegation; therefore, the allegation is unsubstantiated. Continuation 9099-C Unsubstantiated Allegation: Staff prevented resident from attending day program services. It was alleged that staff prevented a resident from attending day program services. This investigation consisted of interviews with residents, facility staff and the reporting party. On 1/13/2026, LPA Hughes conducted a visit to the facility. LPA spoke with 2 out of 5 residents who stated that they do not attend day program. Additional interview with resident (R1) stated that facility staff allow them to attend day program daily, stating staff assist them with preparing for day program. Interview with the facility administrator reported that the resident (R1) enjoys day program, and facility staff have never prevented the resident from attending day program services. LPA attempted to speak with the reporting party but could not obtain any further details. There was not enough evidence present to corroborate this allegation; therefore the allegation is unsubstantiated. Allegation: Staff did not dispense medication to resident as prescribed. It was alleged that staff did not dispense medication to a resident as prescribed. This investigation consisted of interviews with residents, facility staff, and a review of records. On 1/13/2026, LPA Hughes conducted a visit to the facility and spoke with facility staff (S2) who stated that they primarily dispense resident’s medications, stating that residents are given medications timely as prescribed. Interview with 3 out of 5 residents stated that they receive their medications timely as prescribed. Review of the Medication Administration Record (MAR) and Centrally Stored Medication Administration Record (CSMDR) for resident (R1) and (R2) indicated no discrepancies in medications not being administered as prescribed. Allegation: Staff did not communicate in a timely manner to coordinate resident’s care and Staff did not ensure resident received timely medical care. It was alleged that staff did not communicate in a timely manner to coordinate resident’s care with physician’s appointments for body rashes. This investigation consisted of interviews with facility staff, residents, the reporting party, and records review. On 1/13/2026 LPA Hughes conducted a visit to the facility and spoke with the facility administrator who reported that the resident has been seen by their primary care physician regarding a body rash initially on 10/2025. The administrator stated that the resident was medically cleared on 10/16/2025. The resident was seen again by their primary care physician on 01/2026 regarding a body rash and cleared on 1/30/2026. Interview with resident R1 stated that they suffer from itching due to rashes on their body. Resident (R1) stated that the facility administrator assists the resident with scheduling and transportation to physician’s appointments. Continuation 9099-C Additional interview with the reporting party reported that resident (R1) left the facility unassisted and was found at a gas station, additional information regarding the incident was not provided as the RP did not provide further details regarding the incident. LPA conducted a review of the LIC 602 Physician's report for resident (R1) it was reported that resident (R1) is unable to leave the facility unassisted. However, staff reported that resident R1 was followed and monitored by facility staff at the time of the elopement. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During an additional interview, the reporting party stated that the resident was suspected of having body lice twice, and at their request, resident (R1) was evaluated by a physician and were cleared of any indication of body lice. The reporting party further stated that the resident was observed to have a body rash only, and the facility did send medical clearance for the resident. Review of resident (R1) records indicated the resident was evaluated by a physician and medically cleared for two separate instances. There is not enough evidence present to corroborate this allegation. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 27-AS-20260105163353

Allegation investigated: Facility staff did not properly supervise client resulting in elopement

On 05/15/25, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to open and closed the complaint allegation outlined above. LPA met with caregiver Netani Tuivu to explain the purpose of the visit. A brief interview was conducted with administrator Salote Lewis via telephone call. The census is 5 with 1 facility staff. It was alleged that facility staff did not properly supervise client resulting in elopement. This investigation included interviews with staffs and records review. In an interview with both administrator Salote Lewis and caregiver Netani Tuivu, both admitted that resident 1 (R1) left the facility unsupervised. Based on records review it was learned that on 04/30/25, R1 left the facility unsupervised and was brought back to the facility by law enforcement. Per R1's LIC 602, Physician Report dated 10/02/23 R1 has a history of wandering behavior and is unable to leave the facility unassisted. Based on the interviews conducted during the investigation process and records review, LPA Lee was able to corroborate the allegation. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met.the state’s words, verbatim · CDSS document, May 15, 2025 · control 27-AS-20250507142611

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: May 24, 2025

87464(f)(1) Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidenced by: Based on records review, and interview with the administrator and care giver the facility did not ensure staff provide care and supervision to R1. Due to not providing care and supervision, R1 left the facility unassisted. This posed an immediate risk to residnets in care.the state’s words, verbatim · CDSS document, May 15, 2025

Plan of correction: Administrator agrees to conduct basic services (to include care and supervision) training for all staff using an approved vender through CCLD. Administrator will read the regulation cited and provide LPA Hughes a letter of acknowledgement that the regulation cited was reviewed and understood. Administrator will also put a plan in place for residents who are wonderers to ensure the residents safety. Administrator will email documents used for training and sign in sheet and plans in place for residents who are wonderers by POC Date 05/24/2025 by end of day 5:00pm.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Pang Lee arrived at this facility unannounced on 05/15/25, to conduct a case management visit. LPA Lee met with direct care staff Netani Tuivu and explained the purpose of the visit. A brief interview was conducted with administrator Salote Lewis via telephone call. The census is 5 with 1 facility staff. The purpose of the visit is to follow up on deficiency learned during complaint investigation control number # 27-AS-20250507142611. Through the complaint investigation, it was learned that on 04/30/25, resident (R1) left the facility unsupervised and was brought back to the facility by law enforcement. Per R1's LIC 602, Physician Report dated 10/02/23 R1 has a history of wandering behavior and is unable to leave the facility unassisted. Moreover, the facility did not The following deficiencies were observed and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. The deficiencies can be found on the 809-D page. An exit interview was conducted, and a copy of the 809 report, 809-D page, and appeal rights were given to the facility.the state’s words, verbatim · CDSS document, May 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: May 24, 2025

87211(a)(1)(D) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below… (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: Based on interviews and record review an incident report was not reported to CCLD after R1 left the facility unsupervised and was brought back to the facility by law enforcement which poses a potential health, safety, and/or personal rights risk.the state’s words, verbatim · CDSS document, May 15, 2025

Plan of correction: Licensee agrees to send LPA Hughes an incident report, and to review the applicable 22 CCR sections regarding reporting requirements, and to send LPA a signed Hughes statement acknowledging these requirements by POC due date 05/24/25 end of day 5:00 PM.

Type of visit: Case Management - Incident

On 04/23/2025 at 10:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes and Pang Lee arrived unannounced to conduct a case management regarding an AWOL incident report received by the Dept on 04/16/2025. LPA’s met with direct care staff, Netani Tuivu, and LPA's called administrator, Salote Lewis to inform that Community Care Licensing Department (CCLD) is present in the facility. LPA’s explained the purpose of the visit. LPA Hughes read the report to administrator, and administrator gave permission to direct care staff to sign citation. The census is 5 residents with one facility staff. LPA’s reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA’s interviewed administrator, and reviewed incident report dated 04/16/2025. Based on interview and incident report R1 left for a doctor’s appointment with facility staff, upon returning to the facility the resident left the facility unassisted. Per interview with facility administrator, there was only 1 staff present at the facility. Law enforcement was called, and a missing person report was filed. R1's LIC 602, Physician Report dated 09/12/2024 was reviewed by LPA Hughes and it revealed that (R1) is unable to leave the facility unassisted. Interview with Administrator revealed facility's internal plan includes providing supervision for R1 and all other residents in care. Additionally, it was revealed through interview that R1 left the facility, and facility staff did not redirect the resident. As of today’s visit, 04/23/2025 resident has returned to the facility. Based on today's case management, a citation is issued under Title 22, Division 6. An immediate civil penalty in the amount of $500 is issued in addition to citation due to absence of supervision. An exit interview was conducted with direct care staff, Salote Lewis. A copy of this report LIC 809, LIC 809-D, LIC 421IM and appeal rights was provided to direct care staff at the end of the visit.the state’s words, verbatim · CDSS document, Apr 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Apr 23, 2025

(f) Basic services shall at a minimum include: 87464 (f) (1) Basic services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code This requirement is not met as evidenced by: Based on observation, file review, and interview with the administrator did not ensure staff provide care and supervision to R1. Due to not providing care and supervision, R1 left the facility unassisted.the state’s words, verbatim · CDSS document, Apr 23, 2025

Plan of correction: Administrator agrees to conduct basic services training for all staff. Administrator will read the regulation cited and provide LPA Hughes a letter of acknowledgement that the regulation cited was reviewed. Administrator will email documents used for training and sign in sheet by POC Date 04/31/2025 by end of day 5:00pm.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Netaim Tuivu, Caregiver and explained the purpose of the visit. The facility is a one story building licensed to serve 6 ambulatory and non-ambulatory residents aged 60 and over, 2 of which may be hospice residents. Bedrooms #3, #4 and #5 can be used for non-ambulatory residents. As observed by LPA Campbell, upon entry, LPA Campbell observed one client eating breakfast and another watching the news on television. There was one caregiver on duty with gloves on their hands washing dishes, mopping and putting away groceries and assisting clients. At LPA Campbell's request, staff provided staff and clients files for review. LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furniture and furnishings were sufficient to meet the needs of residents. Bedrooms contained, beds, drawers, nightstand, lamp, chairs and closets. The facility temperature was 71 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature in the kitchen and bathroom measured 109 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. The backyard was toured by LPA Campbell. There are two emergency exits from the backyard to the street and pathways and exits were found to be clear. LPA Campbell observed first aid supplies, a fully-charged and up-to-date fire extinguisher that was last inspected on 08/20/2024, and working carbon monoxide/smoke detectors. LPA Campbell observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Campbell observed locked cabinets for the storage of medication. LPA Campbell observed locked storage areas for the storage of cleaning solutions and knives as well in the laundry room above the washer. . Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted with and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 23, 2025

Allegation investigated: Facility is not meeting the hygiene needs of a resident in care. Staff did not ensure that resident was wearing shoes when being transported to the hospital.

On 08/12/2024 at 8:46 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care giver Melvin Hinds and explained the purpose of the visit. LPA Lee explained the purpose of this visit is to deliver complaint findings for the allegations above. Care giver called administrator Salote Lewis and was not able to get a hold of the administrator. The current census is 5 with 1 facility staff. A brief interview with conducted with care giver Melvin. Allegation: Facility is not meeting the hygiene needs of a resident in care. It was alleged that the facility is not meeting the hygiene needs of a resident in care. This investigation consisted of observations, records reviewed, interviews with staff and residents. Throughout the course of the investigation, LPA Lee observe 5 out of 5 residents on 05/30/2024 and all the residents appeared to be in good hygiene. 5 out of 5 residents did not observe to have any outgrown fingernails. All residents were observed to be clean and comfortable. During today's visit, LPA Lee also observed 3 resident who was present in the home to appear clean and groomed. Continued LIC 9099- Unsubstantiated LPA Lee interviewed 5 out of 5 residents who stated that they have no concern with facility staff not meeting the resident’s hygiene needs. LPA Lee interviewed resident 1 (R1) using (R1)’s iPad. (R1) stated that (R1) has no concerns with facility not meeting (R1)’s hygiene needs. Based on interview with (R1)’s responsible party (RP), (RP) has no concerns and stated that facility staff are encouraging and reminding (R1) to take showers and that sometimes (R1) refuses services from the staff. Based on (R1)’s record review it was learned that (R1)’s personal grooming consisted of brushing teeth, facial wash, brush/style hair, shave facial hair, dressed appropriately, apply lotion/deodorant, nail care and maintenance and shower/sponge bath. (R1) is receiving (R1)’s personal grooming from the facility staff. Records review also indicated that (R1) is receiving 4 sponge bath and 3 showers from 04/15/2024 to 06/02/2024. LPA was unable to corroborate the allegation that facility staff is not meeting hygiene needs of residents in care. All resident interviewed denied the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. Allegation: Staff did not ensure that resident was wearing shoes when being transported to the hospital. It was alleged that staff did not ensure that resident was wearing shoes when being transported to the hospital. This investigation consisted of observations and interviews with staff and residents. Throughout the course of the investigation, LPA Lee observe 5 out of 5 residents on 05/30/2024 who either had on shoes, socks and slipper. It was observed that (R1) was wearing socks and had on a slipper. LPA Lee also interviewed 5 out of 5 residents who did not witness (R1) being transported to the hospital without shoes. LPA Lee also interviewed (R1) who communicated with LPA Lee via iPad. LPA Lee asked resident to explain what happen when (R1) was transported to the hospital and if (R1) had any shoes and socks on and (R1) stated “good.” (R1) stated (R1) has no concerns. Based on interview with (R1)’s responsible party (RP), (RP) has no concerns and stated that (RP) visits (R1) occasionally and does observe (R1) to have socks and slippers on. It was learned from administrator that on 05/20/2024 the facility staff called EMT for (R1) since (R1) have been refusing (R1)’s medication from 05/17/2024 to 05/19/2024. It was also learned that (R1) was being combative with the EMT staff and the facility staff. (R1) was being combative because (R1) didn’t want to go to the hospital. Administrator stated that (R1) may have lost (R1)’s shoe during the altercation and is not sure since administrator was not present that day. Continued LIC 9099-C It is unclear if resident was transported to the hospital with or without shoe. Regarding the allegation that staff did not ensure that resident was wearing shoes when being transported to the hospital, there is not a preponderance of evidence to prove that it occurred. LPA was unable to corroborate the allegation that staff did not ensure that resident was wearing shoes when being transported to the hospital. All resident interviewed denied any knowledge of the allegation and the described incident while (R1) was being transported to the hospital. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was conducted with the facility staff and a copy of this report was left at the facility with care giver Melvin Hindes at the end of today’s visit.the state’s words, verbatim · CDSS document, Aug 12, 2024 · control 27-AS-20240521154127

Allegation investigated: Staff did not administer resident's medication

On 7-25-24 at 12:47pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss investigative findings for the allegation noted above. LPA met with lead caregiver Melvin Hinds and explained the purpose of the visit. Administrator Salote Lewis was notified via phone of LPA's visit and purpose and gave permission for lead caregiver to sign in her absence. Allegation: Staff did not administer resident's medication. During this investigation, LPA conducted interviews with four residents and Administrator. LPA also reviewed facility file documentation including medication log sheets. Additionally, LPA conducted a facility observation on 7-19-24. LPA Truong conducted additional investigation for this allegation. Based on record review, it was revealed that facility staff did not administer as prescribed eye drop medication for resident5 (R5) on 6/28/2024 at 12pm, 4pm, an 8pm. Based on record review, it was revealed that medication Amlodipine 5mg was not administered as prescribed to R5 on 6/28/24. No additional documentation to describe reasons for R5 not receiving these medications was available. {Cont. on 9099C} Substantiated As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6. An exit interview was conducted with lead caregiver and a copy of this report was provided to lead caregiver. Appeal rights provided. LIC 811 provided. Additionally, it was revealed through interviews that no corroborated statements existed which describe staff making inappropriate comments towards residents. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not assist resident in a timely manner. LPA conducted interviews, observation, and record reviews as noted above. Based on interviews and record reviews, it was revealed that staff are assisting residents as needed within appropriate amounts of time and providing adequate supervision during assistance. LPA’s observation did not reveal an inadequate response time to residents’ needs. Record reviews indicate staff are meeting residents’ needs timely in various activities of daily living (ADL) components. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not meet resident’s bathing needs. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that staff are performing bathing assistance in an adequate and timely fashion. Records reviewed indicated various type of bathing needs for residents. These records indicate staff is completing bathing assistance needs for residents in care. Additionally, interviews did not reveal corroborated statements of staff not meeting residents’ bathing needs. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not safeguard resident’s personal belongings. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that Licensee maintains documentation adequate for tracking residents’ personal belongings along with options for residents’ to record what personal items are brought in and removed. Additionally, interviews conducted did not reveal any corroborated statements of staff mishandling or otherwise not safeguarding residents’ personal belongings. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. {Cont. on 9099C} Allegation: Staff inappropriately video record residents. LPA conducted interviews and observations as noted above. Based on interviews conducted, there were no corroborated statements which revealed facility staff recording residents with any devices including wall mounted cameras or cell phones. LPA’s observation did not reveal the presence of any recording devices inside or outside of facility. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not provide a comfortable and safe environment for resident. LPA conducted interviews and observations as noted above. Based on observation, facility at this time maintains adequate furniture and furnishings throughout with adequate lighting and functional devices necessary for resident comfort and safety. Observation revealed no obstruction to fire exits and dangerous items were secured and inaccessible to residents in care. Interviews conducted did not reveal any corroborated statements of staff not providing a safe and comfortable environment. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff are not providing adequate food service to residents. LPA conducted interviews, observation, and record reviews as noted above. LPA compared current facility menu to food items on hand. LPA observed food items in appropriate quantities and able to match established menu items. Additionally, menu reviewed contains various food choices as well as snacks available to residents throughout the day. Established food items contain the regulatory required nutrition available to residents. Interviews conducted revealed facility staff is providing a variety of food choice between breakfast, lunch, and dinner. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with lead caregiver and a copy of this report was provided to lead caregiver. Appeal rights provided.the state’s words, verbatim · CDSS document, Jul 25, 2024 · control 27-AS-20240508134903

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 26, 2024

87465(a)(4). Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility… (4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by: Based on record review, Licensee did not ensure R5 was assisted with prescribed medication. This posed an immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 25, 2024

Plan of correction: Licensee to submit a plan ensuring the timely and accurate delivery of prescribed medication to residents in care. Plan to be submitted to LPA by POC due date. Licensee to read regulation 87465(a)(4) and submit a signed declaration of understanding to LPA by POC due date.

Allegation investigated: Staff did not prevent residents from having access to illegal drugs Staff inappropriately touched resident

On 7-19-24 at 1:05pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with lead caregiver and explained the purpose of the visit. Administrator Salote Lewis was contacted by LPA via phone and gave permission for lead caregiver to sign in her absence. During this investigation, the Department conducted interviews with three staff members and three residents in care. Allegation: Staff did not prevent residents from having access to illegal drugs. Based on interviews conducted, it was revealed R1 was witnessed by a staff member to have returned to the facility “high” after leaving facility with R1’s family member for an outing, however, was not revealed by staff that R1used drugs in the facility. Additionally, it was revealed that no corroborated statements existed to suggest illegal drug use within the facility by any residents. {Cont. on 9099C} Unsubstantiated This includes witnessing residents using illegal drugs or the observation of illegal drugs within the facility. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff inappropriately touched resident. This allegation was investigated by the department and consisted of interviews as stated above. This allegation included an accusation of molestation by staff. Based on interviews conducted, it was determined that R1 required assistance with bathing and preferred not to have “his private parts” washed. It was further revealed through interview that on one occasion, staff2 (S2) was assisting R1 with bathing and proceeded to mistakenly wash R1’s private area in the shower and stopped once told by R1 to do so. Additional interviews revealed no corroborated statements of being touched inappropriately by S2. Based on evidenced obtained, there is no preponderance of evidence to show that S2 inappropriately touched R1 with the intent to sexually gratify either party involved, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with lead caregiver and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, Jul 19, 2024 · control 27-AS-20240508134903

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.

Allegation investigated: Staff did not ensure resident's room was free from odors

On 5/15/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a complaint visit regarding the allegations above. LPA met with Administrator Salote Lewis and explained the purpose of the visit. Based on observations and interviews conducted, LPA discovered urine odor throughout this facility especially in the resident bedrooms. The administrator acknowledged that there is urine odor in the facility and corroborated that staff will need to clean the bedrooms more frequenlty. As a result of this investigation, LPA finds this allegation 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. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. Exit interview was conducted, a copy of the report, LIC 9099-D and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, May 15, 2024 · control 27-AS-20240508134903

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(3) · Plan of correction due date: May 16, 2024

Managed Incontinence. (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 is not met as evidence by: Based on observation, the licensee did not ensure the facility free of odors from incontinence. LPA discovered strong urine odor in the hallway especially in the resident bedrooms.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: The Licensee agrees to submit a plan to CCL on how the facility presenting malodorous will be addressed by POC due date.

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: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a case management visit on 5/15/2024. LPA met with Administrator Salote Lewis and stated the purpose of today’s visit. The purpose of today's visit is in response to deficiencies observed during a complaint visit on 5/9/24. On 5/9/24, LPA observed a staff room with a bed; however, the facility sketch does not indicated that there is a staff room. Based on record review, it was learned that the room was initially designated as an office. The facility has converted the office into a staff room for the live-in staff without notifying the Department. LPA informed the Administrator that if the facility chooses not to have a staff room, a plan of operation addendum shall be sent to Licensing indicating awake staff at all times. Deficiencies were cited on the LIC 809-D pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code. An exit interview was conducted, a copy of this report, LIC 809-D and appeal rights were provided.the state’s words, verbatim · CDSS document, May 15, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(b) · Plan of correction due date: May 22, 2024

87305(b) Alterations to Existing Building or New Facilities: The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidence by: Based on the LPA's findings, the facility has converted the office into a staff room. The facility failed to submit the plan to licensing, which poses a potential Health, Safety risk to residents in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: The Licensee shall read regulation 87305 and submit a signed declaration of understanding to LPA by POC due date. The Administrator has removed the bed and no longer uses the room as a staff room.

Allegation investigated: Personal Rights: Facility staff touched a resident inappropriately

Licensing Program Analysts (LPA) Kevin Gould made an announced inspection to the Sacramento Senior Living II RCFE on 3/7/24 at 9:00am to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Misivono Qadroka 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 because R1, in discussing the allegations over two interviews clarified that he was initially uncomfortable with a staff member of the same gender assisting with bathing but has come to understand that staff is only assisting with daily living and is not a sexual act. R1 states they have made adjustments to bathing and R1 can wash his body with assistance of staff. Staff interviewed denied any issues with bathing and that R1 prefers to wash parts of himself and there have been no issues. S1 states R1's physician reports and needs and services plan R1 requires assistance with bathing. Per file review R1's 602 does indicate that R1 needs assistance with bathing. Unsubstantiated 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 Personal Rights 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 home.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 27-AS-20231215155605

Type of visit: POC

On 2/7/24 at 1:00pm, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection to ensure previous plans of corrections have been addressed and completed per the plan of correction identified during the complaint inspection on 1/31/24. LPA Gould tested the hot water temperature and recorded a temperature 116 degrees which meets title 22 regulations. The deficiency is cleared and POC letter generated. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 7, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with administrator and explained purpose of visit. Administrator certificate expires 8/8/2024. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside backyard area. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in resident's bathroom at 113.4 degrees Fahrenheit which is within the required range of 105 to 120 degrees. Fire extinguishers last inspected on 10/10/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. Facility fire drill was completed on 1/4/2024. LPA reviewed four resident files and three staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA Wallace requested the following updated documents be emailed to community care licensing by February 9, 2024: LIC 308 - Designation of Administrator, LIC 500 Personnel Report, and Staff Hours Log Copy of Liability Insurance, Articles of Incorporation and Bylaws, Copy of Control of Property, and Copy of Administrator's Certificate. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. Exit interview held with administrator. A copy of reports and LIC 811 (Confidential Names) were left at facility.the state’s words, verbatim · CDSS document, Feb 2, 2024

Allegation investigated: Facility staff was sleeping while at work.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Sacramento Senior Living II on 1/31/23 at 9:00am to conclude the investigation of the above allegation and to deliver the findings. LPA met with staff and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated because two of the resident's interviewed confirmed that they could not wake a staff member with pages sent from the resident's bedroom following an incident where a resident fell in their room overnight. Residents attempted to page the staff member for assistance with no response and called 911 for assistance. Staff interview confirmed the events as described by residents. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of Neglect/Lack of Supervision is substantiated but if any additional information is received this complaint can be amended and the finding can be changed. Substantiated The following deficiencies are cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 31, 2024 · control 27-AS-20231219121552

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Feb 1, 2024

Care Of Person's With Dementia: In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre- admission appraisal, reappraisal or observation to require awake night supervision. this requirement was not met as evidenced by statements obtained from staff and residents and R1's assessment that indicates the need for awake staff and nighttime supervision due to diagnosis of dementia which poses an immediate health/safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: Facility will provide a written plan of correction that will become part of their plan of opperation: The POC will include details for night supervision of resident with an awake staff member on duty and awake at all times and a detailed description of staff duties while awake during overnight shift.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Sacramento Senior Living II on 1/31/23 at 9:00am to conduct a case management deficiencies inspection to address additional deficiencies observed while conducting a complaint investigation. Based on the interviews and statements obtained during a complaint investigation, two of the resident's interviewed confirmed that they could not wake a staff member with pages sent from the resident's bedroom following an incident where a resident fell in their room overnight. Residents attempted to page the staff member for assistance with no response and called 911 for assistance. Staff interview confirmed the events as described by residents. The requirements for basic services such as care and supervision were not met by the staff member present at the facility. Additionally, when LPA Gould washed his hands he observed the water to be very hot. When the water temperature was tested a temperature of 136 degrees was recorded. LPA requested staff to turn down the hot water. The following deficiency is cited per California Code of Regulations, Title 22. Exit interview conducted and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 31, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Feb 1, 2024

Basic Services: Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by statements from staff and residents that the staff member did not respond to resident pages when he sustained a fall at the facility which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: facility will conduct additional training with staff and a written plan of correction that indicates the appropriate response time for assisting residents with care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(e)(2) · Plan of correction due date: Feb 1, 2024

Maintenance and Operation: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). this requirement was not met as evidenced by LPA testing of hot water temperature which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: facility staff turned down the hot water temperature, Facility will provide a written plan of correction indicating how the facility will ensure the hot water temperature meets regulations and the frequency of hot water testing by facility staff on a regular basis.

Type of visit: POC

On 12/11/23 at 9:30am, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection to ensure previous plans of corrections have been addressed and completed per the plan of correction identified during the complaint inspection on 12/1/23. LPA Gould inspected the medication administration logs for residents and observed all medications documented appropriately. Staff present was receiving POC training in the presence of LPA by an outside agency. LPA Gould approved additional time for administrator to complete POC for written plan of correction as LPA requested additional information on the written plan of correction. POC extension to 12/12/23 by COB. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 11, 2023

Allegation investigated: Resident was left in soiled garments for an extended length of time Staff did not ensure resident hygiene needs were met

Licensing Program Analyst (LPA) Tung Truong conducted an unannounced facility visit to complete and deliver findings for a complaint investigation received on 11/6/23. LPA met with Staff Misivono Qadroka and discussed the conclusion for complaint and the findings. Throughout the course of the investigation, LPA conducted interviews and reviewed records. Based on resident interviews, resident (R2) and (R3) corroborated that staff (S2) had left R3 in soiled garments overnight. R3 reported that they needed to be changed, but S2 ignored and didn’t change R3 until the next morning. Based on interviews conducted during the course of this investigation, it was learned that residents’ hygiene needs were not being met. It was learned that showers were not being provided to resident (R1) as R1 appeared dirty. It was learned that S2 didn’t know when the last time residents were showered. Continued on 9099-C Substantiated As a result of this investigation, the Department finds the allegations above 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. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. Exit interview was conducted, a copy of the report, LIC 9099-D and appeal rights were provided. As a result of the investigation, the Department finds the allegations above to be UNSUBSTANTIATED- A finding that the complaint 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 was conducted and a copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Dec 6, 2023 · control 27-AS-20231106165238

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Dec 7, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, ... This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the regulation cited above. R3 was left in soiled garments overnight. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2023

Plan of correction: Licensee shall submit a plan of correction to LPA on how the facility will be in compliance with regulation 87468.1(a)(3) at all times by POC due date 12/7/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 13, 2023

87464. Basic Services. (f) Basic services shall at a minimum include… (1) Basic services care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: Based on interviews and records review, the Licensee did not ensure resident's hygiene needs are met. Staff did not provide showers to R1. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2023

Plan of correction: Licensee shall submit a plan of correction to LPA on how the facility will ensure that residents' hygiene needs are met by POC due date 12/13/23.

Allegation investigated: Medications: 1) Staff mishandled a resident's medication while in care. 2) Staff have inadequate record keeping for a resident.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Sacramento Senior Living II RCFE on 12/1/23 at 1:00pm to inform the licensee of complaint allegations mentioned above and to deliver the findings. LPA met with Staff Misivono Qadroka and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated because LPA reviewed resident records and medication administration records and observed several instances for all residents where the medication administration was not documented according the the facility program and title 22 regulations. There was no documentation for any residents medication administration on today's date. Additionally LPA observed that there were gaps in the medication administration due to alleged waiting for pharmacy refills but LPA determined the refill request was made after the recommended date of the refill and resident was not administered medications per physician's orders. Substantiated The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegations of Medications is substantiated but if any additional information is received this complaint can be amended and the finding can be changed. The following deficiencies are cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 1, 2023 · control 27-AS-20231127140349

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Dec 2, 2023

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by LPA review of all resident MARs and observation of incomplete documentation of medication administration with poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 1, 2023

Plan of correction: facility will provide training to all staff member who administer medications and the appropriate steps in documenting medication once it is given to the residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Dec 2, 2023

Incidental Medical and Dental Care: Once ordered by the physician the medication is given according to the physician's directions. the requirement was not met as evidenced by LPA observed there were several days resident did not receive medications due the waiting on refill and LPA observed in documentation the refill request was made once med the medication refill order was not made until resident was out of medications which poses an immediate health safety and personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Dec 1, 2023

Plan of correction: facility will provide a written plan of correction indicating the changes and steps the facility will make to ensure resident medications are refilled and available for residents as prescribed by the physician.

Type of visit: Collateral

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced in order to conduct a collateral visit. LPA Moleski met with staff member Misivono Qadroka and explained the purpose of the visit. LPA Moleski called facility administrator Salote Lewis and left a voicemail explaining the purpose of the visit. LPA Moleski attempted to interview a resident (R1), but R1 was not present. LPA Moleski received a telephone number for R1. LPA Moleski reviewed R1's file. No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Qadroka.the state’s words, verbatim · CDSS document, Oct 3, 2023