Safe Haven Oakdale

Allegation investigated: Facility did not ensure staff assisted resident with ADLs

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Caregiver Emilie Carnicar and explained the reason for the visit. LPA Lund spoke with Facility Manager Ryan Alejo who gave permission for Caregiver Emilie Carnicar to sign required paperwork. Census: 5 Facility did not ensure staff assisted resident with ADLs - Based on records reviewed, Oakdale Police report OP26-00201, interviews with staff, witnesses and residents in care. LPA Lund reviewed Appraisal/Needs and Service plan dated 11/15/2025 for resident (R1) which states R1 has a history intermittent episode of confusion, forgetfulness and difficulty managing day to day tasks. R1 has difficulty in Self-Care and Activities of Daily Living (ADLs). Interviewing witness stated that their residents in care were getting their ADLs met by staff and had no concerns. Unsubstantiated . Staff interviewed stated that R1 would refuse to take showers and didn’t have much clothing to meet her needs and would have to wash them constantly. Oakdale Police investigated (Neglect) based on statements provide and other residents stating they are taken care of, it was determined no crime had occurred at this time when reviewing report. Based on records reviewed, Oakdale Police report OP26-00201, interviews with staff, witnesses and residents in care, and staff the information provided, it was unclear if facility did not ensure staff assisted resident with ADLs was deemed UNSUBSTANTIATED. The Department (CCLD) has found the allegations. Unsubstantiated. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview was conducted with and report left.the state’s words, verbatim · CDSS document, May 21, 2026 · control 27-AS-20260123122247

Type of visit: Required - 1 Year

At 9:45 AM on 8/13/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility unannounced to conduct a required annual inspection. The LPA was greeted by a caregiver. The LPA identified herself, explained the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). The LPA spoke with the DFA on the phone. The DFA authorized her representative, designated on the LIC308, to assist and accompany the LPA on a tour of the facility and records review. The designated representative arrived at the facility at 10:30 AM. This facility is licensed to serve six non-ambulatory residents. It has a hospice waiver for six residents. Its fire clearance was issued by Oakdale Fire Department Station 27 on 04/10/2024. The census was four residents at the time of this inspection. There was one caregiver on duty. The LPA toured the inside of the house, including four resident bedrooms, the kitchen, two bathrooms, dining room, living room, and garage. The entire house was clean, odor-free, and pest-free. The windows and window screens were in good repair. The required documents were posted in the entry way, including the license, current administrator certificate, personal rights, complaint hotline poster, and ombudsman information. The LPA inspected three smoke detectors, a carbon monoxide detector, and fire extinguisher. The smoke detectors were in the bedroom hallways and were an interconnected system. Staff tested one smoke detector and all three detectors sounded an alarm. Staff tested the carbon monoxide detector and it sounded an alarm. The fire extinguisher was last serviced on 3/28/2025 by Assured Fire Extinguisher Service. The LPA observed documentation of quarterly disaster drills. This report continues on LIC809-C, page 2. Each bedroom contained the required furniture, including bed, bedside table, lamp, dresser, and chair. The bedrooms and their closets were clean, organized, and odor-free. The bedroom hallway had a nightlight and contained storage cabinets with extra linens. One bedroom contained a full bathroom. A second bathroom was located in the bedroom hallway. Both bathrooms contained grab bars and non-slip mats. Both bathrooms were clean and odor-free. The LPA measured the water temperature at a bathroom sink, which was 113 degrees Fahrenheit. The LPA toured the kitchen. The kitchen was clean, the appliances were operable, and the trashcan had a lid on it. There was a seven-day non-perishable and two-day perishable supply of food located in the kitchen refrigerator-freezer, cabinets, and pantry. Sharp objects were kept locked in a lower kitchen cabinet. The LPA observed chemical cleaners in an unlocked lower cabinet under the kitchen sink. Staff stated that the lock was broken. Staff immediately moved the chemicals to a locked staff office. The LPA toured the dining room and living room, which contained enough furniture for all residents, including a dining table and chairs and six recliners. There is artwork on the walls and large windows that let in natural light. The LPA toured the garage. The garage contained an extra refrigerator-freezer, water heater, washing machine and dryer, and storage cabinets. The LPA observed additional perishable food in the refrigerator-freezer and extra supplies for residents in the storage cabinets. The LPA observed chemical cleaners in an unlocked storage cabinet in the garage. Staff immediately locked the access door that led from the house to the garage with a key that only staff had. The LPA toured the back yard, which included a large, wooden shade structure with a table and chairs under it. The concrete patio and walkways on the side of the house are free of obstructions and the surrounding fence is intact and sturdy. This report continues on LIC809-C, page 3. The LPA inspected the central medication storage area. Residents’ medication was kept in a locked cabinet in the kitchen. Each resident’s medication was stored separately in its original containers with intact labels. The LPA observed the electronic-based medication administration record, which was complete and up-to-date. There was a first aid kit in the medication cabinet that contained all the required items. The LPA reviewed records for four residents and two staff and found the records to be complete. Both staff had criminal background clearances and current first aid/CPR certifications. The Administrator’s certificate was valid (#7026256740) and expires 2/14/2027. The LPA requested that updated copies of these documents be submitted to Licensing by 8/27/2025 at ellen.lindstrom@dss.ca.gov. (1) LIC 308 Designation of Facility Responsibility (2) Copy of a current Administrator Certificate (3) LIC 610 Emergency Disaster Plan (4) Proof of Liability Insurance (5) LIC 500 Personnel Report (6) LIC 309 Administrative Organization As a result of this annual visit, one deficiency was cited (see LIC809-D). The facility was not in compliance with Title 22 Regulation. An exit interview was conducted with the designated staff and a copy of the LIC 809, LIC 809-D, and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Aug 13, 2025

Allegation investigated: Facility staff mismanaged resident's medications.

On 07/10/2025, Licensing Program Analyst (LPA) Renee Campbell went to the Safe Haven Oakdale LLC residential home for the elderly to deliver a complaint that was filed with the department on 3/5/2025: Facility staff mismanaged residents’ medication Based on a review of the MAR report and interview with S1, the allegation could not be substantiated as there was no indication that medication had been shared with another resident and S1 denied sharing a resident’s medication with other residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. There are no deficiencies noted or cited per California Code Regulation. An exit interview was conducted with the House Manager Appeal Rights were issued, and a copy of this report was left at the facilit Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 10, 2025 · control 27-AS-20250305161401

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to open a complaint investigation. During the course of that investigation, LPA Campbell discovered other deficiencies unrelated to the complaint allegations, which will be addressed in this case management report. LPA Campbell met with Caregiver, Chyl-c Anaviso and Emilie Carno, Caregiver and explained the purpose of the visit. LPA Campbell conducted a review of resident Medication Administration Records (MAR) and observed that Staff 1(S1) had not initialed the form for medication dispersal for five days in a row. Per regulation 87465(a), the facility is to establish 'a plan for incidental medical care' to 'encourage routine medical and dental care.' LPA Campbell observed missing staff initials for Resident 2 (R2) and R3 for five days from March 6 to March 11. When questioned, S1 admitted that they had not filled out the form as required in the plan established by the facility and they reported that they had been tired and busy with a resident. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiency is being cited on the attached 809-D during this visit. An exit interview was conducted, and copies of the report and appeal rights left.the state’s words, verbatim · CDSS document, Mar 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a) · Plan of correction due date: Mar 21, 2025

Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by each facility. The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by: Based on a review of the facility medication administration record (MAR) and Controlled Medication Administration Record, it was observed that required names/initials for medication dispersal were not filled out which poses/posed an immediate risk to the health, safety, and personal rights of the residents in care.the state’s words, verbatim · CDSS document, Mar 11, 2025

Plan of correction: The lincensee will establish a procedure for auditing the MAR to ensure established procedures are followed and read and present a memorandum of understanding for regulation 87465.

Type of visit: Post Licensing

On 01/17/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced to conduct a post-licensing inspection. LPA Campbell met with Vince Popanes and explained the purpose of the visit. The facility is a single story facility licensed for 6 non-ambulatory and hospice residents over 60. There are 4 bedrooms. Of the 4 bedrooms, 2 are shared rooms and 2 are private rooms. One of the shared rooms has an en suite bathroom. Occupants of the rest of the rooms use the bathroom in the hallway. There is no body of water found on the facility. The facility sketch shows no alterations in comparison to the building during the visit. Upon Entry, LPA Campbell observed a sign in sheet in the entry. A See Something, Say Something poster and Ombudsman poster were on the wall. Certificate #6060598740 for administrator Aileen Poquiz was framed as well. It expires on 02/14/2025. The facility was odor free and free of debris. The fire extinguisher was last inspected on March 21, 2024. LPA Campbell conducted a tour of the premises that included but was not limited to the dining room, bedrooms, bathrooms, common area and backyard. The dining rooms and common areas were furnished appropriately. Bedrooms contained the appropriate items including beds, chests, closets, chairs, night stand and lamp. The thermostat was observed at 71 degrees Fahrenheit (F). Water was measured at 115 degrees F. The Pantry contained enough food to last the residents seven days. Perishable foods were observed to be enough to last residents 3 days. The outside area and the pathway to the fire exit was free of obstacles. A shaded area was observed with seating and a table. The smoke alarm was tested and found to be functioning. Knives were observed to be locked in a lower cabinet in the kitchen. Of the 6 residents, 4 of their files were reviewed and found to be complete. No staff files were found at the facility. When copies of files were requested, the administrator offered to email the records. However, they could not be provided within a reasonable amount of time and had not arrived by 2:00 pm. Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited and noted on LIC 809D. Note that failure to correct any deficiencies will result in additional civil penalties.the state’s words, verbatim · CDSS document, Jan 17, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jan 27, 2025

87355(e)(1) Criminal Record Clearance. Prior to working,... in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidenced by: Based on record review, the licensee did not ensure a criminal record clearance was obtained for 1 of 2 staff members (S2) present in the facility, which poses an immedicated Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: Effective Immediately, but no later than 01/17/2025; the Administrator shall remove S2 from the facility and have all employees fingerprinted, complete a health screening and TB test prior to returning to work by POC date. Written certification is required to show Administrator has read regulation by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87412(g) · Plan of correction due date: Jan 27, 2025

87412 (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met as evidenced by: LPA and staff were unable to find complete staff files on premises for review. Of the one file found, the paperwork is incomplete.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: Administrator will ensure staff files are present, complete and easily available to staff and LPA for review by POC date.

Type of visit: Prelicensing

On 7/18/24 Licensing Program Analyst (LPA) Maja Jensen arrived at 524 E Union St in Modesto announced to continue a pre-licensing inspection related to a change in ownership. LPA Jensen met with current Licensee Maria Acedo and applicant Aileen Grimesey, LPA Jensen received photographic evidence that the doors connecting resident rooms have been equipped with a locking mechanism to allow for passage from room to room. LPA Jensen received an updated copy of the Plan of Operation with all requested revisions made. The applicant has agreed that no surveillance cameras will be used in the interior of the facility unless a waiver is requested and approved by the Department which details a compelling health and safety reason for use. The current owner is sending formal written notification of transfer of the business today and providing a 60 day notice. LPA Jensen reviewed the notice and determined it to be compliant. The applicant has passed the pre-licensing inspection and component III was conducted however licensure will require a 60 day waiting period so that residents or resident representatives have an adequate period of time for consideration. An exit interview was conducted and a copy of this report was giventhe state’s words, verbatim · CDSS document, Jul 18, 2024