Saint Benedict Care

Type of visit: Required - 1 Year

On March 20, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry into the facility by staff, after stating the reason for the visit. Administrator (Admin) Uldarico "Rico" Almiranez arrived shortly to assist with the visit. Uldarico Almiranez has an Administrator Certificate which expires on April 10, 2028. The facility is licensed to operate for age 60 and over for (6) non-ambulatory residents, of which one (1) may be bedridden, and has a Hospice waiver for four (4). The building is a single story structure located in a residential neighborhood, which consists of the following: six (6) resident bedrooms, one (1) staff bedrooms, three (2) bathrooms, living area, dining area, kitchen, an outdoor covered seating areas, and an attached two car garage. LPA Bentley toured the inside and outside of the physical plant with staff. There were no bodies of water or obstructions inside the facility. All rooms were inspected and the facility was observed to be appropriately furnished at the time of visit. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Additional linens, comforters, and bath towels were adequately stocked and available. The kitchen was observed clean, all appliances were operational, and there is a two-day supply of perishable and seven-day supply of non-perishable food available. Toxins, disinfectants, sharps, and medications were secured and inaccessible to residents in care. Bathrooms were found to be clean, however water temperatures measured between 126.6 degrees F to 129.6 degrees F. A deficiency was cited. CONTINUE TO LIC809-C.... The backyard was observed free of clutter and debris and the facility has one exit gate that was operational. An emergency safety drill was last conducted on March 19, 2026 and are being conducted quarterly. The smoke alarms and carbon monoxide detectors were operable. Emergency food, emergency water, and emergency supplies were stored in the garage. The facility has one (1) fire extinguisher that was charged, mounted, and serviced on January 11, 2026. First aid kit is maintained and contains all the necessary elements. A working telephone (657-845-4355) remains available, however the facility does not have a device that can be used for video teleconference purposes. A Technical Violation was provided. LPA Bentley conducted an audit of five (5) resident files (R1-R5), four (4) staff files (S1-S4), and medication and medication administration records review were all found in order and complete. LPA Bentley conducted four (4) resident interviews and two (2) staff interviews. Liability Insurance is effective October 13, 2025, and expires on October 13, 2026. Based on today’s observations, a deficiency was cited during the visit, per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator Uldarico Almiranez, and a copy of this report, LIC809-D, and Technical Violations, were provided at the end of the visit.the state’s words, verbatim · CDSS document, Mar 20, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Facility failed to communicate with resident's conservator regarding resident's finances. Facility forged signature on resident's check.

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Uldarico Almiranez and discussed the purpose of the visit. The investigation into the allegations of facility failed to communicate with resident's conservator regarding resident's finances and facility forged signature on resident's check revealed the following: It was alleged that facility staff did not inform Resident #1 (R1) responsible party in regards of a check that R1 received and that facility staff forged R1s signature on the check. LPA reviewed a physicians report for R1 dated October 7, 2022, stating that R1 was diagnosed with Mild Cognitive Impairment and can manage their own cash resources. LPA reviewed an incomplete social security form for R1 dated May 24, 2021, stating that R1 does not have a conservator and that R1 is responsible for their social security benefits. Continue on 9099C Unsubstantiated Interviews with R1 revealed that they do not have any evidence to share with LPA and that they sent the Department everything they already had obtained. LPA reviewed the evidence that was previously sent to the Department and found alleged forged signatures. LPA was unable to determine what the alleged forged signatures were for and if they were in fact not R1s signatures. LPA did not observe conservator papers for R1. Interviews with W1 revealed that they did not know much about the complaint and referred to R1 for evidence and details of the allegations. Interviews with AD revealed that they did not forge the signatures and R1 was handling their own money and social security benefits. Based on information gathered and interviews conducted the Department is unable to ascertain if the above mentioned complaint allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred: therefore, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026 · control 22-AS-20231101155257

Allegation investigated: Facility is not adhering to resident's dietary needs

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of investigating the above mentioned complaint allegation. LPA was greeted and granted entry into the facility by staff. LPA met with Administrator (AD) Uldarico Almiranez and discussed the purpose of the visit. The investigation into the allegation facility is not adhering to resident's dietary needs revealed the following: Resident 1 (R1) moved into the facility on September 28, 2018. LPA reviewed records and observed a physician’s report for R1 dated April 4th, 2024, that stated that R1 has no special diet orders. It was also noted on R1s physician’s report that they were unable to feed themselves and were unable to communicate their needs. LPA reviewed R1’s needs and service plan dated January 08, 2022, which notates a need for staff to assist R1 with full Activities of Daily Living (ADLs). Continue on LIC9099C Unfounded On October 26, 2024, R1 was hospitalized due to difficulty breathing. Per interview with R1’s Responsible Party, Responsible Party was unaware of any special diet R1 may have been on. R1’s responsible party stated that R1 was still eating and swallowing towards the end of their time at the facility and had no concerns with aspiration. During the course of the investigation the Department conducted interviews. During interviews with AD & Staff #1 (S1), it was revealed that R1 had no dietary restrictions that either were aware of. S1 informed LPA that R1 was able to eat all the food that was provided just fine with staff assistance. LPA was unable to interview R1 at the time of the investigation. Based on observation, interviews, records reviewed, and information gathered during the investigation the preponderance of evidence standard has not been met, therefore the above allegation is deemed UNFOUNDED. Meaning the allegation facility is not adhering to resident’s dietary needs was false, could not have happened and/or is without a reasonable basis. The Department therefore dismissed the complaint. An exit interview was conducted and a copy of this report was left at the facility. The Department reviewed Hospital medical records for R1 dated October 26, 2024, through November 2, 2024. The records revealed the following: Upon admission, R1 was diagnosed with sepsis, pneumonia, bacteremia and a urinary tract infection. A pressure injury was found on R1’s coccyx and was diagnosed to be a stage 4 pressure wound that required daily wound care and dressing changes with repositioning every 2 hours. Per hospital staff notations, the family was aware of the pressure injury prior to hospitalization of R1 and reported that a physician assistant was coming to treat the wound. During the Department’s interview with R1’s Responsible Party it was revealed that they knew about a wound and felt it was due to the resident being bedridden. Interviews with staff #1 (S1) revealed that they would help treat and dress R1’s pressure injury themselves. No skilled professional was found to be treating R1’s pressure injury while in care at the facility. During interviews with the staff #2 (S2) it was revealed that R1 was on hospice when R1 first arrived at the facility but was discharged and had not been readmitted. Hospice discharge summary dated July 29, 2019, did not indicate R1 had any pressure injuries at the time of discharge. A review of facility records revealed no documentation of R1’s wound or pressure injury prevention measures for R1 such as notations of repositioning, incontinence care and skin integratory reports. Hospital discharge summary notes that R1 was transitioned to inpatient hospice care on October 30, 2024. On October 31, 2024, wound culture results revealed that there was a presence of bacterial growth in the pressure wound. R1 later passed away at the hospital on November 2, 2024. Based on interviews conducted, record review and information gathered during the investigation, the facility failed to address resident’s care needs resulting in an untreated pressure injury. Therefore, the preponderance of evidence standard has been met, the allegation Resident sustained a pressure injury while in facility care due to neglect is found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 are being cited on the attached LIC9099D. A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49(e). An exit interview was conducted and a copy of this report, LIC9099-D, confidential names list and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026 · control 22-AS-20241028152659

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Mar 19, 2026

Basic Services 87464(f)(1) Basic services shall at a minimum include: Care and supervision defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: The Department reviewed medical records for R1 that states that R1 had a stage 4 pressure injury upon admission to the hospital that facility staff was caring for. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: Licensee stated they will conduct an In service on how to identify a stage 1 and 2 pressure injury, when to send resident out for higher level of care due to pressure injury and how to care for a stage 1 and 2 pressure injury with staff and send proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct a case management visit in conjunction to complaint 22-AS-20241028152659. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Uldarico Almiranez and discussed the purpose of the visit. During the investigation of complaint 22-AS-20241028152659, it was revealed that Resident #1 (R1) had a stage 4 pressure wound and was not being treated by a medical professional. The Department reviewed R1s medical records from October 26, 2024, through November 2, 2024. R1 was admitted to the hospital on October 26, 2024 and a pressure injury was found on R1s coccyx and was diagnosed to be a stage 4 pressure wound that required daily wound care and dressing changes with repositioning every 2 hours. Upon interviews with AD and Staff #1 (S1) it was revealed that facility staff were treating the wound only. Based on information gathered and interviews conducted a citation is being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC809D, 811 and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Mar 19, 2026

Prohibited Health Conditions 87615(a)(1) (a) Persons who require health services for or have a health condition including, but not limited to... shall not be admitted or retained... (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidence by: The Department reviewed R1s medical records stating that R1 had a Stage 4 pressure injury upon admission. 2 of 2 staff informed LPA that staff were treating the wound only. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: Licensee stated they will conduct an in service with staff on the cited regulation and how to identify a stage 3 and 4 pressure injury and when to send the resident out for a higher level of care and send to LPA by POC due date.

Type of visit: Required - 1 Year

On September 25, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Uldarico Almiranez and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents of which one (1) may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, and Resident Room 6. LPA Kim observed there was a bed setup with curtains to provide private space for staff member. A staff member was sleeping in the garage one time per a week. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measure 118.0 degrees F to 118.9 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored. LPA observed the lock under the kitchen sink was not working and contained a 102 FL oz bottle of Palmolive and 155 oz bottle of Cascade. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The staff bedroom was missing a smoke detector, but all other smoke detectors and carbon monoxide detectors were operable. A working telephone (657) 845-4355 remains available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen that was serviced on March 20, 2025. Emergency drills are conducted quarterly and last conducted on September 5, 2025. Evidence of liabilityInsurance is effective October 13, 2024, to October 13, 2025. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S5), and medication and medication administration record. LPA observed R1's Reappraisal dated 3/18/2022, R2's Reappraisal dated 1/5/2023, R3's Reappraisal dated 5/20/2022, and R4's Reappraisal dated 5/28/2022. LPA Kim conducted interviews with two (2) staff and two (2) residents. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed a bed that staff were using to sleep on in the garage. LPA observed in the staff bedroom that there was no smoke detector installed in the bedroom. LPA observed the lock was not working under the kitchen sink which contained a 102 FL oz bottle of Palmolive and 155 oz bottle of Cascade. LPA observed R1's Reappraisal dated 3/18/2022, R2's Reappraisal dated 1/5/2023, R3's Reappraisal dated 5/20/2022, and R4's Reappraisal dated 5/28/2022. An exit interview was conducted, and a copy of this report, LIC811, and appeal rights were provided to Administrator Uldarico Almiranez.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: -Staff were inebriated while on duty

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of delivering findings to address the allegations listed above. The 10-day visit complaint investigation was conducted on 11/15/2023. On today's date, LPA Quiroz arrived to the facility and was greeted by Caregiver Rhodora Cabrera. LPA Quiroz called Licensee/Administrator (L/AD) Uldarico Almiranez and discussed purpose of today's visit. Regarding the allegation, “Staff were inebriated while on duty,” the investigation revealed the following: LPA Quiroz conducted multiple interviews with residents and staff. Interviews with eight of eight interviewees reported denying ever witnessing staff drinking alcohol on the job. Two of four interviewees consisting of residents reported Resident 1 (R1) has stated they are going to get staff in trouble and would report things that are untrue. Six of eight interviewees reported that R1 can be paranoid, does not follow rules, and tends to forget things and get confused. During the course of the investigation for complaint control # 22AS- 20211012143927 ,interviewees reported (R1) collected alcoholic beverage bottles and placed them in front of staff and would take pictures in an attempt to say staff are drinking on the job. CONT ON LIC 9099-C PAGE... Unsubstantiated CONTINUED...Photographs and videos of staff with alcoholic beverage bottles placed in front of the staff were provided to Community Care Licensing and observed by LPA Quiroz; Four of four interviewees consisting of staff indicated R1 would recycle and collect empty alcoholic beverages, place them in-front of them and take videos or photographs. Four of four staff denied drinking alcoholic beverages and or using illicit/illegal drugs while on duty. During facility inspection visits conducted on 11/15/2023 and 6/17/2024, LPA Quiroz did not observe alcoholic beverages and or illicit/illegal drugs on facility premises and did not observe staff to be under the influence of drugs and or/alcohol. Therefore, based on the preponderance of evidence gathered through interviews, documentation review and observations conducted by LPA Quiroz, the allegations that the "“Staff were inebriated while on duty,” is deemed UNSUBSTANTIATED, meaning 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. This agency has investigated this complaint. No deficiencies cited during today's visit. An exit interview was conducted with Caregiver Rhodora Cabrera and with (L/AD) Almiranez via telephone and a copy of this report and LIC 811-Confidential Names were provided at exit.the state’s words, verbatim · CDSS document, Jun 17, 2024 · control 22-AS-20231108161451

Allegation investigated: -Facility staff yelled at residents. -Facility staff do not respond timely for assistance. -Facility staff provided alcohol to resident who cannot have alcohol.

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of delivering findings to address the allegations listed above for a complaint initiated on 9/19/2023. The 10-day visit complaint investigation visit was conducted by LPA Quiroz on 09/26/2023. On today's date, LPA Quiroz arrived to the facility and was greeted by Caregiver Rhodora Cabrera. LPA Quiroz called Licensee/Administrator (L/AD) Uldarico Almiranez and discussed purpose of today's visit. Regarding the allegation, “Facility staff yelled at residents,” the investigation revealed the following: LPA Quiroz conducted multiple interviews consisting of residents, staff and witnesses. Interviews conducted with eleven of eleven interviewees reported denying ever witnessing staff yelling at residents at this facility. Four of four interviewees consisting of residents reported Resident 1 (R1) would be the one to yell at staff indicating staff employed at the facility are nice to all residents in care. During the course of the investigation, LPA Quiroz concluded that the video of staff yelling at resident provided to Orange County Regional Office (OCRO) during initiation of complaint was addressed during investigation of Complaint Control #22-AS-20230413150926 pertaining...CONTINUED ON LIC 9099-C PAGE... Unfounded CONTINUED...to Fountain Valley Senior Homes 2 facility #306005475. The Investigation concluded that resident being yelled at in video provided to OCRO as evidence was not a resident residing at Saint Benedict Care LLC. Regarding the allegation, “Facility staff do not respond timely for assistance,” four of four residents denied the allegation indicating staff are very helpful and respond to assistance requests timely. Two of two witnessed who reported frequently visiting the facility indicated witnessing staff responding to resident’s request for assistance timely. Regarding the allegation, “Facility staff provided alcohol to resident who cannot have alcohol,” the investigation revealed the following: LPA Quiroz conducted multiple interviews consisting of residents, staff and witnesses. Interviews conducted with eleven of eleven interviewees reported denying ever witnessing staff providing alcohol to residents in the facility. During the course of the investigation, LPA Quiroz reviewed physician report for Resident 2 (R2) dated 2/11/2021, page 4 under 14. Mental Condition indicating (R2) is able to leave the facility unassisted. During the course of the investigation, (R2) admitted to leaving the facility on their own during the day indicating “I would sometimes go and buy my own beer from the liquor store without telling staff, but not anymore.” Administrator Almiranez indicated meeting with (R2s) responsible party and discussing reassessment of needs and services plan and physician report to address need for increased supervision for (R2) due to admitting drinking alcohol when leaving the facility unassisted. Therefore, based on the preponderance of evidence gathered through interviews, documentation review and observations conducted by LPA Quiroz, the allegations that the “Facility staff yelled at residents,” “Facility staff do not respond timely for assistance,” and “Facility staff provided alcohol to resident who cannot have alcohol” are deemed UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis; Therefore complaint is dismissed. This agency has investigated this complaint. No deficiencies cited during today's visit. An exit interview was conducted with Caregiver Rhodora Cabrera and with (L/AD) Uldarico Almiranez via telephone, and a copy of report and LIC 811-Confidential Names were provided at exit.the state’s words, verbatim · CDSS document, Jun 17, 2024 · control 22-AS-20230919143528

Allegation investigated: -Client was being emotionally abused while in care

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of delivering findings to address the allegation listed above for a complaint initiated on 03/17/2023. The 10-day visit complaint investigation visit was conducted by LPA Quiroz on 03/27/2023. On today's date, LPA Quiroz arrived to the facility and was greeted by Caregiver Rhodora Cabrera. LPA Quiroz called Licensee/Administrator (L/AD) Uldarico Almiranez and discussed purpose of today's visit. Regarding the allegation, “Client was being emotionally abused while in care,” the investigation revealed the following: LPA Quiroz conducted multiple interviews consisting of residents, staff and witnesses. Interviews conducted with ten of eleven interviewees reported denying ever witnessing staff emotionally abusing Resident 1 (R1) or any other residents in care. During the course of the investigation, six of eleven interviewees consisting of residents, staff and witness reported Resident 1 (R1) would be the one to be verbally abusive to staff and other residents in care. Two of five residents in care indicated (R1) would share that (R1) would fabricate stories to get staff in trouble reporting “R1 was trouble and just wanted to get staff in trouble.” CONTINUED ON LIC 9099-C PAGE... Unsubstantiated CONTINUED...The physician report for R1 dated 10/7/2022 page 4, section 14. Mental condition indicates "Yes" under confused/disoriented with mild cognitive impairment. Therefore, based on the preponderance of evidence gathered through interviews, documentation review and observations conducted by LPA Quiroz, the allegations that the “Client was being emotionally abused while in care”is deemed UNSUBSTANTIATED, meaning 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. This agency has investigated this complaint. No deficiencies cited during today's visit. An exit interview was conducted with Caregiver Rhodora Cabrera and with (L/AD) Uldarico Almiranez via telephone, and a copy of report and LIC 811-Confidential Names were provided at exit.the state’s words, verbatim · CDSS document, Jun 17, 2024 · control 22-AS-20230317093401

Type of visit: Required - 1 Year

On today's date, Licensing Program Analysts (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required Annual inspection. LPA was greeted and granted entry into the facility by House Manager (HM) Kristine Guevarra. LPA Quiroz called Licensee/Administrator (L/AD) Uldarico Almiranez and discussed purpose of today's visit. This is a Residential Care Facility for the Elderly, licensed to provide services to age range 60 and over, approved for capacity of (6) six Non-Ambulatory residents, of which 1 (one) may be bedridden and has a Hospice waiver approved for 4 hospice residents. There is currently one (1) resident receiving hospice care services. There are no active COVID-19 cases in the facility at this time. AD Uldarico Almiranez has an Administrator certificate with expiration date of April 10, 2024. AD Almiranez indicated currently in process of renewing Administrator certificate, and agreed to submit copy of renewal to Community Care Licensing upon completion. LPA along with (HM) Guevarra toured the interior and exterior of the facility. During today's inspection tour, LPA observed 3 of 6 Residents in the living room with staff supervision and 3 of 6 residents in their bedroom resting. LPA Quiroz interacted and interviewed with three caregivers and 3 of 6 residents during today's visit. LPAs inspected resident's bedrooms and bathrooms. The water temperature in resident's bathrooms were recorded to be within normal limits. LPAs inspected resident's bedrooms and appeared to be clean. Facility temperature in resident's bedrooms and throughout the facility was recorded to be within normal limits. LPAs observed the emergency and disaster and evacuation plan. Facility has supply of emergency food, water in the garage and kitchen area and PPE in the medication closet readily available for staff and residents in care. Fire extinguisher observed last serviced on March 19, 2024. LPA observed functional and operational washer and dryer in the laundry room area. The disinfectants were observed to be locked and secured. CONTINUED ON NEXT LIC 809-C PAGE... On or about 10:25am, while inspecting the kitchen area, LPA Quiroz observed the following in refrigerator area unlocked and unsecured: Ozempic injection, Basaglar injection and Novolog flex pen injection, Simbrinza eye drops and latanprost eye drops readily available for residents in care. On or about 10:36am, while inspecting garage area, LPA Quiroz observed opened door leading to garage area and observed pair of scissors and lighter readily unlocked and unsecured readily available to residents in care. This poses a potential risk to residents in care. (SEE LIC 809-D) LPA toured the outside of the facility and observed seating and shaded area in the backyard for residents and visitor's enjoyment. LPA reviewed 6 of 6 resident records and centrally stored medications and 4 of 4 personnel files. Citation issued during today's visit. During today's visit, LPA provided Consultation on Title 22 and Infection control. An exit interview was conducted with HM Kristine Guevarra, and a copy of this report, LIC 809-D page, Appeal Rights, LIC 858- Client/Resident's records review and LIC 859- Staff Records Review were provided at exit.the state’s words, verbatim · CDSS document, Apr 23, 2024

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Apr 26, 2024

87705(f)(1)(2): Care of Persons with Dementia(f)The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).(2)Over-the-counter medication... CONTINUED... This requirment is not met as evidenced by:PA Quiroz observed the following in refrigerator area unlocked and unsecured: Ozempic injection, Basaglar injection and Novolog flex pen injection, Simbrinza eye drops and latanprost eye drops readily available for residents in care. CONT...the state’s words, verbatim · CDSS document, Apr 23, 2024

Plan of correction: On or about 10:36am, while inspecting garage area, LPA Quiroz observed opened door leading to garage area and observed pair of scissors and lighter readily unlocked and unsecured readily available to residents in care. This poses a potential risk to residents in care.

Allegation investigated: Staff left residents unsupervised in the facility. Staff did not properly store medications. Staff did not manage residents’ medication properly.

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection to deliver findings on a complaint investigation. LPA identified themselves and discussed the purpose of the visit and the elements of the allegations with Caregiver. During course of the investigation, the department interviewed staff, residents, and witnesses as well as reviewed documentation. The investigation conducted revealed the following: On 10/5/2020, it was reported that Staff left residents unsupervised in the facility, staff did not properly store medications and staff did not manage residents medications properly. Based on interviews conducted with staff, four of four staff members stated that facility residents were not left alone in the facility. Four of four staff confirmed that staff member S1 was at facility inside staff room during the time of alleged non-supervision on 10/2/2020. CONTINUED ON 9099C Unsubstantiated Interviews revealed that S1 did not hear resident call out for help and therefore did not respond to resident in timely manner. Four of four staff confirm that they have never left residents unsupervised alone at the facility and staff confirmed their awareness that leaving residents alone is considered neglect. Based on interviews with residents, three of three residents interviewed stated staff have never left residents unattended at the facility. Interviews with residents confirmed that three of three residents stated they like the level of care being provided at facility. Fountain Valley Police Department Report confirms Police Department was contacted and came out to facility to do a Wellness Check on 10/02/20. Police Document did not state any concerns of abuse or neglect reported at facility. Based on interviews conducted with staff, all staff interviewed confirm that medications are stored inside secure medication closet with staff responsible for holding onto closet key. Based off interviews conducted with residents, three of three residents confirm they receive medications at scheduled times. LPA’s observations confirmed medications are centrally stored inside a secure medication closet. Facility documents revealed that staff have completed training in Psychosocial needs of the elderly, Medication Administration, and Understanding abuse & neglect. Based off interviews, observations and records reviewed, LPA is unable to corroborate allegations made that the facility staff left residents unsupervised in the facility, Staff did not properly store medications and Staff did not manage resident’s medications properly therefore although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with staff and a copy of this report along with a LIC 811 Confidential Names list was provided during this visit.the state’s words, verbatim · CDSS document, Jan 11, 2024 · control 22-AS-20201005102352