Saint Michael's Extended Care

Allegation investigated: Due to lack of supervision, resident was pushed and harassed by another resident

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegation, and met with Staff Member, Nataly Solis. Administrator, Rufus Zingkhai, arrived during visit at approximately 9:15AM. During the course of the investigation, the Department reviewed documents, conducted interviews, and made observations. The following allegation was investigated, "Due to lack of supervision, resident was pushed and harassed by another resident." Complaint alleged that Resident 1 (R1) was being pushed and harrassed by Resident 2 (R2). Per complaint, R2 throws R1's personal belongings onto the floor, yells and screams at them, opens the door when they are in the bathroom, and threatens them. Report also stated that another resident at the facility has heard R2 screaming at night. Additional information from the Complainant revealed that R1 and R2 were roommates, and that R1 had been becoming increasingly Continued on LIC9099 Unsubstantiated Continued from LIC9099 paranoid and delusional as a result of refusing their medications. Complainant further stated that when they spoke to facility staff members, staff had stated that they had not been on-site when R1 was allegedly pushed by R2. Department was unable to obtain information on who the other resident was that heard R2 screaming at night. Review of R1's care plan dated 02/13/2026 and R2's care plan dated 05/16/2025, showed that both residents did not require one-on-one supervision. Interview conducted with Administrator revealed that C1's mental health team notified them of the situation between R1 and R2 on 04/07/2026. Per Administrator, they spoke with both R1 and R2 and both residents denied the allegations, stating that they have not pushed or touched each other inappropriately. Interview further revealed that per facility protocol, facility separated R1 and R2 for their safety and moved R1 to a room located on the facility's second floor on 04/08/2026. During visit conducted on 04/17/2026, R1 was observed to be residing on the second floor of the facility. Additional documentation in R1's file further showed that R1 had entered a new roommate agreement with Resident 3 (R3) on 04/08/2026. During visit conducted on 08/21/2026, the Department was informed that R1 had been discharged from the facility on 05/03/2026 by their mental health team. Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 21, 2026 · control 21-AS-20260407102405

Type of visit: Required - 1 Year

At approximately 8:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit and met with Staff Member, Sheila Manansala. Administrator, Rufus Zingkhai, arrived during visit at approximately 9:05AM. Facility is a Residential Care Facility for the Elderly (RCFE) and serves residents with Dementia and has a plan of operation for dementia care and programming on file. Facility is a two story building and has an approved fire clearance for 44 non-ambulatory residents and an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were currently 39 residents in care and 6 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for a sample size of 6 sinks were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility had emergency evacuation chairs at their stairwells. Facility fire extinguishers were last inspected February 2026. Smoke and carbon monoxide detectors are hardwired and were last inspected by the Fire Department February 2026. Facility's last emergency/disaster drill was conducted April 2026. Facility's emergency disaster plan was last reviewed and updated on 02/06/2026. During walkthrough, LPA observed the following: 2 resident rooms did not have a night stand or chair as required, facility did not have tight fitting lids on resident garbage cans, and facility did not have an adequate supply of emergency water accessible in the event they needed to shelter in place for 72 hours. Continued on LIC809C Continued from LIC809 LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized and thorough. Staff files had current First Aid and CPR certification. Resident files had updated assessments and appraisals. LPA discussed with Administrator on ensuring that resident appraisals address behavioral expressions if they have been identified in resident medical assessments. LPA observed that 1 of 5 residents was missing proof of a negative TB test. Medication was observed to be centrally stored and secure. Administrator's Certificate for Rufus Zingkhai (7033932740) was current with an expiration of 08/15/2027. LPA discussed the following with Administrator: Reporting Requirements PIN regarding 911 protocols PIN regarding dementia regulations Review of facility's medication management program by a consultant pharmacist or nurse LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Personnel Report (LIC 500) Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 05/17/2025. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), LIC9102 (Technical Violations/Advisories), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 17, 2026

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff is not administering medication per physician's orders Personal Rights

At approximately 9:35AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for this complaint investigation regarding the above allegations, and met with Administrator, Rufus Zingkhai. During the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegations were investigated, ”Staff is not administering medication per physician’s orders” and “personal rights.” Complainant alleged that Facility staff was not giving Resident 1 (R1) their Lorazepam medication correctly and that R1 may be overmedicated as a result. Complainant stated that R1’s Lorazepam was a PRN or “as needed” medication but that the facility was giving it to R1 every day. Continued on LIC9099 Substantiated Continued from LIC9099 Review of R1’s centrally stored log and Medication Authorization Record (MAR) stated the following: · Lorazepam 1MG Tablet; take 1 tablet by mouth once daily as needed 1 hour prior to attending medical appointments · Centrally Stored Log for R1 showed that Facility received a quantity of 12 tablets. · Review of R1’s MAR shows that R1 received a dose of Lorazepam from 03/11/25-03/20/25, and on 03/24/25 and 03/25/25 Interview conducted with Marin County Mental Health Supervisor stated that the facility was to monitor and observe R1 for withdrawal and increased anxiety. If observed, facility staff were to contact 911 and ensure R1 received medical attention. Review of facility incident reports showed that on 03/30/2025, R1 was sent to the ER due to increase in anxiety and shortness of breath. Interviews conducted with facility staff confirmed that R1 does not have medical appointments every day and revealed that facility staff did not contact R1’s doctor for clarification on the medication. Based on document review and interviews conducted, these allegations are Substantiated. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiencies, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 14, 2025 · control 21-AS-20250320124909

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 15, 2025

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed...(4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: based on interviews and record review, Licensee did not comply with the section cited above and did not ensure that Resident 1’s medication was administered per physician’s orders. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 14, 2025

Plan of correction: Licensee to submit self certification that training will be conducted for all staff that administer medications by POC due date of 05/15/2025. Training to include the following: Trainer, Date, Topics, Job Role, Staff Names and Signatures. Training to be submitted to CCL by POC due date of 05/27/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87648.2(a)(4) · Plan of correction due date: May 15, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, residents...shall have... (4) To care, supervision, and services that meet their individual needs...Based on interviews and record review, Licensee did not comply with the section cited above. Facility provided medication in excess of the amount prescribed by R1’s psychiatrist. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 14, 2025

Plan of correction: Licensee to submit self certification that training will be conducted for all staff by POC due date of 05/15/2025. Licensee to review personal rights. Training to include the following: Trainer, Date, Topics, Job Role, Staff Names and Signatures. Personal Rights Training to be submitted to CCL by POC due date of CCL by POC due date of 05/27/2025.

Type of visit: Required - 1 Year

At approximately 9:35AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit and met with Administrator, Rufus Zinghkai. Facility is a Residential Care Facility for the Elderly (RCFE) and serves residents with Dementia and has a plan of operation for dementia care and programming on file. Facility is a two story building and has an approved fire clearance for 44 non-ambulatory residents and an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there are currently 37 residents in care and 7 staff members on-site. At approximately 9:45AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:50AM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for a sample size of 6 sinks were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility fire extinguishers last inspected February 2025. Smoke and carbon monoxide detectors are hardwired and were last inspected by Fire Department February 2025. Facility's last emergency/disaster drill was conducted May 2025. At approximately 11:00AM, LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Administrator's Certificate for Rufus Zingkhai (7033932749) was current with an expiration date of 08/15/2025. Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Personnel Report (LIC 500) Lease Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 06/14/2025. No Deficiencies Cited during Visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 14, 2025

Allegation investigated: Licensee did not keep the facility free of pests

At approximately 10:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for this Complaint Investigation regarding the above allegation and met with Staff Member, Sheila Managsala. Administrator, Rufus Zingkhai, was available by telephone. Licensee, Ria Garrison, arrived during visit at approximately 10:45AM. During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. There is an allegation of “Licensee did not keep the facility free of pests.” Complainant stated that residents were observed to have bed bugs and bed bug bites on them, and that bed bugs were seen crawling from facility furniture on 07/26/2024. Complainant also stated that on 09/04/2024, bed bugs or cockroaches were observed in a resident’s room and under facility furniture.Interviews conducted with involved parties stated that during a visit on 07/30/2024, bed bugs were not seen or observed. Continued on LIC9099C Unsubstantiated Continued from LIC9099 Interviews conducted with facility staff, Administrator, and Licensee, stated that they have not seen any bed bug activity. Review of facility progress notes dated 07/25/2024 to 08/06/2024 did not notate any concerns regarding bedbugs. Review of Pest Control Inspector visit dated 08/21/2024, stated that there was no bed bug activity at the facility. Interview conducted with Administrator acknowledged that the facility has an ongoing cockroach issue and that the facility has routine visits from Pest Control to monitor and inspect for pests such as bedbugs and cockroaches. Review of Pest Control Service Agreement corroborates monthly treatment and review of facility receipts indicated that Pest Control visited facility on 08/13/2024 for inspection and monitoring. LPA was informed that Pest Control is scheduled to come back for another visit on 09/23/2024. Based on document review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Licensee. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 11, 2024 · control 21-AS-20240801154438

Allegation investigated: Staff did not address resident behavior resulting in a resident's injury Staff did not seek medical attention for resident in a timely manner Staff did not accord resident dignity in their relationship with staff or other persons Staff did not follow resident's special accommodations

At approximately 9:20AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegations and met with Staff Member, Sheila Manansala. Administrator, Rufus Zingkhai, arrived during visit at approximately 10:00AM. During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegations were investigated, “Staff did not address resident behavior resulting in a resident's injury, Staff did not seek medical attention for resident in a timely manner, Staff did not accord resident dignity in their relationship with staff or other persons, and Staff did not follow resident's special accommodations.” The Department reviewed facility records, facility logs, and conducted interviews with involved parties and facility staff. Continued on LIC9099C Unsubstantiated Continued from LIC9099 Reporting Party stated that there was a physical confrontation between Resident 1 (R1) and Resident 2 (R2) and facility did not address R2’s behaviors resulting in R1 having their hand injured. LPA conducted interviews with involved parties and received inconsistent statements. Some interviews conducted stated the confrontation happened while others denied it occurred. LPA conducted staff interviews. Per staff interviews, LPA was informed that R1 and R2 used to be roommates, but the facility separated R1 and R2 into different rooms because they would argue with each other. Since R1 and R2 were separated, staff have not observed the residents interacting much. Review of R2’s Physician Report dated 02/17/2022 stated they did not have a history of aggressive behavior. LPA did not find any documentation on how facility staff are to address resident behaviors. Reporting Party stated that facility staff speak to R1 in an annoyed way and do not clean R1’s room or take out their trash. Per staff interviews, staff have not observed or seen residents being spoken to in a rude or demeaning way. Staff interviews stated that R1 would refuse to have their room cleaned and preferred to leave their trash bags outside of their room for staff to pick up. Staff interviews also stated R1 has been observed to have verbal altercations with other residents but were unable to recall specific details. During visit conducted on 04/03/2024, LPA observed that R1’s room was clean, had the trash taken out, and did not have any strong odors. Reporting Party stated that facility staff did not seek medical attention for R1 in a timely manner. Facility documents dated 12/06/2023, showed that facility staff were informed by R1 that their hand was slammed by their bathroom door. Facility staff assessed R1’s hand and did not observe bruising or swelling. Review of R1’s file showed a signed agreement dated 04/28/2022 between R1 and the facility. The agreement stated that R1 did not authorize facility staff to communicate with their Primary Care Physician regarding any medical condition. Staff interviews conducted corroborated this agreement, and stated R1 would verbally tell staff when they had appointments scheduled. Facility staff interviews also stated that they provided transportation to and from these medical appointments but would sit in the waiting room. R1’s Physician Report dated 02/27/2023, showed that R1 can leave the facility unassisted and can communicate their needs. Review of R1’s Care Plan dated 02/28/2023, stated that R1 attends their medical appointments independently. Facility documents showed that R1 had a Primary Care Physician appointment scheduled for 12/15/2023 and 12/19/2023. Per staff interviews, facility staff took R1 to their appointment on 12/19/2023 and provided ice when R1 requested it, per doctor’s instructions. LPA conducted interviews with involved parties and was informed that R1 did not tell facility staff their hand hurt. Reporting Party stated that staff did not follow R1’s special accommodations. Review of R1’s Physician’s Report dated 02/27/2023, stated that R1 had environmental allergies and chemical sensitivities. Review of R1’s file showed a signed agreement dated 08/26/2022 between R1 and the facility. Continued on LIC9099C Continued from LIC9099C The agreement stated the facility can use cleaning products such as diluted Clorox and Bon Ami to clean R1’s bedroom and bathroom, and that the facility cleaning cart would be placed five feet from R1’s room. Staff interviews conducted corroborated this agreement. During visit conducted on 04/03/2023, LPA observed that R1’s room was clean and did not have any strong smelling odors. Based on inconsistent statements and lack of corroborating evidence, LPA is unable to determine if violations occurred, therefore these allegations are Unsubstantiated. A finding that the complaint is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 17, 2024 · control 21-AS-20231228160617

Type of visit: Case Management - Annual Continuation

At approximately 10:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Administrator, Rufus Zingkhai, and Designated Representative Giov Alipio. Upon arrival, LPA was informed that there were 33 residents in care and 6 staff members on-site. At approximately 10:40AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-through of facility and observed the following: There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility's fire and sprinkler system was last inspected March 2024. LPA reviewed staff and resident files and resident medication. Resident files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. During staff file review, LPA observed that two staff members did not have a health screening form in their file but did have proof of negative TB test (See technical violation, LIC9102, Regulation 87411(f)). Medication was observed to be centrally stored and secure. Administrator's Certificate for Rufus Zingkhai (6053315740) was current with an expiration date of 08/15/2025. Facility has an Infection Control plan on file. LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Documents to be submitted to Community Care Licensing (CCL) by due date of 05/17/2024. No Deficiencies Cited during visit. Exit interview conducted. Copy of report, LIC9102 (Technical Advisory/Violation) discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 17, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 3:00PM, Licensing Program Analysts (LPAs) Felias and Florio arrived unannounced to conduct a required annual visit. LPAs were greeted by Francisco Preciado, Medical Technician. LPAs were informed that Giov Alipio, Medical Technician and Designated Representative would tour the facility with LPAs to complete the inspection. LPAs conducted a physical plant walk-through and inspection. LPAs observed the following: The facility was found to be clean with all exits free from obstruction. Facility had emergency lighting. Facility is a two story building with a census of 34 residents with a capacity for 44 residents. LPAs observed required postings including the CCL Complaint Poster. Mattress pads were in place or available for client use. Hot water temperatures for 4 out of 5 sinks were found to be within Title 22 Regulations of 105 to 120 degrees Fahrenheit. LPAs observed one sink without functioning hot water and tempeurature was unable to be tested (See Technical Advisory, LIC9102, Regulation 87303(e)(6)). Facility's fire extinguishers were last inspected March 7, 2024. LPAs unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. Exit interview conducted. Copy of report, LIC9102 (Technical Advisory/Violation) discussed and provided to Designated Representative. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 3, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.