Select Senior Living IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA met with staff and later with Administrator, Kim Anderson. Reason for the visit was explained. Also present during the annual visit was Dylan Hull. At approximately 11 a.m., LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards. Facility is fire cleared for six (6) non-ambulatory rooms, of which one (1) may be bedridden. The facility has a hospice waiver for six (6). The LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Facility has six (6) non-ambulatory resident bedrooms, one (1) staff room and one (1) room used for staff office/rest area. BEDROOMS: The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms observed appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. The staff bedroom and office/rest area observed locked during today's visit. BATHROOMS: There are six (6) total bathrooms, four (4) for resident use, one (1) for staff use and one for guests. All bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water was measured between 115.5 - 117.6 degrees Fahrenheit. KITCHEN: Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. COMMON AREAS: Furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. STORAGE/ OUTDOORS: Storage areas observed locked and inaccessible at the time of visit. Fire extinguisher observed with purchase date 6/1/2026. An adequate supply of emergency food and water was observed. Sufficient supply of Personal Protectant Equipment (PPE) observed. (Continue to LIC809c). Cleaning supplies and toxins observed in the storage area inaccessible to residents in care. Laundry area observed with washer and dryer. Detergents and other cleaning supplies stored inaccessible to residents. The backyard has a shaded area with furniture for resident use. The LPA observed two (2) exit gates that self-latches with a clear passageway in case of an emergency. Garage is converted into office space. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. Activities were observed in the common areas; required postings observed posted. Exit alarms and Smoke/Carbon Monoxide detectors observed operable during visit. RECORDS: Records review began at 12:45 p.m., four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Resident files observed complete. MEDICATIONS: Medications review began at approximately 1:30p.m. Routine medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. At approximately 2:30pm, two (2) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR and required training. Staff files observed complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last (fire) drill conducted in 06/2026. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA met with staff and later with one of the Administrator, Kim Anderson. Reason for the visit was explained. At 10:45 a.m., the LPA along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards. Facility is fire cleared for six (6) non-ambulatory rooms, of which one (1) may be bedridden. The facility has a hospice waiver for six (6). The LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Facility has six (6) non-ambulatory resident bedrooms, one (1) staff room and one (1) room used for staff office/rest area. BEDROOMS: The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms observed appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. The staff bedroom and office/rest area observed locked during today's visit. BATHROOMS: There are six (6) total bathrooms, four (4) for resident use, one (1) for staff use and one for guests. All bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water was measured within 105 - 120 degrees Fahrenheit. KITCHEN: Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. COMMON AREAS: Furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature.(Continue to LIC809c). Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The last emergency disaster drill took place on 6/24/2025 and conducted every three months. Activities were observed in the common areas; required postings observed posted. Exit alarms and Smoke/Carbon Monoxide detectors observed operable during visit. STORAGE/ OUTDOORS: Storage areas observed locked and inaccessible at the time of visit. Fire extinguisher observed with purchase date 06/03/2025. An adequate supply of emergency food and water was observed. Sufficient supply of Personal Protectant Equipment (PPE) observed. Cleaning supplies and toxins observed in the storage area inaccessible to residents in care. Laundry area observed with washer and dryer. Detergents and other cleaning supplies stored inaccessible to residents. The backyard has a shaded area with furniture for resident use. The LPA observed two (2) gates that self-latches with a clear passageway in case of an emergency. Garage is converted into office space. RECORDS: Records review began at 12:30 p.m., five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Resident files observed complete. Two (2) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Staff files observed complete. MEDICATIONS: Medications review began at approximately 2:25 p.m. Routine medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No medication errors observed at this time. Following deficiency observed during today's visit: The licensee has retained a resident (R1) with a feeding tube. Interview with staff revealed that the facility care staff are responsible for providing meals, fluids, and medication through the G-tube for R1. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Exit interview conducted. Copy of the report provided.the state’s words, verbatim · CDSS document, Aug 19, 2025

Allegation investigated: Unqualified staff are administering medications to residents in care. Staff are administering medication(s) to resident without physician's approval.

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation at 10:45AM. Upon arrival, LPA met with staff and Administrator Kim Anderson. Entrance interview conducted. During today’s visit, LPA Barutyan conducted a brief physical plant tour upon entry, interviewed two (2) staff between 10:46AM-02:37PM, conducted a medication review for two (2) residents between 10:50AM-11:30AM, and reviewed and obtained copies of pertinent documents between 11:50AM-12:20PM. During the initial visit on 01/29/2025, LPA Z. Chochian conducted staff interviews, reviewed staff/resident records, reviewed the centrally stored medication records for two (2) residents, obtained copies of pertinent documents, and discussed allegations with Kim Anderson. It was alleged that staff are not receiving medication administration training, and that staff are administering controlled medications. Report Continued on LIC 9099-C. Unsubstantiated LPA reviewed training records for two (2) staff who administer medications and observed ten (10) hours of medication training upon hire, one (1) hour of hands-on medication orientations conducted monthly, and two (2) hours of medication management conducted by Administrator. Training was in the format of videos, tests/quizzes, and shadowing. All staff handling medications are training certified by Administrator and Licensed Vocational Nurse (LVN) Kim Anderson. Staff are qualified to administer prescription medications, as-needed (PRN) medications, over-the-counter medications, controlled medications, and assist with self-administered medications. Staff interviews confirmed that staff are knowledgeable in medication administration and management. No concerns were noted. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. 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 above allegation “Unqualified staff are administering medications to residents in care” is deemed UNSUBSTANTIATED at this time. It was further alleged that Staff #1 (S1) administered nonprescription melatonin to Resident #1 (R1) without physician’s or responsible party(ies)’ order/approval. Staff interviewed during the initial visit and today’s visit had no evidence supporting the allegation. LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) and Medication Administration Record (MAR) for R1 and another resident and observed no documentation of melatonin administration. Medications were centrally stored and locked in the kitchen. All medications and PRNs had physicians’ order on file and PRN authorization letters. Medications were prepared for one (1) day in advance and were properly documented on the CSMDR and MAR. No errors were observed during the medication review. LPA observed that R1 had two (2) prescription medications of Lorazepam 1 mg and Divalproex Sodium 125 mg. Administrator stated that R1 is not administered melatonin as there is no physician’s order and no need because of their prescribed sleep aids. Administrator stated that there is one (1) resident who takes over-the-counter melatonin, and there is physician’s approval. LPA did not observe melatonin stored with R1’s medications. Based on interviews, record review, and medication review the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. 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 above allegation “Staff are administering medication(s) to resident without physician's approval” is deemed UNSUBSTANTIATED at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 15, 2025 · control 29-AS-20250122154020

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Zabel Chochian conducted a Pre-licensing visit. Upon arrival LPA met with Applicant representative Dylan Hull and Administrators Tracy Varnell, Kathleen Leiterman, Kim Anderson. Administrators share duties and responsibilities at all 3 facilities. Applicant currently operates three other licensed facilities therefore Component III was waived for applicant. Fire Clearance for this facility is approved for six (6) non-ambulatory rooms, of which one (1) may be bedridden. The facility has a hospice waiver for six (6). Upon arrival a tour of the physical plant was conducted with Dylan Hull and Tracy Varnell; the LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. New complete first-aid kit observed; facility has adequate linen, water, nonperishable food supplies. Facility has six (6) non-ambulatory client bedrooms, two (2) staff rooms, four (4) full resident bathrooms, one (1) staff bathroom and a guest bathroom. One resident bedroom was observed staged with all required furniture during todays visit. Hot water temperature measured in residents bathroom which measured between 113 and 115 degrees Fahrenheit. Resident bathrooms observed with grab bars and non-skid shower floor. The kitchen, dining and living areas observed appropriately furnished. There are no bodies of water on the premises. Facility has working alarms on all exits and Smoke/Carbon Monoxide detectors. All medications, chemicals and sharp objects are in locked cabinets/drawers. Laundry area observed with washer and dryer. Backyard is completely fenced and gated. There is a covered area in the backyard for outdoor activities. The backyard is currently undergoing landscaping. Mr. Hull stated that the landscaping should be finished soon. LPA observed the detached garage under construction/upgrading to an office space for Administrators. Garage was observed to have a lock and Mr. Hall ensured that this area will be kept inaccessible to residents until the work is complete. The side of the house observed with landscaping and lumber supplies. This area should be cleared prior to licensure. Mr. Hull agreed to clear out the area and submit photos. Upon receipt of the photos LPA will forward the report to the CAB analyst. Applicant will be notified by the CAB Analyst when license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Aug 21, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Dylan Hull (applicant/licensee), Tracy Varnell, Administrator Interview Method: microsoft teams On 7/19/24, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 19, 2024