Senior Care Villa of Loomis

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday August 27, 2026, to conduct an unannounced case management visit. LPA met with Administrator Roxana. LPA and Roxana discussed recent improvements at the facility. LPA toured the facility. No deficiencies cited. Exit interview conducted. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday August 5, 2026, to conduct an unannounced case management visit. LPA met with Administrator Roxana. LPA and Roxana discussed recent improvements at the facility. LPA toured the facility. LPA requested the following documents from Roxana by the end of the week: LIC501, LIC503 and TB, administrator certificate, LIC200, first aid/cpr, and LIC500. No deficiencies cited. Exit interview conducted. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 5, 2026

Type of visit: Office

On Monday June 29, 2029, at 2:30 PM, a Non-Compliance Conference was held at the Sacramento North Regional Office located at 9835 Goethe Road Suite 100, Sacramento CA 95827. The purpose of this Non-Compliance Conference meeting was to discuss the citations that have been issued in since licensure on December 27, 2023. Present in the meeting was Regional Manager (RM) Harpreet Humpal, Licensing Program Manager (LPM) Laura Munoz, Licensing Program Analyst (LPA) Melissa Parks, Owner Aaron Whitfield, Regional Vice President of Sales and Operations Julie Myers, Administrator Shay Ewing, and Roxana Bucurenciu. The Non-Compliance Conference process was explained during this meeting to include the Administrative Process. In the last three years, Senior Care Villa of Loomis has been issued three type A and six type B deficiencies. The facility was cited for the following issues cleanliness, personal rights, lack of supervision, insufficient staffing, medication management, infection control practices, and care and supervision. Issues discussed during the meeting were: · Substantiated complaint: neglect/lack of supervision · Medication management · staffing · Infection control procedures The facility has stated they will do the following to achieve continued and substantial compliance: Facility will provide the following: training topics and dates for med tech staff medication plan for compliance Infection control procedures for staff Reporting requirement procedures The Department requests licensee to submit the following by: updated LIC500 submitted every 30 days for the upcoming 90 days CCLD will do the following: · Increase Monitoring refer the facility to the technical support program Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Administrator Shay. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 29, 2026

Allegation investigated: Staff did not follow infection control practices

Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday May 5, 2026 unannounced to conclude a complaint which was received by the Department on 4/24/2026. LPA met with acting Executive Director Heidi and explained the purpose of the visit. LPA interviewed the acting Administrator, staff, and home health regarding the allegation. LPA learned the following: North Star Senior Living, the management company for this facility, has an infection control policy and procedure for staff to follow. Per staff, this was not being followed. Specifically, staff did not immediately contact primary physicians regarding scabies exposure, bagging and sealing clothes for 14 days, and cleaning/disinfecting furniture. Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Exit interview. Copy of report and appeal rights provided. Substantiatedthe state’s words, verbatim · CDSS document, May 5, 2026 · control 59-AS-20260424101341

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2) · Plan of correction due date: May 19, 2026

87470 Infection Control Requirements (a) A licensee shall ensure that infection control practices are maintained as follows:(2) Environmental cleaning and disinfection activities shall be performed . . .This requirement was not met as evidenced by staff interviews. This poses a direct threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Facility to submit a plan regarding the facility following infection control plan.

Allegation investigated: Facility did not report scabies outbreak to health department Medication error Insufficient staffing

Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday May 5, 2026 unannounced to deliver findings for a complaint received on 2/26/2026. LPA met with acting Executive Director Heidi and explained the purpose of the visit. LPA interviewed home health providers, staff, and administration regarding the allegations. The result of the investigation is as follows: Although the first case of diagnosed occurred in September 2025, Placer County Public Health was not notified March 3, 2026. Once notified, the facility was provided with scabies management and prevention guidance. LPA reviewed R1’s medication administration record. R1 was diagnosed with scabies and prescribed treatment. Per R1’s MAR, hydroxyzine HCL 25 mg tablet was prescribed on February 10, 2026, and to be given at 4am, 10am, 4pm and 10pm. Per February 2026’s MAR, only one 4am tablet was given Substantiated between February 11th and February 28th. Additionally, between February 10th and February 28th, 7 doses were not given at 10pm. Additionally, there was no follow-up documentation as to why the medication was not given. LPA learned that there has not been a med tech on NOC shift since October 2025. Therefore, if a resident needed a PRN medication on NOC shift, there was no one on site to give it. Additionally, R1 was prescribed routine medications (Hydroxyzine and Lorazepam) to be given on NOC shift and per the February MAR most doses were not given. Based on the information detailed above, LPA finds the allegations to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, May 5, 2026 · control 59-AS-20260226151044

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 6, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility . . .(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by R1 missing routine prescribed medications on NOC shift. This poses a direct threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Facility will submit a plan regarding covering NOC shift medications.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: May 19, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by not staffing a med tech on NOC shift. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Facility to submit staffing plan by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(b)(1)(a) · Plan of correction due date: May 19, 2026

87470 Infection Control Requirements (b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a contagious disease, the following shall apply:. . . (A) The licensee shall consult with a medical professional, local health official, health department, or other research- . This requirement was not met as evidenced by public health not being contacted when the first case of scabies was diagnosed. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: Facility is currently in contact with public health. Citation is cleared during visit.

Allegation investigated: Neglect/Lack of Care and Supervision

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Tuesday March 17, 2026, to deliver findings for a complaint received on 10/6/2025. LPA met with Administrator Shreetika and explained the purpose of the visit. During the course of the investigation, the Department conducted interviews and obtained documentation pertinent to the investigation. The following timeline of events is as follows: on 10/3/2025 at approximately 3:00 am, R1 entered the apartment of R2. R2 attempted to escort R1 out of their apartment when an unwitnessed altercation occurred. R1 was transported to the hospital and diagnosed with an acute chronic left front subdural hematoma, right lateral clavicle fracture, and multiple right-sided rib fractures. R2 was also transported to the hospital and diagnosed with a laceration to their hand and leg. Continued on 9099-C Substantiated Staff interviews revealed that on the night of the incident, there were only two staff working. According to staff and Administrator interviews, there should have been three staff on NOC shift. According to the October staffing schedule, the NOC shift schedule was not consistently staffed with 3 employees. Per the Administrator, a full-time NOC shift employee had recently reduced their hours due to personal reasons. Interviews described R1 as having a tendency of wandering exit seeking behavior, and aggression towards staff and other residents. Although there was no previous incident of physical attacks from R1 to other residents, staff noted it was only a matter of time that R1 attacked a resident due to their aggression. According to R1’s needs and services plan, they required total assistance with interventions due to agitation and aggressiveness to ensure the safety of other residents. Additionally, R1 was identified as frequently exit seeking. R1’s physicians report lists R1’s primary diagnosis as Dementia with agitation and aggressive behaviors. Due to the facility’s inadequate staffing, staff on site could not properly supervise the residents which resulted in an altercation between two residents. Based on interviews conducted and documentation obtained, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached 9099-D page. As a result of the resident's serious bodily injury, an immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 is being assessed for a violation that the Department determines resulted in the injury or illness of a person in care. An additional civil penalty assessment is under review and determination is pending. LPA will return on a future date to assess an additional civil penalty if warranted. See 9099-D for citation Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 59-AS-20251006123021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Mar 18, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision... This requirement is not met as evidenced by based on documentation reviewed and interviews conducted, the facility did not ensure staff were sufficient in number to provide care and supervision to residents, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: The facility agrees to: submit a plan for the facility to maintain adequate staffing in the event of staff quitting, call offs, no shows, etc.

Allegation investigated: Staff are serving undercooked food to residents in care. Staff did not keep facility free of vermin. Staff did not treat residents scabies infection.

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday February 11, 2026, to deliver findings for a complaint received on 1/26/2026. LPA met with Administrator Shreetika and explained the purpose of the visit. LPA interviewed the Administrator, cook, and staff regarding meals which were served to the residents. No interviews stated that food was undercooked. Additionally, no interviews acknowledged residents becoming sick after eating meals. LPA interviewed the Administrator and staff who stated that there was no current diagnosis of scabies. Per staff, R1-R4 had/were experiencing skin irritation. Staff followed up with care for those residents and received the following diagnosis: R1 had dermatitis, R2 had hyperglycemia , R3 had an allergic reaction and shingles, and R4 had dermatitis. LPA did not review any documentation where scabies was tested for and confirmed. Unsubstantiated While no staff acknowledged that they witnessed vermin in the facility, the Administrator stated that it was reported to her that a staff member observed a rodent near the kitchen. The administrator then contacted the contracted pest control company to immediately provide interior pest management services. Previously, pest control services were only provided to the outside of the facility. LPA toured the kitchen and did not find any evidence of rodents. Based on information obtained during the investigation, LPA finds the allegations to be 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 that the alleged violation occurred, Exit interview conducted. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 59-AS-20260126154603

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday December 23, 2025 to conduct a case management regarding a citation given during the annual inspection on 12/4/2025. The facility's plan of correction (POC) was due on 12/18/2025. LPA issued civil penalties for failure to correct. LPA obtained the plan of correction during todays visit, however, temperatures are still outside of the required range of 105 - 120 degrees therefore the POC is not accepted. A new POC due date is being issued as 1/2/2026. If the POC is not provided to LPA by 1/2/2026, civil penalties will be issued. Exit interview conducted. Appeal rights given. A copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Dec 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Parks arrived on Thursday December 4, 2025, to conduct the unannounced annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (8) and staff (6) files. LPA and Administrator Shreetika toured the facility together to ensure the health and safety of residents in care. The areas toured included the following areas in resident apartments, resident bathrooms, common areas, kitchen, laundry room, and medication room. Facility had current inspection tags on fire extinguishers. Water temperatures in resident rooms were measured above 120 degrees. Facility had a fully stocked first aid kit. All required postings were observed. LPA obtained a copy of the facility's 610E and current liability insurance. LPA obtained the required documents to associate Shreetika as the facility's Administrator. See 809D for deficiency cited. Exit interview conducted. A copy of this report and appeal rights were emailed to the Administrator.the state’s words, verbatim · CDSS document, Dec 4, 2025

Allegation investigated: Staff pushed resident in care

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday November 13, 2025 to conduct a visit regarding a complaint received on 11/12/2025. LPA met with Administrator Shreetika and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Resident Care Director, and staff regarding the allegation. LPA reviewed R1 and S2's facility file. LPA reviewed staff statements from the incident. LPA learned the following: On 11/11/2025, R1 moved into the facility. R1 has a diagnosis of Dementia. R1 was experiencing behaviors such as agitation and wandering. At the beginning of NOC shift, S1 was on the phone with the Resident Care Director, obtaining additional information about R1. S1 witnessed the following: R1 hit S2 on their chest. As R1 began to walk away, S2 slapped R1 on their back, using both hands. RCD heard the interaction and immediately came to the facility. S2 was then suspended. Substantiated Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Appeal rights were given. Exit interview conducted. A copy of this report was left with the facility.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 59-AS-20251112131435

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Nov 14, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, . . This requirement was not met as evidenced by staff hitting a resident. This poses a direct threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: Administrator to schedule training for all staff regarding: elder abuse, personal rights, and mandated reporting.

Allegation investigated: Staff neglect resulted in a resident's death Staff did not ensure a resident was properly fed while in care Staff did not report incidents involving a resident

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Christina Brown to deliver findings for the above complaint allegation. During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: *** Report continued on 9099-C*** Unfounded Staff neglect resulted in a resident's death Records reviewed indicate that Resident R1’s death was not due to facility neglect. Medical records reviewed do not indicate there was staff neglect for R1. The Death certificate does not indicate that R1’s death was questionable in any manner. Therefore, the allegation staff neglect results in a resident’s death is unfounded. Staff did not ensure a resident was properly fed while in care Records reviewed indicated that R1 was eating meals appropriately. Interviews conducted with staff indicated that R1 was eating meals and did not refuse meals while in care. Staff encouraged R1 to eat and drink on a daily basis. Therefore, the allegation that staff did not ensure a resident was properly fed while in care is unfounded. Staff did not report incidents involving a resident Records reviewed indicate that staff were contacting R1’s responsible party (RP) when an incident occurred. Internal incident reports documented contact with R1’s RP indicating that when an incident occurred staff was contacting R1’s RP to report the incident and update on R1’s status. Therefore, the allegation staff did not report incidents involving a resident is unfounded. Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 59-AS-20250623154126

Allegation investigated: Staff cut resident’s hair without consent from authorized representative.

Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 05/12/2025 to complete and deliver findings to a complaint received on 10/07/2024. LPAs met with Executive Director, Ilona Corpus and explained the purpose of the visit. Throughout the course of the investigation, the department conducted interviews and record reviews. Please continue to LIC9099C.. Substantiated Staff cut resident’s hair without consent from authorized representative. – Substantiated Staff cut R1’s hair without obtaining prior consent from the authorized representative, which is a violation of the R1’s personal rights. However, there is no evidence that the resident sustained any physical or emotional harm. Based on staff and resident interviews the investigation revealed that the facility provides routine haircuts to male residents every three to five weeks as part of grooming and hygiene care. According to the Executive Director (ED), Resident 1 (R1) typically does not request a haircut, and in this case, a caregiver independently decided to cut R1’s hair, citing hygiene concerns due to the residents at the time. The caregiver did not obtain prior consent from R1’s authorized representative. Although the facility stated that routine haircuts are standard practice, staff failed to obtain consent from R1’s authorized representative prior to the haircut, which is required. There was no indication that R1 experienced emotional distress, physical injury, or any other form of harm as a result of the haircut. As a result of this investigation, LPA finds allegations to be Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Staff does not ensure call button is accessible to resident. – Unsubstantiated During staff interviews, staff reported each client has a pull cord at bedside and in each bathroom. Based on investigation, LPA Gunby observed each resident room has a pull cord on the wall by resident bed and one in each resident bathroom. LPA Gunby observed a R1’s room with a pull cord attached to the wall with a longer cord for easier access to pull. LPA Gunby requested call button logs and observed only several residents using the call buttons. Based on the investigation, observations and interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. Staff not keeping an accurate medication log. – Unsubstantiated During the initial visit and walk through, the medications were reviewed, and it was noted that the facility staff were logging all new and current incoming medications and prescriptions. It was also observed in the medications log that the staff were checking off that they are giving the resident their medication. The ED stated that if they were to dispose of medication for a resident, that there would be two staff persons that would witness the disposal and that the two staff persons would sign and log that they did dispose of the medication. Based on the investigation, observations and interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, May 12, 2025 · control 59-AS-20241007123249

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(a)(1) · Plan of correction due date: May 19, 2025

87468.1 (a) (1) Personal Rights of Residents in All Facilities:(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, facility did not confirm with responsible party to cut the residents hair.the state’s words, verbatim · CDSS document, May 12, 2025

Plan of correction: Facility agrees to obtain prior consent from authorized representatives before providing grooming services, including haircuts. The facility will include this document in their admission agreement.

Allegation investigated: Resident developed a pressure injury due to staff not repositioning resident Facility staff left resident in soiled clothing for an extended period of time

Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 05/12/2025 to complete and deliver findings to a complaint received on 10/07/2024. LPA met with Resident Care Coordinator Christina Brown and explained the purpose of the visit. Throughout the course of the investigation, the department conducted interviews and record reviews. Please continue to LIC9099C.. Unsubstantiated Resident developed a pressure injury due to staff not repositioning resident. – Unsubstantiated The Department received and reviewed R1’s medical records. The medical records indicated there were not pressure injuries present on R1. Throughout interviews with staff and medical record reviews, it was determined R1 had irritation and redness on the coccyx area. The facility provided documentation acknowledging that R1 primary stayed in bed or a wheelchair and would need to be repositioned frequently. With repositioning’s often and application of cream to the area, the facility and hospice were aware of the affected areas. Based on the investigation, observations and interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. Facility staff left resident in soiled clothing for an extended period of time. – Unsubstantiated The complaint alleges facility staff did not address R1 being left in soiled clothing in a timely manner. Based on interviews that were conducted, LPA could not prove or disprove that the allegation occurred. LPA received consistent statements, that residents are checked every 2 hours throughout the day and night. LPA reviewed the Service Plan which indicated that the resident needed assistance with toileting and dressing. LPA could not corroborate the allegation. Based on the investigation, observations and interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, May 12, 2025 · control 59-AS-20241120142205

Allegation investigated: Staff did not ensure that resident's care needs were met

Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 02/12/2025 to complete and deliver findings to a complaint received on 10/14/2024. LPA met with Executive Director Ilona Corpus and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator and staff. LPA reviewed R1’s file including face sheet, physicians report, and care plan. The result of the investigation is as follows: Based on the investigation, it was determined that staff acted within appropriate care protocols. According to care plans for R1, wound care of this nature must be performed by a licensed skilled professional. Evidence collected during the investigation, including staff interviews and documentation review, confirmed that staff were instructed not to replace the patch because doing so falls outside their scope of practice. Further, it was confirmed that the licensed staff responsible for wound care were promptly notified to address the issue when it arose. Unfounded Additionally, the care plan for R1 explicitly notes that wound care must be conducted by qualified personnel. There is no evidence to suggest a delay or neglect in responding to R1’s care needs within the scope of the staff’s responsibilities. Interviews and record reviews indicated that staff were alerting hospice of any problems relating to the dressing, therefore the above allegations are UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was emailed to the Executive Director.the state’s words, verbatim · CDSS document, Feb 12, 2025 · control 59-AS-20241014103928

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratajczak arrived on Wednesday November 20, 2024 to conduct the unannounced annual inspection. LPAs met with Executive Director (ED) Ilona Corpus and explained the purpose of visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed resident (7) and staff (5) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. LPAs and Executive Director Ilona toured the facility together to ensure the health and safety of residents in care. The areas toured included common areas, bedrooms, bathrooms, kitchen, laundry room, front yard and back yard. All chemicals, toxins and sharps were kept locked and inaccessible to clients. Facility has updated fire extinguishers. In the areas toured, there were no health or safety violations observed. No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the ED.the state’s words, verbatim · CDSS document, Nov 20, 2024

Allegation investigated: Facility staff failed to seek medical attention in a timely manner Facility staff failed to assist resident in distress. Facility staff interfering with hospice agency agent

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday August 1, 2024 to complete and deliver findings to a complaint received on 7/23/2024. LPA met with Administrator Ilona and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator and staff. LPA reviewed R1’s file including face sheet, physicians report, and care plan. The result of the investigation is as follows: LPA interviewed the Administrator who stated that they worked on NOC shift on Friday July 19th. She performed frequent rounds and had no instances of R1 falling or being on the floor. LPA interviewed all morning staff who worked on Saturday July 20th who stated that when they started their shift, R1 was in bed. Interviews acknowledged that around breakfast time, R1 began to exhibit behaviors and threw their food on the floor. R1 then lowered themselves to the ground. Staff attempted multiple times to assist R1 back into bed, but they refused. R1 was also refusing their morning medications. Continued on 9099-C Unfounded At this point, the Health Services Director called hospice for assistance. Staff interviewed stated that R1 did not state that they were in pain and that they had exhibited this behavior before. Hospice arrived to evaluate and assist resident. Hospice wanted staff to force resident back in bed, even though resident wasn’t wanting staff assistance. 911 was called for a lift assist. Hospice, along with the first responders, assisted R1 back into bed. The hospice nurse then left to attend to another resident at a different facility. A short time later, R1 was given their morning medications. Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 1, 2024 · control 59-AS-20240722164103

Allegation investigated: Staff does not ensure facility is free of pests Staff does not ensure kitchen is clean and sanitized

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday July 11, 2024, to complete and deliver findings to a complaint received on 6/18/2024. LPA met with Administrator Ilona and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator and staff regarding the allegations. LPA toured the kitchen and observed the following: evidence of pests in pest glue traps and baby pests on kitchen shelf. Food particles were observed on the floor and kitchen shelves. The kitchen floor was observed to be dirty. Kitchen refrigerator shelves were observed to be dirty. LPA photographed the items detailed above. Based on the information detailed above, LPA finds the allegations to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Appeal rights were given. Exit interview conducted. A copy of this report was left at the facility. Substantiated LPA learned that R2 requires staff to assist them with all meals. R2 is on a pureed diet. Through staff interviews, LPA learned that R2 is assigned staff who will assist with feeding once the residents in the dining room have their food. LPA learned there is another resident on a modified diet, but they eat their meal in the dining room. No staff interviews acknowledged that R2 eats their meals outside of the facility’s designated mealtimes. Staff interviews also did not reveal that R2 has missed any meals (other than when R2 has refused meals/food). Staff interviews acknowledged that there are always two staff on the NOC (overnight) shift. No interviews revealed that facility has only one employee working at night. LPA reviewed staff training documents for the previous 3 hires: activities assistant, caregiver, and kitchen employee. Staff training documents show that staff complete online (Relias) training, training by the Resident Services Director, and shadowing. Additionally, care staff are trained several times per week and as needed. Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 11, 2024 · control 59-AS-20240619163711

From the deficiency page — Deficiency type: Type B · Section cited: CCR 8755(b)(27) · Plan of correction due date: Jul 25, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply:(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by uncleanliness and pests in kitchen. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jul 11, 2024

Plan of correction: Administrator to send LPA pictures of deep cleaned kitchen and copy of pest control records.

Type of visit: Post Licensing

On Tuesday March 12, 2024, Licensing Program Analyst Melissa Parks arrived to conduct an unannounced post licensing inspection. During today's visit, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed 4 resident and 2 staff files. LPA toured the facility with Administrator Ilona. Due to a planned power outage, LPA will return to the facility at a later date to finish the post licensing visit. No deficiencies cited. An exit interview conducted. A copy of this report was emailed.the state’s words, verbatim · CDSS document, Mar 12, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Melissa Parks arrived on Monday December 11, 2023 to complete an unannounced prelicensing visit. LPA toured the facility with Administrator Chad. Previous prelicensing visits were conducted on 10/19/2023 and 10/26/2023. During todays visit, there were no health or safety violations observed. This facility has been approved for a secured perimeter by the South Placer Fire Protection District (inspection date 11/14/2023). The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Administrator and a copy of this report will be left at the facility.the state’s words, verbatim · CDSS document, Dec 11, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday October 26, 2023 to continue the prelicensing inspection. This application is a change in ownership with residents in care. Applicant has fixed the previous issues: non-skid mats not observed in all resident showers, incomplete first aid kit, and no safety measures in resident apartments to address behaviors such as ingestion of toxic materials. LPA observed a complete first aid kit, non-skid mats in shower rooms, and locks on bathroom cabinets to secure personal hygiene and grooming supplies. LPA observed the facility to have a secured perimeter which the recent fire inspection clearance does not show approval. LPA obtained a waiver letter requesting for a secured perimeter from the Administrator. If approved, the Department will request a fire inspection to be conducted. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) that facility did not meet all the pre-licensing components yet. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 26, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Thursday October 19, 2023 to conduct a prelicensing inspection. This application is a change in ownership with residents in care. During today's prelicensing inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed 7 resident files. All resident files contained the required paperwork. LPA conducted an inspection of the facility to ensure compliance with Title 22 regulations. Facility inspection was completed in the following areas: resident apartments, resident bathrooms, common area shower rooms, kitchen, staff apartments, garages, and backyard. Applicant has NOT satisfied all requirements in accordance to Title 22, California Code of Regulations due to the following: non-skid mats were not observed in all resident showers, incomplete first aid kit, and no safety measures in resident apartments to address behaviors such as ingestion of toxic materials. The Administrator stated that the facility will be in full compliance by 10/26/2023. LPA will conduct a follow-up visit at a later date. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) that facility did not meet all the pre-licensing components yet. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 19, 2023