Senior's Retreat

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Lorna Smith and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 11:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 4-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 5 residents present at the facility in addition to AD. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 118 and 119 degrees F in the 3 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen and garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:30AM, LPA reviewed 5 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 5 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on documents and admission, the facility does not have an infection control plan; based on documents, the facility's liability insurance expired on 06/17/26 and AD stated they are still in negotiations with the insurance company over a possible rate increase and the policy will be renewed any day now and be retroactive to the expiration date of the current insurance; based on observation, the 2 fire extinguishers do not have inspection tags or receipts attached indicating they were purchased or inspected in the last year; based on documents, S2's health screening does not have a TB test result and S3's TB test results do not indicate whether S3 is fit to perform their duties; based on Guardian records, S3 is background cleared but is not associated to this facility and has been working for more than 5 days; based on observations and documents, the facility does not have doctor's orders for R1's folic acid and R3's multivitamin, vitamin c, and melatonin; based on documents, the physician's reports for R1 and R5 are on the old form and do not contain required information, including behavioral expressions; based on documents, the appraisals for R1 and R5 are more than a year old. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jun 25, 2026

The state marks this report as 10 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Allegation investigated: Staff restrain resident in chair.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Administrator (AD) Lorna Smith at 8am and explained the purpose of the visit. Currently there are five residents in care. LPA reviewed the following documents for Resident #1 (R1): Identification and Emergency Information Form, Physician's Report, Hospice paperwork and orders, Admission Agreement, Centrally Stored Medication Log, Medication Administration Record, Progress Notes and Medication Release Record from the prior facility. The Physician's Report form January 6, 2026 states R1's diagnosis is Neurocognitive disorder with Lewy bodies, that the resident was not ambulatory and required a walker and wheelchair. The assessment states R1 must have 24/7 supervision and assistance with Activities of Daily Living (ADLs) and medications. Resident received hospice services upon admission to the facility on December 14, 2025. R1 had recently started hospice services on December 3, 2025. R1 required two-person assist for transfers. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) It was reported that Staff restrain resident in chair. LPA reviewed the Physician's Report and Hospice Paperwork and orders. R1 came to the facility from the hospital and was transported via ambulance on a gurney. R1 is a two-person assist. R1 has a history of six falls from the prior facility and a wheelchair with a seat belt, as well as a walker, were provided. A geri-chair recliner was ordered and provided by the hospice agency. The geri chair is able to fully recline to a bed; which assisted staff in changing diapers. Since R1 was a two-person assist, instead of moving R1 from a chair to R1's bed; the geri-chair was used. A request for an exception for the geri-chair was not received by the Department. Upon interview, three of three staff denied that Staff restrain resident in chair but did report the resident often tried to get out of the chair and was a fall risk. Three of three staff confirmed the chair was reclined so resident was unable to get up from chair. Therefore, the geri-chair was intentionally being reclined in an effort to restrain resident from getting up from the chair. One of two witnesses confirmed the allegation. One of two witnesses did not confirm, nor deny the allegation. Based on LPA record review and interviews, the preponderance of evidence standard has been met. Therefore the allegation that Staff restrain resident in chair is Substantiated. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Lorna Smith, Administrator and a copy of this report was given to the facility along with a copy of the LIC 811, LIC 9099-D and Appeal Rights.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 22-AS-20260116161217

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5) · Plan of correction due date: May 7, 2026

Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself...(5) Under no circumstances shall… postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement was not met as evidenced by: Based on witness and staff interviews a geri-chair was used to restrain a resident which poses a potential health and safety risk.the state’s words, verbatim · CDSS document, Apr 28, 2026

Plan of correction: POC: Resident has moved. LPA spoke with AD regarding geri-chair use requiring an exception from the Department. AD will read Postural Support regulations and email LPA a signed Memo of Understanding. AD will also in-service staff on restraints by the POC due date and email documentation to LPA.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert conducted a Case Management Deficiences Visit. LPA was greeted and granted entry by Staff at 8am. There are currently five residents in care. LPA met with Administrator (AD) Lorna Smith and explained the purpose of the visit. The purpose of the visit is to deliver amended licensing reports (LIC 9099s) from March 20, 2026, and April 9, 2026. An exit interview was conducted and a copy of this report and amended reports was provided.the state’s words, verbatim · CDSS document, Apr 28, 2026

Allegation investigated: Staff left resident in soiled diaper for a period of time. ***This is an amended report.***

LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Lorna Smith and explained the purpose of the visit. LPA reviewed the following documents for Resident #1 (R1): Identification and Emergency Information Form, Physician's Report, Hospice paperwork, and Progress Notes. The Physician' s Report from January 6, 2026 states R1's diagnosis is Neurocognitive disorder with Lewy bodies, that the resident was not ambulatory and required a walker and wheelchair. The assessment states R1 must have 24/7 supervision and assistance with Activities of Daily Living (ADLs) and medications. R1 required two person assist for transfers. Resident received hospice services upon admission to the facility on December 14, 2025. R1 had recently started hospice services on December 3, 2025. Resident changed hospice agencies on December 29, 2025. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) It was alleged that Staff left resident in soiled diaper for a period of time. Staff interviews reported that the routine was to check R1's diaper at 6am. R1 would be bathed by the hospice bath aide between 7-8:30am and breakfast would be at 9am. After breakfast R1 would "walk" in the wheelchair outdoors if weather permitted. After lunch the diaper would be checked and R1 would take a nap. R1 would awaken before dinner and, after dinner, R1 would return to the bedroom to watch television. Staff reported R1 did not have any rashes and did not sit in soiled diapers. Staff tried to keep R1 busy throughout the day so R1 would sleep better at night. R1 would be restless and get out of bed at night. The allegation that Staff left resident in soiled diaper for a period of time is Substantiated. R1 changed hospice agencies on December 29, 2025. On January 1, 2026, a witness stated R1 had a soiled diaper from 6am. The witness arrived at 9am and asked staff why R1 had not been changed. AD stated they had expected the hospice bath aide, who normally arrived between 7:30 to 8am. The facility reached to the hospice agency and were told the aide had called off and someone would be arriving. The bath aide did not arrive until noon. Two of two witnesses confirmed the allegation that Staff left resident in soiled diaper for a period of time. Two of three staff confirmed the allegation but one staff member was not present and could not confirm nor deny the allegation. Based on LPA record review and interviews, the preponderance of evidence standard has been met. Therefore the allegation that Staff left resident in soiled diaper for a period of time is Substantiated. The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Lorna Smith, Administrator and a copy of this report was given to the facility along with a copy of the LIC 811, LIC 9099-D and Appeal Rights. ***This is an amended report.***the state’s words, verbatim · CDSS document, Mar 20, 2026 · control 22-AS-20260116161217

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Mar 21, 2026

87464 (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing... This requirement is not met (cont'd) as evidenced by: Based on LPA interviews one of four residents was in a soiled diaper for a period of time. This poses an immediate health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: AD stated staff will be in-serviced and documentation, dated and signed by staff, will be emailed to LPA by POC due date.

Allegation investigated: Staff did not provide an accurate dosage of medication to resident. ***This is an amended report***

LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Administrator (AD) Lorna Smith and explained the purpose of the visit. LPA reviewed the following documents for Resident #1 (R1): Identification and Emergency Information Form, Physician's Report, Hospice paperwork and orders, Admission Agreement, Centrally Stored Medication Log, Medication Administration Record, Progress Notes and Medication Release Record from the prior facilty. The Physician's Report form January 6, 2026 states R1's diagnosis is Neurocognitive disorder with Lewy bodies, that the resident was not ambulatory and required a walker and wheelchair. The assessment states R1 must have 24/7 supervision and assistance with Activities of Daily Living (ADLs) and medications. Resident received hospice services upon admission to the facility on December 14, 2025. R1 had recently started hospice services on December 3, 2025. R1 required two-person assist for transfers. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) Review of the Hospice & Facility Integrated Plan of Care shows a hospice nurse would assess and conduct case management visits once per week and a bath aide would assist with personal grooming, hygiene and bathing twice a week. Resident #1 (R1) changed hospice agencies on December 29, 2025. It was alleged that Staff did not provide an accurate dosage of medication to resident. LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) from December 14, 2025 to January 14, 2026. R1 began taking Seroquel on December 23, 2025. Per review of text messages between Administrator (AD) and Responsible Party (RP); on December 28, 2025 AD requested to increase Seroquel dosage from 2 tablets daily to three; due to combative behavior. RP requested staff only give R1 one tablet per day. A text from December 29, 2025 between RP and AD stated NuPlazid medication would be ordered for R1 and received by January 5, 2026. Text messages from January 5, 2026 relayed NuPlazid had not been received and RP contacted pharmacy to expedite a new order to the facility. The medication was delivered to the facility and a photo was sent of the packaging. The second medication order also arrived at the facility a few days later. Interview of three of three staff denied the allegation that facility was over medicating resident. Staff gave the dosage requested by RP. One of two witnesses confirmed the allegation. One of two witnesses could not confirm, nor deny the allegation. Thus the allegation that Staff did not provide an accurate dosage of medication to resident is Unsubstantiated. Based on LPA record review, interviews and observations the allegations may have happened or are valid, but there is not a preponderance of evidence to prove the alleged violations occurred. Therefore the allegations that Staff did not provide an accurate dosage of medication to resident and Staff restrain resident in chair are Unsubstantiated. An exit interview was conducted with Lorna Smith, Administrator and a copy of this report and LIC 811 was provided to the facility. ***This is an amended report.*** (Continued from LIC 9099-C) (The text on this page has been moved to the amended LIC 9099-C) ***This is an amended report.***the state’s words, verbatim · CDSS document, Mar 20, 2026 · control 22-AS-20260116161217

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry at 1:15pm and met with Lorna Smith, Administrator. The facility is a single-story, five bedroom, two bathroom home with an approved fire clearance of six non-ambulatory residents; of which six may be on hospice. The facility currently has a census of five residents receiving care and four are on hospice. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 107.0 and 113.7 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on March 30 2021. The facility’s last fire drill was conducted on March 22, 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. There were extra canned goods and non-perishable items in the garage. Hazardous chemicals were locked, both under the sink and the garage, and knives and sharps were secured in a locked drawer. All appliances were in working order and a washer and dryer were in the garage. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the outside of the facility and observed a self-latching exterior gate and shaded seating areas for residents to enjoy. There is ample space outdoors for activities and gatherings. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. Facility also has a First Aid Manual. LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on August 16, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Lorna Smith, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, May 30, 2025

Allegation investigated: Facility does not have a current administrator

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Lorna Smith and explained the reason for the visit. The Administrator reported they have a current Administrator's certificate but they have not received it from the Agency (CCL). LPA verified on the Agency website that the Administrator has a current certificate, number 7023081740 that expires on August 16, 2026. The Administrator reported that she sent in all the required documents to renew her certificate prior to the last certificate expiring. Based on the evidence gathered the allegation is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided and explained. Unfoundedthe state’s words, verbatim · CDSS document, Mar 10, 2025 · control 22-AS-20250228145518

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to amend a LIC 809-D report generated on January 17, 2025. LPA was greeted and granted entry by Lorna Smith, Administrator (AD) and explained the purpose of the visit. LPA observed residents were asleep or watching television in their rooms. LPA amended the LIC 809-D and obtained the required signatures. An exit interview was conducted with Lorna Smith Administrator and a copy of this report and the amended LIC 809-D were given at the time of the visit.the state’s words, verbatim · CDSS document, Feb 13, 2025

Allegation investigated: Resident was abandonded at the hospital

Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit regarding the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Before interviews began, LPA toured the interior and exterior portion of the facility with Staff 1 (S1). Regarding the complaint allegation: Resident was abandonded at the hospital During the complaint investigation, Staff 1 (S1) admitted to abandoning Resident 1 (R1) at the hospital. According to S1, R1 was fine the first day of admission. According to S1, the second day at the facility the resident was observed to be confused and wanted to leave the facility. R1 successfully eloped on third day. The police found the resident and called the facility and asked if they are missing a client. S1 said no and checked on the residents and noticed R1 was not present. Continued on LIC9099C Substantiated The police brought the resident back to the facility and S1 informed the family that R1 needed a higher level of care and the family understood. R1 was able to leave the facility a second time and facility staff were alerted by the sound of the auditory exit alarm and were able to catch up with the resident and redirect R1 back to the facility. At that time S1 called the family and informed them they need to find a new facility for R1. The family called the Psychiatric Evaluation Team (PET) to go check on R1 however, the PET said they could not see R1 at the facility (Senior’s Retreat) the resident could only be evaluated in the emergency room. At that time R1’s family called 911 and had the resident sent to the hospital. According to S1, after a few days the nurse, discharge planner, and the social worker from the hospital called and asked if R1 could return to the facility. S1 admitting to telling hospital staff, R1 could not return because the resident needed a higher level of care. Based on the evidence gathered through the interview with Staff 1, and observations the preponderance of evidence standard has been met, therefore, the above allegation is SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 22-AS-20250117140319

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Jan 27, 2025

(a) Residents in all residential care facilities... shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not being met as evidenced by R1 not being accepted back at the facility after being discharged by the hospital.the state’s words, verbatim · CDSS document, Jan 24, 2025

Plan of correction: Licensee stated they will read and review regulation sections 87468 (Personal Rights) and regulation section 87224 (Evictions). Licensee will send LPA Haley a signed statement of acknowledgement and understanding upon completion by the POC due date. 1.27.25 at 12 noon.

Allegation investigated: Staff applied a colostomy bag without a doctor's order Facility heater is inoperative

Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit regarding the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Before interviews began, LPA toured the interior and exterior portion of the facility with Staff 1 (S1). Regarding the complaint allegation: Staff applied a colostomy bag without a doctor's order During the complaint investigation 3 of 4 individuals interviewed provided information that confirms the complaint allegation, including Staff 1(S1) who admitted to placing a bag on the residents rectum/bottom area. S1 admitted to placing the colostomy bag on the resident 1’s rectum/bottom area. According to S1, R1 was dealing with a lot of “loose stool” so S1 used the colostomy bag to catch the loose stool to prevent further damage to R1’s already compromised skin area on the rectum/bottom area. Continued on LIC9099C Substantiated According to S1, R1’s rectum area was already damaged and the bag wouldn’t even stick to R1’s bottom area. S1 claims the area on R1 was not a bed sore, but it was a little worse than a diaper rash. According to S1, the acid in R1’s loose stool could cause the skin to open and create a sore. Regarding the complaint allegation: Facility heater was not in operating condition. 3 of 4 individuals interviewed provided information the supports the complaint allegation. Including Staff 1 (S1) who admitted the facility heater was not functioning properly. According to S1 the duct needed to be replaced or repaired. S1 provided documents to show the heater was repaired on Saturday, January 18, 2024. At the time of the complaint visit (1.24), S1 adjusted the thermostat and turned on the heater. LPA Haley verified warm air coming out the vent during the visit. Based on the evidence gathered through interviews, and document review the preponderance of evidence standard has been met, therefore, the above allegations are SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 22-AS-20250117100656

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jan 27, 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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not being met as evidenced by S1 admitting to using a colostomy bag on the rectum/bottom area of Resident 1 to prevent loose stool from causing additional damage to the residents’ skin area that was already damaged and being treated.the state’s words, verbatim · CDSS document, Jan 24, 2025

Plan of correction: Licensee stated they will read and review regulation sections 87468 (Personal Rights). Licensee will send LPA Haley a signed statement of acknowledgement and understanding upon completion.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 27, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by S1 admitting to having issues with the facility heater heating the entire facility. S1 arranged for major repairs to the heating system January 18, 2025 and provided receipts.the state’s words, verbatim · CDSS document, Jan 24, 2025

Plan of correction: The facility heater has already been repaired. LPA verified the heater is in good working condition during the complaint visit. No further action necessary.

Allegation investigated: Staff caused injury to resident Facility failed to maintain comfortable temperature for the residents

Regarding the complaint allegation: Staff caused injury to resident During the complaint investigation, 3 of 4 individuals confirmed R1 was dealing with skin irritation on the rectum/bottom area. One witnessed described the skin irritation to be like a diaper rash. The witness claims the facility was provided cream to apply to the affected area. Staff 1 (S1) also confirmed R1 was dealing with irritation to the rectum area from the time R1 was admitted on January 8, 2025. S1 confirmed cream was being applied to the irritated area and it was improving until R1 began having loose stools, which irritated the already sensitive skin around R1’s rectum/bottom area. It is not clear what damage if any was caused by the bag that was placed on the rectum/bottom area as 3 of the individuals interviewed all confirmed R1 was already dealing with skin irritation to the area. Regarding the complaint allegation: Facility failed to maintain comfortable temperature for the residents Continued on LIC9099C Unsubstantiated During the complaint investigation, it was discovered the facility was having issues with the heater. According to S1, the heater would not properly heat the entire facility. S1 says, the heater would come on, but the entire house was not getting warm enough. S1 claims she called someone to come and repair the heater and they would work on it and the heater would work, but it would malfunction again. The second time the repair man came out the repairs worked, but S1 was advised the repairs were temporary and additional work to the ducts was needed. Eventually the heater stopped working again and two portable were provided until the final repairs were completed. S1 made the necessary repairs on Saturday, January 18, 2025. Receipts were provided. Based on the information gathered during the investigation through interviews and document review the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations above are deemed Unsubstantiated.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 22-AS-20250117100656

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit to issue a citation for deficiencies discovered during the investigating of complaint control # 22-AS-20250117100656. During the complaint investigation, it was discovered Individual 1 (ID1) who was identified as a staff member, was not fingerprint cleared and associated to the facility. Staff 1 (S1) admitted ID1 was working in the facility for about 2 months as a cook. S1 was advised all individuals need to be fingerprint cleared and associated to the facility roster before being allowed to work in the facility. Violations are being cited per California Code of Regulations title 22. An exit interview was conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 24, 2025

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

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance… This requirement was not met as evidenced by: Based on an interview with S1, the licensee did not ensure ID1 was background cleared prior to working at the facility, which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 24, 2025

Plan of correction: Licensee has already removed ID1 from the facility and understands ID1 can not return until fingerprint cleared and properly associated to the facility. Licensee will read and review regulation section 87355 Criminal Record Clearance and submit a statement of acknowledgement and understanding to LPA Haley by the poc due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct a Case Management Visit. LPA was greeted and granted entry by Lorna Smith, Administrator (AD) and explained the purpose of the visit. The facility is a five bedroom, three bathroom, single story home with an approved fire clearance of six non-ambulatory residents of which six may be on hospice. The facility currently has a census of four residents in care. LPA and AD toured the facility and did a health and safety check on the residents in care. Two residents were asleep in their respective bedrooms and two residents were seated in the living room area chatting and relaxing with each other. One resident was visiting from the home across the street, Senior's Retreat of Brea, Inc. #306006253; since solar panels were being installed at the time of LPA's visit. The visiting resident and one staff member return to the other facility at the end of the day. All residents were properly cared for. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Lorna Smith, Administrator and a copy of the report was given at the time of the visit.the state’s words, verbatim · CDSS document, Jan 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Administrator (AD) Lorna Smith and explained the purpose of the inspection. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, two bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 114.8 F degrees. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Sharps were observed locked in a kitchen drawer. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication cabinet was observed to be locked. LPA reviewed four of four resident files and two staff files. Staff files did not contain any documentation for initial staff training, or annual staff training conducted, and AD was unable to provide LPA with a copy of staff training completed; Deficiencies were cited on today’s date. LPA interviewed staff and residents present. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 17, 2024