Shearwater Residence

Type of visit: Case Management - Health Checks

Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Talwinder Bains arrived on 5/7/26 to conduct an unannounced case management visit. LPA and LPM met with House Manager, Emonnie Rowe and explained the purpose of today's visit. This visit is a health and safety check in response to three (3) residents who were relocated to this facility on 5/4/26 from another facility. LPA and LPM spoke with all three residents. LPA and LPM toured the facility. LPA and LPM did not observe any deficiencies per Title 22 Regulations. Exit interview was conducted and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 7, 2026

Allegation investigated: Staff financially abused resident in care.

On 3/30/26, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with staff during today's visit and explained the purpose of the visit. LPA spoke with administrator, Rebecca Thomas via phone who gave permission to coduct today's visit with staff, Med Tech Ayanna Thompson. The Department conducted a financial audit and found that staff, S1 financial abused resident, R1 by using R1’s bank card to make unauthorized personal purchases. R1 has a diagnosis of dementia and does not have the capacity to give consent. R1’s bank records showed $351.41 in successful charges made and $869.96 in attempted charges. Video surveillance obtained shows S1 using R1’s bank card to make purchases. Once the licensee was made aware of the fraudulent charges on R1’s bank card, the licensee terminated S1 and notified the licensing office. Based on the documentation and video surveillance obtained, S1 falsely used R1’s bank card to make unauthorized personal purchases. Based on the information gathered, the preponderance of evidence standards has 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 LIC 9099-D page. Exit interview conducted. Appeal rights and a copy of this report were provided. Substantiatedthe state’s words, verbatim · CDSS document, Mar 30, 2026 · control 59-AS-20260106101405

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87217(f) · Plan of correction due date: Mar 31, 2026

87217- Safeguards for Resident Cash, Personal Property, and Valuables (f) No licensee or employee of a facility shall make expenditures from residents' cash resources for any basic service specified in this Chapter, or for any basic services identified in a contract/admission agreement between the resident and facility....this requirement was not as evidenced by; Based on the documentation and video surveillance obtained, staff, S1 falsely used resident, R1’s bank card to make unauthorized personal purchases, which poses a immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: Licensee/Administrator shall send a letter of understanding of this Regulation and shall conduct all staff training. All POC documents are due by 3/31/26.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 01/26/26 to conduct the annual inspection. LPA met with staff and explained the purpose of today's visit. House Manager, Emonnie Rowe came after short while and assisted LPA with today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed five (5) residents and three (3) staff files. Residents and staff files were found to have required paperwork. Facility was clean and well organized. All required postings were observed. LPA and staff toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Hot water temperature was observed to be 111 degrees F, which is within the regulation range of 105-120 degree. Inside temperature was 73-74 degree F. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 02/05/26. Deficiencies were observed and cited per Title 22, CCR Regulations as listed on LIC 809-D. Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today. Exit interview conducted. Copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 26, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 12/16/25 to do case management visit to follow up on incidents reported by facility for residents . LPA met with House Manager, Emonnie Rowe (S1) and explained the purpose of the visit. LPA spoke with Administrator, Rebecca Thomas via phone and Administrator gave permission to conduct today's visit with S1 since they were not able to come to facility today. Incident for Resident, R1- Department followed up on SOC 341 sent by facility on 12/15/25 stating that staff (S) yelled at resident, R1 due to sandwich issue on 12/09/25 and witnessed by other staff and visitors. It was learnt that staff S was no more employed at the facility after that incident. Incident for Resident, R2- Department followed up on SOC 341 sent by facility on 12/04/25 stating that resident, R2 went to hospital due to change in condition on 11/24/25. R2's family came to facility to collect 2 rings belonged to R2 as R2/family left in R2s room but could not find the rings. Staff did the through search to look for missing rings but were unsuccessful. Incident for Resident, R3- Department followed up on LIC624/LIC624A sent by facility on 11/26/25 stating that resident, R3 went to hospital due to change in condition on 11/21/25. It was learnt that R3 condition get worsened at the hospital due to R3's cardiac issues and R3 passed away at hospital during hospital care. Facility notified LTCO, local law enforcement and responsible parties regarding these incidents. Department conducted interviews with 1 resident and 2 staff during today's visit. At this time, these incidents are under review and department will do follow up if warranted. No citations were issued per Title 22 Regulations.Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Dec 16, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 10/02/25 to do case management visit . LPA met with staff and explained the purpose of the visit. Administrator, Rebecca Thomas came after a short while and assisted LPA with today's visit. Incident for Resident, R1- Department followed up on SOC 341 sent by facility on 09/30/25 stating that resident, R1 reported to staff that $200.00 in cash was missing on 09/24/25 from their dresser drawer. R1 has initiated search of the room for the missing funds and facility also initiated search of the room. Facility notified LTCO, local law enforcement and responsible party regarding this matter. Department conducted interviews with 1 resident and 3 staff during today's visit. At this time, this incident is under review and department will do follow up if warranted. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 01/23/25 to conduct the annual inspection. LPA met with Administrator- Rebecca Thomas and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed two residents and two staff files. Residents and staff files were found to have required paperwork. Facility was clean and well organized. All required postings were observed. LPA and Administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Hot water temperature was observed to be 114 degrees F, which is within the regulation range of 105-120 degree. Inside temperature was 72-74 degree F. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 02/05/25. No deficiencies were observed or cited per Title 22, CCR Regulations during this visit . Exit interview conducted and copy of this report left at facility.the state’s words, verbatim · CDSS document, Jan 23, 2025

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

Allegation investigated: Facility staff did not follow admission agreement. Facility staff did not meet resident's incontinence care needs. Facility staff did not maintain resident's bedroom floors clean. Facility staff did not meet resident's dental care needs. Facility staff did not communicate with hospice as needed. Facility staff spoke inappropriately to resident.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 12/10/24 to deliver complaint findings for above allegations. LPA was greeted by staff and staff called Administrator, Rebecca Thomas who came to the facility after short while. LPA expained the purpose of today's visit. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unfounded ***Report Continued from 9099..... Allegation- Facility staff did not follow admission agreement. Facility staff did not communicate with hospice as needed. -Unfounded During investigation, the Department interviewed four (4) residents and four (4) staff and reviewed records to investigate this allegation. Record review indicated that facility kept proper documentation regarding residents’ admission agreements, hospice care plan for hospice care residents and other required components regarding resident’s care per Department’s Regulations. Resident’s interviews reflected that facility was meeting their care needs per their needs and service plan and per admission agreements and there were no problems. Staff interviews indicated that they were aware about residents’ care needs per their needs and service plans and hospice care plan for hospice care residents and providing care accordingly without any issues. Interview with hospice agency regarding resident, R1s care did not reflected any care concerns while R1 resided at the facility from November 2023 till October 2024. Based on gathered information, this allegation was found to be UNFOUNDED. Allegation- Facility staff did not meet resident's incontinence care needs. Facility staff did not meet resident's dental care needs.- Unfounded The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with four (4) facility staff and four (4) residents, it has been discovered that facility was providing appropriate care to the residents based on resident’s documented needs and service plans. During department visits on 11/26/24, Department observed that staff were attentive to residents care needs and helping them with their care needs. Four staff interviews reflected that facility provide adequate staffing and there were no issues with staff not helping residents with their care needs. Staff stated that they were assisting residents with toileting needs every 2 hours or as needed without any issues. Resident’s interviews indicated their satisfaction with their care needs including toileting, dental, showers and other care needs and did not express any concerns in this area, therefore this allegation is UNFOUNDED. (report continued....) ***Report continued from 9099.... Allegation- Facility staff did not maintain resident's bedroom floors clean. -Unfounded On 11/26/24, Department conducted a tour at the facility and observed the facility to be clean, safe, sanitary, and in good repair. An inspection of the facility was conducted and there was no dirt or smell observed. LPA found the kitchen appliances, floors, and food preparation areas to be clean and free from dirt and other debris. Four (4) staff interviews indicated that facility was in good repair and did not report any problems with any housekeeping issues. Staff interviews stated that staff kept facility clean and sanitary. Four (4) residents interviews indicated that there were no issues with facility's housekeeping and maintenance services, therefore this allegation is Unfounded. Allegation- Facility staff spoke inappropriately to resident. -Unfounded During investigation, the Department interviewed four (4) residents and four (4) staff to investigate this allegation. Based on interviews that was conducted with four residents, residents stated that they did not witness staff handling residents in rough manner or staff speaking in inappropriate manner with residents. Four Staff who were interviewed stated that they have not observe other staff being rough or having inappropriate interaction from staff to residents in any manner. Staff interviews indicated that sometimes staff talk loud to each other which could have been perceived as threatening tone or some staff having strong personalities, but staff treat all residents with respect and dignity and work at facility in a professional manner. Based on gathered information, this allegation was found to be UNFOUNDED. A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Dec 10, 2024 · control 59-AS-20241122161951

Allegation investigated: Residents care needs are not met. Staff are not giving residents medications as ordered by doctor. Staff are rough while providing care to residents.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 11/26/24 to deliver complaint findings for above allegations. LPA met with Administrator, Rebecca Thomas and explained the purpose of the visit. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unfounded **report continued from 9099...... Allegation- Residents care needs are not met.-UNFOUNDED --The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with four (4) facility staff and four (4) residents, it has been discovered that facility was providing appropriate care to the residents based on resident’s documented needs and service plans. During a records review, Department observed facility provided assistance to meet residents care needs. During department visits on 10/22/24 , Department observed that staff were attentive to residents care needs and helping them with their care needs. Four staff interviews reflected that facility provide adequate staffing and there were no issues with staff not helping residents with their care needs. Residents interviews indicated their satisfaction with their care needs and did not express any concerns in this area, therefore this allegation is UNFOUNDED. Allegation- Staff are not giving residents medications as ordered by doctor. - UNFOUNDED--Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. During these interviews with four (4) staff and four (4) residents, it was revealed that the facility dispensed all residents' medications on time and administered them as scheduled. Residents’ interviews indicated that staff were assisting them with their medications without any issues. Furthermore, a review of the records for the month of October 2024, indicated that the facility maintained a proper logs for all medications in the centrally stored medication log, following physician's orders, and documenting them in the Medication Administration Record (MAR) without any errors. Staff interviews reflected that residents were given medications on time per their physician’s orders and there were no problems to address. Based on these findings, this allegation is considered UNFOUNDED. Allegation- Staff are rough while providing care to residents.-- Unfounded- During investigation, Licensing Program Analyst (LPA) Bains interviewed four (4) residents and four (4) staff to investigate this allegation. Based on interviews that was conducted with four residents, residents stated that they did not witness staff handling residents in rough manner. One of four residents interview reflected that they prefer not to work with one of the staff who work there, and facility was acknowledging their request. Four Staff who were interviewed stated that they have not observe other staff being rough with residents in any manner. Staff interviews indicated that sometimes staff talk loud to each other which could have been perceived as threatening tone or some staff having strong personalities , but staff treat all residents with respect and dignity and work at facility in a professional manner. Furthermore, Department did not observe any kind of bruising, body marks or any other injury related to staff being rough with residents in facility’s records and documentation. Based on gathered information, this allegation was found to be UNFOUNDED. A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 59-AS-20241021141241

Allegation investigated: Staff are not meeting residents needs. Staff left residents in soiled diapers for extended periods of time.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 10/02/24 to deliver complaint findings for above allegations. LPA met with Administrator, Rebecca Thomas and explained the purpose of the visit. The Department conducted interviews with staff and residents and reviewed records to investigate the allegation. Department conducted interviews with Administrator, Five (5) staff, and four (4) residents to investigate this allegation. During the interview process it was reported that staff supervise residents twenty-four (24) hours a day and check on residents every two hours to provide residents toilet care needs. It was reported that staff are conscience of keeping the residents clean and dry. Resident’s interviews reflected that staff were providing care per their needs and service plan and there were no issues. LPA toured the facility and facility observed to be clean sanitary and free from odors. LPA did not observe any dirty diapers or smell of urine/feces. Record review reflected that facility has adequate staffing to meet all resident’s needs. It was also noted that facility staff were providing care to residents per their needs and service plan without any issues and keeping documentations records as needed. Based on this information, this allegation is Unsubstantiated.A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted. Copy of the report provided. Unsubstantiated **Report continued from 9099-A..... Allegation- Unqualified staff administering medications.-UNFOUNDED The Department conducted interviews with five (5) staff members and reviewed record regarding the allegations cited above. Staff interviews revealed that facility has trained staff who were managing residents’ medications and has access to medication room. Staff interviews denied that any unauthorized person was dispensing residents’ medications. There were some staff who were cross trained to do other duties and those staff also fill-in to do Med Tech job as needed per facility’s staffing needs. Record review indicated that facility has proper documentation of resident’s medication administration and there were no discrepancies. Record review also indicated that facility has proper training records for all staff who were administering resident’s medications per Department’s Regulations. Based on information gathered, this allegation was found to be Unfounded. Allegation- Staff are not providing activities for residents.-UNFOUNDED The Department conducted interviews with staff and residents and reviewed records to investigate the allegation. Five (5) staff interviews indicated stated that they offered multiple activities to all residents but most of the residents like to play bingo most of the times. Four Residents interviews indicated that facility was offering a variety of activities and there were no issues to address. Four (4) residents interviews indicated that the facility was providing a variety of activities for the residents to take part in. During department visit, it was observed the facility was providing different activities to residents who wish to participate. Additionally, Department observed monthly activity calendar posted in common areas at the facility, therefore the above allegation is UNFOUNDED. Allegation- Staff engaged in a verbal altercation with another staff in the presence of residents.-UNFOUNDED During investigation, Licensing Program Analyst (LPA) Bains interviewed residents and staff to investigate this allegation. Based on interviews that was conducted with four residents, residents stated that they did not witness facility owner, administrator or staff was threatening or had verbal altercation with any staff member. Five Staff who were interviewed stated that they have not observe facility owner threatening any staff member in any manner. Staff interviews indicated that sometimes staff talk loud to each other which could have been perceived as threatening tone, but staff treat everyone with respect and dignity and work at facility in a professional manner, therefore the allegation is UNFOUNDED. ***Report continued... **Report continued from 9099-A..... Allegation- Staff did not ensure the a/c was not in disrepair. Staff did not ensure residents rooms were not leaking.- UNFOUNDED The Department conducted interviews with staff and residents to investigate the allegation. Four resident’s interviews did not indicate any issues with facility’s physical operations including working A/C unit or any leakage in any residents’ rooms. Residents stated that sometime in August 2024, one of A/C unit was not working properly but facility followed up on that issue in timely manner and that issue has been resolved completely. Residents care or safety were not affected by issues with A/C unit not been working at that time. Five staff interviews reflected that facility A/C was operating without any problems and they were not aware about any water leakage in any rooms. Furthermore, staff stated that facility administration follow up in in timely manner if there were any issues with any physical operations at the facility, therefore the allegation is UNFOUNDED. A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Oct 2, 2024 · control 59-AS-20240828114235

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 10/02/24 to do case management visit . LPA met with administrator Rebecca Thomas (Becky) and explained the purpose of the visit. Department followed up on Incident Report and SOC 341 sent by facility on 09/30/24 stating that resident, R1 reported to staff on 09/20/24 that staff, S1 yelled at R1 while providing care to R1 during routine care on 09/19/24 around 10AM . Facility notified R1s family, Adult Protective Services, Long Term Care Ombudsman and other required agencies regarding this incident on 09/30/24. Per facility’s records, R1 was doing fine after this incident. LPA was notified by administrator that facility took appropriate action with S1 regarding this incident per facility policy. During today’s visit, the Department conducted interviews with resident, R1 and staff ,S1 regarding this incident. At this time, this case in under review and department will do follow up as warranted. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Oct 2, 2024

Type of visit: Required - 1 Year

On 02/20/24 Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify administrator of LPA's presence at the facility. Staff called administrator Rebecca Thomas and administrator spoke with LPA via phone. Administrator, Rebecca Thomas arrived at the facility shortly after and assisted LPA with today's visit. LPA and administrator conducted a tour of the facility. Areas toured included but not limited to the kitchen, dining room, residents bedrooms, bathrooms, common areas and backyard. LPA observed sufficient furniture and lighting throughout the facility. LPA observed the facility to have sufficient food supplies for seven (7) day non-perishable and two (2) day perishable. LPA observed toxins, knives and centrally stored medications to be locked and inaccessible to residents in care. All required Licensing posters are present in common area in the facility. The temperature in the facility was 74 degrees. Fire extinguishers was last inspected on 07/25/23. Smoke and carbon monoxide detectors are working and present throughout the facility. First Aid kit is maintained and ready for emergency use. LPA conducted a file review of four (4) resident files . LPA compared medications to those being given for four (4) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). Additionally, LPA reviewed three (3) personnel records which had all required documents. LPA requested a copy of the current liability insurance and LIC500 to be sent to LPA Bains by 03/10/24. LPA completed the full care tool and deficiencies were observed per CCR ,Title 22 Regulations as indicated on 809-D. Exit interview conducted .Appeal Rights and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Feb 20, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.