Sierra Ridge Senior Living

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cassandra Mikkelson conducted a case management visit. LPA met with Administrator and explained the purpose of today's visit. The purpose of today's visit is to follow up on an incident report received on 04/20/2026. On 04/14/2026, Resident R1 received medication that was intended for another resident (R2). The error was immediately identified and reported. Emergency services was initiated and R1 was transported to hospital for further evaluation. R1 did not sustain any adverse reactions. Facility conducted inservice training after the incident occurred. At this time, a deficiency is cited pursuant to California Code of Regulations, Title 22, and documented on the attached LIC809D. Exit interview conducted and a copy of the report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Apr 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5) · Plan of correction due date: Apr 30, 2026

87465 Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility… (5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed…. This was not met by evidenced by: R1 received R2's medication on 04/14/2026.the state’s words, verbatim · CDSS document, Apr 23, 2026

Plan of correction: Facility has already conducted training for med techs. Facility will provide a copy of training to LPA by POC due date.

Allegation investigated: Sharp objects are not locked and inaccessible Not enough staff to meet resident's needs

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Brittany Hall to deliver findings for the above complaint allegation. During the investigation, LPA conducted interviews, conducted tours of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: *** Report continued on 9099-C*** Unsubstantiated Sharp objects are not locked and inaccessible Interviews conducted with Executive Director and Staff members S1 and S2 indicated there have been no incidents related to sharp objects to their knowledge. Facility tour indicated that all drawers accessible to residents in care did not have any sharp objects available for resident use or access. All sharps were locked and inaccessible to residents in care. Records reviewed indicated that there have been no reports from the facility of sharps being left unlocked or incidents where a resident has gotten a hold of a sharp object due to lack of supervision. Therefore, the allegation sharp objects are not locked and inaccessible is unsubstantiated. Not enough staff to meet resident's needs Interviews conducted with Executive Director and Staff Members S1 and S2 indicated that staffing is improving. Staff are able to complete assigned work and the facility is no longer using an outside agency to fill in staff. Records reviewed indicated that there are staff on each shift to assist the residents in care and staff schedule indicates an increase in staff over the last few months to assist with level of acuity in the current residents. Resident records reviewed indicated that staffing is appropriate for the residents level of care. Therefore, the allegation inadequate staffing to provide care is unsubstantiated. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be 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 was conducted with Executive Director. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 7, 2026 · control 59-AS-20260310105752

Allegation investigated: Staff did not ensure that there are an adequate amount of supplies.

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Brittany Hall to open the complaint 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 did not ensure that there are an adequate amount of supplies. Records reviewed indicated that supplies, like gloves, are ordered on a monthly basis if not sooner as requested by staff. Interviews conducted with Executive Director, Business Office Manager and staff indicated that there is an adequate supply of gloves for the staff at the facility. The facility has a process in place to order supplies every few weeks and the staff have the ability to request more supplies if for some reason there was a shortage. Facility tour indicated that there were supplies in the storage closets available to staff. There were also supplies in resident’s rooms that could be used by staff as well. Therefore, the allegation staff did not ensure that there are an adequate amount of supplies is unfounded. Based on records reviewed and interviews, LPA finds the above allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Executive Director. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Apr 7, 2026 · control 59-AS-20260326155130

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced and met with Executive Director Brittany Hall and Business Office Manager Tony Sellers to conduct an annual inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed resident rooms, common area bathrooms, kitchen, common areas, activities rooms, and perimeter of care facility. LPA observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care facility has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are hardwired and operational in the care facility. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage rooms and medication carts and found medications to be locked away and inaccessible to the residents. LPA reviewed eight (8) resident files, four (4) staff files and resident medications. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of this visit, no deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted with Administrator.the state’s words, verbatim · CDSS document, Apr 7, 2026

Allegation investigated: Facility is understaffed staff did not prevent resident on resident altercation

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Executive Director Alyssa Sellers 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*** Unsubstantiated Facility is understaffed Interviews conducted with Staff Members S1, S2, S3 and S4 indicated that care is being provided adequately to all residents in care. It was indicated that staffing is increasing and overall care is easier to manage with the current number of staff. S1, S2, and S3 indicated that they would like one more staff on the floor for the morning AM shift but are able to still complete all tasks assigned. Records reviewed indicated that there are staff on each shift to assist the residents in care and staff schedule indicates an increase in staff over the last few months. Therefore, the allegation inadequate staffing to provide care is unsubstantiated. Staff did not prevent resident on resident altercation LPA reviewed LIC624 and SOC341 reporting that R2 assaulted R1 on 10/20/2025. Staff who were interviewed stated they did not witness the incident. Staff were quick to respond after incident had occurred and called 9-1-1 on behalf of R1 to get R1’s injuries assessed. Executive Director stated that the two residents were inside R1’s room when R2 pushed R1 resulting in R1 falling to the ground. It was determined that this incident did occur and was reported by the facility to licensing and R1’s power of attorney. However, there is no regulation that has been violated and as a result a citation cannot be issued for this allegation. Therefore the allegation staff did not prevent resident on resident altercation is unsubstantiated. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be 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 was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents. Staff negligence resulted in resident sustaining fall w/ injuries Records reviewed indicated that R1 sustained a fall on 10/18/2025 in their room. R1 sustained an injury to their left eyebrow and skin tears on forearm and hand. R1 utilizes the Safely You program which captures a video of any fall in the resident rooms. The incident was captured on 10/18, staff responded immediately after getting the fall notification and followed protocols by calling emergency services to have R1’s injuries assessed. Licensing and R1’s power of attorney (POA) were notified of incident. Interviews conducted indicated that R1 needed assistance at times with transferring and utilized a walker for mobility. R1 had 1 previous fall with no injuries on 8/28/2025 so R1 was considered a “fall potential” and not an immediate “fall risk”. Staff monitored appropriated based on R1’s service plan. Therefore, the allegation staff negligence resulted in resident sustaining fall w/ injuries 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, Feb 12, 2026 · control 59-AS-20260106124506

Allegation investigated: Lack of staffing/supervision

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Executive Director Alyssa Sellers 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*** Unsubstantiated Lack of staffing/supervision Interviews conducted with Staff Members S1, S2, S3 and S4 indicated that care is being provided adequately to all residents in care. It was indicated that staffing is increasing and overall care is easier to manage with the current number of staff. S1, S2, and S3 indicated that they would like one more staff on the floor for the morning AM shift but are able to still complete all tasks assigned. Records reviewed indicated that there are staff on each shift to assist the residents in care and staff schedule indicates an increase in staff over the last few months. Therefore, the allegation inadequate staffing to provide care is unsubstantiated. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be 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 was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents. Lack of hygiene supplies Interviews conducted indicated that there are plenty of hygiene supplies available to staff at the facility. Observations indicated that each of the three supply closets had a large stock of hygiene supplies in different sizes available. There were also hygiene supplies in resident rooms available for staff and resident use. Interviews with Staff members S1, S2, S3 and S4 indicated that there is a good supply of hygiene products that are available for use for resident care. Therefore, the allegation lack of hygiene supplies in unfounded. Lack of appropriate incontinence care leading to wounds Records reviewed indicated that there are no residents who currently have open wounds at the facility. Staff are doing checks for wounds during brief changes and showering. Staff document if there are any skin integrity issues while showering. Interviews conducted with Staff members S1, S2, S3 and S4 indicated that there are no current residents with wounds at this time. Staff check residents daily to ensure there are no new skin issues, this is done during brief changes and showering. Therefore, the allegation lack of appropriate incontinence care leading to wounds is unfounded. Kitchen area not kept sanitary Observations indicated that kitchen is kept clean, sanitary and free of any pests. Records reviewed indicated that facility kitchen is audited once a quarter in order to check for cleanliness and overall sanitation along with food management. In review of the audit reports, it was indicated that the facility has maintained a 100% score in sanitation and overall kitchen services with no areas of concern. Interviews conducted indicated that kitchen is maintained as a clean environment with proper procedures in place to uphold kitchen and food standards. Therefore, the allegation kitchen area not kept sanitary is unfounded. Staff are not following activity schedule Interviews conducted indicated that the facility utilizes a program called “The Moment Program” which allows the facility to pivot their activities schedule based on the residents abilities. The program is flexible and supports individualized care and resident choices. Observations indicated that staff were assisting residents with activities, residents were also participating in watching a movie, and staff were heard asking residents what activity they would like to participate in at that time. Therefore, the allegation staff are not following activity schedule is unfounded. Continued on 9099-C2 page Incidents are not being reported by appropriate agencies Records reviewed indicated that facility is reporting to appropriate agencies in a timely manner. Review of facility procedures indicated that staff are trained on how and when to report to the appropriate agencies. Interviews conducted indicated that when an incident occurs, it is documented and the proper staff are notified, then the appropriate agencies are notified either via phone call or LIC624 incident report sent by email or fax. Therefore, the allegation incidents are not being reported by appropriate agencies in 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, Feb 12, 2026 · control 59-AS-20251209112349

Allegation investigated: Inadequate staffing to provide care Emergency pull cords not functioning

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Executive Director Alyssa Sellers to deliver findings for the above complaint allegations. 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*** Unsubstantiated Inadequate staffing to provide care Interviews conducted with Staff Members S1, S2, S3 and S4 indicated that care is being provided adequately to all residents in care. It was indicated that staffing is increasing and overall care is easier to manage with the current number of staff. S1, S2, and S3 indicated that they would like one more staff on the floor for the morning AM shift but are able to still complete all tasks assigned. Records reviewed indicated that there are staff on each shift to assist the residents in care and staff schedule indicates an increase in staff over the last few months. Therefore, the allegation inadequate staffing to provide care is unsubstantiated. Emergency pull cords not functioning Interview with Executive Director (ED) indicated that a family member had informed her that there were several pull cords not working properly. ED immediately took action and had the maintenance team change all batteries in all pull cord devices in the facility. Multiple tests have been conducted on the pull cord system which indicated that all pull cord devices are working properly. Although the pull cord system might have not been working properly, when it was brought to the attention of the ED, it was quickly addressed and all pull cord devices were accessed. Therefore, the allegation emergency pull cords not functioning is unsubstantiated. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be 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 was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents. Medications are not given as directed Interviews conducted with staff members S1, S2, S3 and S4 indicated that medications are being given as directed per physician’s orders. Med techs are careful to ensure proper medication distribution to the residents in care. Records reviewed of resident medication administration records (MAR) shows that medications are being given correctly and are documented properly to avoid error. Therefore, the allegation medications are not given as directed is unfounded. Not reporting incidents Records review of multiple resident files indicated that staff document in daily progress notes when family is contacted and the reason for contact. Staff inform resident’s responsible party of any incidents or concerns that arise while at the facility. Facility staff also inform licensing and the Ombudsman of any concerns or incidents that occur. Therefore, the allegation not reporting incidents is unfounded. Staff not following activities calendar Interviews conducted indicated that the facility utilizes a program called “The Moment Program” which allows the facility to pivot their activities schedule based on the residents abilities. The program is flexible and supports individualized care and resident choices. Observations indicated that staff were assisting residents with activities, residents were also participating in watching a movie, and staff were heard asking residents what activity they would like to participate in at that time. Therefore, the allegation staff are not following activity schedule is unfounded. Inadequate hygiene supplies for residents in care Interviews conducted indicated that there is an adequate supply of hygiene supplies available to staff at the facility. Observations indicated that each of the three supply closets had a large stock of hygiene supplies with different sizes available. There were also hygiene supplies in resident rooms available for staff and resident use. Therefore, the allegation lack of hygiene supplies in unfounded. Continued on 9099C2 page Showers not being given to residents Interviews with Staff members S1, S2, S3 and S4 indicated that staff given residents showering at least two times a week with additional showers as needed. Staff follow a shower schedule and document on the online system and paper shower sheet to indicate that a shower was provided, if there are any skin issues and if there is any concerns that need to be noted. S1, S2, S3 and S4 indicated that staff will attempt to change face or request assistance from a later shift if the resident refuses a shower, which happens occasionally. Records review indicated that staff are filling out shower forms and indicating whether a shower was provided and if any concerns came up. Therefore, the allegation showers not being given to residents is unfounded. Volunteers not fingerprint cleared Records reviewed indicated that there are no volunteers at the facility at this time. Review of staff roster and staff files indicated that all personnel that work at the facility are actual staff and not volunteers. Interviews conducted indicated that there are only qualified staff at the facility and no volunteers although sometime family members of residents will come in and sit with the residents in common areas. Therefore, the allegation volunteers are not fingerprint cleared 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, Feb 12, 2026 · control 59-AS-20251203135514

Allegation investigated: Facility did not allow resident to go their doctor appointment.

Licensing Program Analyst Kerry Hiratsuka conducted this unannounced complaint visit to deliver the results of the allegation above. LPA interviewed Administrator and staff. LPA reviewed records. One day, R1’s power of attorney (POA) arrived at the facility to take R1 to an appointment. Interviews indicate staff were instructed to call the R1’s POA for instructions before the resident was allowed to leave the facility. After the doctor's visit R1’s POA changed and the documentation was provided to the facility. Facility staff contacted the incorrect POA resulting in R1 missing their appointment. R1’s POA left the facility because they were too late to make the appointment. Although the facility did not restrict the resident from attending their appointment, the facility caused an unnecessary delay resulting in the resident missing their appointment. Substantiated Based on the information gathered through interviews, LPA was able to determine that the allegation is substantiated. Therefore, the Department finds the allegation 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. The following deficiencies were cited on 9099-D, per Title 22 Regulations. Immediate civil penalties of $250.00 were issued because this is a repeat violation within the past 12 months and shall accrue at $100.00 per day until corrected. Appeal rights were left with facility representative. A review of the medication orders the facility has showed the resident had a prescription for 5mg of a medication that was to increase to 10mg after 30 days. Per the records the resident started the 5mg prior to moving into the facility and the 10mg started shortly after the resident moved in per the prescription. There was an entry made by someone at the facility in the computer program the facility uses for medication that changed the order to 5mg, but there was no medication order in the resident’s file indicating the prescription change. The medication administrator record (MAR), which the staff have to log in the dosage of medication given to the resident shows they never stopped giving the 10mg dose until a written doctor’s order came in changing the medication to 5mg. The MAR dosage was based on the original doctor’s order of 10mg. LPA is unable to contact the person who made the medication change in the computer. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be 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. No citations were issued for this report Exit interview was conducted with facility representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 22, 2025 · control 59-AS-20250717092158

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Oct 22, 2025

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This was not met as evidenced by: a resident was not able to leave the facility without the staff confirming it with the power of attorney. This poses a potential threat to the care and supervision of residents.the state’s words, verbatim · CDSS document, Oct 22, 2025

Plan of correction: By October 23, 2025, the licensee shall come up with a written plan of correction on how they shall ensure staff understand the limitations of what a power of attorney may and may not do and what type of training they shall provide on the two types of power of attorney. Corrected this from a previous citation issued on 08/19/2025.

Allegation investigated: Staff did not provide responsible party resident's records.

Licensed Program Analyst (LPAs) Cassandra Mikkelson and Kerry Hiratsuka arrived at the facility unannounced and met with Tony Sellers to deliver findings for the above complaint allegations. 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*** Unsubstantiated Staff did not provide responsible party resident's records. Interviews conducted with Administrator indicated that records that were requested were given to the responsible party on the day the resident moved out. It was a verbal request made by Resident R1’s responsible party to the Administrator who gave the documents prior to R1 leaving the building. Therefore, the allegation staff did not provide responsible party resident’s records is unsubstantiated. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be 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 was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents. Staff did not provide responsible party a refund in a timely manner. Interviews conducted indicated that there is a refund due to R1’s responsible party(RP). Facility has attempted on numerous occasions to reach out to R1’s RP to get an address to send the refund check to but have not received an answer from R1’s RP. Documents reviewed showed multiple attempts to collect an address from R1’s RP for the refund check. Therefore, the allegation staff did not provide responsible party a refund in a timely manner is unfounded. Staff did not provide responsible party with an itemized bill. Interviews conducted indicated that itemized bills are sent to each resident’s responsible party on a monthly basis. Records reviewed indicated that an itemized bill is sent to the responsible party on a monthly basis. Therefore, the allegation staff did not provide responsible party with an itemized bill 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. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 59-AS-20251006095132

Allegation investigated: Staff did not provide medication assistance to resident in care Staff did not provide proper meals to residents in care Staff did not prevent resident from engaging in inappropriate behavior in residents' rooms Staff did not provide shower assistance to resident in care Staff did not properly report resident's incident Hygiene supplies are not readily available to residents in care Staff left resident in care in soiled clothes for an extended period of time

Licensed Program Analyst (LPAs) Cassandra Mikkelson and Kerry Hiratsuka arrived at the facility unannounced and met with Tony Sellers 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 did not provide medication assistance to resident in care Interviews with staff indicated that they follow medication assistance to residents who are taking medications. Staff assist with making sure each resident receives the correct medication on time each day. Observations of medication logs indicated that residents are receiving their correct medications on time each day. Medication lists were logged with correct doses and amounts as prescribed by their physicians. Therefore, the allegation staff did not provide medication assistance to residents in care is unfounded. Staff did not provide proper meals to residents in care Interviews with staff indicated that there was a menu that was followed by kitchen staff for each meal. Interviews with residents indicated that they like the food that is served and that there is a good variety of food options. Observations of the weekly menu indicated that there is a variety of meal options each day with good nutritional value. Therefore, the allegation staff did not provide proper meals to residents in care is unfounded. Staff did not prevent resident from engaging in inappropriate behavior in residents' rooms Interviews conducted indicated that the staff monitor and will try to redirect residents as needed. Staff indicate in their charting/progress notes on if a resident is engaging in certain behaviors so all staff are aware. Title 22 regulations do not indicate a staffing requirement and do not require 24/7 monitoring. The facility has the appropriate number of staff to meet the residents needs and give proper supervision. Therefore, the allegation staff did not prevent resident from engaging in inappropriate behavior in residents’ rooms is unfounded. Staff did not provide shower assistance to resident in care Records reviewed indicated that staff are providing shower assistance to residents in care. Staff are documenting showers that are given and when a shower is refused after multiple attempts. Interviews conducted indicated that staff are assisting with showers and attempting more than once to give a resident a shower if they refuse the first time. Therefore, the allegation staff did not provide shower assistance to resident in care is unfounded. **Continued on 9099-C2 page** Staff did not properly report resident's incident Interviews conducted indicated staff document in each resident’s chart if there is an incident that has occurred. Staff protocol is that emergency services are called if there is a fall or unwitnessed injury and then resident’s responsible party (RP) is called to inform of incident. Records reviewed indicated that incidents with or without injury are documented in each resident progress notes and alert charting is indicated for closer monitoring. Therefore, the allegation staff did not properly report resident’s incident is unfounded. Hygiene supplies are not readily available to residents in care Interviews conducted indicated that staff are providing each resident room with the necessary hygiene supplies needed. Observations of resident rooms indicated that rooms are stocked with necessary hygiene items. Staff were also checking resident rooms for hygiene items to ensure residents had what they needed for proper hygiene. Therefore, the allegation hygiene supplies are not readily available to residents in care is unfounded. Staff left resident in care in soiled clothes for an extended period of time Interviews conducted indicated that residents are changed based on their incontinence needs and level of assistance needed. Records reviewed indicated that it is listed in the facility system the level of incontinence and what assistance is required by facility staff. Observations indicated staff assisting residents with trips to the restroom and incontinence needs as needed or requested. Therefore, the allegation staff left resident in care in soiled clothes for an extended period of time 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. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 59-AS-20250825141240

Allegation investigated: Staff are not following resident's care plan. Staff did not notify resident's responsible party of resident leaving the facility.

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Alexis Thacker 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 are not following resident's care plan Records reviewed indicated that staff were following Resident R1’s care plan. R1 was always accompanied by a family member or friend when leaving the community as it stated in R1’s LIC602A that R1 is “unable to leave the facility unassisted”. Interviews conducted with staff and facility management indicated that R1 was fairly independent and able to be directed by verbal queues to help with daily tasks. Therefore, the allegation staff are not following resident’s care plan is unfounded. Staff did not notify resident's responsible party of resident leaving the facility Records reviewed indicated that Resident R1’s responsible party was changed through new power of attorney (POA) paperwork which was given to the facility. Staff followed proper protocols based on the paperwork that was received from R1’s new POA. Interviews conducted with facility management and staff indicated that R1 had been requesting to “go home” when R1’s family and friends were present at the facility. Facility staff called R1’s spouse as a curtesy as they were no longer the POA and the new POA was aware of R1 moving from the facility. Therefore, the allegation staff did not notify resident’s responsible party of resident leaving the facility 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, Oct 8, 2025 · control 59-AS-20250902172728

Allegation investigated: Resident sustained multiple injuries while in care due to staff neglect Staff does not provide drinking cups for residents Staff not maintaining residents hygiene

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Administrator Tony Sellers 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 Resident sustained multiple injuries while in care due to staff neglect. Interviews conducted indicated that Resident R1 was not considered a fall risk. Records reviewed indicated that R1 fell out of bed during the night and sustained injuries. Staff immediately assessed R1 and took appropriate action for R1 due to injuries sustained. Therefore, the allegation resident sustained multiple injuries while in care due to staff neglect is unfounded. Staff does not provide drinking cups for residents. Interviews with Residents indicated that there are drink cups provided for resident use at all times. Observations during visits indicated that there are water stations located in different hallways with cups provided and ready for use for residents. Therefore the allegation staff does not provide drinking cups for residents is unfounded. Staff not maintaining residents hygiene. Interviews with staff indicate that they assist with helping residents maintain their hygiene and continue to encourage proper hygiene practices each day. Observations indicated that staff are actively involved in the resident’s care and assisting with hygiene needs. Records reviewed indicated that residents are receiving showers and hygiene assistance in a timely manner or as scheduled. Therefore the allegation staff not maintaining residents hygiene 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 27, 2025 · control 59-AS-20250807102552

Allegation investigated: Staff are not permitting resident to leave the facility Staff are not permitting resident to have visitors

On August 19, 2025 LPA Tryon visited the facility to complete the complaint. LPA met with Interim Executive Director Tony Sellers and spoke by phone with covering ED Alyssa Sellers. LPA has interviewed witnesses, resident, Directors and staff. In speaking with witnesses, LPA learned that on at least one occassion, family members came to visit resident R1 at the facility. They were told by the ED at the time that R1 could not go into the community with them; and that they needed to leave. Therefore, the allegations that staff are not permitting resident to leave the facility; and staff are not permitting resident to have visitors is Substantiated. A finding of substantiated means that the allegation is valid because a preponderance of the evidence standard has been met. Deficiency cited as per Title 22 Regulations and the Health and Safety Code. Appeal rights provided, exit interview conducted. Substantiatedthe state’s words, verbatim · CDSS document, Aug 19, 2025 · control 59-AS-20250520151357

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Sep 19, 2025

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. Through interview LPA has learned that on at least one occassion R1 was denied the right to go into the community with a family member, causing a potential violation of Personal Rights.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: The facility will do a review of resident rights with all staff and submit proof of training to CCL by 9/19/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(a)(11) · Plan of correction due date: Sep 19, 2025

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors... permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. Through interview of witnesses LPA has learned that on at least one occassion family members of R1 were denied entrance to the facility to visit R1. This is a potential violation of Personal Rights.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: As above, The facility will do a review of resident rights with all staff and submit proof of training to CCL by 9/19/2025.

Allegation investigated: Staff did not dispense medication to residents as prescribed. Staff did not refill residents’ medication prescriptions in a timely manner.

On 8/6/2025 LPA Tryon and LPM Ordonez visited the facility to complete the complaint. LPAs met by phone with Alyssa Sellers covering Executive Director. LPA has interviewed staff, reviewed facility documents and records. Regarding the allegation that staff did not dispense medication to residents as prescribed, LPA has interviewed 4 involved staff and reviewed records. LPA learned that a new medication administration computer system was initiated in about January 2025. In the process of switching from the old to the new system, there were some "glitches" and issues; apparently not all the information transferred correctly, some dropped, etc. From interviews it appears that staff did the best they could with trying to keep up with the medications, used a combination of systems until it got straightened out, etc. Opionions seemed to differ somewhat between staff interviewed as to whether medicatons were given correctly, there were issues between various staff, etc. At this time, LPA is not able to ascertain if some medications did or did not get dispensed; allegation is UNSUBSTANTIATED. (continued) Unsubstantiated Regarding the allegation that Staff did not refill residents’ medication prescriptions in a timely manner. LPA has interviewed 4 involved staff, reviewed facility records. Some staff related that orders were turned in to the pharmacy by med techs timely, but then they did not get filled, and sometimes multiple requests were made, sometimes causing medications to be late. There were apparently differing opinions regarding whether staff were well-trained regarding medications, re-ordering and so forth. At this point, LPA is not able to come to a conclusion regarding the allegation, as there are several differing opinions about issues, "blame", etc. Allegation is UNSUBSTANTIATED. A finding that an 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 is occurred. .the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 59-AS-20250414122356

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Cassandra Mikkelson arrived announced and met with Business Office Director McKenna Evans to conduct a case management visit regarding a incident report received on July 28, 2025. LPA conducted a tour of the facility, collected pertinent documents and conducted interviews. No deficiencies cited during today's visit. Exit interview conducted with McKenna Evans. Report left with facility.the state’s words, verbatim · CDSS document, Aug 6, 2025

Allegation investigated: Licensee overcharged resident for services Staff did not provide resident’s DNR directives to medical personnel

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Cheya Lovelace, Resident Care Coordinator 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 Licensee overcharged resident for services. Records reviewed indicated that resident R1 was not charged a pre admission fee of $3000.00 when moving in to the facility. R1 previously resided at a facility that was owned by the licensee. Upon moving into the previous facility, the resident was charged $3000.00 pre-admission fee. When R1 moved into Sierra Ridge, the licensee honored the pre-admission fee R1 paid at the previous facility and did not charge an additional fee upon move in at Sierra Ridge. Based on the information gathered during the complaint investigation, the facility did not overcharge R1 therefore the allegation is UNFOUNDED. Staff did not provide resident’s DNR directives to medical personnel Records reviewed indicated that Resident R1 received discharge paperwork from the hospital during a visit on 05/08/2025. At that time, R1 had a “do not resuscitate (DNR)” order on file with the hospital. Facility records indicate that R1 had a Physician’s Order for Living Sustaining Treatment (POLST) form on file that indicated R1 had a DNR order. Interviews conducted indicated that facility sends documents with a resident when they are sent to the hospital, which includes a resident's emergency contact information, birthdate and physician name, current medication list, and POLST/DNR form. Based on interviews conducted and document’s reviewed, the hospital was provided and aware of R1’s POLST and DNR wishes. 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 Resident Care Coordinator. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 59-AS-20250626150100

Allegation investigated: Staff not providing care and supervision to resident

On 5/1/2025 LPA Tryon visited the facility to complete the complaint. LPA met with Executive Director Alexis Thacker. Over the course of the investigation LPA has interviewed 6 staff, reviewed documentation. LPA found that resident R1 had fallen several times while living at the facility. Through interview and review, LPA learned that R1 spent a lot of time walking around the facility; and walked head-down. R1 had a frequently recurring medical condition. When the condition popped up, R1 would suddenly start running down the hall, head-down. Staff would get medical attention ASAP for R1, but since the condition recurred fairly often, it would happen before anyone was aware, and R1 would run. When R1 ran, R1 would run into objects like tables/chairs, the wall; and then fall. Staff tried diligently to redirect R1 to activities; tried putting R1 to bed after meals to rest; tried having R1 sit, but R1 would frequently "bounce back up" and attempt to run. Hospice services were started, and saw R1 frequently, and treated the medical issues as quickly as possible, but agreed that there would likely be falls due to the behaviors related to the condition and the apparent need to run. It is not possible to say at this time if additional staff/supervision would have made any difference Unsubstantiated to the number of falls, as staff could be right there, and R1 would still get up and run; and staff could not stop R1 or obviously could not do any type of restraint. Therefore, at this time, LPA finds the allegation to be UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the the alleged violation occurred. Appeal rights provided; exit interview conducted.the state’s words, verbatim · CDSS document, May 1, 2025 · control 59-AS-20240805134831

Allegation investigated: Resident developed Stage 4 pressure injuries while in care.

Licensing Program Analyst Todd Tryon visited the facility unannounced on 04/9/25 to deliver the findings of the investigation completed by the Department. LPA met with Executive Director Alexis Thacker. During the course of the investigation, CCL staff has interviewed witnesses, staff, residents, outside agencies, reviewed documentation, reviewed medical records. Neglect: Lack of care/ supervision resulted in resident R1 developing stage four pressure injury. Based on interviews, medical documentation, and facility records, it was determined that the facility failed to provide adequate care and supervision to Resident 1 (R1), resulting in the progression of a pressure injury from stage two to stage four within a span of seven days. The facility did not ensure proper wound care, consistent repositioning, or timely medical attention, which contributed to R1's decline and subsequent admission to hospice care. Based on review of the medical documentation, on 6/19/2024 R1's medical records documented a stage two pressure ulcer on the right buttock and a deep tissue injury on the left lower back. On 6/26/2024 during the initial home health visit, R1's condition had significantly worsened, and the pressure injury had Substantiated progressed to stage four, requiring hospice intervention. Hospice records indicated severe tissue breakdown, with a portion of the wound being unstageable due to necrosis and surrounding non- blanching purple skin, further confirming a lack of adequate care. Based on staff interviews S1 stated that R1 did not have pressure sores upon admission but developed one approximately a month before discharge. S1 observed that wound dressing changes were not done frequently enough, and staff were not consistently repositioning R1 every two hours as required. S1 and S2 reported that caregivers were not responsible for wound care, and wound dressing changes were supposed to be conducted by Med Techs or home health nurses. However, dressing changes were observed to be inadequate, with S2 specifically noting that the dressing was sometimes soaking wet, indicating prolonged exposure to moisture and lack of timely intervention. S2 and S3 confirmed that R1 was not always repositioned every two hours, with gaps of up to five hours between changes. S2 further corroborated that the pressure sore worsened significantly within a week, indicating an accelerated deterioration due to lack of preventive care. According to S4 and S2 the facility had protocols for room checks every two hours and documentation of skin integrity issues. However, no facility records were provided to demonstrate consistent adherence to these protocols for R1. Staff interviews revealed staff shortages, with only one or two caregivers present at times, which impacted R1's care. Despite S2 stating that staff were advised to reposition R1 every two hours and place pillows to offload pressure, interviews with multiple staff members revealed inconsistent compliance, leading to the worsening of the wound. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency and civil penalty are being issued. An immediate civil penalty in the amount of $500.00 is to be assessed for a resident sustaining a serious bodily injury while in care at this facility. As a result of resident’s injury, the violation warrants a civil penalty assessment based on Health and Safety Code §1569.49. At this time, the civil penalty assessment is under review. LPA will return at a future date to assess a civil penalty, if warranted. Regarding Hygiene needs being met, again, staff related that R1 was very stiff/rigid physically, and movement appeared to cause pain/distress. Staff stated that a nurse from outside agency (wound care/hospice) was working with R1 and was reportedly bathing/cleaning R1 several times a week; but it's not clear if it was adequate. Staff related that they would clean R1 also. It appears that facility staff attempted to keep R1's hygiene needs met, but due to stiffness, pain, and wounds, it was difficult to move R1 around to provide hygiene. At this point it is not possible to say whether better care could have been provided given all the circumstances; or whether there was actually any neglect on the part of staff. Allegation is UNSUBSTANTIATED. A finding of 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.the state’s words, verbatim · CDSS document, Apr 9, 2025 · control 59-AS-20240926141557

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Apr 10, 2025

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and record review, R1 had a stage four pressure injury and did not report worsening of pressure injury to home health which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The facility must submit a Plan of Correction (POC) within 24 hours, detailing the following: Preventative Measures -A detailed plan on how the facility will prevent similar incidents, including staff training, monitoring systems, and wound care protocols. An immediate civil penalty in the amount of $500.00 is to be assessed for a resident sustaining a serious bodily injury while in care at this facility. As a result of resident’s injury, the violation warrants a civil penalty assessment based on Health and Safety Code §1569.49. At this time, the civil penalty assessment is under review. LPA will return at a future date to assess a civil penalty, if warranted.

Type of visit: Required - 1 Year

On 2/20/2025 LPA Tryon visited the facility to do an annual review LPA met with Executive Director Alexis Thacker. LPA toured the facility with Ms. Thacker including common areas, resident rooms, bathrooms, dining room, kitchen, hallways, storage areas, med room, offices, break room, and outside area. The facility was recently renovated/redecorated last year. The facility is clean, bright, newly furnished and pleasant. Furnishings are all in good condition. Bedroom furnishings are appropriate. Food supplies are plentiful, appear fresh and varied. Supply appears to meet the requirement of 2 days perishable and 7 days non-perishable. Food is stored appropriately and cooler/freezer at appropriate temperature per regulation. The facility has plenty of dishes, pots/pan/cookware. The kitchen appeared very clean and orderly, Plumbing and fixtures appear to be functional and in good condition. Temperature in the facility was comfortable, water temp within appropriate range as per regulations. LPA reviewed 6 resident files and 5 staff files. Files included required information. LPA was not able to interview residents due to disability. LPA spoke with one staff member. LPA reviewed the CARE Tool with Ms. Thacker. At this time, the facility appears to be in substantial compliance with the regulations. No deficiencies were cited. Exit interview conducted, copy of report given to Executive Director.the state’s words, verbatim · CDSS document, Feb 20, 2025

Type of visit: Case Management - Health Checks

On 9/27/2024 LPA Tryon visited the facility to do a Wellness Check related to a report received by the Department on 9/26/2024. LPA toured the facility including common areas, resident rooms, kitchen, dining area, bathrooms, etc. The facility appears to be clean and free of hazards, food supplies look appropriate to meet requirement fo 2 days perishable and 7 days non-perishable. Medications are centrally stored and locked. LPA was able to speak briefly with a few residents. There was a large group of residents in a large common room at the back of the building, participating in an afternoon activity. There were also several residents chatting with each other in the sitting area just inside the front door. Overall residents appeared to be safe and comfortable during this visit. At this time, LPA notes no hazards or pressing issues at the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 27, 2024

Allegation investigated: Licensee does not ensure sufficient number of staff on site to assist residents with toileting needs. Staff are not providing adequate laundry services for resident

On 9/25/2024 LPA Tryon and LPA Gunby visited the facility to complete the complaint. LPAs met with Executive Director Jennifer Fuston. During the course of the investigation, LPA has toured the facility, checked resident rooms and closets, inspected the laundry area, visited residents in common and dining areas, and interviewed 6 staff and ED. Regarding the allegation that Licensee does not ensure sufficient number of staff on site to assist residents with toileting needs, LPA learned that there has been an issue with hiring and retaining qualified staff. However, during the past months staff who were present worked hard to meet resident needs. Even though residents may have had to wait a little longer, residents appear to have had basic needs met by staff who were present. At this time the facility has been working hard to maintain a staff consisting of 4 caregivers and 2 med techs on day and evening shifts; and 2 caregivers and 1 med tech on night (NOC) shift. The facility does use agency staff to cover shifts when needed. LPA finds the allegation to be unfounded. Regarding the allegation that staff are not providing adequate laundry services for resident, LPA learned that Unfounded the facility has had trouble in past months with keeping a dedicated laundry person in the facility. However, during times that a laundry person was not available, other staff have pitched in and made sure laundry got done. If it was noted that a resident was running low on clean clothes, someone from the staff or administration would do laundry to make sure there were clean clothes. The facility now has been successful in hiring 2 full-time housekeepers to clean and do laundry. So even though the situation was a little rough for staff for a while, they did get clothes washed for residents. Allegation is unfounded. A finding of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Sep 25, 2024 · control 59-AS-20240708155450

Type of visit: Case Management - Deficiencies

On 5/29/2024 LPA Tryon visited the facility to follow up on an incident that was reported by the facility on 5/24/24 and dated 5/23/24. LPA met with ED Jennifer Fuston and Director of Health and Wellness Kaitlyn Sutherland. On 5/23/24 a POA for a resident reported that there was concern that a medication had not been given to resident R1 based on the resident's condition at a medical appointment on 5/14/24. The ED and Director of Health and Wellness immediately investigated, and found that staff S1 had signed on the Electronic Medication Administration Record (EMAR) that the medication was being given as per doctor order. Further investigation revealed that the medication had NOT been given, possibly for some period of time. This put R1 at potential serious risk to health and safety. The employment of R1 was terminated, and the medication was re-started as per doctor order. Administrator made appropriate reports to CCL, POA, LTC Ombudsman and Placer County Sheriff. R1 did have a follow-up medical appointment on 5/28/24 and is doing well, the health issue has returned to normal baseline at this time. The following deficiency is cited as per Title 22 Regulations. Appeal Rights provided, exit interview conducted.the state’s words, verbatim · CDSS document, May 29, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 29, 2024

The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Through review of records and interview of staff it was learned that staff S1 had signed on the MAR daily that a prescribed medicaton was being given to resident R1 daily. However, it was learned that the medication had NOT been given to R1 for some time, causing a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, May 29, 2024

Plan of correction: The Administrator will ensure that each resident is receiving all of their medication as prescribed. The Administrator and DHW immediately investigated, found that the medication was not being given, and had it re-started. The staff involved was terminated, R1 received a follow-up medical check and is back at normal baseline for the issue. Medication staff received in-service training on 5/28/24. POC is complete.

Type of visit: Case Management - Other

On 5/29/2024 LPA Tryon visited the facility to do an interview with staff and work on a complaint that was filed on 4/19/2024 against the prior license for the facility. This complaint has nothing to do with the new/current license issued on 4/25/2024. LPA met with the Director of Health and Wellness Kaitlyn Sutherland and explained the purpose of the visit. LPA met with and interviewed staff. Further investigation is needed at this time. Exit interview conducted.the state’s words, verbatim · CDSS document, May 29, 2024

Type of visit: Case Management - Other

On this date, LPA Tryon visited the facility to do interviews and work on a complaint that was filed on 4/19/2024 against the prior license for the facility. This complaint has nothing to do with the new/current license issued on 4/25/2024. LPA met with Resident Care Director Julie Ellison and explained the purpose of the visit. LPA met with staff. Exit interview conducted.the state’s words, verbatim · CDSS document, May 20, 2024

Type of visit: Prelicensing

On April 12, 2024 LPA Tryon visited the facility unannounced to perform a pre-licensing visit related to a new application for Change of Ownership. Visit was unannounced due to current residents in care. LPA met with Executive Director Jennifer Fuston. LPA toured the facility with Ms. Fuston including common areas, resident rooms, bathrooms, kitchen/food storage, dining room, activity rooms, hallways, laundry, etc. The facility has just been completely re-decorated throughout the interior and is clean and in "brand-new" condition. Common areas, sitting areas are nicely furnished with new furniture and fixtures. Rooms are clean and include appropriate furniture as per Title 22 Regulations. Activity areas are furnished appropriately and the facility has materials and equipment for activities. The facility keeps individual files on each resident with appropriate documents and forms available. There are also staff files for each staff member, records of training, criminal record clearance, experience, medical exams, etc. Facility has appropriate postings such as Resident Rights, agencies to call with issues/complaints, etc. LPA reviewed the CARE Tool with Ms. Fuston. The facility appears to be in compliance with regulations at this time. LPA has waived the requirement for Orientation Component III as the Administrator has many years of experience as an Administrator and working in the facility and is familiar with regulations, policies, procedures, etc. At this time the facility appears to be in substantial compliance.the state’s words, verbatim · CDSS document, Apr 12, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 65 Census (if any clients in care): 38 Interview Method: Telephone interview On 12/15/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 15, 2023

Type of visit: Case Management - Incident

LPA Tryon visited the facility briefly to find out about a few recent cases of residents with a possible skin condition. The facility has followed through with individual physicians and everyone is doing better. There has been one new resident with a skin condition this week, but that is the only individual currently being watched. Otherwise everyone is fine. It appears the facility has followed through appropriately. No further issues noted at this time. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 30, 2023