Sisters Assisted Living

Allegation investigated: Staff has not provided refund after resident's death.

LPA arrived to the facility on 7/21/26 at 9:09Am to conduct a complaint investigation into the above allegations, LPA met with administrator Karen Fomby to explain the purpose of the visit. As to the allegation that Staff has not provided refund after resident's death, the LPA reviewed the cash resources of the resident. in interview with the administrator it was learned the client had paid basic services from march through to the end may in advance, and had passed on 4/19/26, leaving a month and some days of funds that should be returned. LPA reviewed a photo of the sent check for 4160 drafted 5/16/26 payable to "the estate of jack manning" and a recipt for certified mail dated 5/21/26 with the client representative's signiture verifying it was recieved. the check has not been cashed as of 7/21/26 and the facility remains in control of the funds. In interview it was learned the check is likely not been cashed due to the payable line not being directed to the clients representative, in this case the clients offspring who has durable power of attourney. the amount may come into dispute, the facility is obligated to return a prorated value, calculated as the basic services divided by the number of days in the month after the clients property has been removed. The original check value is for 10 prorated days days + 1 month on its purpose line. Continued on C,page. Substantiated Supplemental to the second allegation, record review of the MAR indicated that the prescriptions were given as ordered and PRN administration was documented appropriately. It's unclear by the mar documentation, that a particular medication was given too often, or another medication was not given often enough, as the client has multiple regular medications which can cause chemical restraint type effects. Review of the 602 and medical records both indicated a certain level of psychotropic medication was needed to address agitation with physical violence. LPA gave guidance that if the medication is being noticed as too effective at sedating a client, that would bear health and personal rights risks that should be addressed with client and their the primary care provider/psych. As to the fifth allegation, it was learned in interview with the hospice care nursing administrator that no order for bedrails existed, and no bedrails were supplied to the facility. 602 doesnt indicate the need for bedrails, no doctors order for bedrails is on file at the facility. as to the sixth allegation, it was learned in interview with the administrator that the clients property was released to the clients representative on 4/21/26, for which a previous arrangement was reached on the 4/19. the recovery of the property did not include a signed receipt, as the representative of the client refused to sign, but they allowed a picture of thiery drivers license be taken. LPA gave guidance that per regulation the licensee must allow reasonable access to the property for the collection of safeguarded valuables. LPA toured the facility and the list of safeguarded valuables is not currently within the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. a copy of the report was read and given to the administrator, no citations issued, exit interview was conducted. The LPA issued guidance that the facility is required by regulation to collect a signed receipt of the property that was returned to the clients representative. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations,is being cited on the attached LIC 9099D. A copy of the report was read and given to the administrator, appeal rights were provided. exit interview conducted.the state’s words, verbatim · CDSS document, Jul 21, 2026 · control 27-AS-20260514144343

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(j)(3) · Plan of correction due date: Aug 19, 2026

87217 Safeguards for Resident Cash, Personal Property, and Valuables (j) Upon the death of a resident, all cash resources, personal property, and valuables of that resident shall immediately be safeguarded. (3) If no executor or administrator has been appointed, the responsible person shall be notified, and the cash resources, personal property, and valuables shall be surrendered to said person in exchange for a signed itemized receipt. This requirement was not followed as evidenced by, record review of the check is issued to the estate without evidance of an executor or administrator of the estate seperate from the DPOA, Not following this requirement posed a risk to the clients in care, via health, saftey, or personal rightsthe state’s words, verbatim · CDSS document, Jul 21, 2026

Plan of correction: LPA suggested the POC should include canceling the current check and reissuing the refund to the clients representative and sent certified. Licensee agreed to cancel and reissue, sending the LPA pictures of the rewritten check and the signed back certified mail reciept by the poc date

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a 1 year/required annual inspection. LPA met with Administrator Karen Fomby and explained the reason for the visit. Census:5 LPA Lund & Administrator Karen Fomby toured/inspected the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 112 degrees F which does the 105-120 degree Fahrenheit regulation. LPA observed facility staff turn down hot water and purchased a new digital thermometer to ensure hot water temperature. LPA observed sufficient seven- day non-perishable and two- day perishable food supplies. Fire extinguishers (11/3/2025) and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. No deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report left.the state’s words, verbatim · CDSS document, Nov 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a 1 year/required annual inspection. LPA met with Administrator Karen Fomby and explained the reason for the visit. Census:5 LPA Lund & Administrator Karen Fomby toured/inspected the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 112 degrees F which does the 105-120 degree Fahrenheit regulation. LPA observed facility staff turn down hot water and purchased a new digital thermometer to ensure hot water temperature. LPA observed sufficient seven- day non-perishable and two- day perishable food supplies. Fire extinguishers (11/15/2024) and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. No deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report left.the state’s words, verbatim · CDSS document, Nov 21, 2024

Allegation investigated: Facility staff did not allow a resident a choice of hospice services Facility staff signed a hospice transfer request form without the resident's family authorization Facility staff caused delays in residents at the facility receiving timely hospice services

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Care Staff Princess Major-Banks and explained the reason for the visit. Care Staff called Administrator Karen Fomby who could not make today visit. Administrator Karen Fomby gave permission to have Care Staff Princess Major-Banks sign any required paperwork. Census:3 Facility staff did not allow a resident a choice of hospice services- Based on records reviewed and interviews conducted with Administrator Karen Fomby, Reporting Party (RP) and witnesses. Resident (R1) was admitted to Home Health with Progressive Home Health & Hospice on 5/9/2023 through 1/19/2024. Conservator of R1 made the choice to change hospice services on 1/19/2024 from Bristol Hospice Services to Progressive Home Health & Hospice because the familiarity of staff working with R1. Unsubstantiated Based on records review, interviews with, Administrator Karen Fomby, RP and witnesses the information provided, it was unclear if facility staff did not allow a resident a choice of hospice services therefore the allegation was deemed UNSUBSTANTIATED. Facility staff signed a hospice transfer request form without the resident's family authorization- Based on records reviewed and interviews conducted with Administrator Karen Fomby, Reporting Party (RP) and witnesses. Resident (R1) was admitted to hospice on 1/17/2024 while at the hospital and was discharged to the facility on 1/18/2024. Conservator for Resident (R1) gave permission to Administrator Karen Fomby to sign the transfer request of Hospice services for R1. Based on records review, interviews with, Administrator Karen Fomby, RP and witness the information provided, it was unclear if facility staff signed a hospice transfer request form without the resident's family authorization therefore the allegation was deemed UNSUBSTANTIATED. Facility staff caused delays in residents at the facility receiving timely hospice services- Based on records reviewed and interviews conducted with Administrator Karen Fomby, Reporting Party (RP) and witness. Resident (R1) was admitted to hospice on 1/17/2024 and discharged to the facility on 1/18/2024. The transfer on hospice services from Bristol Hospice Services to Progressive Home Health & Hospice was on 1/19/2024. Records indicate that Progressive Home Health & Hospice Services started services with R1 on 1/19/2024 one day after returning from the hospital on hospice. Based on records review, interviews with, Administrator Karen Fomby, RP and witness the information provided, it was unclear if facility staff caused delays in residents at the facility receiving timely hospice services therefore the allegation was deemed UNSUBSTANTIATED. The Department (CCLD) has found the allegations. Unsubstantiated. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was, and report left.the state’s words, verbatim · CDSS document, May 9, 2024 · control 27-AS-20240124192506

Type of visit: POC

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a proof of correction (POC) visit. LPA Lund met with Care Staff Princess Major-Banks and explained the reason for the visit. Care Staff called Administrator Karen Fomby who could not make today visit. Administrator Karen Fomby gave permission to have Care Staff Princess Major-Banks sign any required paperwork. Census:3 LPA Lund received proper POC documentation for the deficiency cited on 2/2/2024. No deficiencies were observed and cited during this visit. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, May 9, 2024

Allegation investigated: Facility staff abandoned a resident at the hospital

On 2/22/2024 Licensing Program Analyst (LPA) Jason Lund arrived unannounced to amend a complaint investigation. LPA Lund met with Administrator Karen Fomby and explained the reason for the visit. LPA Lund had to do a new LIC9099 based not having a LIC9099 D on the previous complaint. Facility staff abandoned a resident at the hospital- Based on records reviewed and interviews conducted with Administrator Karen Fomby, Reporting Party (RP) and witness. Resident (R1) was admitted as a patient at Dignity Health Mercy Medical Center in Merced California. R1 was admitted at the hospital with no responsible party. On September 20, 2022, the hospital paid the admission fee for R1 to stay at the facility. The facility got paid for the three months of service for R1. From January 1, 2023, through December 31, 2023 the facility didn't get paid for services rendered. Substantiated On September 20, 2023, the facility filled an Unlawful detainer (UD-23-001136) on September 26, 2023, R1 and Mercy Medical Center was served. On October 6, 2023, the Superior of Court of California County of Stanislaus signed a right to possession. On 12/31/2023 R1 was dropped off at the Emergency Room Dignity Health Mercy Medical Center in Merced California. On 12/31/2023 The licensee left a note with R1 when dropped off which stated R1 has not been paid in 9 months. Based on records review, interviews with, Administrator Karen Fomby, RP and witness the information provided, it was clear that the facility staff abandoned a resident at the hospital therefore the allegation was deemed SUBSTANTIATED. Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.the state’s words, verbatim · CDSS document, Feb 22, 2024 · control 27-AS-20240102142039

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Mar 7, 2024

87468.1 (a)(1) to be accorded dignity in their person relationships with staff, residents, and other persons. This requirement was not met by: Based on interviews, the licensee left a note with R1 when dropped off which stated R1 has not been paid in 9 months. This poses a potential Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 22, 2024

Plan of correction: Administrator will look over the regulation and email LPA Lund confirming they understand the regulation.

Type of visit: POC

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a proof of correction visit. LPA Lund met with Administrator Karen Fomby and explained the reason for the visit. LPA Jason Lund received documentation (Proof of correction) for the two deficiencies from the visit on 11/3/2023. An exit interview was conducted with Administrator Karen Fomby and report left.the state’s words, verbatim · CDSS document, Nov 16, 2023

Type of visit: Required - 1 Year

On 11/3/23 at 12:30pm Licensing Program Analyst (LPA) Kevin Gould arrived at Sisters Assisted Living for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Karen Fomby and together conducted a tour of the home. LPA observed a licensed capacity of 4 residents with 6 residents in placement. Administrator was able to provide LPA with documentation of new fire clearance with a capacity for 6 and communication with the department for an updated capacity and documents required to change capacity. An advisory note was issued in consultation with Licensing Program Manager. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 142 degrees F which does not meet the 105-120 degree Fahrenheit regulation. LPA observed facility staff turn down hot water and purchased a new digital thermometer to ensure hot water temperature. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA requested a copy of the facility liability insurance and facility representative stated they do not have one. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Nov 3, 2023