St. Thomas Retirement Center

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility, to conduct a annual inspection of the facility. LPA met with Sister Margaret Homa and explained the purpose of the visit. The facility is a 49 bed facility there are some care conditions that are currently self managed in the facility, 1 catheter, 1 colostomy, 2 diabetics. 3 clients are currently on hospice. LPA physically inspected the facility, including 6 bedrooms and bathrooms of the residents, exteriors, evacuation route gate, kitchen. Facility is clean, traffic areas are unobstructed and well lit. Kitchen has adequate supply of food to accommodate 2 days perishable and 7 days non perishable. The LPA observed lunch, meat and veg, adequate in quality for consumption regulation and quantity for nutrition regulation. The residents during the service seemed happy with the food in a general sense. Kitchen has adequate lockable storage for sharps and toxics to be stored seperately from each other and food. Kitchen has daily menu posted on a community channel that broadcasts to the Resident's TV's, and takes input during the intake process for prefered foods and dietatry restrictions. Alternate meals provided for medical necessity or convenience are possible with advance notice to the kitchen. Senior Chef claims to have adequate equipment to serve the menu. Kitchen is clean, grease traps look good. Bedrooms/bathrooms have hardware in good repair, and all required furniture and furnishings. Some clients have extensively personalized their room, others have not. Water temperature was measureed low and high at differenct sinks in the facility, LPA asked the senior maintenance staff to recalibrate the water heaters to deliver between 105-120*F to all the residents rooms on the water circuit. continued on c page. Common areas and exteriors are clean, have space for activities. Some public areas have video only camera surviellance, LPA asked for the facility to add to the admission agreement an amendment document that notifies the resident they would be potentially video recorded. One balcony fence is out of repair, Maintenance Director was made aware of the fence and immediately put in a work order. evacuation route is a open parking lot, its accessible from most exits from the facility with cement sloped walkways of at least 36 inches. MARs/Medication inspection had doses missing in the MARs for 3 clients for routine medication passes. One client was missing 1 medication on 2 days in a row. Explanation given to the LPA verbally was that the doses were forgotten to be recorded, explanation did not make it to the daily log. LPA noted medication doses were not forgotten to be logged with other medications dispersed at the same time. One client was missing multiple (3+) medications on 5pm and 8pm dispersals for the 30th of June. Explanation given to the LPA verbally was that other concerns going on with the client at the time(client refusing medications, hospice complication), explanation for the refusal made it to the log, record was not updated to reflect the status of the other medications dispersed or not dispersed. One clients MARs for the 8am morning dispersal was missing 7/1/26. LPA was given the verbal explanation that the log for this morning has yet to be filled out, LPA was checking the logs at 1pm, after the noon dispersal. LPA gave guidance to use the daily notes sections of the log invesigate issues with the dispersal log. Signal system in use was tested, response time was 27 seconds. First aid kit has all requred items. fire extinguishers are dated May/2026. Administrator records were reviewed, required postings (ombudsman, federal workers rights, patient rights, evacuation route on facility sketch), liability insurance, infection control plan, evacuation plan, Administrator certificate, and facility license. Files are present and up-to-date, 9 Client files were reviewed, preapprisial, admission agreements, recent 602/603, health screening, and incident reports. files are present and up to date. 5 Staff files were reviewed. health screenings, first aid/cpr, background checks, and starting employee paperwork. files are present and up to date. Contining training, every month hour different topics, is kept seperately from the staff files. 4 staff and 1 administrator was interviewed. 4 clients were interviewed. No citations issued, a copy of the report was read and given to the administrator. exit interview completedthe state’s words, verbatim · CDSS document, Jul 1, 2026

Type of visit: Case Management - Other

On 10/01/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to St. Thomas Retirement Center unannounced. LPA Campbell met with Administrator Sister Basima Margaret Homa and explained the purpose of the visit. Over the course of the visit, LPA Campbell spoke to a family member of a resident and the administrator. A family member spoke of a variety of personal rights issues that had been passed on to the ombudsman and who passed on the families concerns to LPA Campbell. The family was called and the following was shared: · Staff told families they can’t visit during meals · Staff told residents and family members where to sit in the dining room. · Visitors must make arrangements with facility for after hour visits. · Staff telling family to leave during care checks without consulting with residents. · Staff were scolding residents · Visitors were dissuaded from coming to visit the community during meal times. · Staff required residents to remove and/or limit personal photos in their rooms. The issues addressed concerned personal rights. LPA Campbell consulted with the administrator to address communication styles, the rights of visitors, Power of Attorney (POA) and customer service skills among staff. The conversation addressed the meaning of regulation 87468(a)(1-3), specifically the ideas of dignity and intimidation. The administrator stated that staff were harassed by family members so staff told family that they had to leave the room during health checks to change residents or perform other intimate services. LPA Campbell required that an in-service training be completed by all staff on 87468(a)(1-3) by 10/17/2025. The training will include reframing the relationship between staff and visitors and provide opportunities for staff to practice communication skills that emphasize cooperation versus commands to visitors. The in-service training sign in sheet will include the regulation addressed, topics covered and activities completed as well as the signatures of staff who attended. LPA Campbell stated that families and friends have the right to visit resident whenever they want to without prior notice to the facility if the resident wants them to. Residents and families also have the right to sit where they want at meals if they are able to express their wishes. As a result, along with an Admission Agreement Addendum that visitors do not need to make arrangements to visit after visitor hours, the administrator will send out a flyer to all families to address the personal rights issues above. The administrator will send the addendum and the flyer to LPA Campbell for approval before sending it out and later include LPA Campbell in the group email sent to all residents. Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited. An exit interview was held, and a copy of the report was provided to the Facility Administrator, Sister Basima Margaret Homathe state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct an annual inspection. LPA Campbell met with Camille Duralski, Administrative Assistant and explained the purpose of the visit. Residents were observed eating breakfast with the assistance of staff in the dining room. LPA Campbell toured the facility and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas to ensure there are no safety hazards for residents. Furniture and furnishings were sufficient to meet the needs of residents. The facility was observed to be clean with no odors. Of the 34 resident files available, LPA Campbell reviewed 4 files that were found to be completed. Of the 37 people on staff, LPA Campbell confirmed that a random selection of 4 were found to be finger print cleared. Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited. An exit interview was conducted with Camille Duralski and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 5, 2025

Allegation investigated: Staff are not allowing resident to have phone calls from family

On 10/04/2024, LPA Campbell arrived unannounced to the facility to close a complaint. LPA Campbell met with Administrator Sister Margaret Homa and explained the purpose of the visit. Regarding the allegation that staff are not allowing resident to receive phone calls, R1’s POA installed a landline in R1’s room and blocked some family members to prevent them from calling R1. Upon review of the POA document, it was found that R1 had a healthcare POA and this did not include decisions over who R1 could speak to on the phone. When the RP attempted to contact R1 through the landline and was blocked, RP called the facility and asked them to check if their grandmother’s phone was off the hook. At no point did the facility suggest the RP could call the facility to speak to R1 during this inquiry. Based on interview with S1, LPA Campbell explained that denying RP the option to speak to R1 would be a violation of R1’s personal rights. Therefore, this allegation has been SUBSTANTIATED. Substantiated The following deficiency : Personal Rights 87468.1(a)(14), has been cited and appeal rights were given to the administrator. Per the California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed and noted. Failure to correct any deficiencies will result in additional civil penalties.the state’s words, verbatim · CDSS document, Oct 7, 2024 · control 27-AS-20240820100618

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(4) · Plan of correction due date: Oct 11, 2024

87468.1(a)(4) Personal Rights of Residents. Residents shall have all of the following personal rights: (14) to have reasonable access to telephones, to both make and receive confidential calls. Based on interviews, the licensee did not ensure that a resident could receive confidential calls by immediately informing callers of the facility phone that was available.the state’s words, verbatim · CDSS document, Oct 7, 2024

Plan of correction: -Provide a statement of understanding for 87468.1(a)(4). -The facility will inform all incoming callers that there is a facility phone for all residents to receive confidental calls and provided the conact number and review POA for residents.

Allegation investigated: Staff unlawfully evicted a resident

On 09/04/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Camille Duralski, Administrative Assistant and explained the purpose of the visit. Regarding the allegation that staff unlawfully evicted a resident, no record of a documented eviction notice was found. When F1 was contacted, they reported there had been no discussion of eviction. C1 also stated that no eviction notice was issued. The client was also admitted back to the facility per the notice provided by the administrator. Based on the information collected there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, 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, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, nothe state’s words, verbatim · CDSS document, Sep 5, 2024 · control 27-AS-20240703144147

Allegation investigated: Staff did not ensure that the facility is free of hazards

On 05/16/24, LPA Renee Campbell arrived to the facility regarding a complaint filed on 03/26/2024. LPA Campbell met with Administrator, Sister Basima Margaret Homa and explained the purpose of the visit. It was alleged that staff did not ensure that the facility is free of hazards. LPA Campbell took images of R1’s room with several extension cords on the floor obstructing pathways after a power outlet outage on approximately 03/25/24. S2 stated that extension cords were split and combined with other cords when they no longer worked and were then wrapped with electrical tape. LPA Campbell also recorded images of split cords wrapped with tape and then stored in the facility garage. Based on the information provided through interviews and observation, the allegation that the facility did not ensure the facility is free of hazards is SUBSTANTIATED. The following deficiency was cited per Title 22 Division 8 Section 8 of the California Code of Regulations. An exit interview was conducted with Sr. Basima Margaret Homa and a copy of this report was left with the administrator. Substantiatedthe state’s words, verbatim · CDSS document, May 16, 2024 · control 27-AS-20240326121327

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 24, 2024

87303 Maintenance and Operation. (a) The facility shall be clean safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not ensure R1’s room was safe and in good repair at all times, which poses a possible health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 16, 2024

Plan of correction: The facility will replace all cords that are not working or have been split and taped to other cords by 05/24/2024. Images of the new extension cords and surge protectors stored in the garage will be sent to LPA Renee Campbell at renee.campbell@dss.ca.gov

Type of visit: Case Management - Incident

On 05/10/24, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a case management visit regarding a medication error. LPA Campbell met with Administrator Sr. Basima Margaret Homa and explained the purpose of the visit. Per the incident report provided to licensing, Resident 1 (R1) received the incorrect dosage for 4 days. R1's doctor was immediately notified. The Administrator reported that the Med Tech (M1) involved in the medication error was involved in other ongoing issues regarding their performance. M1 then resigned when required to write a report recounting the incident. The administrator also stated that M1 had already given two weeks notice beforehand. Per the doctor's orders, a "plan of correction" was needed to avoid the mistake being repeated. The administrator now requires that 2 staff will need to check and verify accuracy before making changes to the doctor's order. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit.the state’s words, verbatim · CDSS document, May 10, 2024

Type of visit: Required - 1 Year

On 04/19/2024 at 8:39 AM, Licensing Program Analyst (LPA) Renee Campbell arrived at the facility to conduct an unannounced annual inspection. LPA Campbell met with administrator Sister Basima Margaret Home. LPA Campbell explained the purpose of the visit. The administrator assisted with today’s visit. The current census is 38 residents and 37 facility staff which consist of 3 housekeepers, 4 Med-techs, 11 caregivers, 2 cooks and the administrator. The administrator's certification number is #6025873740 and the expiration is 4/29/2025. This facility is a single story building licensed to serve 49 non-ambulatory residents ages 60 and over and is approved for 10 hospice residents. LPA Campbell inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Campbell observed the facility to be free of odor, clean and in good repair. LPA Campbell observed bedrooms to be properly furnished with appropriate bedding and lighting. All residents had their own bathrooms. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Residents had access to shower chairs. There are no bodies of water present. LPA Campbell toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. The Turlock Fire Department Inspection form was observed by LPA Campbell for the current and prior two years for the smoke and carbon monoxide alarm inspections. The fire department gave a “Pass” or “All Clear” for each inspection. cont. LIC809C The facility has an infection control plan and an emergency disaster plan. The facility thermostat was observed at 73 degrees Fahrenheit. However, per observation of a sampling of rooms by LPA Campbell, all resident rooms have individual thermostats. A fire extinguisher was observed in the kitchen and was last serviced on 06/05/2023. LPA Campbell observed toxins or cleaning products located in a closet in the kitchen and another in a residential hallway closet. Both were locked and inaccessible to residents. LPA Campbell also observed cleaning products in the laundry room in use by staff. The laundry door is locked when staff are not doing laundry and present in the room. LPA Campbell observed knives in use by kitchen staff stored in a knife block. After hours, the kitchen is locked and inaccessible to residents. The freezer temperature was -5 degrees Fahrenheit, and the refrigerator temperature was observed to be 40 degrees Fahrenheit. LPA Campbell reviewed 4 out of 38 residents files and they were found to be complete. Based on today's inspection conducted by LPA Campbell, no deficiencies are being cited. Exit interview held and copy of report left.the state’s words, verbatim · CDSS document, Apr 19, 2024

Type of visit: Case Management - Other

LPA Campbell conducted an unannounced Case Management visit at St. Thomas Retirement Center, RCFE on 02/16/2024 at 1:00 to amend a previous report. LPA met with facility administrator Sister Margaret Homa to explain the purpose of todays visit. Due to report and technical errors, LPA was unable to complete the amended report on 02/07/24. LPA conducted a visit on this date to amend the report, End of report.the state’s words, verbatim · CDSS document, Feb 16, 2024

Type of visit: Case Management - Incident

This report is being amended to complete the visit for 02/07/24 to update the original POC and correct verbiage. Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced Case Management on 02/07/2024. The case management visit pertains to an incident report received on 12/04/2024. During the visit, the LPA met with Administrator Margaret Homa and collected documents pertinent to the incident report. LPA Campbell obtained R1's MAR for November and December, their 602 and their prescriptions for review. R1’s ID sheet was also utilized to confirm notification procedures. Per the administrator, the medication error that occurred on 12/01/23 was due to med tech error. LPA Campbell observed that the MAR reported that R1 received medication on 12/01/23. Per S2, the details of the med error were entered in the staff notes. No signature/initial key was provided on the back of the MAR to clarify the full name of which Med Tech passed out medication. The Med Tech who passed out the wrong medication for R1 could not be interviewed because they were out of the country. Based on LPAs observations and interviews the preponderance of evidence standards has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. This poses an immediate Health and Safety risk to residents in care. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. Exit interview held. The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Feb 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5)(A) · Plan of correction due date: Feb 21, 2024

87465 Incidental Medical and Dental Care. (a) Staff designated by... licensee may assist ... with self-administered medications. .. limited to the following: (A) Medications usually prescribed for self-administration ... authorized by the person's physician. This requirement was not met as evidenced by: Based on observation and interviews and record review, the facility provided the wrong medication to the wrong resident (R1) which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 7, 2024

Plan of correction: The administrator will complete a memorandum of understanding and include a plan to cover absent Med-Techs for emergencies by the POC date on 02/22/2024 and email it to LPA Campbell at renee.campbell@dss.ca.gov