St. Timothy's Home

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Albert Johnson conducted a health and safety check on this day. LPA met with Staff. Five Residents have been relocated and are adjusting to their new environment. Today's Health and Safety check included food supply, physical plant and staffing. Based on this inspection/visit the facility is in compliance. The remaining resident has been given assistance with relocation effort and has refused when offered to move to one of these facilities. Out of the ten care homes visited, three were willing to accept R1. As of today, those facilities are still waiting to know when he will be moving in. However, R1's POA has declined those options because they are looking for a care home in Stockton with a monthly rate of $2,700. No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted.the state’s words, verbatim · CDSS document, Jul 16, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct a Case Management Inspection on today's date. The LPA met with care staff and talked to the Administrator/Licensee on the phone. The licensee has made the decision to cease operations at St. Timothy’s Home effective August 15, 2026. The closure is based on administrative and operational considerations and is not due to any immediate health or safety concerns. The facility will maintain adequate staffing levels to ensure resident health and safety through the closure date. This includes: Sufficient caregivers for ADL support medication‑trained staff for medication administration, administrative oversight by the licensee/administrator, Staff availability to assist with relocation activities. Staff will not be reduced below minimum regulatory requirements at any time. Medication records will be updated daily, refills will be coordinated prior to transfer, medications will be transferred directly to the receiving facility with proper documentation, narcotics will be logged and transferred per regulation. No deficiencies were cited as a result of this visit. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jun 16, 2026

Allegation investigated: Licensee did not follow proper eviction protocols with resident in care.

On 05/26/2026, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to open the complaint for this facility. Based on the information obtained, the allegation that the facility engaged in unsafe discharge practices, failed to coordinate continuity of care, and refused to accept R1 back into the facility is substantiated. The preponderance of evidence supports that the facility failed to follow required discharge and eviction procedures, failed to coordinate continuity of care, and refused to accept R1 back into the facility following ED evaluation. Therefore, the allegation is substantiated. A deficiency will be cited on the LIC 9099D page. Substantiatedthe state’s words, verbatim · CDSS document, May 26, 2026 · control 27-AS-20260522125335

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87422(a) · Plan of correction due date: Jun 2, 2026

"(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)." This requirement was not met as evidenced by: Based on record review and interviews, R1 was given an unlawful eviction notices, which poses a potential health, safety, and/or personal rights risk.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: Licensee has already conferred with CCLD regarding future notices. Licensee agrees to pick-up R1 after equipment is sent to the facility and will provide LPA with a written statement acknowledging 22 CCR eviction procedures.

Type of visit: Case Management - Legal/Non-compliance

A Non-Compliance Conference (NCC) was conducted today on April 23, 2026, via Microsoft Teams with the Sacramento South Regional Office. Present in the meeting were Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Liza King, LPM Lisa Rios, Licensing Program Analyst (LPA) Michael Bilger, LPA Charlie Yang, and LPA Albert Johnson. Also present were Ombudsman Kathryn Thomas. Licensee and designees Richie Almendrala and Maria Almendrala were present during this meeting. The non-compliance conference process was explained during this meeting to include the administrative process. Since 4-23-2025 and within this yearly time period, Licensee has received a total of four A citations and one B citation. The regulated areas of which the citations occurred were Admission agreements, care and supervision, prohibited health conditions, observation of the resident, and administrator qualifications Citations issued by the Department include: {Cont. on 809C} 7-17-2025: Type B - Section 87507(5)(c) Admissions Agreement. The facility was found to be deficient as evidenced by review of the resident records that upon notice of death to a resident this facility has still not issued a refund for the pre-paid basic services fees. 10-10-2025: Type A – Section 87615(a)(1) Prohibited Health Conditions. This facility was found to be deficient as evidenced by the retention of a resident diagnosed with a Stage IV pressure ulcer. 10-10-2025: Type A - Section 87466 Observation of The Resident. This facility was found to be deficient as evidenced by repeated visits to the local medical facility for a resident exhibiting the same medical issues eventually resulting in more serious health conditions. 3-19-2026: Type A – Health and Safety Code 1569.39(b) Assistance with accessing home health or hospice services; receipt of medical services. Licensee did not ensure appropriate and timely medical intervention for R1’s wounds leading to a worsening condition including severe sepsis. 3-19-2026: Type A – Section 87405(d)(1) Administrator-Qualifications and Duties. Licensee and designee did not ensure an appropriate exception request necessary for proper care and supervision of R1’s wound. {Cont. on 809C} Topics discussed during today’s Non-Compliance Conference were: · Care and Supervision · Client Records – proper maintenance of various documentation · Administrator qualifications and duties · Prohibited Health Conditions · Emergency protocols and when to call 9-1-1 The Licensee has agreed to the following for purposes of reaching substantial compliance: · Facility program administrator will ensure compliance plan is being followed · Licensee will ensure facility program administrator is physically present at facility for a minimum of 20 hours per week · Licensee to send copy of a current skin check lists by end of day 4-24-2026. {Cont. on 809C} · Ensure all staff including Administrator and Licensee are in compliance with required training: Observing and reporting changes in residents’ conditions, restricted and prohibited health conditions, various stages of wound care, Emergency protocols/calling 9-1-1, Training to be conducted initially by 5-23-2026, then every three months thereafter, and evaluated by LPA during visits and inspections. · Daily documentation of residents’ conditions including but not limited to: Participation in Activity of Daily Living (ADL) functioning, various changes in conditions including those warranting exceptions, waivers, or 9-1-1 calls · Monthly audits of residents’ skin/body check forms to ensure accuracy · Maintenance of other documentation including but not limited to: Care notes, needs and services plans (updated yearly or sooner if significant changes occur), physician’s reports, medication log sheets, and incident reports · Submit an updated LIC 500 to include Administrator days and hours scheduled. Submit by end of day 4-24-2026. · Submit an updated LIC 308 by end of day 4-24-2026. For best practices and consistency purposes in regards to maintaining compliance, the above implementations are to also be included at licensee’s additional facilities: ST Mary’s Home #502701255 and ST. Stephen’s Home #502700261. {Cont. on 809C} In addition, at this meeting the notified Licensee/Administrator was advised future non-compliance regarding the above and other regulatory components will result in additional citations, civil penalties, and further potential administrative action. Community Care Licensing Department (CCLD) will do the following: · Quarterly visits to ensure above compliance plan and other Title 22 and Health and Safety code requirements. Completing the Non-Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager. Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Licensee and a copy of this report and supplemental LIC 9111 was provided via email with request to return with signature no later than 4-24-2026.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Untiimely medical care resulted in sepsis

On 3-19-2026 at 1:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with staff 2 (S2) and explained the purpose of the visit. LPA contacted Administrator Maria Almendrala and explained the purpose of the visit. Administrator gave permission for S2 to sign in her absense. During the course of this investigation, LPA reviewed various facility file documentation including physician’s report, medication log sheets, and care notes regarding resident1 (R1). Additionally, LPA reviewed hospital visit records pertaining to R1, and conducted interview with staff1 (S1). Allegation: Untimely medical care resulted in sepsis. Based on documentation reviewed, it was revealed that on 10-14-2024, a facility care note reads: “Resident not feeling well, Administrator ask if she wants to see Doctor, she refused.” Additional care notes beyond this date did not indicate a follow up until 12-27-2024 which a care note states: “Resident sent to ER, barely response, weak and refused to eat breakfast…” Hospital notes reviewed revealed that a stage 3 coccyx wound was discovered on R1 upon admission to hospital on 12-27-2024. Additional diagnosis of severe sepsis was also noted in hospital notes. {Cont. on 9099C} Substantiated On or about 1-4-2025, R1 was sent back to and accepted by facility for re-admission. Additional documentation review did not reveal facility follow up or other sufficient outside intervention for the stage 3 wound. On 1-28-2025, hospital notes revealed that R1 was received at hospital on this date with diagnosis of “severe sepsis most likely secondary to sacral decubiti.” According to pms.ncbi.nlm.nih.gov, a “sacral decubiti (pressure ulcers) are localized damage to the skin and underlying soft tissue over the tailbone, cause by prolonged pressure, friction, or shear…” Facility care notes state R1 was later discharged back to facility on 1-31-2025 with plans for hospice care. R1 passed away on 3-27-2025. Based on evidence reviewed, there is a preponderance of evidence to conclude that resident experienced a worsening condition of a wound within facility leading to a stage 3 wound and related diagnosis of sepsis. As a result, the above allegation is SUBSTANTIATED. The following deficiencies were observed (see LIC 9099-D) and cited from the California Code of Regulations, Health and Safety Codes. Failure to correct the deficiency may result in additional civil penalties. An immediate civil penalty in the amount of five-hundred dollars ($500) was issued in addition to citation due to a violation resulting in a severe injury. At the time of the complaint visit, the issuance of an additional Civil Penalty was still being determined, and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49(f). An exit interview was conducted with S2, and a copy of this report was provided. Administrator was made aware of findings via phone call as she was off site. Appeal rights provided. LIC 811 provided.the state’s words, verbatim · CDSS document, Mar 19, 2026 · control 27-AS-20251003154007

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.39(b) · Plan of correction due date: Mar 20, 2026

1569.39(b). 1569.39 Assistance with accessing home health or hospice services; receipt of medical services. (b) A residential care facility for the elderly that accepts or retains residents with restricted health conditions, as defined by the department, shall ensure that residents receive medical care as prescribed by the resident’s physician and contained in the resident’s service plan by appropriately skilled professionals acting within their scope of practice…This requirement was not met as evidenced by: Based on evidence reviewed, licensee did not ensure appropriate and timely medical intervention for R1’s wounds leading to a worsening condition including severe sepsis. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2026

Plan of correction: Licensee to develop and submit a plan outlining appropriate steps taken to ensure timely medical attention for residents. Plan to include but not be limited to: How licensee will comply with regulation 1569.39(b)

Type of visit: Case Management - Other

On 3-19-2026 at 2:40pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management. LPA met with staff1 (S1) and explained the purpose of the visit. Administrator Maria Almendrala was not present and gave permission for S1 to sign in her absence. LPA reviewed documentation related to complaint #27-AS-20251003154007. Based on review of this documentation, it was revealed that resident1 (R1) was admitted to local hospital on or about 12-27-2024. Hospital notes revealed R1 was received at hospital with a stage 3 coccyx wound. R1 was then discharged back to facility on or about 1-4-2025 with the stage 3 coccyx pressure wound diagnosis, a prohibited health condition as stated in Community Care Regulations (CCR) Section 87615(a)(1). Upon further record review, it was revealed that facility administrator and licensee did not ensure an approved exception request for R1’s prohibited health condition. As a result of today’s case management, a citation is issued under Title 22 regulations, division 6 and noted on LIC 809D. An exit interview was conducted with S1, and a copy of this report was provided. Appeal rights provided.the state’s words, verbatim · CDSS document, Mar 19, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(1) · Plan of correction due date: Mar 20, 2026

87405 Administrator – Qualifications and Duties. (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7) … (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidenced by: Based on documentation review, Licensee and designee did not ensure an appropriate exception request necessary for proper care and supervision of R1’s wound. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2026

Plan of correction: Licensee and designee to read regulations 87405(d)(1) and related regulation 87616. Licensee and designee to submit a signed declaration of understanding to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst Albert Johnson arrived unannounced to conduct an Annual inspection. Currently 6 clients reside at the assisted living facility. Facility has a fire clearance granted for 2-ambulatory and 4-non-ambulatory. LPA inspected the physical plant with including but not limited to the kitchen, bedrooms for residents, resident bathrooms, laundry area and general assembly area. LPA observed the facility to be free of odor and clean. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 117.9 degrees Fahrenheit, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Fire drill was conducted on 1/2026 as required. LPA observed centrally stored medications and toxins are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 4 resident and 2 staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility. Per California Code of Regulations, Title 22 Division 6, Chapter 8, No citations given. Exit interview conductedthe state’s words, verbatim · CDSS document, Feb 17, 2026

Type of visit: Case Management - Incident

On 11-6-2025 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding an incident reported by facility on 9-4-2025. LPA met with lead caregiver Avia Singh and explained the purpose of the visit. Administrator Maria Almendrala was contacted by phone and made aware of LPA's visit and purpose. LPA spoke briefly with Administrator via phone, and conducted brief interview with staff2 (S2) LPA also reviewed facility file documentation including incident report dated 9-4-2025, caregiver schedule, care notes pertaining to resident1 (R1), physician's report and needs and service plan pertaining to R1. Based on interview and record review, it was revealed that on 9-1-2025 at approximately 5:00am, R1 contacted caregiver who arrived to find R1 sitting on his bed. R1 informed caregiver that he had fallen. Caregiver informed R1 9-1-1 would be called, however, R1 refused services stating he was not in pain. Caregiver asked R1 if he can stand, and R1 stated he was unable to stand. As a result, caregiver again informed R1 that 9-1-1 would be called. Caregiver called 9-1-1 at approximately 5:10am. According to care notes reviewed, it was revealed that on 9-11-2025, family member of R1 notified administrator that R1 will not be returning. Interview conducted revealed that Administrator was informed R1 went to a rehabilitation facility for 2 weeks after a hip surgery at the hospital. R1 was then discharged to another facility. Interviews and record reviews further revealed that R1 did not have a history of falls, but had previous medical issues regarding R1's hip. Interviews and record reviews revealed R1 did not require special supervision level, and two staff were on duty at time of fall. {Cont. on 809C} Based on today's case management, it is undetermined if R1's fall was the result of a Title 22 or health and safety code regulatory violation. As a result, no citation is issued. An exit interview was conducted with lead caregiver, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 6, 2025

Allegation investigated: Resident developed a pressure injury due to neglect. Facility didn't seek medical attention in a timely manner.

Unannounced complaint visit made out to this facility on 10/10/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person, Avia Singh, who was briefly interviewed at this time. This LPA requested that this facility staff person go ahead and contact the facility designated Administrator, Maria Almendrala, to inform her that CCL was present at this time. This LPA was informed that the facility designated Administrator would not be able to be present for todays complaint visit and allowed the present facility staff person to accept all documents related to this complaint at this time. Current census was 5 residents. The purpose of this complaint visit was to deliver the findings of this investigation to this facility, and it's representative, at this time. Based on a review of the forms and documents related to this investigation, it was learned that R1 had several medical issues requiring care and supervision related to R1's mental and physical conditions. The mental health conditions required the facility staff to be present and available to assist with R1's daily issues Substantiated of wandering, elopement, and stimulation in order to engage and maintain proper quality of life unto R1. In addition, it was learned that R1 had several physical conditions which required staff to check up on R1 with R1's Activities of Daily Living (ADLs), medication management, and proper documentation of any changes to R1's overall status in order to address them and integrate new policies and procedures. Based on a review of the medical records for R1, it was learned that R1 was sent to the local medical facility on several dates requiring extensive treatment and follow up with hospice and wound care. It was learned that in the month of December 2024, R1 was seen at the local medical facility for severe sepsis due to an infected wound that required adequate cleaning and a prescription for antibiotics. Follow up visits were conducted to the local medical facility for R1 in regards to the same issue of sepsis and was even admitted to the local skilled nursing facility as well for treatment and labs. It was learned that several admissions were also made in the month of January 2025 for the same medical issue related to severe sepsis for R1 with the discovery of a Stage IV pressure ulcer as well to the sacrum area. Upon discovery of the Stage IV pressure ulcer, it was initially deemed to be unstageable since the scar tissue was thick and the ulcer was unable to be evaluated at that time for proper assessment. A licensed medical professional was tasked to clean and clear the wound area for R1. It was learned that R1 was then discharged from this local medical facility with a referral for wound care and another one for hospice care. Based on a review of the forms and documents conducted during the course of this investigation, it was learned that proper notifications were not given to the family or responsible parties for R1 in regards to the hospital visits and changes to R1's medical conditions. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegations were valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was left with the facility designated representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Oct 10, 2025 · control 27-AS-20250610161834

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Oct 11, 2025

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 facility was found to be deficient as evidenced by repeated visits to the local medical facility for a resident exhibiting the same medical issues eventually resulting in more serious health conditions which posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.the state’s words, verbatim · CDSS document, Oct 10, 2025

Plan of correction: The facility designated representative stated that this facility will implement a training regiment to address the topic of resident observation, documentation of such changes, and reporting to the appropriate responsible parties and entities in order to facilitate proper care and supervision to the residents in care. Proper training regiment will include the name of the trainer, topics of training, and a list of the attendees. This training will be conducted for no less than (1) hour in duration. Proof of training will be completed and submitted into CCL by the due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Oct 11, 2025

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This facility was found to be deficient as evidenced by the retention of a resident diagnosed with a Stage IV pressure ulcer which posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.the state’s words, verbatim · CDSS document, Oct 10, 2025

Plan of correction: The facility designated representative stated that this facility will implement a training regiment to address the topic of Prohibited Health Conditions and how this facility should address this issue with the residents in care. Proper training regiment will include the name of the trainer, topic of training, and a list of the attendees. This training will be conducted for no less than (1) hour in duration. Proof of training will be completed and submitted into CCL by the due date.

Allegation investigated: Facility failed to disburse funds owed to the deceased's family.

Unannounced complaint visit made out to this facility on 07/17/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregiver, Nicole Golving, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. It was learned that the facility designated Administrator, Maria Almendrala, was unable to be present at this time so this LPA would have to deliver and present all findings to the present facility staff person, Nicole Golving, at this time. Current census was 4 residents. The purpose of this visit was to deliver the findings of this complaint investigation to this facility, and it's representatives, at this time. Based on a review of the forms and documents retrieved during the course of this investigation, it was learned that R1 had passed away at this facility after having been a resident here for about a year. It was learned that R1 was R1's own responsible party upon admission to this facility and did not have any Substantiated additional persons named in R1's admission forms and documents. It was learned that this facility did not have an alternate person, or entity, to disburse the refund to upon R1's death so one was not given at this time. As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was left with the facility designated personnel at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 17, 2025 · control 27-AS-20250506095159

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(5)(c) · Plan of correction due date: Jul 24, 2025

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident's estate, within 15 days after the personal property is removed. The facility was found to be deficient as evidenced by review of the resident records that upon notice of death to a resident this facility has still not issued a refund for the pre-paid basic services fees which posed a potential threat to the Health, Safety, and Personal Rights of residents in care.the state’s words, verbatim · CDSS document, Jul 17, 2025

Plan of correction: The facility designated representative stated that a refund will be given and deposited into the bank account, or estate, of the deceased. A statement of correction, along with proof of refund given, will be completed and submitted into CCL by the due date.

Type of visit: Required - 1 Year

On 2-11-2025 at 10:21am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Maria Almendrala and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly (RCFE) with a current census of 6. Facility has 3 bedrooms and 2 bathrooms for resident use. 1 extra bedroom is for staff use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 3 ambulatory residents, 2 hospice, 1 non-ambulatory, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 79*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 1-16-25. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed and contained accompanying regulatory required Physician’s orders. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 5 resident files and 5 staffing files were reviewed for regulatory compliance. All staff noted on LIC 500 contained criminal background clearances. {Cont. on 809C} LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained required contents including updated admission agreements, and medical assessments. Facility’s liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility to have sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. An exit interview was held and a report was given to Administrator.the state’s words, verbatim · CDSS document, Feb 11, 2025

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

Allegation investigated: Licensee is financially abusing resident in care

On 10/23/2024 at 2:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegation noted above. LPA met with lead caregiver Dave Gorbon and explained the purpose of the visit. Administrator Maria Almendrala was not on site and gave permission via phone for lead caregiver to sign in her absence. During this investigation, LPA conducted interviews with Licensee (S1) and resident1 (R1). LPA also reviewed facility file documentation including needs and services plan, admissions agreement, and physician’s report all pertaining to R1. Additionally, LPA reviewed redacted financial documents submitted by Licensee. Allegation: Licensee is financially abusing resident in care. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was determined that R1 was admitted to facility on 5/21/24, and a stopped payment for a check written by R1 for $2800 was initiated by R1’s bank shortly after admission after the bank was told by R1 that R1 could not recall the reason for the written check. {Cont. on 9099C} Unsubstantiated It was further determined through interviews and record reviews that this check was for R1’s partial payment of rent and supplies for R1s residency from 5/21/24 to 5/31/24. Interviews also revealed that Licensee accompanied R1 to the bank at R1’s request after learning of the stopped payment, and Licensee was seeking a new amount of $3800 to cover the full amount for rent and supplies from 5/21/24 to 6/21/24 instead of the original request for the partial payment as stated above. A review of R1’s admissions agreement revealed rent and supplies amount charges were consistent with Licensee’s charges as requested above. A review of financial documents submitted by Licensee revealed charges consistent with those stated in the admission agreement for rent and supplies from May 2024 to current. Licensee submitted redacted cashier’s checks indicating amounts for rent and supplies, and a review of invoices for R1’s rent and supplies matched the amounts written on the cashier’s checks. A review of the invoices and cashier’s checks, and interviews conducted did not reveal any additional unauthorized charges or requested amounts. An interview with Licensee revealed Licensee originally stated in May 2024 while at the bank with R1 that it would have been easier for R1 to write a check for the rent and make it out to Licensee personally due to current facility bank account issues. A review of correspondence between Licensee and Licensee’s bank confirmed that in May 2024, facility’s bank account activity was suspended due to security issues. A review of R1’s current physician’s report and needs and service plans do not indicate a cognitive decline for R1. Interview conducted with R1 did not reveal an accusation of financial abuse perpetrated by Licensee. As a result, there is a not a preponderance of evidence to conclude Licensee was financially abusing resident, therefore this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with lead caregiver and a copy of this report was provided to lead caregiver. Appeal rights provided.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 27-AS-20240910134824

Allegation investigated: Facility did not retrieve a prescribed medication for a resident in care

On 3-19-24 at 2:27pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with Administrator Maria Almendrala via phone and explained the purpose of the visit. Administrator gave permission for staff2 (S2) to sign paperwork in her absence. During this investigation LPA conducted interviews with two staff members and resident1 (R1). LPA also reviewed facility file documentation including care notes and medication log sheets for R1. Based on interviews, it was determined that R1 was to receive a prescribed antibiotic medication on 1-2-24 after a stay at the hospital. It was further determined through interviews that although facility staff verbalized attempts to retrieve the medication for R1, there was no evidence to prove such attempts were made by facility staff. {Cont. on 9099C} Substantiated Record reviews revealed no attempts by facility staff to retrieve medication during the above time period, and it was determined that R1 did not receive medication as prescribed. The preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6, Chapter 8 and noted on LIC 9099D. An exit interview was conducted with S2 and a copy of this report was provided to S2. Appeal rights provided. Copy of LIC 811 provided.the state’s words, verbatim · CDSS document, Mar 19, 2024 · control 27-AS-20240105132112

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 20, 2024

87465(a)(4). Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility… (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure the retrieval of a prescribed medication for R1. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2024

Plan of correction: Licensee will submit a plan outlining effective procedures for facility staff to ensure effective and timely retrieval of residents’ medications. Plan to be submitted to LPA by POC due date.

Type of visit: Required - 1 Year

On 2-13-2024 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Maria Almendrala and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly with a current census of 6. Facility has 3 bedrooms and 2 bathrooms for resident use. 1 extra bedroom is for staff use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 4 ambulatory residents, 1 non ambulatory residents, 1 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 75*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 1-23-24. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed and contained accompanying regulatory required Physician’s orders. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 5 resident files and 5 staffing files were reviewed for regulatory compliance. All staff noted on LIC 500 contained criminal background clearances. {Cont. on 809C} LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Administrator departed prior to completion of this inspection and designated lead caregiver Elizabeth Gines to sign in her absence. Exit interview was held and a report was given to Elizabeth Gines..the state’s words, verbatim · CDSS document, Feb 13, 2024