Sterling Senior Community 8

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six non-ambulatory residents. The facility currently has six residents and all six residents were present during the visit. There’s a total of 6 bedrooms of and 4 restrooms available. There’s a living room space, a dining space, laundry area, backyard area and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in between 111.5 – 113.5 degrees F. Kitchen: 4 of 4 burners and the warmer were operational on the gas stove. Sharps are stored in a drawer near the sink equipped with a lock. Soaps and cleaning chemicals are stored below the sink. Food Service: A food supply that meets regulation requirements was observed. Client & Staff Files: Resident and staff files are located in locked bins stored in a hallway cabinet. File Review: Three resident files and three staff files were reviewed during the inspection. Medications/First-Aid Kit: Client medications are stored in a kitchen drawer equipped with a lock. A first aid kit with all the required elements was observed in the hallway cabinet near the secured staff and resident files. Medication Review: Three resident medications were reviewed during the visit. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in locked cabinets in both bathrooms, and additional hygiene items were observed in the garage. Garage Area: The garage is used to store miscellaneous facility items like holiday decorations, bed frames, and other items. Walkways were free of obstruction. An additional perishable and non perishable food supply was observed. Emergency items were observed including a supply of emergency food and water. There’s a small office area set up in the garage with a computer. Backyard/Exterior: The backyard is clean and organized. Walkways are free of obstruction. A table and chairs was observed under a shaded patio area in between the front and backyard. Bodies of Water: None Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: A fire extinguisher was observed mounted on the hallway wall right outside the kitchen. An emergency evacuation drill: Was conducted April 1, 2026. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted are available for review on the main postings board in the dining room. Additional Comments: Licensing fees are current. Contact information was reviewed and confirmed during the visit. Deficiencies are being cited as a result of today’s inspection. An exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 7, 2026

Type of visit: Office

Licensing Program Managers (LPM) Kevin Saborit-Guasch and Alisa Ortiz along with Licensing Program Analyst (LPA) Nancy Guillen met with Licensee Albert Pimentel and Michelle Kellogg in regards to concerns with consistency of complaints investigations and also wanted clarification on Title 22. The following were discussed: - Complaint Investigation Process, - Expectations of collaboration between LPAs and Licensees, - Appeal rights, - Title 22 requirements regarding staff training, awake staff, and staff records. Licensee expressed intention to continue building rapport with the Department. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 21, 2026

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 3 residents, with 1 resident on hospice. Administrator (AD) Sheryl Tongol arrived shortly to assist with the visit. LPA along with staff toured the facility at 8:45 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 6 resident bedrooms, living room, dining room, and kitchen as well as 4 bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured at 116.7 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarm in room 5 was not operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. At 8:50 AM, LPA observed Clorox wipes unsecured on the bathroom counter top. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 03/20/2025. Outside grounds were toured. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. At 9:15 AM, LPA observed sharps including hedge shears and a bolt cutter unsecured on the ground next to the garage entrance through the backyard. Continued on LIC809-C dated 07/22/2025 First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed three resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. One out of two staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Jul 22, 2025

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on a self-reported incident report received in the Orange County Regional Office (OCRO) on April 1, 2025 regarding Resident #1 (R1) and Staff #1 (S1). LPA met with Licensee (LE) Michelle Kellogg and discussed the purpose of the inspection. During the inspection, LPA inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. LPA observed the facility to be clean and organized, the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations, and the medications, sharps, and toxins were properly stored. LPA interviewed staff, residents, and witnesses and requested and reviewed copies of the resident roster, staff roster, resident files, and staff files. There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jun 4, 2025

Type of visit: Required - 1 Year

On November 20, 2024 at 9:19 am, Licensing Program Analyst's (LPAs) Jenifer Tirre and Eboni Bentley conducted an unannounced required visit using the CARE Inspection Tool. LPAs were greeted by staff and granted entry after stating the purpose of the visit. Administrator (Admin) Albert P. Nanez was not present. Administrator (Admin) Kian Pascual was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents, one (1) bedridden, with approved hospice waiver for six (6) residents. Currently, there are four (4) residents of which there are two (2) hospice residents and (1) bedridden resident present during today’s visit. This is a single story with attached garage facility. The facility has six private bedrooms and three full bathrooms, currently occupied by four residents. At around 9:30am, LPAs conducted a tour of the physical plant accompanied by Admin Pascual, and the following was observed: There were no bodies of water on the premises, all rooms were inspected, beds and bedding supplies were in operational condition, lighting was provided in all rooms, and storage for the client's personal belongings were observed in residents’ closets. Additional bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperatures measured between 114.4 to 116.9 degrees F. maintained in the bathrooms within the facility. LPAs observed the facility to be furnished at the time of the visit. Storage areas for toxins and sharps objects were stored and not accessible to residents. The kitchen was inspected, appliances such as stove, oven and fridge were operational. Sufficient perishable and non-perishable food was maintained adequately. Facility has emergency food and water supply. Facility has two fire extinguishers which are mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPAs observed the records are in compliance. During the visit, LPAs observed the facility's infection control practices. LPAS observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPAS observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. CONTINUED ON LIC 809 LPA's observed First Aid Kit was maintained. The last fire drill was conducted on September 19, 2024. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. A review of four residents (R1-R4) service files and four staff (S1-S4) personnel files revealed to be complete. The facility has the current administrator's certification on file for Albert P. Nanez with Expiration Date: 04/18//2025. Facility has liability insurance on file effective 11/18/24-11/18/25. The current items were addressed during visit: Facility plumbing is exposed and capped leading to hallway. Licensee to cover area and have plumbing redirected facility thresholds between kitchen and hallways and laundry doors need to be shaved down. The following will be cited on 9099 D page An exit interview was conducted with Administrator Kian Pascual, and a copy of the report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Nov 20, 2024

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility is not adequately staffed. Facility failed to maintain complete accurate resident records. Facility failed to maintain complete and accurate staff records.

On 12/22/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsquent unannounced complaint visit to this facility. Upon arrival at the facility, LPA Dabuet was greeted by house manager Erly Wilson who contacted the administrator Albert Narez who later join for the visit. The purpose of the visit was provided to Narez is to investigate the allegations mentioned above. The investigation consisted of the following: Interviews conducted with staff 1- 2 (S1-S2) and interview with resident #3 and #4 (R3-R4), witness #1(W1). Inquiry questions were relevant to the nature of the complaint. A review of service records for resident #1- #6 (R1-R6) and staff #1- #5 (S1-S5). A tour of the facilty on 12/12/23 and 12/22/23. (Evaluation Report continues LIC 9099-C) Substantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #3: Facility is not adequately staffed. It is alleged the facility is operating with inadequate As a result of the complaint, the complainant was concerned that the facility operates with a minimum number of staff. On 12/12/23 between 3:03 pm – 5:59 pm, the Department interviewed (2) out of (2) staff #1-#2 (S1-S2) revealing there are two caregivers for supervision to five residents during shift 7:00 am through 7:00 pm. (S1-S2) stated an “awake” staff in place to work overtime when any residents post restlessness behavior or incontinent assistance. Service records revealed residents #1 and #2 (R1-R2) are diagnosed with dementia. On 12/22/23 between 8:30 am - 9:24 am the Department reviewed resident #6 (R6) who was admitted on 12/16/23 and requires continuous bed care, bowel & bladder Impairment, and unable to evacuate according to (R6's) Physician's Report (date 12/14/23). (R1) diagnosed with dementia requires observation/night supervision and is not able to self-evacuate, needs assistance with toileting, and a fall risk according to (R1's) Pre-placement Appraisal Information LIC 603 (date: 07/20/23) Appraisal/Needs Services Plan (date: 07/28/23), and Physician's Report LIC 602 (date: 07/13/23). (R3 and R5) both are hospice residents. (R3) is bowel & bladder Impairment, who cannot self-evacuate, and requires observation/night supervision according to (R3's) Physician's Report (date: 07/30/23) and Resident Appraisal LIC 603 A (date: 07/30/23). (R5) is bed bound, has seizures, a falls risk, requires maximum (ADL) assistance, and is unable to self reposition according to (R5’s) Physician’s Report (date: 01/19/22). Based on the gathered information, there is sufficient evidence to support the allegation mentioned above. The facility requires a permanent night staff for care and supervision for (4) out of (6) residents. Allegation #4: and Facility failed to maintain complete accurate resident records. The details of the complaint alleged that the facility failed to maintain complete and accurate resident records. The complainant was concerned the facility was not operating within Title 22 requirements. (Evaluation Report continues LIC 9099-C) On 12/12/23 between 1:52 pm - 2:46 pm, the Department conducted a review of resident #1-#5 (R1-R5) service files. The review of resident #1 (R1) records revealed to be complete. (R2), (R3), and (R4) did not include a Safeguard for Property Valuables (LIC 621) on file. (R4) was admitted on 11/20/23 and did not include an Appraisal/Needs and Services Plan (LIC 625) and (R5) LIC 625 is incomplete missing page 3 and 4. (R6) admitted on 12/16/23 did not have Identification and Emergency Information (LIC 601). Based on the information gathered, there is sufficient evidence to support the allegation mentioned above. Allegation #5: Facility failed to maintain complete and accurate staff records. The details of the complaint alleged that the facility failed to maintain complete and accurate staff records. The complainant was concerned because the facility was not operating within Title 22 requirements. On 12/12/23 between 3:05 pm - 4:30 pm, the Department conducted a review of staff #1-#5 (R1-R5) personnel files. Upon examination of staff #2 (S2) hired on 07/07/22, file was found incomplete. (S2), did not have Health Screening LIC 503, Employee Rights LIC 9052, Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders SOC 341 and TB Test. (S1), (S3), (S4) and (S5) personnel files were found to be within Title 22 regulations and accurate and complete. Based on the information gathered, there is sufficient evidence to corroborate the allegation mentioned above. Based on observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are cited on the attached LIC 9099-D. An exit interview was conducted with Albert Narez, and a hard copy of the report along with appeal rights. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, Dec 22, 2023 · control 22-AS-20231211124236

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Jan 5, 2024

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. This requirement was not met as evidenced by: On 12/12/2023, LPA interviewed two staff (S1-S2). Interviews with S1 and S2 revealed there are two caregivers providing care and supervision to five residents during day shift from 7:00 AM through 7:00 PM. S1 and S2 stated an awake staff is placed to work overtime at night from 7:00 PM - 7:00 AM when any residents pose a restless behavior. Based on interview with S1 and S2 and LPA's records review, it was revealed that four residents (R1, R3, R5 &R6) need close supervision due to their medical conditions, however S1 and S2 stated there are no on-duty staff during night shift unless needed. This poses a potential health, safety, and/or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 22, 2023

Plan of correction: Licensee shall ensure there's always one aware staff during night shift to provide care and supervision to residents with dementia and hospice. Licensee shall self-certify understanding of the section cited herein and shall comply. POC shall be submitted to CCLD via email to ernand.dabuet@dss.ca.gov by the POC due date, 01/05/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jan 5, 2024

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on record review. LPA reviewed records of 4 out of 6 residents (R1-R6). Service records were incomplete (see LIC 9099-C). This poses a potential health, safety, and/or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 22, 2023

Plan of correction: Licensee shall ensure all resident records are complete and accurate. Administrator agreed to obtain all missing resident records and shall submit copies to CCLD via email to ernand.dabuet@dss.ca.gov by the POC due date, 01/05/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(11-12) · Plan of correction due date: Jan 5, 2024

87412 Personnel Records a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:.... This requirement was not met as evidenced by: Based on record review, staff #3 had an incomplete personnel file and missing required licensing forms. (See LIC 9099-C) This violation poses a potential health and safety to residents in care.the state’s words, verbatim · CDSS document, Dec 22, 2023

Plan of correction: Licensee shall ensure all staff records are complete and accurate. House Manager agreed to obtain all missing staff records and shall submit copies to CCLD via email to ernand.dabuet@dss.ca.gov by the POC due date, 01/05/24.

Allegation investigated: Facility is in disrepair. Facility staff failed to properly administer resident’s medications.

On 12/12/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint visit at this facility. LPA was greeted by caregiver Erly Wilson. Wilson contacted licensee Michelle Kellogg who later arrived at the facility. LPA explained the purpose of the visit is to investigate the allegations mentioned. The investigation consisted of the following: Interviews with staff #1-#2 and licensee, witnesses #1, and resident #4. A review of resident #1-#5 (R1-R5) service records and other pertinent documents associated with this complaint. A physical tour of the facility was conducted. (Evaluation Report continues LIC 9099-C) Substantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Facility is in disrepair. It is alleged the facility is in disrepair. The complainant reported the physical plant is not maintained in good condition. On 12/12/23 between 2:01 pm - 2:47 pm an inspection the entire facility. The inspection revealed that the central stove burner was not operable at 2:01 pm. The bathroom in resident's room #6 is missing a window covering for privacy. At 2:21 pm resident #4 (R4) who occupies room #6 was interviewed and who stated preferred having a window covering for privacy in the private bathroom. Based on the information gathered, there is sufficient evidence to support the allegation mentioned above. Allegation #2: Facility staff failed to properly administer the resident’s medications. The details of the complaint alleged the facility is not properly administering resident's medications. The complainant reported the facility is not administering and storing medications properly. On 12/12/23 between 2:01 pm - 2:47 pm inspection the entire facility. At 2:05 pm the Department identified refrigerated prescription medications were not stored properly for residents #2 and #5 (R2 and R5). (R2's) was in a locked box with a key attached and key not stored away from box. (R5's) medications were stored in a snap box plastic container with no lock. Both (R2 and R5) medications were accessible to other residents diagnosed with dementia. Based on the information gathered, there is sufficient evidence to support the allegation mentioned above. Based on observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099-D. An exit interview was conducted with Michelle Kellogg, and a hard copy of the report along with appeal rights.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 22-AS-20231211124236

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 12, 2024

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. LPA identified window covering missing for room #6 and central stove burner not in working condition. The violaiton which poses/posed a potential health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Licensee will ensure the facility is maintained in good repair at all times. Licensee will repair central stove burner and have a window covering for room #6 bathroom. Proof of correction must be sent to LPA by due date: 01/12/24 via email.ernand.dabuet@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(2) · Plan of correction due date: Dec 13, 2023

87465 Incidental Medical and Dental Care (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. LPA identified refrigerated medications for resident (R2&R5) not locked up storage accessible to other residents. The violaiton which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Licensee will ensure the facility is to store all medications for residents in locked storage not accessible to other residents. Proof of correction must be sent to LPA by due date: 12/13/23 via email.ernand.dabuet@dss.ca.gov

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.