Sterling Senior Community III

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

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1). During today’s visit, LPA met with Kian Pascual, Administrator Designee (AD). The facility is a five bedroom, two bathroom single-story home with an approved fire clearance of six non-ambulatory residents of which one may be bedridden. Five residents are approved for hospice. The facility currently has a census of five residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 109.4 and 112.1 degrees Fahrenheit and all smoke and carbon monoxide detectors were operational. The fire extinguisher is charged and was serviced on December 3, 2024 and an appointment for service is scheduled on December 9th from 12-3pm. The facility’s last fire drill was conducted on September 9, 2025. This quarter's fire drill will take place by the end of this week. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. Water and emergency supplies were located in the front closet and garage. A weekly menu was posted on the refrigerator door. All stove burners and appliances were operational. The sharps and knives drawer had a lock that needed repair but facility brought in a person to fix the lock prior to LPA's exit. LPA confirmed lock is in working order. (Continued on LIC 809-C) (Continued from LIC 809) LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. The First Aid Kit had all of the required elements with a First Aid Manual. LPA observed four of five residents watching the news in the living room, LPA interviewed alert residents for quality care being provided. LPA toured resident rooms and observed all the rooms had the required furnishings and linens. Postural supports were provided for one resident with bed rail orders on file. AD addressed that other residents would benefit from bed rails and will follow up with Primary Care Physician for residents. Upon touring the exterior LPA observed two self-latching exterior gates with an alarm system. The garage is detached and is only used for car and supplies storage. There were no hazards or obstacles in outdoor pathways and a shaded seating area and cycle machine were observed for resident use. LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 25, 2026. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Kian Pascual, Administrator Designee and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Dec 8, 2025

Type of visit: Required - 1 Year

On February 28th, 2025 Licensing Program Analyst (LPA) William Vanegas made and unannounced inspection for the purposes of an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Hangki Ari. LPA Vanegas explained the purpose of the visit and began to conduct a tour of the facility and observed the following. This is a one storied home with five bedrooms one of which is a staff room. There are two bathrooms that are available to residents in care. There is a detached one car garage as well. LPA Vanegas observed kitchen area clean and free of debris. LPA Vanegas observed there to be a dishwasher, microwave, gas stove, and refrigerator all in good repair and in working condition. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non perishable food on hand. LPA Vanegas observed a sufficient amount of emergency water on hand as well. LPA Vanegas observed fire extinguisher to be fully charged and up to date, and for carbon monoxide detectors to be in good condition and tested to be operational. LPA Vanegas observed resident bathrooms to be clean and free of mildew and debris. LPA Vanegas observed bathrooms to have all required furnishings such as a shower chair, grab bars, and slip resistant floor matts. Water faucets and toilets tested to be operational. Water tested between and . LPA Vanegas observed all resident rooms to have all required furnishings such as chest drawers, enough storage space, screened windows, a bed, a lamp, and clean linens meaning no strains or tears. The rooms are big enough to move freely with no obstructions blocking entry ways. CONTINUED ON LIC809C LPA Vanegas observed outside of the facility to be clean and free of debris with no items blocking the emergency exit paths. Side doors are self latching and are not looked. Backyard is big enough to participate in out door activities upon resident request. There is also an outdoor shaded sitting area. LPA Vanegas observed first aid kit to have all the required materials such as adhesive tape, scissors, tweezers, bandages, and a thermometer. LPA Vanegas observed all toxins, medications, and sharps to be locked away, and inaccessible to residents in care. LPA Vanegas reviewed all medications with Assistant Administrator (AA) Arnold Mendoza and observed the medications to be documented correctly and per LPA Vanegas review all medications are being administered per physicians orderes. LPA Vanegas reviewed two staff files and six resident files. After review all documents (Staff and Resident) contain all required documentation and annual staff training is up to date and documented correctly. Based on observations made during today's visit no deficiencies will be cited per title 22 chapter six of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 28, 2025

Allegation investigated: Facility failed to maintain a complete and accurate staff records.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 12/12/23 regarding the above allegations. LPA Ramirez was met by Administrator Albert Narez and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Client Roster (LIC 9020), Staff #1 - 4 interviews(S1 – S4), Resident #1-2 interviews (R1 – R2 ), attempted interview of residents# 3-6 (R3-R6), review of six (6) resident records (R1-R6), copies of Resident#1-5 (R1-R5): Medication Administration Record (MAR) for the month of December 2023, review of three (3) personnel records (S1- S3), copies of Staff#3-4 (S3-S4) In-Service Training dated 4/2022-(S4) and 8/2022-(S3) and physical plant tour. SEE 9099-C for continuation of report. Substantiated The investigation revealed the following. Regarding Allegation(s): Facility is in disrepair- It is alleged the facility is in disrepair. LPA Ramirez conducted both interior and exterior tour of facility plant. LPA Ramirez did not observe facility to be in disrepair during visit. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Facility staff failed to properly administer resident’s medications- It is alleged facility staff are not properly administering medications to residents. LPA Ramirez reviewed and compared five (5) out of six (6) residents medications administration records (MAR) for the month of December 2023, to five (5) out of six (6) residents’ prescriptions and Centrally Stored Medications and Destruction Record (LIC 622). Resident#6 (R6) was out of the facility and medications were not available. LPA Ramirez did not find any irregularities during records review. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Facility is not adequately staffed- It is alleged the facility is not adequately staffed. LPA Ramirez observed S3 and S4 providing care and supervision to five (5) out of the six (6) residents. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Facility failed to maintain a complete and accurate resident’s records- It is alleged the facility failed to maintain a complete and accurate resident's records. LPA Ramirez reviewed of six (6) resident records (R1-R6) and did not observe any irregularities or deficiencies to cite. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted. A copy of this report and appeals rights was provided. Facility failed to maintain a complete and accurate staff records- It is alleged the facility failed to maintain a complete and accurate staff records. LPA Ramirez reviewed three (3) personnel records, out of the four (4) staff present at the facility. During records review, LPA Ramirez discovered two (2) out of the three (3) records reviewed, were missing documented annual training per 1569.625 (b)(2) in their personnel record. Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above two allegations are found to be SUBSTANTIATED. Deficiency is being cited. Exit interview conducted. A copy of this report, 9099-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 22-AS-20231211123948

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Dec 26, 2023

87412 Personnel Records (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement was not met as evidence by: S3 and S4 did not have documented annually required training per 1569.625 (b)(2) in personnel record.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Licensee will document staff training and place in personnel record. Licensee will certify plan to address future staff training and documentation by 12/26/23.

Type of visit: Case Management - Deficiencies

CASE MANAGEMENT FINDINGS: LPA Ramirez conducted case management deficiencies visit on 12/12/23, stemming from initial complaint investigation conducted on 12/12/23. Upon entering facility, LPA Ramirez observed staff#1 (S1) washing dishes in facility kitchen and cleaning up kitchen. LPA Ramirez observed four (4) residents seated living room area and one (1) resident seated at dining room table. During record review, LPA Ramirez discovered S1 does not have criminal record clearance or criminal record exemption. According to staff interviews, S1 has only been in the facility today (12/12/23). LPA Ramirez will issue Civil Penalty Assessment (LIC 421 BG) of $100 for violation and deficiency. Exit interview was conducted and a copy of this report, 809-D, LIC 421BG and appeals rights was provided.the state’s words, verbatim · CDSS document, Dec 12, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.17(b)(D) · Plan of correction due date: Dec 13, 2023

1569.17 Fingerprints and criminal records of individuals in contact with clients; (b) In addition to the applicant, the provisions of this section shall apply to criminal record clearances and exemptions for the following persons: (D) Any staff person, volunteer, or employee who has contact with the clients. This requirement was not as evidence by: S1 was observed in facility washing dishes and coming into contact with residents without criminal clearance or exemption.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: Licensee will not allow S1 back into the facility until S1 has criminal clearance or exemption. Licensee will certify understanding of regulation (1569.17(b)(D) by 12/13/23.