Summer Springs Board & Care

Type of visit: Required - 1 Year

On 03/20/2026 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Administrator, Soccorro "Ann" Telmo, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 6 residents present during todays visit. There are currently no residents who receive hospice services or are bedridden. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher observed fully charged and last purchased 01/2026. Last fire drill on conducted on 3/5/26. 5 of 6 resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: Roach baits were observed under kitchen counter stored with food. Food observed in facility freezer in the garage was not stored properly and undated. Food in the kitchen refrigerator/freezer was not stored properly and with out dates. Medications are being pre-poured for the day. Medications are being kept in a container in the kitchen cabinet. Facility has a "facility account" where all resident funds go into. Facility is not properly safeguarding resident cash. Facility is not completing functional capabilities for residents in care. Pre-admission appraisals are not being completed. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. LPA requested the following documents to be submitted to CCL by 3/27/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), a current copy of liability/surety insurance in order to update the facility file. Exit interview was conducted with Administrator, Ann. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator.the state’s words, verbatim · CDSS document, Mar 20, 2026

Type of visit: Case Management - Deficiencies

On 03/20/2026 Licensing Program Analyst arrived at the facility to complete an unannounced Case Management visit. LPA met with Administrator, Soccorro "Ann" Telmo, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 6 residents present during todays visit. There are currently no residents who receive hospice services or are bedridden. This case management is being conducted from a complaint visit occurring on 2/21/26. During this visit LPA observed a conversation between R1 and S1. S1 was informed by R1 that they "overdosed" on medication. Interview with S1 disclosed that family of R1 picked up a prescription (Metformin 500 mg tablet 2x daily by mouth) from the pharmacy and provided the medication to R1. S1 stated they were unaware family already provided the medication to R1. S1 provided R1 the medication a second time. R1 received 1000 mg in am instead of 2x's daily as prescribed. Review of incident reports for the facility does not disclose there was a medication error on this date for R1. During the annual visit being conducted on 3/20/26, a medication audit was completed. The audit disclosed that R2 also has medication errors. Review of medication record disclosed R2 has prescription for the following medications: 1) Carvedilol 3.125 mg tablets 2x daily. Prescription states that medication is to be held if BP is<110/HR<60. Review of record does not show that R2 had their BP taken on 3/8/26 and 3/12/26. 2) Sertraline 25 mg tablets 1x daily. Medication started on 3/7/26. Review of records/medication show the prescription is missing 1 tablet. S1 and Administrator is unaware what occurred. 3) Tramadol HCL 50 mg tablet as needed for pain 3x daily. Medication started on 2/26/26. Review of record/medication shows 3 tablets are missing. 4) Lisinopril 2.5 mg tablets 1x daily. Medication started 2/16/26. Medication audit show medication ran out on 3/17/26 and was not provided to R2 on 3/19/26 and 3/20/26 and a refill has not been received. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. Exit interview was conducted with Administrator, Ann. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator.the state’s words, verbatim · CDSS document, Mar 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 23, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by: records reviewed and interviews completed. The licensee did not comply with the section cited above in that R1 was provided medication 2x in the am instead of 2x daily as prescribed and medication audit for R2 disclosed 4 medication errors. This poses an immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: Administrator stated they will provide training to all staff on medication administration and documentation. In-service sign in sheet and training material will be provided to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Mar 27, 2026

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement was not met as evidence by: record review of special incident reports submitted to the Department. Incident reports were not reported for medication errors with R1 and R2. This poses a potential health safety and or person rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: Administrator stated they will be providing In-service training to all staff on reporting requirements. In-service sign in sheets and training material will be provided to CCL by POC date as proof of correction.

Type of visit: Case Management - Deficiencies

On 2/21/26 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced case management visit. LPA met with Maria Agatep and Elmer Agatep, explained reason for visit and was permitted entry into the facility. Administrator, Soccorro Telmo was contacted and arrived some time later. LPA completed a tour of the facility was completed inside and out. A health and safety check was completed on residents in care. This case management visit is being completed to address issues observed during a complaint (#24-AS-20260218162333) visit on todays date. During review of records LPA observed the facility did not have a complete resident file for R1. File was missing documentation (Identification and Emergency Information (LIC 601), Pre-Placement Appraisal (LIC 603), updated Needs and Services Plan (LIC 625) , Release of Client/Resident Medical Information (LIC 605A), valid Admission Agreement. This poses a potential health safety and or personal rights risk to residents in care. Deficiencies issues per California Code of Regulations, Title 22. Deficiencies cited on attached 809D. Exit interview completed with Administrator, Socorro "Ann". A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 21, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506 · Plan of correction due date: Mar 6, 2026

87506 Resident Records (b)Each resident’s record shall contain at least the following information:... This requirement was not met as evidence by: records reviewed and interviews conducted. The licensee did not comply with the section cited above in that R1's file was reviewed and missing a Identification and Emergency Information (LIC 601), Pre-Placement Appraisal (LIC 603), updated Needs and Services Plan (LIC 625) , Release of Client/Resident Medical Information (LIC 605A), valid Admission Agreement. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 21, 2026

Plan of correction: Administrator stated they have been updating records as needed. Administrator stated that since accepting R1 TSP has been provided 2x. Administrator stated they will update files and provide a sample file to CCL as proof of correction.

Type of visit: Required - 1 Year

On 04/15/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and met with Licensee/ Administrator Socorro “Ann” Telmo. LPA toured facility with A1. All six residents were present during the inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Medications were observed locked in kitchen shelf. Residents’ MARS and Centrally Stored Medication Records were reviewed. Medications were checked. Fire extinguisher was observed with a service date of: 03/18/25. Chemicals observed locked under kitchen sink. An adequate supply of perishable and non-perishable food was observed. Freezer temperature maintained at -16 degree F and refrigerator temperature maintained at 40 degrees F. Knives observed locked in kitchen drawer. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mat. Hot water temperature was tested range at 116.3 degrees F in hall bathroom and 117.1 degrees F in master bathroom. Extra linens were observed. Outside of facility toured and observed free of debris. Side gate was self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. A sample of staff files were reviewed to have all required documents. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 04/21/25. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, current liability insurance, and current Administrator Certificate. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Apr 15, 2025

Allegation investigated: Staff did not ensure resident received assistance with going to medical appointments Staff did not ensure resident received meal service Staff did not ensure activities were provided for residents Staff did not ensure incontinence care needs of residents were being met

Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation. LPA identified herself and explained the purpose of the visit with Staff Maria Edna Agatep. Administrator Socorro Telmo responded to the facility to assist with the visit. Based on interviews and records review R1 was on Hospice and Hospice was ensuring medical care. Based on interviews, it is unknown if there was a time R1 did not receive meal service. Per interviews, residents are fed all meals. Based on interviews, facility provides activities to residents in care. It is undetermined if there was a time residents were not offered activities. Based on interviews, residents recieve incontinence care. It is undetermined if there was a time R1 did not recieve incontinence care. Unsubstantiated Based on record reviews and interviews, 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. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 22, 2024 · control 24-AS-20240717161359

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Socorro Telmo. During yesterday's visit LPA's toured the facility. LPA Doucette observed 4 bedrooms in the facility. While touring the facility, LPA observed an added staff bedroom/office/garage which was not on the facility sketch and was not fire cleared. Facility had two different facility sketches posted in the facility. The first sketch did not identify a caregiver room. The second sketch identified the caregiver room as bedroom 1 where residents reside. LPA pulled the sketch from licensing file which does not identify a caregiver room. The staff bedroom/office/ garage contained a fully made bed with sheets and blanket, a recliner and filing cabinets. Facility did not have plan of operation at the facility. Hot water temperature was measured 115 F. Bathroom did not have skid mats but had grab bars. Facility staff purchased skid mats during visit. Kitchen toured, supply of food observed. Carrots were expired October 2023. Knives were locked in kitchen drawer. Medications were stored in a Medication cart which was found to be unlocked in the dining room. Refrigerator for medications were found to be unlocked containing morphine and insulin in the dining room. LPA's took photos. Cleaning supplies were in a locked cabinet under the kitchen and bathroom sinks. Smoke detectors and carbon monoxide detectors were checked and operating. Resident, medication, and staff records were reviewed. R3's centrally stored log was reviewed and errors were observed. One of R3's narcotic medications was not logged. R1's records were reviewed and it was found that R1 self administers injections. R1 had a sharps container in a shared room with R2, which made sharps accessible to R2. Facility does not have a Home Health Care Plan for R2. Facility did not have a Hospice Care Plan for R4. Staff have current first aid and CPR training. Staff did not have training logged correctly. Training was missing hours and dates. Facility staff did not have training from Hospice for R4. Administrator was not able to provide intial staff training for staff. During today's visit Administrator was able to provide plan of operation and plan of operation for dementia. LPA rechecked the medication cart and two drawers were unlocked with medication. LPA took photos. LPA educated Licensee/Administrator on where to locate care tool to assist Licensee/Administrator in becoming compliant. Refer to 809D for deficiencies. Civil Penalties were issued for repeat violations. An exit interview was conducted with the Administrator. A copy of this report, plan of correction and appeal rights were discussed and left with the Administrator, Socorro Telmo, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 17, 2024

The state marks this report as 20 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA)'s Shawna Doucette and Sarah Hurt arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Socorro Telmo. LPA disclosed the purpose of the visit and was granted entry into the facility by Staff Teofila Vipug. A tour of the facility was conducted. LPA's checked the food. LPA's took photos. LPA's reviewed staff and resident records. LPA's reviewed medications. LPA's took photos. Due to time constraints, LPA's will return at a later date to complete the inspection and issue any deficiencies or civil penalties. An exit interview was conducted with the Administrator. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Apr 16, 2024