Sunrise Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Steve Heydon, Administrator Designee. Anita Heydon, Administrator, arrived, at 2:15 pm. LPA observed (5) residents resting in their rooms. There is an approved hospice waiver for (3) residents. Currently (0) residents are under hospice care. The RCFE Annual Inspection Tool was not accessible. Staff Ram Pratap, arrived around 4:00 pm. LPA and the Administrator Designee toured the interior/exterior of the facility including the common areas, (1) shared resident room, (4) private resident rooms, (2) bathrooms, kitchen, and garage/ laundry area. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars and hygiene products. There is 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Additional food is stored in the garage, and there is a small refrigerator for any medications. Sharps are locked in the kitchen and medications are secured nearby. Toxins are stored in the locked laundry/garage area. The fire extinguisher was last serviced 5/6/2026, and the smoke/monoxide alarms were tested and working. Front/back exit doors have sounding alarms. The interior temperature measured 78*F. Hot water measured 115.2*F in the kitchen. There is (1) unlocked exit gate and chairs/table. There is no pool. All required postings are visible in the common area. Rights of Family/Resident Councils was posted today. (3) resident files and (3) staff files were reviewed. Files are organized and contained required documentation, including care plans. Medications were reviewed for (2) residents- orders match medications being administered. There was no documentation on file for (3) of (3) staff files reviewed for the required staff training within the last 12 months. First Aid/CPR is current for all staff. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (2) deficiencies are issued. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Sep 30, 2026

§1569.625 Staff training; legislative findings; contents. (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Based on documentation reviewed and staff statements, the Licensee did not ensure that (3) of (3) staff, whose files were reviewed, completed the required annual training, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Licensee/Administrator agree to ensure all staff complete the required (20) hours of training by September 30, 2026.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.69(8)(b) · Plan of correction due date: Sep 30, 2026

§1569.69 Employees assisting residents with self-administration of medication; training requirements (b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met as evidenced by: Based on documentation reviewed and staff statements, the Licensee did not ensure that (3) of (3) staff, whose files were reviewed, completed the required annual training for medications, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 3, 2026

Plan of correction: Licensee/Administrator agree to ensure all staff complete the required (8) hours of training by September 30, 2026.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection relating to (3) recent incident reports submitted to the Department. LPA met with Anita Heydon, Administrator, Steve Heydon, Administrator Designee and Ram Pratap, staff. LPA observed (4) residents watching television in the common area and (1) resident resting in their room. LPA and the administrator discussed resident (R1) who went to the hospital on January 31, 2026, after having a seizure. (R1) stated they were diagnosed with Pneumonia, was administered antibiotics and went to a skilled nursing for a few days before returning to the facility. LPA reviewed (R1's) physician's report which notes (R1) has a seizure condition. Hospital discharge paperwork note (R1) had several medication changes and is doing well. LPA and the administrator discussed resident (R2) who went to the hospital on January 31, 2026 due to complaining of chest pain. (R1) took their nebulizer treatment and was given a prescribed medication for their condition and still decided to go to the emergency room. (R2) was diagnosed with COPD Exacerbation with lung nodules and was prescribed (2) new medications. The administrator stated (R2) returned 10 hours later the same day and is doing fine with the new medications. LPA and the administrator discussed resident (R3) who went to the emergency room on January 29, 2026 due to issues related to anxiety. (R3) returned the following day and met with their social worker on February 3, 2026. (R3) is doing well since returning and will continue to meet with their social worker weekly. It appears the facility took appropriate and timely action in sending the residents out for medical attention. There are no citations issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 10, 2026

Allegation investigated: Staff hit resident.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to the above allegation for a complaint received on December 24, 2025. LPA met with Anita Heydon, Administrator, and Steve Heydon, Administrator Designee, stating the reason for today's inspection. Also present was staff, Ram Pratap. During the investigation, the Department interviewed the Administrator, Administrator Designee, (2) facility staff, (3) current residents, resident (R1), (R1's) family member, and a social worker who is familiar with (R1). Documentation was reviewed for (R1) including their physician's report. The results of the investigation are as follows: *cont on 9099C-1.. Unfounded 9099C-1.. Allegation: Staff hit resident. The allegation states that staff (S1) pushed and hit resident (R1). (R1) was observed to have redness on their right cheek when evaluated by a medical professional. The alleged incident was reported to have occurred on a Saturday eveningon/around December 27, 2025. Staff (S1) stated resident (R1) was very confused and would often get up at night to use the bathroom. (S1) stated (R1) would use the bathroom in the hallway since their walker would not fit through the bathroom door in their room. (S1) stated (R1) got up around midnight on a Saturday night, on/around December 27, 2025, and walked to the kitchen/dining area and asked (S1) and another staff (S2), "who are you guys- my mom is selling her house". (S1) stated he responded to (R1) that they could talk more about it tomorrow. (S1) stated (R1) began to open many kitchen cabinets and so (S1) asked (R1) if they needed anything, and (R1) stated "water". (R1) willingly returned to their room to go back to sleep. (S1) stated they "never pushed (R1)". (S1) explained the next day a nurse and (R1's) family member visited (R1), who told the story to them that (S1) hit them. (S1) indicated the family member responded that (R1) used to do this at home. (S1) stated on Monday morning, (S1) was sent to their health care clinic, but then told the administrator they wanted to return to the facility and changed their story that it was a female, not a male, that hit them. (S1) Physician's Report (7/18/2025) notes a diagnosis of Cognitive Impairment and is a fall risk. (R1's) family member stated that (R1) is not a reliable reporter, and their story changes- has said it is a male and then a female" that hit her, and shows Sundowning behaviors badly. (R1's) family member stated she went with (R1) to the physician and their cheek was red because they kept rubbing it. A social worker stated that (R1) has "moderate cognitive impairment, is not reliable, as their story kept changing- initially it was a female that hit her" but then told someone else it was a male. The social worker stated that she, (R1) and their family member attended a medical appointment together, following the allegation, explaining that they both observed "very little redness" on (R1's) right cheek and felt it was because "(R1) kept rubbing their cheek". The social worker indicated that it appears (R1) got up at night and insisted to go to the bathroom and may have "tried to push the caregiver", who may have tried to stop (R1) due to them being a fall risk, commenting that (R1) had "no major bruising". **cont on 9099C-2. 9099C-2.. Multiple residents indicated that they have not witnessed any staff yell at or hit a resident. Additionally, all residents stated they feel safe and their care needs are being met. Resident (R2) recalls interacting with (R1) and (R1) being very confused and having hallucinations. Specifically, (R2) stated (R1) would say it's their "mom's house" often. Additionally, (R2) recalls hearing (R1) get up at night to use the bathroom and telling (R2) one time that there were "strange men in the kitchen", and (R2) replied that "they work here". (R2) stated she recalls (R1) pointing to their cheek one time and stating it was "pinkish red" and that they were hit by a staff member. (R2) asserted that she "never heard anything" that would have sounded like a commotion. Staff who were interviewed indicated they have never witnessed staff hit a resident and that (R1's) story changed many times. Staff also stated that if they observed a staff hit a resident, they would call the administrator, report the incident, and/or call 911, if needed. The administrator stated (R1) had the same behaviors here they had at their previous facility, moved out the day after they indicated that a caregiver hit them, changed their story- first said male and then female staff, and thought the care home was their house and wanted to kick out the staff. The administrator indicated (R1) received a medical evaluation following the allegation, and no bruises or signs of abuse were noted. The administrator stated they have never witnessed staff hit or abuse the residents. LPA interviewed (R1) stated they "punched (S1) and started to run but (R1) hit me on the right cheek to stop me from running". (R1) also stated that (S1) told them, "I never hit you- you're imagining things". (R1) provided additional details while recounting the alleged incident, many times, such as "guards" being present in the facility. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview. Copy of report providedthe state’s words, verbatim · CDSS document, Jan 30, 2026 · control 59-AS-20251224173301

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada and Licensing Program Manager (LPM) Maribeth Senty arrived unannounced to conduct a required annual. LPA and LPM initially met with staff, Ram Pratap. The Administrator Designee, Steve Heydon, arrived within (5) minutes, and the Administrator, Anita Heydon, arrived at 12:45 pm. LPA observed (1) resident watching television in the common area and (3) residents resting in their rooms. A resident returned from attending their health care program around 1:30 pm, and a new resident moved in at 3:30 pm today. There are currently (0) residents under hospice care. LPA, LPM and the Administrator Designee toured the interior/exterior of the facility including the common areas, (1) shared (3) private resident rooms, (2) resident bathrooms, kitchen, and garage/ laundry area. LPA observed the facility to be clean, in good repair and odor-free. There is 2+day perishable and 7+day non-perishable supply of food. Sharps and medications are locked in the kitchen. Toxins are being stored in the laundry/garage area. The door to the garage has a lock but was not consistently locked during today's inspection. Currently 2/3 cabinets with toxins have a lock; a lock will be added to the third cabinet. The fire extinguisher was last serviced 5/2/2025; smoke/monoxide alarms are working. Front/back exit doors have sounding alarms- an alarm will be added to bedroom #5. Interior temperature measured 78*F. Hot water in the kitchen measured 113*F. Discussed updates to the Admission Agreement and the Dementia Care Plan, effective 1/1/25. Facility to use updated LIC613C- Personal Rights. (4) resident files and (3) staff files were reviewed. Files were organized and contained required documentation. Medications were reviewed for (2) residents- orders match medications being administered. MAR documentation is current. Staff to ensure required training hours are completed by 12/31/25-all staff have current First Aid/CPR and are cleared. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is issued. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 18, 2025

Allegation investigated: Staff interacted with resident in a physically rough manner.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to the above allegation for a complaint received on 7/31/24. LPA met with Anita Heydon, Administrator, and Steve Heydon, Administrator Designee, stating the reason for today's inspection. Also present was staff, Ram Pratap. During the course of the investigation, LPA interviewed the Administrator, Administrator Designee, (1) facility staff, (2) residents, resident (R1) and their family member. LPA reviewed documentation, including (R1's) physician's report and admission agreement, The results of the investigation are as follows: *cont on 9099C-1.. Unsubstantiated 9099C-1..Allegation: Staff interacted with resident in a physically rough manner. The allegation states that when resident (R1) was admitted to the Emergency Room on 7/28/24, for chest pain. Resident stated a staff member interacted roughly with her, grabbing her arm and wrist, when she tried to take a paper towel from the kitchen area, and redirected her back to her room. No visible injuries were noted following the incident for chest pain. Resident's physician's report documents that (R1) has a diagnosis of hypertension, kidney disease, bilateral hearing loss, vision blurriness. Additionally, the report notes (R1) is "extremely hard of hearing", wears glasses, and has motor impairment/paralysis. The Administrator Designee and Administrator both stated they were not present on 7/28/24, when the incident happened, since it was on a Saturday/weekend and that (R1) was looking for another care home with a bigger room. The Administrator stated she believes (S1) was on the phone when resident (R1) entered the kitchen to grab a paper towel, explaining (S1) gently pushed (R1) away from the stove, since there was soup cooking on the stove. Staff (S1) confirmed they were on shift on 7/28/24 when the incident occurred and explained that (R1) "suddenly ran to grab a paper towel" while there was soup cooking on the stove. (S1) stated he "moved her (R1) " touched her shoulder to redirect her", explaining (R1) had "hearing problems". (S1) further stated (R1) "got mad" at him and he is not sure why resident needed a paper towel as she would regularly take napkins into her room. (S1) explained that (R1) did not have a diagnosis of Dementia, but he "worried she was using one hand to tear the paper towel" and she could have fallen doing so. Resident's family member stated (R1) "does not hear well at all, has a short fuse and has a complex" that everyone is out to get her. The family member stated she is familiar with this incident and described when (R1) "got angry" at a staff when she went in the kitchen and he told her she cannot go in there. The family member visited (R1) twice during her stay and felt the facility and staff were not negligent. Resident (R1) stated to LPA that she recalls the incident on 7/28/24. R1 stated she was resting on the couch in the common area and (S1) asked her to nap in her room. After getting up, (R1) stated she grabbed one of the "regular paper towels" from the kitchen and staff (S1) became upset and physically redirected her out of the kitchen. (R1) stated she felt (S1) was upset she had entered the kitchen and stated the stove was not currently being used to cook soup or anything else. (R1) stated she grabbed (S1) back and swung at him. *cont on 9099C-2.. 9099C-2.. Resident (R1) stated she went back to her room and (S1) took her temperature which showed she had a fever. (R1) stated she grabbed a paper towel from the kitchen as the paper towels in the bathroom are "too difficult to access". (R1) confirmed she was not injured, including any bruising, from the incident, and was sent to the emergency room due to a high temperature and pulse. LPA observed the paper towel dispenser to be a center-pull dispenser, or the kind where the towel has to be pulled out. The Administrator stated that residents are able to access the paper towels without a struggle. LPA attempted to interview (2) other residents who were present during the incident; however, neither resident could recall the incident, or any helpful information about (R1). Administrator agrees to post a sign stating when food is being prepared so residents are aware. The kitchen has a counter side that residents can always access. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview. Copy of report provided to the facility.the state’s words, verbatim · CDSS document, Oct 24, 2024 · control 59-AS-20240731165518

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA initially met with Steve Heydon, Administrator Designee, and explained the reason for the inspection. Administrator, Anita Heydon, arrived at 12:15 pm. Also present was staff, Ram Pratap. LPA observed (2) residents watching television in the common area, (3) residents resting in their rooms, and (1) resident returned to the facility during the inspection. The facility is licensed for (6) residents and has a hospice waiver for (3). There are currently no residents under hospice care. LPA and Administrator Designee toured the interior and exterior of the facility including the common areas, (2) shared resident rooms, (2) private resident rooms, (2) resident bathrooms, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. There is 2+day perishable and 7+day non-perishable supply of food with additional freezer storage in the garage. Sharps are locked in the kitchen. The bathrooms have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. Locked medications are secured near the kitchen and toxins are locked in the garage and bathroom. The inside temperature measured 70*F. Fire extinguisher was last serviced 5/21/24, and the smoke/monoxide alarms are working. Hot water temperature measured 109*F in the kitchen. There is a complete First Aid kit. There are sufficient linens/towels/paper products/PPE. There is an outside patio table with chairs and an umbrella, and one unlocked exit. There are no pools. The Infection Control and Emergency Disaster Plans were complete and reviewed within the last year. (3) resident files were reviewed/found to be organized and contain current paperwork. Medications were reviewed for (2) residents- orders matched medications being administered. Documentation was current. cont on 809C. 809C-1.. (4) staff files were reviewed. All staff is cleared and associated. Files were organized and complete. Initial and/or ongoing training documentation was filed. Staff has current First Aid/CPR certifications and will ensure all required ongoing training hours are completed by 11/30/24. An approved on-line vendor is used for staff training. Administrator certification #7019616740- exp 7/4/25 posted at the front entrance. LPA requested an updated copy of LIC500, LIC308 and of the current liability insurance by 10/31/24. Obtained updated email address. Administrator to submit documentation of required staff training hours to be completed within the last 12 months, by 11/30/24. There are no deficiencies issued, but there is a Technical Violation being issued. Exit interview with Administrator. Copy of report provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection. LPA met with Steve Heydon, Administrator Designee, and stated the reason for the inspection. LPA was advised there are (4) resident currently. During today's inspection, LPA interviewed the Administrator Designee and each resident. LPA toured the facility and observed (2) residents to be in their rooms and (2) residents in the common area watching television. LPA also observed multiple personal belongings for prior resident (R1) and took photographs of specific items. There are no deficiencies issued in this report. Exit interview. Copy of report provided to the Administrator Designee.the state’s words, verbatim · CDSS document, Jul 1, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection. LPA met with Steve Heydon, Administrator Designee, and stated the reason for the inspection. LPA was advised there are (4) resident currently, and (1) resident moved in yesterday. During today's inspection, LPA obtained copies of documentation from each resident's file. LPA and Administrator Designee toured the facility and observed (4) residents to be resting in their rooms. LPA observed (2) health care representatives to be talking with resident (R1) in resident's room. LPA discussed Regulation 87507/Admission Agreements and how one should be signed within (7) days of resident moving in. There are no deficiencies issued in today's report. Exit interview. Copy of report provided to the Administrator Designee.the state’s words, verbatim · CDSS document, Jun 25, 2024

Allegation investigated: Staff is financially abusing resident.

**This document was amended on 11/5/2024 (11:05 am) to reflect updated findings following the Department granting an appeal. Some additional information has been added to this report as well as language removed that resident was financially abused by staff. ** Licensing Program Analysts (LPA's) Sabrina Calzada and Kevin Mknelly arrived unannounced to deliver findings to the above allegation for a complaint received on 8/9/23. LPA's met with Steve Heydon, caregiver and Administrator Designee, and explained purpose of inspection. Anita Heydon, Administrator, was contacted by phone and arrived to the facility around 2:30 pm. During the course of the Audit investigation, the Department reviewed bank records for accounts belonging to resident (R1), facility records, other records and conducted interviews. (R1) was always responsible for his own financial and medical decisions and paid the facility with his own checks for rent and reimbursement for items he requested. Although there were some charges made to (R1's) debit card that did not appear to be for (R1), such as gasoline for a vehicle, there was no evidence found that the facility financially abused (R1). LPA's advised there may be additional citation(s) issued related to (R1). Further review indicated that (R1's) rate was not increased at this facility. Based on documentation obtained and reviewed, the Department finds the above allegation to be UNSUBSTANTIATED- a finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview. Copy of report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 18, 2024 · control 59-AS-20230809091944

From the deficiency page

This page was amended on 11/5/24 to reflect the deficiency being dismissed after an appeal was granted. There is no deficiency issued on this page.the state’s words, verbatim · CDSS document, Jun 18, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on an increase in census that was recently approved by the local fire department. LPA met with Francis Iroko, caregiver, and then the Co-Administrator, Steve, who arrived within minutes from the store. LPA observed (1) resident in the common area. LPA and Co-Administrator toured the facility and observed (1) resident in room #1, #3, and #4 each and (2) residents in room #5. Room #2 was observed to be vacant. LPA also observed the new fire door that was recently added to room #5 per the new fire clearance. LPA printed an updated copy of the license reflecting the most recent fire clearance, allowing (1) bedridden resident to reside in room #5. There are no deficiencies issued in this report. Copy of report and an updated copy of the license left at the facility.the state’s words, verbatim · CDSS document, Dec 12, 2023

Allegation investigated: Neglect/Lack of Care and Supervision- Staff ignored resident's calls for assistance Staff does not serve food in consideration of resident's religious background. Staff violated resident's religious rights.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver partial complaint findings to a complaint received on 8/9/23. LPA met with Steve Heydon, caregiver/Administrator Designee, and explained purpose of inspection. Also present was Ram Pratap, caregiver. During the investigation, LPA interviewed the Administrator, (2) caregivers at this facility and (2) caregivers at a related facility where resident (R1) lived prior to transferring to this facility. LPA reviewed documentation pertaining to (R1) including, but not limited to, hospice medication records, patient agreement, hospice assessment and plan of care and facility personnel report. The results of the investigation are as follows: cont on 9099C-1.. Unsubstantiated 9099C-1... Allegation: Neglect/Lack of Care and Supervision- Staff ignored resident's calls for assistance. Complaint alleges that NOC shift staff, (S1), ignored resident's calls for assistance, stating "he is not paying enough" to answer his calls. The Administrator stated on 8/17/23 she had never heard staff (S1) state that (R1) was not paying enough for staff to answer his call button and asserted that (R1) "locked several iPhones" and so would use the call button to request assistance from staff. (S1) confirmed with LPA on 8/17/23 that he knew prior resident, (R1), stating (R1) lived at the facility for approximately 5-6 months. (S1) indicated he would regularly check on (R1) and change him as needed, and sometimes (R1) would ask for hep in the middle of the night, between 2-3 am, and confirmed he (S1) was awake until until around 11:00 pm when all residents were asleep. (S1) asserted, "he was well cared for at night and during the day" and never needed a second care person adding that "(R1) would ask for candies and sometimes wanted to sit in a wheelchair in the morning". (S1) was adamant that he never said (R1) was not paying enough to answer his calls, commenting that (R1) was taken to appointments and staff used ointments on his skin. (S1) confirmed he provided ADL's including feeding, changing and administering PRN meds to (R1) and sometimes assisted "am" staff with transferring (R1) and using the hoyer lift, and the daytime care staff provided bathing to (R1). (S1) stated that over the last 3-4 weeks, before he passed, (R1) was "not clear in his speech" and that previously before declining, (R1) could use his cell phone, the call button and move himself from side to side, but about 4-5 weeks ago, (R1) forgot his password on his cell phone and it became "locked". (S1) stated that over the last month, (R1) was not able to ask for help as he "slowed down, especially with his movement". Hospice records show (R1) was admitted on 7/27/23. LPA was unable to contact staff (S2) who also worked at the facility when (R1) lived there,to speak with him regarding the allegation. Based on interviews conducted, LPA finds the above allegation to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. 9099C-2... 9099C-2... Allegation: Staff does not serve food in consideration of resident's religious background. Complaint alleges that staff continue to serve resident (R1) pork (bacon, ham and pork and beans) which is not permitted under the Muslim religion. The Administrator Designee/caregiver stated on 8/17/23 that (R1) was not supposed to eat pork and staff was aware that (R1) shouldn't be served pork and staff was "able to give other things". This staff was adamant that (R1) "was not served any other food" with pork and he had a discussion with staff about this, explaining that ever since (R1) moved to this location from a related facility, (R1) requested to not be served pork, so staff would mostly serve (R1) chicken, fish and turkey bacon. LPA was shown a package of turkey bacon in the refrigerator during the interview and confirmed it to be 100% turkey meat. LPA also observed an almost finished bag of frozen turkey sausage links. This staff confirmed that the facility does buy and serve "pork and beans", but it was "never served to (R1) to my knowledge". The Administrator stated on 8/17/23 that (R1) used to order his own food and "he had a lot of food in his room". The Administrator explained that (R1) "was going back and forth" between being a Christian and Muslim and (R1) did ask for pork as he was told it's okay by an Islam guy who visited him (R1). The Administrator said she called the Muslim priest and told him (R1) is still asking for pork, and was told "it's okay, it will take him time to change". The Administrator commented (R1) was "served turkey bacon and sausage and because he (R1)) loved pork bacon and sausage so much, he went on a hunger strike" telling staff, "I'll stop eating pork next week". (S1) explained that when (R1) moved in, he ate "normal food" like "fried eggs and toast",but the last 2-3 weeks (R1) lived, it was hard for him to swallow, even water, and he called hospice out. (S1) stated "No, (R1) never said he didn't want pork, but Steve told me he didn't want any", explaining that most of the time, normally chicken and meatballs are served to residents and they don't use bacon much, stating it has too much grease in it. A staff at a related facility stated (R1) could eat anything and did not have any food preferences while living there; a second staff stated (R1) liked to eat - a lot of food and did not have any restrictions when she worked with him and confirmed (R1) "used to eat pork" Based on interviews conducted, LPA finds the above allegation to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. cont on 9099C-3... 9099C-3...Allegation: Staff violated resident's religious rights. Complaint alleges facility staff violated resident's Muslim rights. The Administrator Designee/caregiver, stated on 8/17/23,"I didn't know about a conversion either way" and explained that he found out about (R1) converting to Islam after he passed, explaining there was one caregiver at the related facility who converted (R1) to Islam. This staff stated that it was his understanding that "sometime in the spring, he (R1) converted back to Christianity which was news to us", asserting "we really didn't know what his religious preference was". Staff (S1) was interviewed and stated "No, he never mentioned his religious preference- I think he had a Bible in his closet". The Administrator stated on 8/17/23 she has no documentation of (R1) changing to Islam religion and commented "it happened probably" at the related facility. One staff who works at a related facility commented that she believes (R1) "used to be Christian and was converted to Islam by a staff member". A second staff at that facility stated "I heard" (R1) was converted to Islam", but she is not sure if it's true as she went on leave for several months in 2023. LPA reviewed admission paperwork for (R1), specifically LIC601, dated 8/18/22, which does not list any religious preference. The Administrator Designee stated that on 8/8/23, someone from the Mosque talked to (R1). LPA was provided with copies of Home Health notes entered on 8/10/23, by the Chaplain indicating that (R1) was Muslim and converted to Christianity under his (Chaplain's) care. (R1) began receiving hospice services on 7/27/23 and passed on 8/9/23. Notes were entered by the Hospice Chaplain on 7/28/23, when the initial assessment was made. Notes say that (R1) is Christian. There are nursing notes entered on 8/3/23 and on 8/5/23. The Administrator stated (R1) "was going back and forth" between being a Christian and Muslim and he called the Chaplain through the hospice company to say he wanted to be a Christian, adding (R1) said he wanted to eat pork as he was told it's okay by an Islam guy who visited him (R1). The Administrator asserted "Everything came as a surprise and without me- it never happened with me there" and stated the Chaplain spoke to her months back, when (R1) was previously on hospice in May, and (R1) was Christian at that time and commented "I was never sure what to do". Based on interviews conducted, LPA finds the above allegation to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview. Copy of report provided to the facility.the state’s words, verbatim · CDSS document, Nov 9, 2023 · control 59-AS-20230809091944

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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Ram Pratap, caregiver and explained the reason for the inspection. Also present was caregiver, Francis Iroko. LPA spoke to the Administrator, Anita, and lead caregiver, Steve, by phone who were not able to attend today's inspection,but provided assistance in locating binders/documentation for review. The facility is licensed for (5) residents currently and has a hospice waiver for (3). There is (1) resident currently on hospice. LPA observed (2) residents watching tv in the common area and (3) residents to be in their rooms. LPA and Ram, caregiver, toured the interior and exterior of the facility including the common areas, (2) shared resident rooms, (2) private resident rooms, (2) resident bathrooms, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps in the kitchen. Locked medications are kept in a separate cabinet nearby and locked toxins are kept in the garage. The inside temperature to be 73*F. Fire extinguisher was last serviced 5/25/23. Hot water temperature measured 116*F in the kitchen. There is a complete First Aid kit on site and sufficient paper products and PPE. All required postings are posted, including a blank Admission Agreement, Resident Personal Rights and Theft and Loss Policy. The Administrator agreed to complete the Infection Control Plan (LIC9282). LPA reviewed the Emergency Disaster Plan that was last updated in July 2023. LPA observed (1) unlocked gate outside and covered patio seating. There are no pools or bodies of water. LPA reviewed (2) resident files and found them to be organized, current and complete. Meds were reviewed for (1) resident -orders matched meds being administered. LPA reviewed all staff files - all staff have current First Aid/CPR certification and have completed required initial or ongoing training through an approved on-line vendor. LPA requested an updated copy of LIC500, LIC308 and of the current liability insurance by 10/18/23. There are no deficiencies issued, but there is a Technical Violation being issued. Exit interview with Administrator. Copy of report provided.the state’s words, verbatim · CDSS document, Oct 11, 2023