Talega Terrace

Allegation investigated: Registered Sex Offender who is not a client allegedly resides, is present and/or has contact that may pose a risk to the health and safety of clients in care.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and grantd entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility. This agency has investigated the complaint alleging a Registered Sex Offender (RSO) is in care at a licensed facility or resource family home or has presence/contact that may pose a risk to the health and safety of the client(s) in care at a licensed facility or resource family home. The Department has found that the complaint was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Apr 27, 2026 · control 22-AS-20260424170254

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit as well as a health and safety visit based upon the deficiencies cited in LIC form 809D on 03/24/2026 and 04/10/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87355(e)(2) pertaining to Criminal Background Association has been cleared. Licensee associated staff to the facility. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medication has been cleared. Medication is secured during today's visit. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. Licensee repaired noted items. Licensee has complied with the POC. LPA toured the facility and observed residents relaxing in the facility. Facility appears clean and sanitary. There are 5 residents, one staff, Licensee and Licensee's spouse present at the facility. LPA observed ample food and water supply. No health or safety concerns noted during today's visit. Licensee has been advised to maintain all items previously cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 27, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 03/24/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has NOT been cleared. LPA observed Tylenol and Ibuprofen unsecured in resident room. Licensee has NOT complied with the terms of the POC. CIVIL PENALTY ASSESSED. *Deficiency cited under Title 22 Regulation 87465(c)(3) pertaining to PRN documentation has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has NOT been cleared. LPA observed both doors in R1 and R2's rooms still open with difficulty. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. *Deficiency cited under Title 22 Regulation 87411(f) pertaining to TB test has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87412(a)(11) pertaining to Health Screen has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. CONTINUED ON LIC 809C DATED 04/10/2026. *Deficiency cited under Title 22 Regulation 1569.625(b)(2) pertaining to Staff Training has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87405(a) pertaining to Administrator Qualifications has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87411(h) pertaining to Specialized Skills has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. LPA observed facility has corrected all items on the technical advisory and assistance given on 03/24/2026. During the visit, LPA observed Staff 1 (S1) is not associated to the facility. Licensee requested and was approved an extension for citation 87463(h)(1). Extension granted until May 4, 2026. Licensee has been advised to maintain compliance in all items previously cited. Based on the observations made during today’s visit, deficiency is 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 as well as appeal rights.the state’s words, verbatim · CDSS document, Apr 10, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Apr 11, 2026

All individuals subject to a criminal record review.. shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c)..This req is not met as evidenced by: Based on interview conducted and record review, Licensee failed to ensure a transfer of criminal clearance was obtained before S1 started employment at the facility which poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Apr 10, 2026

Plan of correction: Licensee to obtain a transfer of criminal clearance and forward proof to LPA by POC due date.

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kimberly Lyman 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, of which three may be bedridden. Facility has an approved hospice waiver for 3 residents and the home currently has 5 residents. There are no residents on hospice during today's visit. Administrator Jaya Pichika has an administrator certificate that has expired on 09/13/2025. Administrator indicates applying for re-certification in March 2026. LPA Lyman along with Administrator Pichika toured the facility at 7:56 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The two story home consists of 6 resident bedrooms, tenant room, owner occupied room, living room, dining room, and kitchen as well as 4 restrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. At 8:00 AM, LPA observed Resident 5's (R5) smoke detector has been removed from the resident's room. LPA observed unsecured Tylenol in R2's room. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 114.4 degrees F and 118.2 degrees F in tested restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA observed exit doors in R1 and R2's rooms are difficult to open and require full body strength to open. The two rooms are designated as bedridden. 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. LPA observed a broken cabinet in kitchen. Smoke detectors tested operational during today's visit. Fire extinguisher is fully charged. CONTINUED ON LIC 809C DATED 03/24/2026 Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise and music therapy. LPA observed an ample emergency food and water supply. LPA reviewed five resident files and three staff files. All resident files contained required documentation including admission agreements, physician reports and resident appraisals. Three out of five residents do not have an updated annual physician report. Two out of three staff do not have proof of all required training hours in the file and one out of three staff do not have a health screen/ TB. LPA reviewed medication administration and storage. Medications are stored in a locked cabinet. LPA observed facility is taking blood pressure for parameters for R1. There are no staff who are licensed professionals. LPA observed facility is not documenting PRN administration. 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 as well as appeal rights.the state’s words, verbatim · CDSS document, Mar 24, 2026

Allegation investigated: Resident developed pressure injury due to staff neglect Licensee did not provide assistance in meeting necessary medical needs Licensee did not ensure that resident was properly fed

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, the Department interviewed staff, residents and witnesses as well as reviewed and obtained documentation such as physician report. Regarding the allegations Resident developed pressure injury due to staff neglect; Licensee did not provide assistance in meeting necessary medical needs, and Licensee did not ensure that resident was properly fed, the investigation revealed the following: Resident 1 (R1) was admitted into the facility on February 5, 2025 with a diagnosis of Lewy Body Dementia, non-ambulatory and unable to meet their needs without assistance per physican report dated 01/31/2025. There is no history of skin breakdown noted. Per interview with Administrator, she recalls seeing redness on both of the resident’s ankles during the pre-assessment of R1, prior to admitting into facility. However, pre-assessment conducted was conducted with CONT ON LIC 9099C DATED 12/23/2025 Substantiated R1’s then private caregiver who reported no such redness was observed. Around the end of June or beginning of July, R1’s responsible party (RP) noticed a small red mark on R1’s heel and brought it to the Licensee’s attention. R1’s RP reported Licensee began putting ointment on the red mark per physician order. Licensee initially confirmed statement regarding ointment but later changed the statement and denied the physician ordering the ointment; Stating instead, that the injury was due to poor circulation. As the RP visited 1-2 times weekly, it was observed that the pressure injury was getting progressively worse. R1’s RP requested Licensee seek medical attention for the pressure injury for R1, but no such medical attention was sought. Text messages obtained from July 7, 2025, to July 30, 2025, show RP repeatedly requested medical attention for the wound from the Licensee. Upon noticing the increasingly worsening condition, R1’s RP made an appointment with Home Base Medical to have one of their physicians visit R1 on June 30, 2025. RP requested that Licensee be present to discuss the pressure injury as RP was unable to make the appointment. During the appointment, it is unclear as to whether the pressure injury was brought to the physician’s attention as the Doctor denied being advised of the injury as well denied recommending any treatment for the pressure injury when interviewed. However, Licensee provided a note written with the attending physician’s signature indicating difficulty obtaining care due to the resident’s behaviors. While the physician confirmed they had signed the note, they reported they did not write the contents of the letter as that had been provided by Licensee. Per interview with Licensee, Licensee reported R1 was not seen by a medical doctor due to insurance issues and ongoing behavioral issues related to the resident’s diagnosis. During interview with the Department, Licensee stated a pressure injury was not a reason to go to the urgent care or Emergency Department. Licensee confirm witnessing an occurrence when R1 was being fed large chunks of meat by a caregiver without the dentures inserted. Licensee indicates there was no glue on-site for the dentures. RP denied ever receiving a request for denture glue from Licensee. Two out of two witnesses confirm Licensee later inserted R1’s dentures after it was brought to her attention, however, after the dentures were inserted, big chunks of meat continued to be forced into R1’s mouth. On July 31, 2025, the resident was removed from the facility by their RP. R1 was assessed for hospice care on August 07, 2025, after moving out of the facility. Hospice documentation notates that due to minimal activity and increased weakness, R1 developed pressure ulcers on the left and right foot. The diagnosis is deep tissue injury on the left lateral foot and stage 3 pressure injury on right lateral foot. On November 21, 2025, R1 passed away. Based on interviews conducted and record review, there is sufficient evidence to substantiate the allegations. Therefore, the preponderance of evidence standard has been met, and the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8) are being cited on the attached LIC 9099D. CONT ON LIC 9099C DATED 12/23/2025 A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49(f). An exit interview was conducted, and copies of this report, LIC 9099-D, Appeal Rights, Immediate Civil Penalty Assessment, and LIC 811 (Confidential Names) were provided to Licensee at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 23, 2025 · control 22-AS-20250804142753

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 24, 2025

87464(f)(1)- Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This req is not met as evidenced by: Based on interviews conducted and record review, Licensee failed to ensure care and supervision was provided to R1 resulting in the development of multiple pressure injuries. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide a written detailed plan on how to address resident's health needs and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(6) · Plan of correction due date: Dec 24, 2025

87464(f)(6) Basic services shall at a minimum include: Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services. This req is not met as evidenced by: Based on interviews conducted and record review, Licensee failed to ensure medical care was obtained for R1 following reports of worsening skin redness. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide a written detailed plan on obtaining medical care for residents and forward proof to LPA by POC due date,

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Dec 24, 2025

87464(f)(4) Basic services shall at a minimum include: Personal assistance and care.. and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating... This req is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1’s assistance and care needed by R1 with feeding was met due to R1 being force fed chunks of meat without dentures inserted. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2025

Plan of correction: Licensee to provide an in-service to all staff regarding proper feeding techniques and forward proof to LPA by POC due date.

Allegation investigated: There are no staff present at the facility

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to intiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and residents. Regarding the allegation that there are no staff present at the facility, the investigation revealed the following: Upon entry, LPA observed Licensee and Licensee's husband at the facility. Licensee's husband is associated to the facility. Licensee indicated staff had resigned earlier in the morning but that Licensee and husband had been present all day. Two out of two residents confirmed Licensee and husband had been present all day. Therefore the allegation is deemed UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit Interview conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Nov 18, 2025 · control 22-AS-20251118111625

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 08/06/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87307(e)(1)(A) pertaining to Heating Devices has been cleared. LPA observed heating device is secured. Licensee has complied with the terms of the POC. Licensee has been advised to maintain compliance in all items previously cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 08/06/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87307(e)(1)(A) pertaining to Heating Devices has NOT been cleared. LPA observed two out of five knobs do not have safety devices. Licensee NOT has complied with the terms of the POC. Based on the observations made during today’s visit, deficiency is 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 as well as appeal rights.the state’s words, verbatim · CDSS document, Sep 12, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(e)(1)(A) · Plan of correction due date: Sep 19, 2025

.. Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire. This req is not met as evidenced by: Based on observation, Licensee failed to ensure cook top knobs have protective mechanisms on. LPA observed two burners do not have protective mechanisms on them. This poses a potential health and safety risk to residents in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Sep 12, 2025

Plan of correction: Licensee to obtain and utilize protective mechanisms for the cook top and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20250804142753. LPA was greeted and granted entry into the facility and explained the reason for the visit. Upon entry, LPA was greeted at the door by Resident 1 (R1) with no staff around. Caregiver was attending to other residents. R1 went into the kitchen and was going through cupboards and LPA observed there are no protective mechanisms on two of the burners (photos). Per physician report dated 02/27/2025, R1 is diagnosed with Dementia. Licensee to forward an updated LIC 500 to LPA by 08/08/2025. Based on the observations made during today’s visit, deficiency is 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 as well as appeal rights.the state’s words, verbatim · CDSS document, Aug 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(e)(1)(A) · Plan of correction due date: Aug 20, 2025

.. Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire. This req is not met as evidenced by: LPA observed two burners do not have protective mechanisms on them and a Dementia resident is wandering in kitchen unsupervised. This poses a potential health and safety risk to residents in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Aug 6, 2025

Plan of correction: Licensee to utilize protective mechanisms and forward proof to LPA by POC due date.

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 03/04/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Water Temperature has been cleared. Water temperature tested at 107.5 in downstairs restroom. Licensee has complied with the terms of the POC. LPA observed Licensee has not utilized protective mechanism on the stove as advised on advisory issued 03/04/2025. During the visit, staff attempted to install a device on cook top and device does not work for the cook top. Based on the observations made during today’s visit, deficiency is 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 as well as appeal rights.the state’s words, verbatim · CDSS document, Apr 14, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(e)(1)(A) · Plan of correction due date: Apr 28, 2025

.. Heating devices shall have protective mechanisms or other measures to prevent access to the device, or to make it inoperable when not in use, in order to reduce the risk of burns or fire. This req is not met as evidenced by: Based on observation, Licensee failed to ensure cook top has a protective mechanism to prevent access to knobs. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 14, 2025

Plan of correction: Licensee to obtain protective mechanism and forward proof to LPA by POC due date.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to continue the annual visit from 03/04/2025. LPA was greeted and granted entry into the facility and explained the reason for visit. At 1:05 PM, LPA reviewed medication storage and medication administration for five residents. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 03/04/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under H & S CODE 1569.618(c)(3) pertaining to CPR training has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87412(c) pertaining to Personnel Records has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Licensee provided a copy of the physician order. Licensee has complied with the terms of the POC. Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations. Copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Kimberly Lyman 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, of which three may be bedridden. Facility has an approved hospice waiver for 3 residents and the home currently has 6 residents and one tenant. Administrator Jaya Pichika has a current administrator certificate expiring on 09/13/2025. LPA Lyman along with Caregiver Berenise toured the facility at 12:41 PM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The two story home consists of 6 resident bedrooms, tenant room, owner occupied room, living room, dining room, and kitchen as well as 4 restrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident 2 (R2) has a faulty smoke detector in the resident's room. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. R1's shower handle is observed to be broken and R3's door handle is broken. Water temperature measured between 107 degrees F and 134.7 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. The downstairs common restroom has discoloration on door and a taped hole in the wall outside the restroom. 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. LPA observed rotten tomatoes, bell peppers, cauliflower and green beans as well as out of date milk in the refrigerator. Smoke detectors tested operational during today's visit. Fire extinguisher is fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise and LPA observed residents participating in exercise. CONTINUED ON LIC 809C DATED 03/04/2025 LPA observed the emergency food and water supply. LPA reviewed six resident files and one staff file. All resident files contained required documentation including admission agreements, physician reports and resident appraisals. R5 does not have a physician order for bed rails. One out of two staff present do not have a staff file. Licensee to forward an updated LIC 500 to LPA by 03/18/2025. Due to time constraints, LPA to return to conduct medication audit. 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 as well as appeal rights.the state’s words, verbatim · CDSS document, Mar 4, 2025

Allegation investigated: Facility staff are not ensuring that trash is removed from the property.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the visit, LPA toured the facility and interviewed Administrator. Regarding the allegation that facility staff are not ensuring that trash is removed from the property, the investigation revealed the following: Upon arrival to the facility, LPA observed a broken book shelf and some miscellaneous debris outside the facility. Administrator indicated there was a scheduled pick up for the items on 12/20/2024. LPA observed a van in the driveway. Administrator stated the facility has not used the van for residents in approximately 5 years and is simply parked in the driveway. LPA observed some boxes inside the van. Based on interview conducted and observation, the preponderance of evidence standard has been met, therefore above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted and a copy of this report was left at the facility along with appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Dec 17, 2024 · control 22-AS-20241216083237

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 24, 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 req is not met as evidenced by: Based on observation, Licensee failed to ensure facility is safe and sanitary. LPA observed a broken bookshelf and miscellaneous debris outside the facility. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: Licensee to remove noted items and forward proof to LPA by POC due date.

Type of visit: Office

Licensing Program Manager (LPM) Alisa Ortiz, and Licensing Program Analyst (LPA) Kimberly Lyman, conducted an informal office meeting with Licensee Jaya Pichika to discuss general compliance concerns at the facility. The following items were discussed during the meeting: Staffing levels and schedule. Physical plant issues. Lack of communication between licensee and the department. Non-compliance with citations. Licensing fees Reporting requirements Licensee agrees as follows: Licensee to communicate with the department on all issues or concerns regarding facility operations. Licensee agrees to contact department for clarification and not make assumptions. Licensee to forward a copy of the LIC 500 to LPA by 10/14/2024 that ensures coverage during hours when residents require services. Facility will maintain compliance of Title 22 at all times and failure to maintain compliance may result in the department taking further action. During the visit, Licensee was offered technical support services with the department and Licensee agreed to a referral for the service. Based on the observations made, deficiency is being sited per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with the facility representative and a copy of the report was provided as well as a copy of appeal rights.the state’s words, verbatim · CDSS document, Oct 11, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87156 · Plan of correction due date: Oct 18, 2024

An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure billed licensing fees have been paid. Licensee owes $1484. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 11, 2024

Plan of correction: Licensee to pay fees and forward proof to LPA by POC due date.