Terene Manor

Type of visit: Required - 1 Year

At approximately 9:00 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Administrator Teresita Shevick. Terene Manor is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house with a second level above the garage which is the licensee's residence. The facility has an approved fire clearance for six (6) non-ambulatory residents, one (1) of whom can be bedridden. The facility has a Hospice Waiver for three (3) residents. Upon arrival, LPA was informed that there were five (5) residents in care and three (3) staff members on-site. At approximately 9:10 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:20 AM, LPA toured the facility with Administrator Shevick. All exits were clear and unobstructed. The facility's one (1) fire extinguisher was last serviced and tagged on 3/24/2025. The fire alarm system was inspected in 1/2025. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills Quarterly. The last disaster drill was conducted on 7/30/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. No deficiencies cited during today's visit. Exit interview conducted. Copy of report discussed and provided to Administrator Shevick. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 12, 2025

Allegation investigated: Staff emotionally abuses residents while in care. Staff verbally abuses residents while in care. Residents are not accorded dignity in their personal relationship with staff.

Licensing Program Analyst (LPA) Robert Frank arrived unannounced to deliver findings regarding the above allegations and met with facility Administrator Teresita Shevick. During the investigation LPA interviewed four (4) staff members, five (5) residents, reviewed files and took photographs of parts of the facility. Staff emotionally abuse residents in care Staff verbally abuse residents in care, Residents are not accorded dignity in their personal relationship with staff. Complaint alleges that an identified staff does not accord dignity in their relationships with residents by emotionally and verbally abusing residents in care by speaking to them disrespectfully, making them feel like they are burdens and frequently arguing with them. During resident interviews, LPA asked how staff treated residents. Continued on 9099-C... Substantiated ...Continued from 9099 Resident responded stating that, “I never get anything positive, just negative feedback. It’s hard to take when you can’t take care of yourself” and that staff “like to push the weak down” adding that the identified staff has favorites, is mean to them and is always on their case. Resident reported that they “have basically stopped talking as I just don’t want to deal with it”. “It” being in reference to being treated negatively. Another resident interviewed reported that a resident stated that a staff member yelled at them and other residents. They stated, “we would have yelling matches”. When asked to elaborate, the resident stated, “we used to battle.” When asked if the facility provides snacks a resident said, “I am afraid to ask for snacks, I don’t want to get yelled at.” Resident stated, “I need to be careful when I open my mouth”. Based on LPA’s interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D. Exit interview conducted. Copy LIC-9099, LIC-9099C, LIC-9099D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Shevick. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 23, 2025 · control 21-AS-20250624091321

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 14, 2025

87468.1Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above in that two (2) out of five (5) residents reported incidents of verbal and emotional abuse which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Licensee to schedule training with an approved outside vendor or Long Term Ombudsmen for all care staff regarding personal rights of residents. Licensee to provide scheduled training date to Community Care Licensing (CCL) by due date of 10/1/2025. Proof of training must include Staff Names and Signatures. Proof of training to be submitted to CCL by POC due date of 10/14/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Oct 14, 2025

87468.1Personal Rights of Residents in All Facilities(a)Residents in all residential care facilities...the following personal rights:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions...such as... interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by:Based on observation and interviews, the licensee did not comply with the section cited above in that two (2) out of five (5) residents reported incidents of verbal and emotional abuse which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Licensee to schedule training with an approved outside vendor or Long Term Ombudsmen for all care staff regarding personal rights of residents. Licensee to provide scheduled training date to Community Care Licensing (CCL) by due date of 10/1/2025. Proof of training must include Staff Names and Signatures. Proof of training to be submitted to CCL by POC due date of 10/14/2025.

Type of visit: Case Management - Other

At approximately 12:15 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a case managment visit. During an investigation visit for complaint 21-AS-20250624091321, LPA was told by facility Administrator Teresita Shevick that resident meals where held at the following times: Breakfast: 8:00 AM Lunch: 12:00 PM (LPA observed lunch being served during today's visit) Dinner: 3:30 PM The time between dinner and breakfast is 16.5 Hours. California Code of Regulations (CCL) 87555(b)(1) states that no more than fifteen (15) hours shall elapse between the third and first meal. A Technical Violation (TV) is being issued for the time between dinner and breakfast exceeding fifteen (15) Hours. Exit interview conducted. Copy of report, LIC 9102 discussed and provided to Administrator Shevick. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a required- 1 year inspection, on 1/21/25 at approximately 12:30pm, and met with Administrator Teresita Shevick. LPA observed a caregiver on duty during the inspection, Cindy Magnuson. Facility is fire cleared for six (6) non-ambulatory residents, of which one (1) may be bedridden. Facility has an approved dementia plan of operation. Hospice waiver approval is for three (3) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. Per file review. last emergency drills were held on 12/12/24, Earthquake drill, and on LPA reviewed five (5) resident files; All records were complete. LPA reviewed four (4) staff files, including training. All staff had required criminal record clearance. All staff had required first aid certification. S4, caregiver had both first aid and CPR certification. LPA toured the facility with the Administrator. Hot water was checked at 117.1 degrees Fahrenheit, which is within regulation. The facility was observed to be at a comfortable temperature. The food supply was sufficient in perishable and non-perishable items. All exits had working auditory alarms, all exits were clear and unobstructed. There was a sufficient supply of paper products, cleaners/disinfectants, personal protective equipment (PPE), and hygiene products. There was sufficient lighting in all common areas, resident rooms, hallways, and bathrooms. Sufficient furnishings throughout the facility for resident use. Fire extinguisher was serviced and tagged as required. LPA discussed fire clearance and regulation requirements with the Administrator regarding the backyard walkways and fire exit path are to remain clear and unobstructed at all times; Administrator stated to the LPA their understanding of the above information discussed. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 2/21/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate. The following deficiencies were observed by the LPA during the inspection: Per LPA's file review, there have been two (2) emergency disaster drills held, 12/24 & 10/24, both were earthquake drills; In review of facility emergency disaster drills the requirement has not been met. This deficiency will be cited, HSC 1569.695 (c) -A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D. Per LPA file reviews, staff, S1, S2, & S3, all lack current CPR certification.This deficiency will be cited, HSC 1569.618(c)(3)-Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator/Licensee Teresita Shevick. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Jan 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and was greeted by Administrator, Teresita Shevick. Required postings observed. Annual fees current. LPA/Administrator initiated a tour of the facility at 9:00 AM and made the following observations: Facility consists of two stories but residents occupy only the lower floor. Door to staff living areas were locked. Laundry room was also locked. Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 112.5, 112.8 and 110.5 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Toxins was inaccessible to residents in care. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked in a cabinet and in a locked box in the refrigerator. Facility has a camera without audio in the common living room. LPA confirmed that there were not any cameras in resident rooms. Fire extinguisher was last inspected January, 2023. Smoke alarms tested were operational as well as the Carbon Monoxide detector. Exit doors have auditory alerts that were functional at time of visit. Last disaster drill conducted on 2018. Medications & medication records reviewed. File review was initiated at 9:30 AM. Three staff files and four resident files were reviewed. All residents care plan and medical assessment has been updated within the last 12 months. Staff have required 1st aid/CPR certificates, but 3 out of 3 (S1, S2 & S3) staff have not completed their 20 hours required annual training. Administrator Certificate for Administrator, Teresita Shevick 6006577740 expires 8/13/25. Administrator to submit updates of the following documents by 2/6/24: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and a copy of Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and copy of this report was given.the state’s words, verbatim · CDSS document, Jan 30, 2024