Terra Linda Christian Homes, Inc. # 5

Allegation investigated: Facility did not seek timely medical

At approximately 1:30PM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegation and met with Staff Members, Ronalyn Ladio and Norman Quiambao. Administrator, Bella Nachor, arrived during visit at approximately 1:40PM. During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Staff did not seek timely medical.” Complaint alleged that Resident 1 (R1) was observed to have difficulty walking on 11/14/2025. Report stated that caregivers were using a wheelchair with R1 to prevent falls since they were not steady on their feet with "wobbly legs." Per report, R1 is usually independent with mobilization and does not require the use of a wheelchair, cane, walker, etc. Report further stated that facility staff were asked if R1 had any new or worsening symptoms and they reported that R1 was fine, happy, and eating, etc. Continued on LIC9099C Unsubstantiated Continued from LIC9099 When asked if the facility called 911, Complainant was told that there was no point to call 911 because R1 was fine. Per Complainant, faciity should have contacted 911 so R1 could be checked out by medical professionals since they had a history of stroke and weakness in legs was a new symptom. Review of R1's documents indicated that facility staff were to contact R1's home health agency in the event R1 experienced increased problems with balance. On 09/30/2025, 10/02/2025, and 10/07/2025, facility staff were instructed by R1's home health agency on the warning signs of stroke and who to contact if R1 experienced signs of stroke. Additional records showed that on 11/14/2025, emergency medical personnel conducted a stroke assessment for R1 where R1 denied being in pain and passed the stroke assessment. Interview conducted with Staff Member 1 (S1) stated that on 11/14/2025, R1 was observed to have unsteady gait by Staff Member 2 (S2). Due to this observation, S2 contacted S1 by phone. Interview further revealed that S1 conducted a stroke assessment over the phone with S2 who reported back their observations. Per S1, R1 was not slurring their speech, did not have drooping in their face, and did not show weakness in their arms. R1 was also not reporting any pain or dizziness, any issues with vision, and ate well during breakfast. S1 also stated that they conducted the stroke assessment two additional times on 11/14/2025 - once via video call and again during their scheduled shift at the facility. During the video call assessment, S1 noted that R1 appeared to have normal behavior apart from their unsteady gait. During the assessment conducted during their scheduled shift, S1 observed R1 to have no complaints of pain and was able to walk by themselves to the restroom without supervision. Interview conducted with Staff Member 2 (S2) stated that on 11/14/2025, they observed R1 to be "walking wobbly." Per S2, R1 denied being in pain or discomfort. Interview further corroborated statements made by S1. Per S2, they contacted S1 about R1's gait and S1 performed a stroke assessment where S2 relayed their observations verbally over the phone. S2 contacted S1 via video call so S1 could conduct a stroke assessment visually where they determined that R1 did not have any apparent signs of stroke. Interview conducted with Home Health Agency Staff stated that on 11/14/2025, they conducted a stroke assessment with R1 and did not observe any stroke symptoms apart from R1's unsteady gait. Based on interviews conducted, record review, and observations made, this allegation is Unsubstantiated. A finding that a complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jan 14, 2026 · control 21-AS-20251118090736

Allegation investigated: Staff did not get timely medical care for resident

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Complaint Investigation regarding the above allegation and met with Staff Members, Elena Mendoza and Ana Renderos. Licensee, Ana Bautista, and Administrator, Bella Nachor, arrived during visit at approximately 9:55AM. Licensee left facility at approximately 11:40AM. During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The Department investigated the following allegations, “Staff did not get timely medical care for resident.” Complaint alleged that Resident 1 (R1) had a fall and sustained bruising to their face, back, and bottom. Complaint also stated that R1 was on hospice and facility should have contacted 911 because R1 was “black and blue.” Continued on LIC9099C Unsubstantiated Continued from LIC9099 Incident Report for R1 received on 05/30/2024 stated that R1 had an unwitnessed fall on 05/27/2024 and sustained a small cut to their eyebrow. Report further stated facility notified R1’s responsible party and contacted Hospice for further instructions. Based on staff interviews conducted, facility staff applied first aid and contacted the hospice nurse. Per staff interviews, the nurse conducted a telephone assessment and determined that R1 did not have a head injury since R1 was able to respond appropriately. Per facility documents, R1’s hospice agency visited on 05/28/2025 for a follow-up. Review of hospice documents indicated that R1 denied hitting their head and denied having post-fall pain. Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that a complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents. Continued from LIC9099A LPA conducted interview with R1’s Responsible Party. Per Responsible Party, they have had no concerns regarding R1’s care at the facility. They have never observed R1 to be bruised or “black and blue,” on their back, bottom, or face. Responsible Party stated that they have seen sores or bruises on R1 before but they have always been aware of where the injuries came from. Responsible Party further stated that the facility provides them with a report about R1 every day and that they have never found or observed loose pills at the facility or pills in R1’s pockets. Responsible Party stated that the information being investigated is false and could not be true. Based on record review, interviews conducted, and observations made, these allegations is Unfounded. An allegation that is Unfounded, means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 19, 2025 · control 21-AS-20250923154348

Type of visit: Case Management - Deficiencies

At approximately 9:15AM, Licensing Program Analyst arrived unannounced to conduct a Case Management - Deficiencies visit and met with Staff Members, Elena Mendoza and Ana Renderos. Licensee, Ana Bautista, and Administrator, Bella Nachor, arrived during visit at approximately 9:55AM. Licensee left facility at approximately 11:40AM. At approximately 9:45AM, LPA observed that PM and Bedtime medications were pre-poured for four residents. Per conversation with Staff Member, the medications were poured the night before on 11/18/2025 and placed in the medication cups this morning, on 11/19/2025. LPA discussed regulation with Licensee, Administrator, and Staff Member. All parties stated their understanding that medications must be poured during the appropriate time frame. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Dec 1, 2025

87465 Incidental Medical and Dental Care:(h)The following requirements shall apply to medications which are centrally stored:(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: based on observations and interview conducted, Licensee did not comply with the section cited above. Four residents had medications pre-poured over 24 hours in advance. This is a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 19, 2025

Plan of correction: Licensee to submit proof of in-service training regarding regulation. Training to include: Training to include Date,Topic, Staff Names, Staff Role, and Signatures. Proof of training/supporting documents to be submitted by POC Due Date of 12/01/2025.

Type of visit: Case Management - Annual Continuation

At approximately 1:40PM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a 1-Year Required Visit and met with Staff Members, Elena Mendoza and Glyzelle Recella. Designated Representative, Bella Nachor, arrived during visit at approximately 2:30PM. LPA reviewed resident medication. Medication was found to be centrally stored and secure. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator/Designated Representative. Signature on form confirms receipt of documentsthe state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Required - 1 Year

At approximately 8:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Members, Elena Mendoza and Glyzelle Recella. Designated Representative, Bella Nachor, arrived during visit at approximately 9:15AM. Licensee, Ana Belle Bautista, arrived during visit at approximately 10:00AM and left facility around 11:15AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents where 1 can be bedridden in Bedroom #2. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 5 residents in care and 2 staff members on-site. At approximately 9:00AM, LPA reviewed the Facility's Staff Roster and found that Staff Member 1 (S1) was not associated to the facility per regulation. Administrator provided proof of transfer paperwork submitted to Regional Office to associate S1 dated 05/23/2025. LPA to follow up on S1's association. LPA conducted a walk-though of the facility with Administrator. LPA observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 5 Resident bedrooms, a staff room, 2 1/2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPA observed multiple instances of unlabeled food in facility’s fridge and freezer. LPA also identified freezer burned food and expired canned goods in facility's cabinet (deficiency cited, regulation 87555(a)). There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected November 2023 (deficiency cited, regulation 87202(a)). Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted September 2025. Continued on LIC809C Continued from LIC809 LPA reviewed staff files and resident files. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Administrator's Certificate for Ana Belle Bautistia (7000300740) and Bella Nachor (7008140740) was current with an expiration date of 3/12/2027 and 05/27/2027. LPA discussed the following topics: Reporting Requirements PIN regarding 911 protocols PIN regarding dementia regulations LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 11/02/2025. LPA unable to complete Annual Visit. Annual Continuation Visit to be conducted at a later date. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator/Designated Representative. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Required - 1 Year

11/21/2024, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 6 residents in care. Facility approved/cleared for 6 non-ambulatory, 1 bedridden (bedroom #2), and hospice waiver for 3. At approximately 2:10pm, LPA and staff member toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. Medications were found to be centrally stored. All rooms were equipped with lighting, night stand, and chest of drawers. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 107.8 and 109.5 degrees F which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 11/2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Toxins, sharps and other items that could pose threat if available to residents in care were located in a kitchen drawer and were found to be secured. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of 3 resident records. All records had the required documentation. LPA conducted review of 3 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. continued on LIC809-C No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Updated Lease Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA)Jill Nakagawa arrived at Terra Linda Christian Homes, Inc #5 unannounced for the purpose of conducting a Required-1 year inspection. LPA was greeted at the door by House Manager Jessica Tadaya. LPA toured the facility with House Manager. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguishers was found to be last charged on 11/10/2023. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured 109 degrees which is within Title 22 acceptable regulation of 105 to 120 degrees F. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in the closet in the hallway locked and inaccessible to residents in care. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats. All bedrooms have lighting & appropriate furnishings. Resident’s beds were outfitted with mattress pads as required by Title 22. Medications are stored and locked in cabinet in kitchen. Continued on 809-C Continued from 809..... The backyard was free of debris and provided lots of space for residents to move about and socialize. There were several fruit trees which the residents enjoy watching them change from season to season. At the time of visit, residents were socializing together in the living room, watching a Christmas movie and enjoying conversation and popcorn. No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 19, 2023