Tessie's Place Loving Care Home #3

Allegation investigated: Staff do not ensure facility is free from pests

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 investigation, LPA toured the facility and interviewed staff and witness. Regarding the allegation that staff do not ensure facility is free from pests, the investigation revealed the following: Staff and witness confirms the prior presence of ants but states they have since been eliminated. Facility obtained extermination services on 08/11/2026 and provided an invoice for the services. Additionally, LPA viewed a video of the contractor spraying the yard. LPA toured the facility and did not observe any ants during today's visit. Based on interviews conducted and record review, the preponderance of evidence standard has been met, Therefore, the allegation is deemed substantiated. Violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with facility representative and a copy of this report provided along with Appeal Rights. Substantiatedthe state’s words, verbatim · CDSS document, Aug 18, 2026 · control 22-AS-20260811135915

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 1, 2026

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 interviews conducted and record review, Licensee failed to ensure facility was clean and sanitary. Witness and staff state facility had ants throughout the facility which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 18, 2026

Plan of correction: Facility provided an invoice for pest control. CLEARED DURING VISIT.

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 07/09/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. During today's visit, LPA observed wood and debris have been removed in the backyard. Licensee has complied with the POC. Licensee has been advised to maintain all items previously deficient in the facility. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 18, 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 07/09/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Spaces has been cleared. During today's visit, Noted items have been secured. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. During today's visit, medications are secured in a locked cabinet. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has NOT been cleared. During today's visit, LPA observed multiple pieces of wood and debris in backyard. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. *Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Water temperature has been cleared. During today's visit, water temperature is in compliance. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Personal Accommodations and Services has been cleared. LPA observed protective mechanisms on the cook top knobs. Licensee has complied with the POC. CONTINUED ON LIC 809C DATED 07/30/2026 *Deficiency cited under Title 22 Regulation 87412(f) pertaining to Personnel Records has been cleared. LPA observed staff file is present. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Licensee obtained physician orders for bed rails. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87202(a) pertaining to Fire Clearance has been cleared. Facility provided proof of correction. Licensee has complied with the POC. Licensee has been advised to maintain all items previously deficient in the facility. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 30, 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 07/09/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA Lyman spoke with Administrator Mel Amante via telephone. *Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Spaces has NOT been cleared. During today's visit, LPA observed the unsecured the cleaning supplies noted in the LIC 809 were still unsecured. Licensee has NOT complied with the terms of the POC. CIVIL PENALTY ASSESSED *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has NOT been cleared. During today's visit, medications are unsecured in an unlocked cabinet. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. *Deficiency cited under Title 22 Regulation 87203 pertaining to Fire Safety has been cleared. During today's visit, the exit gate and the exit door in resident bedroom is not blocked. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87465(h)(5) pertaining to Pre-Poured Medication has been cleared. During today's visit, pre-pouring has been discontinued. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87465(c)(3) pertaining to PRN Documentation has been cleared. During today's visit, facility is documenting PRN medication administration. Licensee has complied with the POC CONTINUED ON LIC 809C DATED 07/17/2026. During today's visit, LPA observed a room built in the garage that is not on facility approved floor plan. Additionally, LPA observed the dining room on floor plan is being used as a staff room and the adjoining patio has a wood wall put up where there should be an exit. Based on the observations made during today's visit, Deficiencies are being cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted and a copy of the appeal rights were given at time of visit.the state’s words, verbatim · CDSS document, Jul 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jul 18, 2026

All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This req is not met as evidenced by: Based on observation, Licensee failed to maintain fire clearance. Licensee built a room in the garage, put up a wall in the patio and is using the designated dining room as a staff room, none of which are on approved floor plan. These items negate approved fire clearance which poses an immediate health and safety risk. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Jul 17, 2026

Plan of correction: Licensee to submit LIC 200 with current floor plan and updated floor plan to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Tessie's PL #3. The purpose of today’s visit was to conduct the required annual inspection. LPA was allowed entry into the home and met with Caregiver Brian Bayron. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 5 residents and the home currently has 4 residents of which 2 are on hospice care. LPA Lyman along with Caregiver Jayson Bayron toured the facility at 8:21 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 4 resident bedrooms, 1 resident bathroom, living room, dining room, and kitchen as well as a staff room and 2 shared hall bathrooms. At 8:25 AM, LPA observed unsecured Comet cleaner in the common restroom. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed 1 resident with full bed rails and 2 residents with half rails. LPA observed the bed for Resident 3 (R3) is blocking the exit. 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 96.2 and 104.7 degrees F in tested restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. At 8:45 AM, LPA inspected the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed three burners on the stove top are inoperable and staff is using a lighter to start the burners. LPA observed multiple items of spoiled food including zucchini, onion and fruit. Knives are unsecured in a kitchen drawer. LPA observed unsecured pre-poured medications in an unlocked kitchen cabinet. Smoke detectors tested operational during today's visit as well as the Carbon Monoxide detector. Fire extinguisher is charged. At 9:00 AM, LPA observed the exit gate on north side of property has a concrete block and a piece of wood blocking the gate making it inaccessible. The other exit gate is unlocked and self latching. CONTINUED ON LIC 809C DATED 07/09/2026 There is a drained pool secured with a fence in the backyard. LPA observed multiple piles of debris throughout the yard including wood pieces and old furniture. LPA observed the facility does not have emergency food or water on-site. LPA observed unsecured bleach and floor cleaner in the laundry room. At 9:15 AM, LPA observed four resident files and three staff files. Three out of four residents do not have a current physician report on file. Three out of three residents do not have a written physician order for bed rails. Two out of two staff files do not have proof of required annual training. One out of three personnel files are not present at the facility. At 10:30 AM, LPA observed medication storage and administration. Medication is stored in a locked cabinet. Facility is not documenting PRN medication administration. Licensee has been asked to submit an updated LIC 308 and an updated LIC 500 as well as a copy of the Administrator's Certificate by close of business 07/13/2026. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted and a copy of the appeal rights were given at time of visit.the state’s words, verbatim · CDSS document, Jul 9, 2026

Allegation investigated: Staff abandoned resident at the hospital.

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Romualdo Amante and explained the reason for the visit. The investigation into the allegation revealed the following. Resident 1 (R1) moved into the facility on January 21, 2026 after being discharged from Kaiser Permanente hospital. On January 22, 2026 R1 moved into the facility and later that day R1 hit a staff member and called 911. Staff reported that the Sheriff arrived and called an ambulance to take R1 to the hospital. R1 was admitted to Mission Hospital for an evaluation. On January 26, 2026, R1 was cleared by the hospital to be returned to the facility. It was reported that the facility initially agreed to take R1 back but then reported to the hospital that due to R1's aggressive behavior they would not take R1 back. The Licensee reported that they went to the hospital to speak to R1 on January 27 and they agreed to take R1 back to the facility. R1 reported that they were told initially by the hospital that they could return to the facility but then was told by the facility staff and hospital that they could not return to the facility. R1 reported that the facility informed them that they could return but they had already made arrangements to move to a new facility. Substantiated The Licensee reported R1 informed them they did not want to return to the facility. The Administrator reported that they didn't want R1 to return due to safety concerns to staff and residents but then informed the hospital they would take R1 back if they wanted to move back to the facility. R1 reported that after she was informed the facility would not take her back she found a new place to live. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with the Administrator and a copy of this report provided along with the citation and Appeal Rights.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 22-AS-20260127083506

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Jan 30, 2026

Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interviews the facility did not take R1 back from the Hospital when they were cleared to be released. The licensee did not serve R1 with a 30 day notice to evict. This poses an immediate Health and Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee agrees to review and comply with regulation 87224 Eviction Procedures. Licensee to submit a statement of understanding regulation 87224. Licensee agrees that 30 day eviction notice will be issued before a resident is evicted. Licensee to submit proof of correction to LPA by POC due date 1/30/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. Facility is licensed for 6 non-ambulatory residents and a hospice waiver for 2. Facility is a single story home with 4 resident rooms, 3 bathrooms, 1 staff room, living room, family room, eat in kitchen and a 4 car garage that is used for storage. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry of the facility. LPA toured the kitchen. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed medications are kept locked in a kitchen cabinet. Knives are kept locked in a kitchen drawer. Smoke detectors and the carbon monoxide detector tested operational. LPA observed there are no night lights in the hallways. LPA observed all resident rooms had the required furnishings and bed linens. LPA observed there are no missing window screens. All 3 bathrooms are clean and operational. Hot water measured 103.2 degrees Fahrenheit in all bathrooms. The garage is kept locked and used for storage. LPA observed the room in the garage is now used to store supplies and tools. LPA observed emergency food and water and furniture stored in the garage. LPA and staff toured the backyard. LPA observed the facility has a pool that is empty. The pool is fenced and the pool gate is locked. The pool is inaccessible to residents. LPA observed the backyard exit gate on the South side of the house is operational. The exit gate on the North side is operational. LPA observed all the ladders and building materials that were present at the facility during the last annual inspection have been removed. LPA reviewed 2 staff files. Staff had CPR training and the required 20 hours of annual training. LPA reviewed 5 resident files. 5 out of 5 residents did not have a current appraisal/needs and care plan. No other discrepancies observed. LPA observed there is no dedicated internet device for resident use. A review of facility records shows there is no verification of a recent emergency drill. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. The Administrator's certificate expires on March 26, 2025. LPA observed the See Something, Say Something sign is 8 1/2 by 11 inches and was posted in the hallway. Facility is a single story home with a 4 car garage with 4 resident rooms, 3 bathrooms, 1 staff room, living room, family room and an eat in kitchen. LPA observed the kitchen window above the sink does not have a screen. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed medications are kept locked in a kitchen cabinet. Smoke detectors and the carbon monoxide detector tested operational. There are LPA observed that bedroom number 2 does not have a window screen. LPA observed all resident rooms had the required furnishings and bed linens. All 3 bathrooms are clean and operational. LPA and staff toured the backyard. LPA observed the facility has a pool that is empty. The pool is fenced and gate is locked. The pool is inaccessible to residents. LPA observed the backyard exit gate on the South side of the house does not close all the way and the gate return spring is not working so the gate does not close after it is opened. LPA observed the backyard exit gate on the North side of the house does close on it's own after it is opened but the fence shakes when the gate closes. LPA observed the fence on the North side of the house shakes and wobbles because it's attachments to the ground are loose. LPA observed old ladders, furniture, boxes, pvc pipe and wood along both sides of the house and throughout the backyard. LPA observed the outdoor furniture (table and chairs) to the side of the pool was old and rusty. LPA observed the table with an umbrella and chairs right outside the family room exit door were in fair condition. LPA observed in the garage of the facility, cabinets and boxes stacked next to the wall to form a makeshift room. LPA observed two chairs a table and a TV and a suitcase along with clothes in the room. LPA reviewed 4 resident files. LPA observed that 3 out of 4 residents did not have a current appraisal. LPA reviewed 2 staff files. 2 out of 2 staff files did not have current annual training and no CPR/First aid training. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interviewed conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Jul 16, 2024

The state marks this report as 10 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.