The Estate Home 1

Allegation investigated: Manual fecal impaction removal on resident

At 9:50 A.M., Licensing Program Analyst (LPA) Valeria Conway, conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. LPA was greeted by Back-Up Administrator, Francie Demerey, and explained the purpose of the visit. At 9:57 A.M., Licensee, Estrella Alarcon contacted LPA via telephone and explained that they were unavailable during today's visit, but authorized Back-Up Administrator to sign today's reports. Entrance interview conducted. On 01/14/2026, LPA Conway conducted an initial 10-day visit. During the visit, between 9:05 A.M. and 12:50 P.M., the LPA conducted a physical plant tour, interviewed the administrator and two (2) staff members, and reviewed files, medication logs and obtained copies of pertinent documents relevant to the investigation. Additional in-person interview with Staff #1 (S1) was conducted on 01/28/2026. During today’s visit, LPA conducted a brief tour of the physical plant. The following was determined: Continued on LIC 9099-C Substantiated Continued from LIC 9099 Regarding the allegation of “Staff performed manual fecal impaction removal on resident”, it was alleged that on or around 01/12/2026, Resident #1 (R1) stated that staff hurt R1’s bottom. It was further reported that S1 informed R1’s family that R1 was constipated and compacted therefore, S1 removed the fecal matter from R1s bottom with S1s hands. Interviews conducted during the course of the investigation reflected that R1 was admitted to the facility on 01/01/2023. Per R1’s Physicians Report dated 09/03/2025, R1 has a primary diagnosis of dementia, and is non-ambulatory. R1 is noted to be confused/disoriented, is able to follow instructions; however, unable to communicate needs. R1 requires assistance with all Activities of Daily Living (ADLs) except for feeding R1’s self. Additionally, R1 requires transfer assistance and incontinence care due to bowel/bladder impairment. Moreover, R1 is unable to determine their own need for prescription/non-prescription medication. During the course of the investigation, interview with Staff #1 (S1) reflected that S1 administered suppositories and performed digital stimulation to the rectum with ointment to assist R1 with bowel movements. S1 is not an Appropriately Skilled Professional (ASP) and was unaware that such procedures could only be performed by an ASP. Medication records further documented the administration of Bisacodyl 10MG suppositories on an as-needed basis during the months of November and December 2025. LPA compared the initials recorded on the documentation reviewed with the staff interviewed and observed that the initials appeared to indicate that facility staff administered the suppositories to the resident. Administrator denied allegation, however, interview with R1’s family reflected that administrator and S1 informed the family that S1 performed manual fecal removal on resident. Based on information gathered during the course of the investigation, and interviews there is sufficient evidence to support the allegation occurred. Therefore, the allegation of “Staff performed manual fecal impaction removal on resident” is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided. Continued from LIC 9099 Regarding the allegation of “Resident sustained multiple bruises due to staff neglect or physical abuse” it was alleged that Resident #1 (R1) was being physically and mentally abused by a staff member. Per the Reporting Party (RP), R1 had sustained multiple unexplained bruises and that facility staff were unable to explain how they occurred. Interviews conducted during the course of the investigation reflected that R1 was admitted to the facility on 01/01/2023. Per R1’s Physicians Report dated 09/03/2025, R1 has a primary diagnosis of dementia, and is non-ambulatory. R1 is noted to be confused/disoriented, is able to follow instructions; however, unable to communicate needs. R1 requires assistance with all Activities of Daily Living (ADLs) except for feeding R1’s self. Additionally, R1 requires transfer assistance and incontinence care due to bowel/bladder impairment. Moreover, R1 is unable to determine their own need for prescription/non-prescription medication. Interviews conducted reflected that R1 becomes agitated when visitors leave the facility, displaying changes in mood and attempting to leave with the visitor. Additionally, interviews reflected that when R1 displays these behaviors staff respond by attempting to calm and redirect R1 and offering alternative activities. The Administrator further stated that R1 has fragile skin and takes blood-thinning medication and other medications that may increase the risk of bleeding and bruising. Interviews with other residents did not reveal any concerns related to staff abusing residents. Administrator and staff denied allegations of physically and mentally abusing residents. During the visit, LPA did not observe visible bruising on residents. Additionally, during prior visit on 11/07/2025 unrelated to this complaint, LPA observed that R1 had visitor remain at the facility for a few hours. However, once the visitor left the facility, R1 became visibly upset and agitated and staff responded by redirecting R1 in a calm manner. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Resident sustained multiple bruises due to staff neglect or physical abuse” is deemed Unsubstantiated at this time. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 23, 2026 · control 29-AS-20260112144756

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87622 · Plan of correction due date: Sep 24, 2026

Fecal Impaction Removal, Enemas, and/or Suppositories...use of suppositories under the following circumstances:...according to physician's orders by either the resident or an appropriately skilled professional. This requirement is not met as evidenced by. Based on interview and record review, the licensee did not comply with the section cited above as digital stimulation and suppositories are being administered by non-skilled medical professionals.the state’s words, verbatim · CDSS document, Sep 23, 2026

Plan of correction: A plan to comply with regulation cited and in-service training from a skilled professional regarding this regulation will be submitted to LPA prior to POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced CASE MANAGEMENT- DEFICIENCIES visit to this facility. The case management is being conducted due to deficiencies observed during the investigation of complaint control # 29-AS-20260112144756. LPA was greeted by Back-Up Administrator, Francie Demerey, and explained the purpose of the visit. At 9:57 A.M., Licensee, Estrella Alarcon contacted LPA via telephone and explained that they were unavailable during today's visit, but authorized Back-Up Administrator to sign today's reports. Entrance interview conducted. During complaint interviews conducted, LPA determined that facility staff and the Administrator did not identify, document, and report bruising observed on Resident #1’s (R1’s) hand and temple and did not ensure the changes in the resident’s physical condition were brought to the attention of the Department of Social Services (DSS), R1’s physician and/or responsible person, as required. The Administrator stated that the bruising was initially identified and reported by R1’s family members and subsequently brought to the attention of the Administrator and facility staff. Family members interviewed stated that the bruising was very noticeable and expressed concern that the facility should have identified and reported the physical changes to them rather than the family member identifying the changes and bringing them to the facility’s attention. Staff interviewed were unable to provide an explanation regarding the origin of the bruising. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, deficiencies cited, copy of report and appeal rights provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Oct 8, 2026

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes... a physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interview and record review, the facility did not comply with the above cited section, as R1 sustained an unexplained injury to their left hand and temple while in care, which posed a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2026

Plan of correction: Back-up Administrator and Licensee agreed to review regulation CCR 87466 and write a statement of understanding to ensure compliance with regulatory requirements. Statement will be submitted to CCLD no later than POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced visit at the facility in conjunction with an investigation of complaint control # 29-AS-20260112144756. During the investigation, LPA observed deficiencies unrelated to the complaint allegations. During the physical plant tour conducted at approximately 11:00 A.M., the LPA observed Resident #1’s (R1’s) bed was equipped with full bed rails. Interviews reflected that upon R1’s admission to the facility, R1 was receiving hospice services; however, hospice services discontinued on 03/17/2023. Review of R1’s Physician’s Report dated September 3, 2025, documents an order for half bed rails for mobility assistance. Furthermore, during the medication audit LPA observed suppositories were not stored in their original packaging, which lacked a pharmacy label identifying the resident to whom the medication was prescribed. Administrator stated that the packaging was discarded. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 14, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jan 15, 2026

87608(a)(5)(B) (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, interview, record review, the licensee did not comply with the section cited above. Full bedrail observed on resident's #1 bed and they are not currently on hospice. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 14, 2026

Plan of correction: Admin agreed to remove the full bed rails and replace them with half bed rails to provide mobility assistance. Administrator acknowledged understanding full rails is a form of restraint and not allowed unless under hospice services.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(5) · Plan of correction due date: Jan 15, 2026

Incidental Medical and Dental Care (h) The following requirements shall apply to meds which are centrally stored: (5) Each resident's med... stored in its originally received container. No meds shall be transferred between containers.This requirement is not met as evidenced by: Based on observation, the administrator did not comply as medications were observed without its original labeled container which posed an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 14, 2026

Plan of correction: Administrator agreed to write a statement of understanding on regulation cited above and have in-service training will all staff on this regulation. Statement of understanding due before POC due date. In-service training due 1/22/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 8:45 A.M. LPA was greeted by caregiver, Felicidad “Fely” Cacal who contacted the administrator by telephone. At 9:16 A.M., Administrator, Estrella (Lillian) Alarcon, arrived at the facility, LPA explained the reason for the visit. LPA is conducting the required annual visit for The Estate Home #1 and The Estate Home #2 simultaneously. Entrance interview conducted. Beginning at 10:20 A.M., the LPA, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Hardwired combination smoke and carbon monoxide detectors were tested at 10:11 A.M. and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and purchased on 11/06/2025. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms for resident use and one (1) designated for staff use. RESTROOMS: The LPA observed six (6) restrooms in the facility. Five (5) are for resident use and one (1) is designated for staff use only. Resident restrooms are clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperature was measured in all resident restrooms. All restrooms measured within the required range. LPA did not check hot water temperature in the staff restroom. Continued on LIC 809-C Continued from LIC 809 COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. Two (2) fireplaces were observed to be adequately screened. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a comfortable temperature of 72 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. LPA conducted a review of expiration dates on product labels. At 10:29 A.M. hot water was measured at 115.7 degrees Fahrenheit. OUTDOOR SPACE: The backyard is shared between this facility and another related facility. The shared yard has a covered outdoor area equipped with furniture for residents’ use. The facility does have a fountain, but it was observed to be empty at the time of the visit. GARAGE/LAUNDRY ROOM: Adjacent to the staff room is a garage. LPA observed a washer and dryer. Garage remains locked. Garage contains cleaning, incontinence products, and PPE supplies as well as storage. Garage is shared with next door facility. RECORD REVIEW: Between 12:45 P.M. and 1:55 P.M., Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Six (6) resident records reviewed were complete and contained all required documents. Five (5) staff files reviewed were complete and contained all required documents. Continued on LIC 809-C Continued from LIC 809-C EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to emergency disaster plan are adequate, complete, and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented on 10/12/2025. MEDICATION REVIEW: At 2:05 P.M. medications for six (6) residents were observed. All residents' prescription medications were observed to be maintained and administered in compliance with regulation at the time of the visit. During today's visit, LPA gathered the following items: Personnel Records (LIC 500), Current certificate of insurance, Resident Rooster (LIC 9020). No citations issued today. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:00 A.M. LPA met with Licensee/Administrator Estrella (Lillian) Alarcon. Entrance interview conducted. Beginning at 10:20 A.M., the LPA, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Hardwired combination smoke and carbon monoxide detectors were tested at 11:00 A.M. and were functional at the time of the visit. Fire extinguishers was observed to be fully charged and purchased on 08/12/2024. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms for resident use and 1 (one) designated for staff use. RESTROOMS: The LPA observed 6 (six) restrooms in the facility. 5 (five) are for resident use and 1 (one) is designated for staff use only. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Between 10:35 A.M. and 10:45 A.M. hot water temperature was measured in all resident restrooms. Four (4) restrooms measured within the required range, however restroom next to room # 6, measured 131.3 degrees Fahrenheit. LPA did not check hot water temperature in the staff restroom. Continued on LIC 809-C COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. Two (2) fireplaces were observed to be adequately screened. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The facility maintained a comfortable temperature of 73 degrees. Facility provides sufficient space to accommodate both indoor and outdoor activities. LPA observed a working phone available for residents use whenever needed. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. LPA conducted a review of expiration dates on product labels. At 10:48 A.M. hot water was measure at 128.4 degrees Fahrenheit. OUTDOOR SPACE: The backyard is shared between this facility and another related facility. The shared yard has a covered outdoor area equipped with furniture for resident use. The facility does have a fountain, but it was observed to be empty at the time of the visit. GARAGE/LAUNDRY ROOM: Adjacent to the staff room is a garage. LPA observed a washer and dryer. Garage remains locked. Garage contains cleaning, incontinence products, and PPE supplies as well as storage. Garage is shared with related facility. RECORD REVIEW: Between 11:15 A.M. and 12:35 P.M., Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Six (6) resident records reviewed were complete and contained all required documents. Three (3) staff files reviewed were complete and contained all required documents. EMERGENCY DISASTER PLAN: Facility was evacuated on 11/06/2024 due to the “Mountain Fire”. During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to emergency disaster plan are adequate, complete, and updated annually, as required. Emergency drills are conducted monthly, with the last drill documented on 11/02/2024. Continued from LIC 809 Continued from LIC 809-C INTERVIEWS: Throughout the visit, LPA interviewed 2 (two) staff and 1 (one) resident. MEDICATION REVIEW: At 1:15 P.M. medications for six (6) residents were observed. All residents' prescription medications were observed to be maintained and administered in compliance with regulation. During today's visit, LPA gathered the following items: Personnel Records (LIC 500), Current certificate of insurance, Resident Rooster (LIC 9020). Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 18, 2024