The Farmstead at Dixon

Allegation investigated: Licensee does not ensure facility has adequate staffing to meet the needs of residents

On 09/04/2026 Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a complaint investigation regarding the above allegation. LPA met with Mark Reyes, Administrator to discuss. The complaint alleges that the Licensee does not ensure facility has adequate staffing to meet the needs of residents. The RP states that the facility leaves the memory care residents in their rooms without checking on them at night. RP said the staff often leave the residents alone in a room to watch television as their activity time for the day. LPA inspected the memory care facility on 8/27/2026 and found residents in the dining room eating lunch. At the time of visit there were 22 residents and 3 care staff, 1 activities director, 1 med. tech., 1 one dining staff and 1 housekeeper. A review of staff schedules shows that during AM and PM there are 3 care staff and 1 med. tech. on duty. Unsubstantiated (Continued from 9099) The NOC shift has a med. tech. and caregiver. According to care plans, residents are checked on at least every 2-4 hours throughout the night. LPA reviewed the activities schedule and found that there are activities scheduled throughout the day seven days a week with a full time activities director, specifically for the memory care unit. The activities director stated that residents are encouraged to participate in activities, however they can watch television if they choose - but residents are supervised at all times. Based on the interview of staff, and LPA’s observations of the memory care unit on 11/14/2025, 6/16/2026, 8/27/2026 and 9/4/2026 the allegation that Licensee does not ensure facility has adequate staffing to meet the needs of residents is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Sep 4, 2026 · control 21-AS-20260825121452

Allegation investigated: Staff did not provide adequate supervision, resulting in resident sustaining a fall Staff did not assist resident with ambulating Staff did not assist resident with toileting Staff did not properly report an incident

On 9/04/2026 Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a complaint investigation regarding the above allegations. LPA met with Administrator Mark Reyes to discuss. The complaint alleges that Staff did not provide adequate supervision, resulting in resident sustaining a fall. The complainant states that after an incident regarding R1, staff decided to stop assisting R1, which on 6/10/2026 resulted in R1 falling in the bathroom due to lack of supervision. LPA made observations, reviewed care notes and records, and conducted interviews. LPA interviewed 5 staff, 5 of 5 stated that they were never told not to assist R1. (Continued on 9099-C) Unsubstantiated (Continued from 9099) Review of log and care notes for R1 indicate that R1 received regular care and supervision including supervision and assistance with continence care and other activities of daily living (ADL’s), as is listed in R1’s care summary. LPA observed that R1’s bathroom has grab bars, a hospital bed with side rails and a hoyer lift for safety and assistance with care. In addition, R1 and all residents of memory care, have call bells in the bathroom and bedroom to call for assistance. Based on review of R1’s records, interviews with staff and R1 and LPA’s observations, the allegation that Staff did not provide adequate supervision, resulting in resident sustaining a fall is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The complaint alleges that Staff did not assist resident with ambulating. LPA reviewed resident R1’s care summary which states R1 is non-ambulatory; uses a wheelchair. Based on the care plan for R1, R1 receives full, hand-on assistance with mobility, which LPA observed staff providing. LPA’s review of the care plan and observation of staff and R1, the allegation that Staff did not assist resident with ambulating is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The complaint alleges Staff did not assist resident with toileting. The complainant reported the resident requires assistance with ambulating and toileting. LPA reviewed records of care notes and R1’s Care Summary and found that R1 requires frequent assistance with continence care, and staff are providing that on a regular and as-needed basis, with regular and unscheduled escorts and assistance to the bathroom. Based on the logs documenting assistance with continence care the allegation that Staff did not assist resident with toileting is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The complaint alleges that Staff did not properly report an incident. The complainant states R1 was sent to the ER and even though R1 hit head on something when they fell, R1was able to return to the facility without any injuries. Per complainant a false incident report was submitted. (Continued on 9099-C) (Continued from 9099-C) LPA reviewed Incident Report for R1 and found that the facility followed protocols for an unwitnessed fall and called 911. LPA’s review of R1’s medical records from the Emergency Department incident indicate that R1 was seen by a doctor and released. Based on LPA’s review of the Incident Report and the medical records from the Emergency Room, the allegation that Staff did not properly report an incident is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Sep 4, 2026 · control 21-AS-20260612080523

Allegation investigated: Resident sustained an injury while in care.

On 9/04/2026 Licensing Program Analyst (LPA) Nakagawa arrived unannounced to conduct a complaint investigation regarding the above allegation. LPA met with Administrator Mark Reyes to discuss. The complaint alleges that a resident sustained injury while in care. The complainant states emergency personnel were escorted to resident (R1’s) room by facility staff and found R1 sitting upright on the bathroom floor with visual injuries to their left hand. Emergency personnel were concerned due to observing behaviors of Caregiver helping R1 being verbally hostile toward another staff member and the behavior of R1 with S1 present. LPA Nakagawa reviewed records for R1. On 6/11/2026 caregiver S1 stated that R1 was found in the bathroom with a cut on hand, apparently from hitting it on the wheelchair that was being stored in the bathroom. LPA spoke with R1 who stated that staff are kind to R1and no one is mean. LPA reviewed personnel records of S1 and there were no write-ups or reports regarding the behavior of S1 towards staff or residents. LPA also reviewed phone messages between the Resident Care Coordinator and staff S1 and other staff and there were no issues reported. (Continued on 9099-C) Unsubstantiated (Continued from 9099) Based on the statements of individuals interviewed, the personnel records of S1 and the medical records of R1, the allegation that Resident sustained an injury while in care is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Sep 4, 2026 · control 21-AS-20260611094620

Allegation investigated: Staff fraudulently placed residents in hospice care.

On November 25, 2025,Licensing Program Analyst (LPA) Nakagawa arrived unannounced to complete the investigation regarding the above allegation and to deliver findings. LPA met with Alana Reyes to discuss findings. The complaint alleges that Staff fraudulently placed residents in hospice care. The complainant states that they believe this facility is committing abuse and fraud by forcing patients onto Hospice for a commission check. LPA interviewed 3 independent hospice agencies; 3 of 3 agencies all confirmed that a facility may not demand someone goes on hospice. Residents of a facility may be referred by the family, their primary care physician or the facility, but they must meet the requirements to go on hospice such as failure to thrive, weight loss, decline in health with an expected end of life within 6 months. (Continued on 9099-C) Unsubstantiated Continued from 9099.... The entities that can enroll residents in hospice care are Primary Care Physician (PCP) or other doctors and nurse practitioners whose licenses and training allow them to make the decision along with the patient and/or their responsible party, based on medical condition and guidelines of Medicare. Facility staff do not have the power or authority to place someone on hospice. 3 agencies were interviewed. 3 of 3 stated that there are no commissions paid to facilities for residents enrolling in hospice services. Interviews with responsible parties found that they were not coerced or threatened to sign up for hospice or to enroll with a particular hospice agency. LPA was able to interview 3 families whose family member was/had been on hospice. 3 of 3 stated that they were very satisfied with their choice, which they made independently. Based on the interviews with hospice agencies, staff, and the responsible parties of residents on hospice, the allegation that staff fraudulently place residents in hospice care is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 25, 2025 · control 21-AS-20250918142622

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection of the Farmstead at Dixon on 11/14/2025 and met with Administrator Mark Reyes. LPA toured the facility and found the large common area at the entrance to be warm and inviting. There was ample space for visitors and residents to socialize, including a screened fireplace, an ice cream bar and pizzeria. The dining room provides table service for 3 meals a day. The kitchen was clean and sanitary and had an ample supply of perishable and non-perishable food as required per Title 22. There was also an adequate supply of emergency supplies which are stored in the private dining room. The Memory Care unit appeared clean and comfortably furnished, with activities available throughout the day, including an indoor walking path. There was a Pickle Tasting for Memory Care residents at the time of visit. The Memory Care Unit has its own med. room and medication technician. An inspection of resident rooms found the rooms to be furnished as required and clean and comfortable, with an ambient temperature of 71 degrees F. Assisted Living apartments were also furnished as per regulation, clean and comfortable. The water temperature in ten rooms inspected measured between 110 - 112 degrees F, which is within regulation of 105-120 degrees F. The facility provides Assisted Living with multiple activities daily, including exercise, outings, Bingo, Arts and Crafts, and seasonal activities like a Fall Pie Tasting. The facility has a movie theater for resident use. A tour of the outside of the facility found the grounds to be well-maintained and walkways to be free of obstructions. Continued on 809-C Continued from 809... LPA discussed the following: Submission of the updated: Plan of Operation to include the new Dementia definition LIC500 Emergency Disaster Plan Proof of Liability Insurance No deficiencies were found at the time of inspection. NO CITATIONS ISSUED.the state’s words, verbatim · CDSS document, Nov 14, 2025

Allegation investigated: Staff is not following resident's special diet

Licensing Program Analyst (LPA) Nakagawa arrived unannounced on 10/20/2025 to conclude an investigation and deliver findings regarding the allegation listed above and met with Mark Reyes, Administrator and Maribel Samayoa to discuss. The complaint alleges that Staff is not following resident's special diet. The complainant stated that the resident’s (R1) responsible party checked R1’s camera and saw that someone had brought R1 a plate of shrimp for dinner and told complainant. Complainant stated that R1 is allergic to shrimp and it is listed in more than one place on Farmstead’s records. (Continued on 9099-C) Substantiated (Continued from 9099) LPA reviewed the records for R1 and found that the Physician’s Report dated 4/29/2025 states the section for allergies says “See Attached”. Staff was unable to find the “attached” list; and staff did not follow up with doctor’s office to verify R1’s allergies, however the pre-appraisal, resident assessment and care plan for R1 all list R1’s allergy to shellfish/shrimp. A list of residents and their allergies is posted in the med room for care staff to check which includes R1 and their allergy to shrimp. According to the Administrator there is a list in the kitchen with pictures of the residents and their allergies and it is the dietary staff’s responsibility to review the list before serving. Interviews with R1, Staff (S1) and Staff (S2) confirmed that R1 was served shrimp which was not part of their special diet. Staff S2 reported the resident did not eat the shrimp and staff was able to retrieve the food and bring R1 a meal within R1’s special diet. Based on LPA’s observations, review of records and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation that Staff is not following R1’s special diet is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8), is being cited on the attached LIC 9099D. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-9099-D, Plan of Corrections and Appeal Rights discussed and provided to Administrator Mark Reyes. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 20, 2025 · control 21-AS-20250902171844

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(7) · Plan of correction due date: Oct 20, 2025

87555(b)(7)General Food Service Requirements.Modified diets prescribed....resident's physician... shall be provided. Based on documents and statements of individuals, this requirement has not been met as evidenced by: staff did not follow diet prescribed by R1's physician nor listed in R1's care plan. This posed an immediate risk to the health, safety and personal rights to persons in care.the state’s words, verbatim · CDSS document, Oct 20, 2025

Plan of correction: Administrator shall provide a written plan that outlines how facility will ensure that special diets are served to residents when ordered by physician. Administrator to provide the list of residents and and their allergies usd by kitchen and care staff. Plan and list has been submitted to LPA on 10/20/2025 to clear the POC during LPA's visit.

Allegation investigated: Staff violated residents personal rights Staff did not properly assist a resident during transfers

On 9/23/2025 Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to continue an investigation regarding the above allegations. LPA conducted interviews, made observations and reviewed documents. LPA met with Administrator Mark Reyes to discuss the findings. The complaint alleges that Staff violated resident’s personal rights. The complainant stated that a staff member (S1) pulls a resident’s (R1) arm and tells R1 if they don’t do what S1 says they will get R1 kicked out. LPA interviewed complainant, who stated that there are staff that are not well-trained and should not be working there. LPA reviewed the training and personnel files of S1 and found that S1 is a long-term employe; S1 received all the required training as per regulation. (Continued on LIC9099-C) Unsubstantiated (Continued from 9099) LPA interviewed Administrator and S3 who both stated that S1 has never had any complaints against their care of residents. LPA was unable to interview R1. LPA conducted 5 interviews with staff and family member of R1 and found that there were no concerns or complaints from the 5 of 5 interviewees about the care that S1 provided. Based on the statements of interviewees and the service record of S1 the allegation that Staff violated resident’s personal rights is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence therefore the allegation that Staff violated resident’s personal rights is UNSUBSTANTIATED The complaint alleges that Staff did not properly assist a resident during transfers. The complainant states that a caregiver (S2) is responsible for a resident (R2) falling and now has a full cast. LPA reviewed Incident Reports for a reported fall where a resident suffered a fracture and found no such report. LPA interviewed staff members, R2 and family member of R2. 5 of 5 interviewees stated that R2 had not suffered fracture due to fall of 6/21/2025. LPA interviewed R2 and family member of R2 and asked if Staff properly assist R2. They reported that staff assist R2 properly. LPA reviewed the personnel files for S2 and found that S2 had received all necessary trainings and had no disciplinary actions taken. Based on LPA’s review of medical records of S2, review of staff records, and interviews conducted LPA found the allegation that Staff did not properly assist a resident in transfers is unsubstantiated. Although the allegation may have occurred there is not a preponderance of evidence to substantiate the allegation therefore the allegation that Staff did not properly assist a resident in transfers is UNSUBSTANTIATED. NO DEFICIENCIES FOUND REGARDING THIS INVESTIGATION. NO CITATIONS ISSUED.the state’s words, verbatim · CDSS document, Sep 23, 2025 · control 21-AS-20250624103730

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Nakagawa conducted an unannounced case management inspection. LPA arrived to the facility and was greeted by Administrator Mark Reyes. Mirabel Samoya, Resident Care Coordinator (S2) was contacted to conduct today's inspection at 10:10 AM. The purpose of this case management inspection is to follow up on a self reported incident report submitted to Community Care Licensing (CCL) on 08/08/2025. CCL received an incident report reporting a medication error on 08/06/2025 occurred. Staff (S1) reviewed MARS 08/06/2025 and notified S2 that R1 had received a medication that had been discontinued that same morning. Doctor and family were contacted after medication error. 911 was called due to R1 experiencing some side effects. LPA was informed by S2 that S1 and all other staff handling medications received medication training regarding "Patches and Medications" on 08/07/2025. 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. Appeal Rights Given.the state’s words, verbatim · CDSS document, Aug 14, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 14, 2025

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall... provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review and self-reported incident report, the Licensee did not comply with the section cited above. Resident 1 (R1) did not properly receive a medication doctor had ordered. This poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 14, 2025

Plan of correction: POC cleared at visit: Administrator has submitted training roster of medication training conducted after medication error to CCL on 08/14/2025.

Type of visit: Case Management - Incident

On 07/01/2025, Licensing Program Analyst Jill Nakagawa arrived unannounced to conduct a case management visit and to follow up on staff S1 and status regarding an incident that occurred on 06/23/2025. LPA met with Administrator Mark Reyes and Care Coordinator Mirabeal Samoya. The Administrator was approached by S1 with a video of resident R1 and S1. Administrator conducted an internal investigation. Administrator promptly reviewed the company's policy regarding residents' personal rights with S1 and began disciplinary action. Administrator conducted a staff-wide training regarding resident personal rights. The Department is looking at further disciplinary action against the staff. There were no deficiencies found at the time of visit and no citations issued.the state’s words, verbatim · CDSS document, Jul 1, 2025

Type of visit: Case Management - Annual Continuation

On 01/10/2025, LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to complete the Annual Inspection and met with Administrator Mark Reyes. LPA Nakagawa completed the Care Tool as well as finished a physical tour of the facility. The kitchen and dining room were inspected while there was no meal service going on. LPA observed that the dining room was clean and sanitary and set up for the next meal service. Tableware was clean and tables included a small decoration. Menus are large and easy to read and diners enjoy tableside service. LPA discussed medication management and documentation with the Administrator and new Resident Care Coordinator who will be overseeing the training of medication technicians going forward. Due to errors found in medication records and an incident report self-reporting a medication error a deficiency will be given (see 809-D). The following deficiency was observed (see LIC 809D) and 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 and appeal of rights provided to the Administrator.the state’s words, verbatim · CDSS document, Jan 10, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an Annual Inspection of the Farmstead at Dixon on 01/02/2024 and met with Administrator Mark Reyes. LPA toured the facility and found the large common area at the entrance to be warm and inviting. There was ample space for visitors and residents to socialize, including a screened fireplace, an ice cream bar and pizzeria. The dining room provides table service for 3 meals a day. The Memory Care unit appeared clean and comfortably furnished, with activities available throughout the day. Residents provide their own furniture, but each room inspected had the required furnishings. Assisted Living residents also provide their own furniture; rooms reflecting the interests of the individual. The facility provides activities daily, including exercise, outings and Bingo. Water temperature measured within 105 - 120 degrees F as required in Title 22 in rooms inspected. The kitchen was found to be clean and sanitary with an ample supply of perishable and non-perishable foods. The facility has a movie theatre for resident use. A tour of the outside of the facility found the grounds to be well-maintained and walkways to be free of obstructions. There were no citations issued during today's inspection. LPA will return at a later date to complete inspection due to Administrator's illness.the state’s words, verbatim · CDSS document, Jan 2, 2025

Allegation investigated: Staff mismanaged residents’ medications. Staff did not maintain accurate medication records for residents. Staff did not report incidents involving residents as required. Staff did not appropriately evaluate residents’ service needs. Staff did not provide adequate supervision resulting in a resident wandering away from the facility.

The complaint alleges that staff mismanaged residents’ medications and staff did not maintain accurate medication records for residents. Through interviews LPA learned that staff had been informed by management to document inaccurate information on the MAR. LPA reviewed documents and conducted interviews with staff and found no irregularities in the MARs. A random check of medications found no discrepancies and all medications appeared to have been given as prescribed. LPA could find no evidence to corroborate the allegations therefore they allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated Continued on 9099-C...... Unsubstantiated Continued from 9099... LPA investigated the allegation that staff did not provide adequate supervision resulting in resident (R1) attempting to wander away from the facility. LPA conducted interviews and reviewed records. A review of R1’s current medical records show that R1 is able to leave the facility unassisted. In addition, a review of records does not show that R1 was ever at risk outside of the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. LPA investigated the allegation that Staff did not report incidents involving residents as required. The reporting party cited incident, which occurred on 5/15/2024, believed to have gone unreported. LPA found Administrator did report incidents which required reporting to Community Care Licensing (CCL) within the timeframe specified in regulation; including the incident involving Resident R2 leaving the facility on 5/15/2024 and reported to CCL on 5/16/2024. LPA could find no evidence of incidents which have not been reported per regulations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation that staff did not report incidents involving residents as required is unsubstantiated. The complaint alleges Staff did not appropriately evaluate residents’ service needs. LPA conducted interviews and reviewed records. All records were found to be up to date and assessments completed per regulations based on information provided to the facility. Record reviews revealed that facility made appropriate changes in care plans when additional information was obtained timely. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Sep 27, 2024 · control 21-AS-20240528151013

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a case management visit to follow up on resident R1 and their medication management. LPA met with Administrator Mark Reyes and Care Coordinator Jolene Barnett. The Administrator and Care Coordinator are working closely with R1's family and doctors to ensure that R1's personal rights are respected and that R1's health condition is monitored. LPA observed R1 and found the facility's staff to be diligent in working with R1 to continually maintain a good rapport and high level of trust. There were no deficiencies found at the time of visit and no citations issued.the state’s words, verbatim · CDSS document, Aug 13, 2024

Type of visit: Case Management - Deficiencies

LIcensing Program Analysts (LPAs) Macias and Nakagawa arrived unannounced to conduct a case management visit regarding an incident that was reported by the Administrator pertaining to resident (R1) who eloped from the facility on May 15, 2024. During the course of the investigation record review of resident's files, facility records, and observations were made. The Department concluded that the facility did not meet the responsibility for providing care and supervision to R1. Title 22 regulation states that, the licensee shall provide Safety measures to address behaviors such as wandering, as identified in the resident's needs and services plan. According to the Physician's Report from 01/19/2024, R1 had a diagnosis of dementia and unable to leave facility unassisted The Needs and Services Plan states that R1 needed ongoing redirection due to frequent elopement risk. On May 15, 2024 R1 left the facility unassisted and was not discovered until the 8 PM Medication administration. Resident was recovered unharmed by police, staff and family at 8:15 PM approximately 1/2 mile down the street. The following deficiencies were observed (see LIC 809D) and 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 and appeal of rights provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(b)(2) · Plan of correction due date: Jun 3, 2024

87705(b)(2) Care of Persons with Dementia: Safety measures to address behaviors such as wandering. This requirement was not met as evidenced by: Based on self-reported incident report the facility didn't comply with this section for resident (R1) , who left facility unattended which poses an immediate Health and Safety risk.the state’s words, verbatim · CDSS document, Jun 3, 2024

Plan of correction: Administrator agrees to conduct staff training regarding elopement, wandering and ensuring that all exterior doors are alarmed and monitored. A plan of correction to be submitted to CCL by 6/4/2024.

Type of visit: Post Licensing

Licensing Program Analysts (LPAs) Stefanie Mutialu and Jill Nakagawa arrived unannounced to conduct a Post Licensing Inspection. LPAs met with Mark Reyes, the newly-appointed Administrator. There are currently 10 residents in care. During today’s visit LPAs observed the following items: · All exits were unobstructed · First Aid kit complete and flashlights for emergency lighting · Supply of linens, paper products, and hygiene supplies available · Grab bars and non-slip treatments in resident showers · Fire Extinguishers are current: charged and last serviced 8/10/23, Fire inspection was completed on 01/05/2024 and approves 76 non-ambulatory and 10 bedridden · Administrator Certification (expires 05/15/2025); Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Emergency Disaster Plan, Client personal rights and visitor policy). · Water temperature was tested and within regulation of 105 to 120 degrees F · Auditory devices observed operational · Residents' medications are centrally stored and locked · Food supplies were within regulation · Facility records were reviewed for residents and staff No deficiencies cited during today's inspection. Exit interview conducted with Administrator.the state’s words, verbatim · CDSS document, Mar 8, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jill Nakagawa arrived on 01/23/2024 at approximately 9:30 AM to conduct a pre-licensing inspection at The Farmstead at Dixon and met with Alana Reyes (AR), Administrator and Jason Reyes (JR), Licensee. LPA toured the facility and grounds with AR, JR and staff members. The facility is a new facility, beautifully appointed with spacious surroundings for residents and guests. It will serve independent living, assisted living and memory care. Fire inspection was completed on 01/05/2024 and approves 76 non-ambulatory and 10 bedridden. Fire extinguishers current. Delayed egress has been approved for the exit doors in Memory Care. CCL has a copy of the fire report and facility floor plan. LPA reviewed administration, food service, medication, activities and their schedule, and physical plant. LPA toured the kitchen and observed sufficient emergency food and water and non-perishable food. All appliances working; kitchen and dining area stocked with sufficient supplies. Facility will prepare all food in main floor kitchen and transport food to memory care kitchen to be served by dining staff. The facility has several areas for residents to socialize and enjoy snacks through out the day, with a gelato bar and a bistro area with made to order pizza. Continued on 809-C Continued from 809 Resident bedrooms were completed but unfurnished, except for models, as residents will bring their own furnishings. Memory Care will be on second floor and have safety features on windows and doors, including delayed egress at exits. First aid supplies are adequate. There was an ample supply of PPE and isolation carts were set up and ready to use, if necessary. Hot water was tested at multiple sites and found to be off by 2 degrees in 2 areas. Maintenance adjusted the hot water to be in range. Maintenance will continue to monitor. LPA reviewed records for future residents and staff and found them to be in order and stored appropriately and securely. Medication rooms on first and second floor are well-organized and secure. Component lll was completed successfully. Information regarding resident rights and complaints displayed as required. Proof of liability insurance was provided to LPA. No deficiencies noted at this time. Facility is ready for final approval by Licensing Unit.the state’s words, verbatim · CDSS document, Jan 23, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 86 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Alana Reyes, Administrator; Jason Reyes, Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 16, 2024