The Gate of Beautiful Ripon

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 07/16/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Brittany Rowe, at this time. A brief interview was conducted with the facility caregiver at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Nicole Ell, to inform her that CCL was present at this time. The facility designated Administrator arrived later to this facility. It was learned that this facility was vendorized to be able to accept and retain up to (6) Level 6 residents at any given time. This facility was licensed to serve up to (6) Ambulatory/Non Ambulatory residents at any given time. Current census was 3 residents, of which all (3) of them, were out of the facility at their respectable day programs at this time. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies which were stored in a closet and were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the laundry room cabinets, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. Administrator Certificate for Nicole Ell #7005838740 was observed to have a renewal date of 08/16/2026 at this time. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Laundry area was toured. Cleaning supplies, detergents, and bleach were observed to be locked and made inaccessible to the residents at this time. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. First aid kits were observed to be present and contained all of the required components at this time. Fire extinguishers were observed to be placed near the kitchen area of this facility and in the laundry area and was recently reviewed by the local fire extinguisher company, Touch Down Fire Extinguisher Company, and in compliance at this time. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (3) facility resident files was conducted and noted on the following LIC 858. A review of (4) facility staff files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and noted on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was left with the facility representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 16, 2026

Allegation investigated: Staff do not provide activities for residents in care. Staff do not allow residents to access P&I funds in a timely manner.

Licensing Program Manager (LPM) Liza King arrived unannounced to conduct a complaint investigation. LPM met with Nicole Ell and explained the purpose of the visit.A tour of the facility was taken, 3 months of activities calenders were provided. LPM observed 2 seperate art projects that were drying on the table. The facility has a contracted Activity consultant that provides services every other week with the clients. Invoices for the consultant were provided. LPM observed, one residents room with various arts and crafts, during the visit one resident was was on an outing. Interview was conducted with one staff member and the Adminitrator. During interview resident access to funds was discussed. One resident has a card that is held on the person and able to mange own funds. LPM reviewed P&I cash and receipts, no issues observed. The Admin and ast Admin have a key to the cash and provide direction to the staff on where the key can be accesed. Based on observations, interview and document review the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 19, 2025 · control 27-AS-20250917112838

Allegation investigated: Staff did not prevent resident from sustaining multiple falls while in care. Staff did not prevent resident from sustaining injuries while in care. Staff are not following facility menu. Staff are not following a resident's dietary plan. Staff did not ensure that a resident's catheter was changed in a timely manner. Staff did not seek medical attention for a resident in care. Staff are not properly caring for a resident's infection. Staff are not properly cleaning a resident in care.

Unannounced complaint visit made out to this facility on 07/17/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Nicole Ell, who was briefly interviewed at this time. Current census was 4 residents. The purpose of this visit was to deliver the findings to this facility, and it's representative, from the complaint investigation at this time. Based on a review of the forms and documents retrieved during the course of this investigation, it was observed that there were (4) residents in care at this time. It was learned that resident, R1, was often times allowed to act and conduct themself in a more independent manner as consulted and was also being followed by a behaviorist. It was learned that R1 would often times behave in a manner to seek out attention by not listening to requests from facility staff and refuse to engage when assisting with Activities of Daily Living (ADLs). It was learned that these outbursts and behaviors from R1 were to be ignored until R1 calmed down so that a positive discussion could then be held with R1 in Unsubstantiated order for facility staff to complete and assist with the resident's care needs. It was learned that R1 was able to ambulate and move about the facility independently but often times refused to do so. R1 did have the use of a wheelchair and walker at this time. It was learned that R1 did have a tendency to throw themself on the floor even though R1 was able to get up and move themself off of the floor. By doing this, R1 did suffer lacerations and bruises from self harm and did so even in the presence of the facility caregivers. It was learned that it was very difficult to re-direct and de-escalate behavioral outbursts when R1 got angry. It was learned that the behaviorist recommended that facility staff not engage with R1 when R1 was triggered with their behaviors so that it would slowly calm the situation down by not affirming R1's attention seeking behavior. It was learned that R2 moved into this facility in the latter part of 2024 but this facility was instructed by R2's attending physician that R2 be placed on a lactose free diet due to health concerns. It was observed that the facility menu did take this into account and the meals that were prepared for this resident reflected this detail even though it was not required that this facility maintained and followed a set menu at all times. It was learned that milk was always offered for all meals if desired by the other facility residents. Based on a review of the forms and documents retrieved during the course of this investigation, it was learned that R3 had an in-dwelling catheter, upon admission, which required care in cleaning and maintaining. A review of the medical records for R3 revealed that there was an incident where it was discovered that R3 had sustained a Urinary Tract Infection (UTI) on 01/30/2025. Medical records were reviewed for R3 detailing admission into the local medical institution for treatment and eventual discharge with antibiotics at that time. It was observed that the prior hospital visit conducted for R3 in December 2024 did not present any issues related with the catheter. It was observed that it was noted as being present at that time without any further issues. It was observed that a care plan was put into place where R3 would receive regular maintenance with R3's catheter and have it removed, cleaned, and re-inserted at the local medical institution on a monthly basis. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 17, 2025 · control 27-AS-20250408124304

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 07/17/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Nicole Ell. A brief interview was conducted with the facility designated Administrator at this time. Current census was 4 residents.. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 06/13/2025. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 06/13/2025: All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 06/13/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Nicole Ell, who was briefly interviewed at this time. Current census was 4 residents, of which (3) residents, were out of this facility attending their respectable day programs at this time. It was learned that (1) resident was out of this facility at the hospital at this time. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility does have a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. It was learned that there weren't any residents deemed to be bedridden at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility restroom, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the laundry room were observed to be present and functional at this time. Laundry room was toured at this time. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 7005838740, for Nicole Ell was observed to have an expiration date of 08/16/2026 and in compliance at this time. Forms and documents were being updated in order to renew this Administrator certificate at a later time. Medication cabinet, located in the facility laundry room, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the laundry room, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers were located in the kitchen area and laundry room and observed to have been annually inspected by the local fire extinguisher company, Assured Fire Company, on 03/18/2025 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (5) facility personnel records was conducted and noted on the following LIC 859. A review of (4) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Case Management - Incident

Unannounced case management visit made out to this facility on 06/13/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Nicole Ell, who was briefly interviewed at this time. Current census was 4 residents, of which (3) residents, were out of this facility attending their respectable day programs at this time. It was learned that (1) resident was out of this facility at the hospital at this time. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility does have a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. It was learned that there weren't any residents deemed to be bedridden at this time. The purpose of this visit was to follow up on a reported incident for a resident, R1, at this time. A review of the file for R1 was conducted at this time. A review of the care plan for R1 was conducted and was observed to have been completed on 09/16/2024 upon admission. There were no deficiencies observed or cited during today's case management visit at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 06/20/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Nicole Ell, who was briefly interviewed. It was learned that there weren't any residents under the care of hospice at this time. It was learned that there weren't any residents who were receiving services through home health at this time. This facility does have a hospice waiver approved to accept and retain up to (6) residents at any given time. This facility also has, on file, a program to accept and retain residents diagnosed with dementia at this time. Current census was 0 residents. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Nicole Ell. Forms and documents were submitted to renew for Certificate #6019506740 that was set to expire on 08/16/2024. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in hallway closet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated Administrator at this time. The medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually purchased on 06/20/2024 from the hardware store with receipts attached and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of the facility resident files was not conducted since there weren't any residents in care at this time. A review of (1) facility personnel file was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 20, 2024

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 01/03/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person Serena Phylombia. A brief interview was conducted with the facility staff person at this time. This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Nicole Ell, to inform her that CCL was present at this time. Current census was 1 resident. The purpose of this visit was to verify the plan of correction that was required to be completed for deficiencies that were previously cited on a prior visit conducted on 12/06/2023. Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. The deficiencies were corrected and brought into compliance at this time. Clearance letters were printed and a copy was given to the facility staff person at this time. There were no further deficiencies observed or cited during today's plan of correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 3, 2024

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 12/06/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Nicole Ell. A brief interview was conducted with the facility designated Administrator at this time. Current census was 1 resident. It was learned that there weren't any residents under the care of hospice at this time. This facility does have a hospice waiver to be able to accept and retain up to (6) hospice residents at any given time. It was learned that there weren't any residents receiving any care from a home health care agency at this time. It was learned that there weren't any residents diagnosed with dementia at this time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Nicole Ell. Additional forms and documents were reviewed to make sure that the renewal process was initiated prior to the certificate expiration date of 08/16/2024 with certificate # 6019506740. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in a separate room, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator at this time. This medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguishers, located throughout this facility, were observed to have been annually purchased on 04/23/2023 from the local hardware store and in compliance at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted. A review of (1) facility resident records was conducted and noted on the following LIC 858 form. A review of (2) facility staff records was conducted and noted on the following LIC 859 form. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 6, 2023