The Legacy Collection at Sidlee

We haven’t transcribed this report yet. The complete document is on the state’s site.

Allegation investigated: Alterations made to the facility without permits

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegation. The purpose of this visit is to deliver findings for the above listed allegation. Upon arrival at 12:15 p.m., LPA Mosley was greeted by staff and Administrator / Designee Carthel Mercado and the reason for the visit was explained. On 09/11/2025 the Department received a complaint regarding the following allegation: Alterations made to the facility without permits. To investigate this complaint on 09/16/2025 LPA Mosley conducted the unannounced initial 10-day complaint visit. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 10:30 a.m. LPA conducted an in person interview with the Licensee Representative and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099-C... Substantiated (PAGE 2) Report continued from LIC 9099... On 09/15/2025 at 3:29 p.m.; 3:41 p.m., 09/16/2025 at 4:08 p.m., 10/14/2025 at 1:26 p.m., and 11/3/2025 at 3:50 p.m., LPA corresponded telephonically with the creditable Witness #1 (CW). On 9/16/2025 corresponded via email with CW. During today's visit at 12:28 p.m. LPA and Administrator briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. On the allegation Alterations made to the facility without permits, it is the concern of the Reporting Party (RP) that the facility has undergone major interior changes, including reconfigured bedrooms, added bathrooms, and electrical upgrades without proper permits. To investigate this complaint, LPA conducted an in person interview, telephonic interviews, corresponded via email, and obtained copies of pertinent documentation relevant to the investigation. Interview with Licensee Representative revealed that they are unfamiliar with any specific alterations made to the home. Construction was completed shortly after the home was purchased in March of 2024. They have no knowledge in regard to permits. Interviews with the CW revealed that the property is officially recorded as a 4-bedroom, 2.5-bathroom residence. However, the following un-permitted structural and interior modifications have been made including a wall at the entrance was removed, and the original master bedroom was divided to create Bedrooms 2 and 3, with a new bathroom added to Bedroom 3. Bedroom 1, formerly a den or study, had its window converted into a door and a new bathroom installed, with walls erected to section off the space. Bedroom 4 had its window changed into a door, and the interior door was relocated. Bedroom 5 now includes a door leading to the exterior. The half bathroom was reconfigured, and the bathroom across from Bedroom 4 was modified to include a walk-in shower, with the opposite side of the glass wall remaining a half bathroom. Bedroom 6 now has an attached bathroom. A new half bathroom was added off the kitchen. A door was added from the family room into the garage. Additionally, the property underwent a complete electrical system upgrade. It was noted that that there are no immediate health and safety risk or concerns. The facility has since been compliant with the requests and are in the process of submitting all the required permits for the home’s alterations. As of now there is not a specific deadline for the permits to be made as they are actively working on the request that have been made. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099-C PAGE 2... Based on information gathered during the course of the investigation, interviews and a credible source there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Alterations made to the facility without permits is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiency 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, Dec 5, 2025 · control 29-AS-20250911083156

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Dec 12, 2025

(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on information gathered during the course of the investigation, interviews and a credible source there is sufficient evidence to support the allegation occurred.the state’s words, verbatim · CDSS document, Dec 5, 2025

Plan of correction: The Licensee and Administrator are in the process of actively submitting the requested documentation to the City of TO for permits. The Licensee agrees to update CCLD throughout the process and submit the permits once the process is complete.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 11:30 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator / Licensee Representative, Molly Buck arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and staff / 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. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:52 p.m., hardwire combination of smoke / carbon monoxide detectors, and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 12/31/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 08/13/2025 and are conducted quarterly. Activities were observed in the common areas. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. INTERVIEWS: Starting at 11:38 a.m. two (2) staff and two (2) resident interviews were conducted. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... KITCHEN: The LPA inspected the kitchen/food service area at 11:50 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 111.1 degrees Fahrenheit at 11:52 a.m. Cleaning supplies and other chemicals are kept locked under the sink and inaccessible to residents in care. BEDROOMS: There are six (6) total bedrooms in the facility; all six (6) are designated as private, single occupancy, resident rooms. There is no staff room and Administrator stated that staff remain awake at night. Five (5) out of six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are four (4) total restrooms. Two (2) are designated as a shared / common resident restrooms, Two (2) are designated as a private resident restrooms. The facility also contains a separate shower room for resident use. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 109.2-111.1 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. GARAGE /LAUNDRY ROOM: LPA observed the locked garage /laundry room adjacent to the kitchen. Laundry room has a washer and dryer. LPA observed a sufficient supply of emergency food and water. LPA observed a staff / office area. Medications are stored in the locked cabinets inside the garage. LPA observed an extra refrigerator with food. Refrigerator was checked for proper labels and expiration dates. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including tables and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. LPA observed a swimming pool that was properly fenced and locked at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... MEDICATIONS: Medication review began at approximately 12:02 p.m. Medications are locked, centrally stored in cabinets located in the garage adjacent to the kitchen. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. RECORDS: Resident Records were reviewed beginning at 1:05 p.m. Five (5) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, PRN authorization letters, Home health records, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 2:03 p.m. six (6) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. DOCUMENTS: Documents obtained during the visit include: LIC 500 - facility roster , LIC 9020A - Resident roster and copy of the current Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced post-licensing visit to this facility at 11:00AM. LPA met with co-Administrator Molly Buck. Entrance interview conducted. Beginning at 11:28AM, the LPA, along with co-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: 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, all of which are designated for private resident use. RESTROOMS: The LPA observed 4 (four) restrooms in the facility; 2 (two) are shared restrooms and 2 (two) are designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Water temperature was measured in the common restroom and measured at 116.2 degrees Fahrenheit. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and other sharps were observed locked in a kitchen drawer. Cleaning supplies were observed in a locked under-sink cabinet. Fire extinguisher was observed to be fully charged and purchased 09/23/2024. OUTDOOR SPACE: The back yard area is enclosed. One gate was observed to be self-closing and self-latching. The other gate was locked and is not used as a passageway or resident exit. The backyard contains a shaded seating area and appropriate outdoor furnishings, as well as outdoor activity supplies. The backyard has a pool, which was properly fenced and locked. Report Continued on LIC 809-C RECORD REVIEW: Began at 12:15PM, 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. 4 (four) resident records reviewed were complete and contained all required documents. 5 (five) staff files were reviewed; 1 (one) staff file reviewed did not contain proof of fingerprint background clearance transfer prior to employment. All other staff files reviewed were observed to be in compliance. MEDICATION REVIEW: Began at 03:00PM. Medications for 2 (two) residents were observed. No discrepancies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete. Emergency disaster drills will be conducted quarterly. INTERVIEWS: Throughout today's visit, LPA interviewed both residents and staff. No concerns were noted. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 809-D.) Civil penalty issued in the amount of $500. Exit interview conducted, appeal rights discussed and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kelly Dulek conducted an announced Pre-Licensing inspection at the facility today and met with Licensee Representatives/Applicants Joan Buck-Plassmeyer, Molly Buck, and Craig Plassmeyer. Entrance interview conducted. The facility obtained a fire clearance on 08/28/2024 for 5 (five) non-ambulatory and 1 (one) bedridden (in bedroom #1), with a total capacity of 6 (six) residents. The Licensee Representatives submitted a hospice waiver request for 6 (six) residents, which is pending at this time. The facility also has a dementia care plan pending. Component II was completed on 09/23/2024. During today's visit, LPA completed Component III with the Applicant Representatives. The facility is a single-story home in the Thousand Oaks area, which consists of 6 (six) bedrooms and 4 (four) bathrooms. There is no staff room and Applicant stated that staff will remain awake at night. Beginning at 10:12AM, the LPA, along with Applicant Representatives, conducted a physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed: KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of non-perishable foods, emergency food and water. Knives and sharp items will be stored in a locked drawer in the kitchen island. Cleaning supplies and disinfectants will be stored underneath the locked kitchen sink and in the locked garage. The facility has a sufficient supply of plates, cups and utensils. Medications will be locked and centrally stored in a kitchen cabinet. Files will be stored in a separate locked kitchen cabinet. RESIDENT BEDROOMS/BATHROOMS: The resident bedrooms were observed. All 6 (six) bedrooms are fully furnished for resident use. The resident bathrooms were observed to be clean and sanitary with non-skid tiles, strips and available mats. 2 (two) bathrooms did not have grab bars by the toilets. Hot water was measured in a common resident restroom and measured within the required range. The facility has a sufficient supply of linens and towels. Facility has a call button system for resident use. Report continued on LIC 809-C COMMON AREAS: The living room and 2 (two) dining areas are furnished appropriately. A fireplace was observed in the living room to be inaccessible to residents. Paint, windows, window coverings, and floors are in good repair. The LPA observed the required postings in the common areas. Auditory devices on all exits were operational. Common areas were maintained at 71 degrees during the visit. Hardwired combination smoke alarms and carbon monoxide detectors and fire doors were tested at 12:12PM and were operational at the time of the visit. Fire extinguisher was observed to be fully charged and Applicant stated it was recently purchased. LPA advised Applicant to maintain the receipt from purchase or proof of annual inspection. First aid supplies were reviewed and observed to be in compliance. LPA observed the locked garage to contain laundry area, staff/office area, extra cleaning supplies, and storage. OUTDOOR SPACE: The back yard area is enclosed. One gate was observed to be self-closing and self-latching. The other gate was locked and will not be used as a passageway or resident exit. The backyard contains a shaded seating area and appropriate outdoor furnishings, as well as outdoor activity supplies. The backyard does have a pool, which was properly enclosed and locked. The following needs to be corrected/proof provided to Community Care Licensing (CCL) prior to Licensure: Grab bars need to be installed in 2 restrooms - by the toilet in restroom #1 and by the toilet in restroom #4. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 10, 2024

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: JOAN BUCK-PLASSMEYER, CRAIG PLASSMEYER Interview Method: Telephone interview On September 23, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Sep 23, 2024