The Residence IV

Type of visit: Required - 1 Year

At 9:05am, on 4/28/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee/Administrator Meynard Marcos, announced who he was and the reason for the visit. Backup Administrator and LPA conducted a full tour of the facility. This facility is a single-story residential home with six private resident bedrooms and three full bathrooms (one is en-suite and two are for public use). There is a living room, dining space, and a kitchen. Access to the laundry area and garage is through locked doors for resident safety. In the garage is a staff break room, permitted per the Licensee. LPA noted that the backyard has seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the kitchen in the green compression range, purchased on 2/28/2026. LPA tested facility hot water at 110.8°F, within regulation temperatures 105-120°F. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility has no obstructions in hallways, doorways or exits. Medications are locked in a cabinet in the kitchen area. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records. Staff and client files are locked. LPA conducted a staff and resident file review. During the tour at 9:21am LPA noted in bedroom #1 an L-shaped hole in the east wall approximately three inches long in both directions, on the north wall below a solid faceplate an approximate one inch by one... (Continued on LIC809-C) inch hole in the dry wall, as well as, an electrical outlet with no faceplate and blue painters tape covering the wires. In the public bathroom between bedrooms #4 and 5 a round hole in the dry wall, one inch in diameter. At 9:33am in the living room next to the couch a round indentation in the dry wall approximately two inches in diameter. Many of the interior shelves of the kitchen cabinets have debris and residue. At 9:30am LPA noted in the un-lockable storage room next to bedroom #6 a plastic storage container with multiple drawers. In two of the drawers were two bottles of staff prescription medication and diabetic supplies including insulin pen needles. At 9:37am in the kitchen refrigerator a three code dial locking medication box left unlocked with medication inside of it. At 9:53am on the north side of the backyard a bottle of auto antifreeze approximately a quarter full. LPA and Licensee conducted a review of the annual care tool modules. Exit interview conducted, deficiencies cited on the LIC809-D page, report signed, report and appeal rights provided to the Licensee.the state’s words, verbatim · CDSS document, Apr 28, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff yell at residents Staff do not speak to residents with dignity and respect

On 04/22/2025 at 08:16am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to investigate the allegations to this complaint and conduct an annual facility inspection. LPA met with Licensee Meynard Marcos and explained the purpose of the visit. During the visit, LPA interviewed staff, clients, licensee, and obtained relevant documents. On the allegations: Staff yell at residents and staff do not speak to residents with dignity and respect. It was alleged Staff 1 (S1) aggressively speaks to the residents, yelling at residents several times within a few minutes, and telling them repeatedly to sit down. Interviews revealed S1 will speak with a raised voice to residents and commandingly tell residents to sit down repeatedly. Based on the information obtained, the allegations are deemed Substantiated at this time. Exit interview,the state’s words, verbatim · CDSS document, Apr 22, 2025 · control 29-AS-20250421084939

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 6, 2025

(a)Residents... shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when S1 raised their voice commandingly at the residents and repeatedly commanded them to sit down.the state’s words, verbatim · CDSS document, Apr 22, 2025

Plan of correction: Licensee agreed to train all staff on Residents Personal Rights and email LPA a signed roster of staff who participated in the training and any documents reviewed at the training by 05/06/2025.

Type of visit: Required - 1 Year

At 08:16am, on 04/22/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Licensee/Administrator Meynard Marcos, announced who he was and the reason for the visit. Licensee and LPA conducted a full tour of the facility. This facility has six resident bedrooms, three full bathrooms (one bathroom is on-suite and the other two are for public/shared use). There is a living room, dining room and kitchen. Access to the laundry room and garage is through a locked door for resident safety. LPA noted that the backyard has seating and shade for residents and visitors. LPA noted fresh fruit in the kitchen for residents to enjoy freely. The facility has battery and hard wired smoke/carbon monoxide detectors in each room and througout the facility that are all working. LPA observed a fire extinguisher near the kitchen that was in the green compression range, purchased on 03/10/2025. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility has no obstructions in hallways, doorways or exits. Medications are locked in a cabinet in the kitchen area. LPA noted during tour, Resident 1 (R1) had unlocked over-the-counter medications stored in their bathroom and R1's medical assessment states they are not able to safely manage their medications. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review. LPA noted 3 of 5 staff do not have current 1st aid and CPR training. LPA and Licensee/Administrator conducted a review of the annual care tool modules. Exit interview, deficiencies cited on 809-D, report given, and appeal rights given.the state’s words, verbatim · CDSS document, Apr 22, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff administered a felony drug to resident in care. Staff is not repositioning resident in care.

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to deliver findings for the above allegation. LPA met with Meynard Marcos and explained the reason for the visit. On the allegation: Staff administered a felony drug to resident in care. On 10/11/2024, the Department received a complaint alleging resident #1 (R1) tested positive for Fentanyl, a felony drug. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Jorge Jauregui. On 10/14/2024, from 1:25 p.m. to 3:50 p.m., Licensing Program Analyst (LPA) Melisa Rankin conducted the 10-day complaint visit to the facility. LPA Rankin met with Administrator Meynard Marcos and explained the purpose of the visit. LPA requested records pertinent to the investigation. The Administrator was informed the complaint was assigned to the Community Care Licensing Division (CCLD) Investigation Branch (IB) and that the investigator would return at a later date to complete the investigation. Continued on 9099-C Unsubstantiated On 10/22/2024, from approximately 11:36am to 3:49pm, Investigator Jauregui conducted interviews with Witness #1 (W1), residents, Administrator, and staff; on 11/06/2024, from approximately 9:05am to 3:46pm, with French Hospital social worker and Central Coast Home Health (CCHH) personnel; on 11/12/2024, at approximately 2:42pm, with R1’s friend; on 11/14/2024, at approximately 1:48pm, with R1’s friend; on 11/19/2024, at approximately 2:55pm, with CCHH personnel; on 11/21/2024, from approximately 2:21pm to 3:44pm, with the Department’s nurse consultant, and attempted interviews with French Hospital social worker and physician; on 12/05/2024, from approximately 2:01pm to 2:52pm, with R1’s friend and attempted to contact French Hospital social worker. In addition, the investigator reviewed French Hospital medical records and facility file documents pertinent to the investigation. A review of R1’s Physician Report, dated 07/06/2024, lists the primary diagnosis as generalized weakness and the secondary diagnosis as Parkinson’s disease. The report documented R1 had mild cognitive impairment, motor impairment/paralysis with stiff and slow movements, needed minimal assistance with activities of daily living (ADLs), intermittently confused and disoriented, able to follow directions and communicate needs. The report further documented R1 as ambulatory, but not able to independently transfer to and from bed. There was no indication of any drug abuse past or present. A review of the French Hospital medical records for the period of 9/12/2024 through 10/19/2024 revealed denial of illegal substances, and lab work showed no presence of illegal substances for prior visits on 09/12/2024 and 09/30/2024. The records document on 10/07/2024, R1 was admitted to the French Hospital regarding increased weakness. It was determined R1’s mild cognitive impairment/dementia was progressively worsening. According to the 10/07/2024 record “a urine drug test was conducted on R1 which tested negative for opiates.” “The test also showed Fentanyl < (less than) 1.0 nanograms per milliliter (ng/mL) were found in R1’s system. The records indicate that to be considered a positive result, the concentration value must be greater than or equal to the cut off which is 1.0 ng/mL…” “The exam did not contain the quantitative results. On 10/08/2024, unknown time, under progress notes, the doctor documented a positive exam for the use of Fentanyl.” According to the hospital, R1’s prescribed medications indicated they would not have caused a positive Fentanyl result. Continued on 9099-C Information obtained from the Department’s nurse consultant’s review of R1’s medical records “confirmed a urine test was conducted on R1 on 10/07/2024. The results of this test were negative for the use of Fentanyl. The urine test returned a result of less than 1.0ng/ml which is below the threshold for a positive result. However, the notes of a doctor’s progress notes documented a “positive test”. The nurse consultant could not confirm if a second test was performed and not documented, or if the note was erroneously based on the negative urine exam. The nurse consultant also reviewed a list of medications from the facility and did not find any Fentanyl prescribed for R1. Information obtained from the interviews conducted found that facility staff denied providing R1 or any other residents with illegal drugs. The residents reported feeling safe at the facility and expressed satisfaction with the staff. R1’s visitors acknowledged occasionally taking R1 out of the facility but denied providing any illegal drugs. One visitor admitted to taking R1 to a pharmacy, where R1 purchased Tylenol, but was unaware of other items purchased on a separate occasion. R1 indicated they received visits from friends but denied any of them provided R1 with any medication or drugs. R1 was aware of the positive test for Fentanyl but indicated they did not know a reason why it was positive. R1 provided various events involving outings with friends while R1 lived at the facility. R1 stated during an outing an event occurred where R1 “wrestled” with individuals who “wanted to fight” and R1 ran away from them but later when investigator summarized R1’s statement, R1 was confused and stated the events never occurred. However, it was noted that R1 is unable to run. Based on the information obtained from interviews and medical records, the Department’s investigation did not find sufficient evidence to support the allegation. 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 at this time. Continued 9099-C On the allegation: Staff is not repositioning resident in care. Hospital records and interviews indicate R1’s medical tests showed R1 had muscle tissue breakdown or Rhabdomyolysis on their right side. Per the allegation, Rhabdomyolysis is common in residents who consistently lay on one side and are not being turned. A review of R1’s Physician Report, dated 07/06/2024, lists the primary diagnosis as generalized weakness and the secondary diagnosis as Parkinson’s disease. The report documented R1 had mild cognitive impairment, motor impairment/paralysis with stiff and slow movements, needed minimal assistance with activities of daily living (ADLs), intermittently confused and disoriented, able to follow directions and communicate needs. The report further documented R1 as ambulatory, but not able to independently transfer to and from bed. On 2/26/25 LPA interviewed staff regarding R1, both staff stated R1 was able to walk, but was unstable, they also stated R1 would refuse assistance and wanted to be independent. Based on staff interviews, physicians’ documentation, and R1’s ability to leave the facility frequently with visitors, R1 was able to reposition self in bed and could transfer to their wheelchair and walker independently. 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. Exit interview conducted, and a copy of this report issued.the state’s words, verbatim · CDSS document, Feb 26, 2025 · control 29-AS-20241011094730

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 9:12 am to conduct a 1 year annual visit to the facility above. LPA met with administrator, Meynard Marcos and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectant spray and cleaners stored in garage. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). There were trash cans in garage without a tight-fitting lid that contained soiled gloves and bed pads, administrator immediately discarded contents of the trashcan and will remind staff to discard trash properly. Physical Plant & Environment Safety: LPA Miller observed the main bathroom toilet seat was not in good repair. Administrator showed LPA the new seat and will replace it today. There is water damage to the wall near shower revealing old blue paint. Administrator advised that he will repaint the wall. LPA also observed that heating vent requires cleaning, as there is a significant amount of dust accumulated. The kitchen door leading to the garage needs cleaning and cabinets and walls have an accumulation of dust and cobwebs that need cleaning. LPA also observed microwave had food splatter and needed cleaning. The area above the stove needs cleaning of grease and food splatter. The fireplace mantel in the living room also needs dusting. LPA observed debris on floors in a bedroom and kitchen. Continued 809-C LPA observed damage to wall near large window in dining room. Administrator stated that damage was due to a wheelchair and will patch the wall as soon as possible. Dining room furniture has significant amount of cat hair on dining room chairs, and couch in living room has significant damage due to cat scratching furniture. Administrator advised that he will use a slip cover over the couch. The fire extinguisher was purchased on June 5, 2022 and is charged and Administrator will replace today. The facility has 6 resident bedrooms,1 staff bedroom and 3 bathrooms currently occupying 6 residents. The staff bedroom is not included on the facility sketch. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and stored in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on July 11, 2024. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-Ambulatory. Hospice is approved for 4. Staffing: The facility currently employs 7 full time staff, and 1 administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements. However, one staff member does not have an application on file and will completed on May 6, 2024. Administrator Certificate expires April 10, 2025. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023. Continued 809-C Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms. Medical Assessments and Appraisal Needs and Services are not current, but will be provided May 6, 2024. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assist in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents medications, no labels were altered, no medications were expired and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill March 20, 2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 self latching gates on side of the home. The facility currently has 4 hospice residents in care. The facility does not currently have residents receiving Home Health services. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report issued to administrator.the state’s words, verbatim · CDSS document, Apr 25, 2024