The Tahoe

Type of visit: Required - 1 Year

On 12/4/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility to conduct the annual inspection visit. LPA met initially met with the Administrator Assistant, Mary Jan Mitchell (S1), and stated the purpose of the visit. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 6 may be non-ambulatory. Facility has a hospice waiver granted for 6 residents. Facility does not have bedridden clearance. Facility does not manage residents cash resources. Initial Observation: Present were 5 residents with 3 staff on duty. LPA observed required posters and facility license. Visitors from outside agencies and some residents’ family members were also present during this visit. Other residents were doing exercise with staff. Room temperature was at 74 degrees Fahrenheit upon arrival. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 4 of 6 resident bedrooms and the 2 of 3 bathrooms. LPA hot water temperature was at 112 degrees Fahrenheit. Resident bathrooms were observed to be clean and in good repair at this time. Fire extinguisher was observed in the kitchen area and was last inspected on 1/22/2025. Smoke and carbon monoxide detectors were observed throughout. LPA observed centrally stored medications, toxins, sharp objects and other dangerous items were kept locked and inaccessible to residents in care. {1 of 2} In the kitchen area, LPA observed at least seven-day non-perishable and two-day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Proper storage of food items was observed. Kitchen refrigerator and freezer were maintained at regulatory temperature. Outdoor area was inspected. LPA observed outdoor furniture for resident use. Ramps were observed to be in good repair at this time. Emergency walkways were observed to be unobstructed. Fence and gate were in good repair. Record Reviews: Review of 3 of 5 resident files was conducted, including, including but not limited to, review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. 2 resident medications were reviewed. No issues were noted at this time. Review of 3 staff files included but not limited to review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts quarterly drills. Documents Requested: LPA requested a copy of current Liability Insurance Certificate, LIC500, LIC308, updated facility sketch, and updated Dementia Care Plan to be emailed to arvin.villanueva@dss.ca.gov. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited. Exit interview was conducted. A copy of the report was provided upon exit. {2 of 2}the state’s words, verbatim · CDSS document, Dec 4, 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.

Type of visit: Case Management - Annual Continuation

On 11/21/24, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced Case Management - Annual Continuation visit at the facility to continue with the Annual Required Inspection visit initiated on 11/19/24. LPA initially met with a staff on duty (S1) and stated the purpose of the visit. The Administrator Bernadette Descargar was notified of this visit and arrived shortly after Present during today's visit were 3 residents in care with 2 staff on duty. The LPA continued with facility visit to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Facility is fire cleared for 6 non-ambulatory residents and approved to admit/retain 6 hospice residents. Review of 3 sample resident files (R1, R2, R3) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Technical Advisory was provided to facility to complete residents Needs and Services Plan annually for dementia residents and any change of conditions. Medication review of 3 sample residents include review of physician orders for over-the-counter medications. No issues were noted at this time. Review of 3 sample staff files (S1, S2, and S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. No issues were noted at this time. Facility conducts monthly disaster drill and last drill was on 11/20/24. Facility has a dementia and infection control plan. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during today's visit. Exit interview was conducted and a copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Nov 21, 2024

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 11/19/24, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct an annual required inspection. LPA met with staff on duty (S1) and explained the purpose of the visit. The Licensee/Administrator Bernadette Descargar and Assistant Administrator Mary Jan Mitchell arrived shortly after. Upon arrival, there were 4 residents in care with 2 staff on duty. LPA evaluated the physical plant with Bernadette to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed 3 of 5 bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature in 2 resident bathroom between 112 and 116 degrees F. Room temperature was observed at 73 degrees F. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Two fire extinguisher were observed and were last inspected on 1/23/24. Smoke and carbon monoxide detectors were observed. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. No bodies of water was observed at this time. Fireplace was observed to be screened and non-operational at this time. Due to insufficient time, this annual visit requires a continuation visit. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 19, 2024

Allegation investigated: Staff does not ensure water temperature is within regulation standards.

{This is an amended version of the report originally created on 5/15/24} On 5/15/24, at 10:04am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a follow up complaint investigation regarding the allegation noted above and deliver the findings. LPA met with the facility administrator, Bernadette Descargar, and explained the purpose of the visit. Present during this visit, were 5 residents in care with 3 staff on duty. Additionally, an outside agency was also present assisting some residents in care. During this visit, LPA and facility manager (S1) conducted hot water temperature check in all 3 resident bathrooms and the kitchen sink. LPA and S1 each have their own thermometer to use. Additionally, LPA utilized a digital stopwatch to time how long each faucet reaches 105 degrees F. Per observation, hot water temperature in all 3 bathrooms and kitchen faucet were within regulatory standard, between 105 degrees F and 120 degrees F. {Con't to LIC9099-C...} Unfounded {...Con't from LIC9099} During an unannounced visit on 5/6/24, LPA and S1 also conducted hot water temperature check on all 3 resident bathrooms and the kitchen sink. Per observation, hot water temperature in all 3 bathrooms and kitchen faucet were within regulatory standard between, 105 degrees F and 120 degrees F. Additionally, required unannounced annual visits were conducted on 12/06/23, 11/18/22, and 11/03/21. LPAs conducted these visits observed the measurement of the facility’s hot water temperature were within regulatory standard, between 105 degrees F and 120 degrees F. Based on observation and interviews, the allegation that staff does not ensure water temperature is within regulation standards has been determined to be UNFOUNDED. A finding of unfounded means that the allegations are false, could not have happened, or is without a reasonable basis. An exit interview was conducted with Bernadette Descargar, administrator, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 15, 2024 · control 27-AS-20240429152716

Type of visit: Case Management - Deficiencies

{This is an amended version of the report originally created on 5/15/24} On 5/15/24, at 11:30am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit. LPA met with the facility administrator, Bernadette Descargar, and explained the purpose of the visit. Present during this visit, were 5 residents in care with 3 staff on duty. Additionally, an outside agency was also present assisting some residents in care. During a complaint visit on 5/6/24 (complaint #27-AS-20240429152716), it was observed during an inspection of residents’ beddings that two pillows of one resident in care were covered with white plastic bags, then covered with pillowcase on top. Per interview with staff, the white plastic garbage bags were being used as pillow protectors in case of accidental incontinence. Staff on duty immediately removed the plastic garbage from the pillows. Staff stated they will purchase pillow protectors for resident’s pillows. During this visit, LPA observed pillowcases were covered with pillow protectors. As a result of this case management, the following deficiency was observed (see LIC 809-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted with Bernadette and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 15, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(C) · Plan of correction due date: May 22, 2024

87307(a)(3)(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths…The linen shall be in good repair. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the regulation noted above. During bedding inspection of one resident, it was discovered that plastic garbage bags were being used as pillow protectors for resident's pillow which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: Corrected prior to this visit: Licensee purchased pillow protectors for residents in care.

Type of visit: Case Management - Annual Continuation

On 12/11/23, at 10:15am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility to conducted an unannounced Case Management-Annual continuation visit to continue with the Annual visit initiated on 12/6/23. The LPA met with Bernadette Descargar, Administrator on record, and explained the purpose of today's visit. During this visit there are 5 residents in care with 3 staff on duty. During this inspection, LPA conducted an audit of facility files, 5 resident files, and 6 staff files for regulatory compliance. All staff noted on LIC 500 have criminal background clearances and are associated to this facility. LPA attempted 2 resident interviews, however, residents were not available for interviews. LPA also completed 2 staff interviews. 5 out of 5 resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. 5 out of 5 staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required trainings. Facility’s liability insurance is current per regulatory requirements. The facility is current on annual license fees. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed for accuracy. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each resident Centrally Stored Medication, Destruction Record and PRN Log. LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed facility to have sufficient equipment and supplies to meet activity program needs of residents in care. {Con't LIC809-C} {Con't from LIC809} Per California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). The following deficiencies were observed during today’s inspection: · During medication review of 3 residents, LPA observed prescribed PRN medications in 2 of the residents do not contain pharmacy label. Additionally, 1 out of 2 bottles of Trazadone 100mg in one of the residents’ medication contains the wrong label which does not match with the current physician’s prescription. Per label reads Trazadone 100mg to be taken 2 tablets by mouth. Per review of the physician’s order, the prescription reads to take 2 and a half tablets by mouth. Per staff interview, staff have been giving the Trazadone as prescribed and that staff were trying to finish that particular bottle of Trazadone. · During medication review, LPA observed that 1 out of 3 residents were being given the wrong dosage of the prescribed PRN. Per review of resident’s physician order, this resident was supposed to be receiving Docusate Sodium 250mg by mouth one time a day for constipation. However, per medication review, LPA observed that the Docusate Sodium is at 240mg. Per staff interview, staff have been giving the Docusate Sodium 240mg since the facility received this medication. An exit interview was held with Bernadette Descagar, Administrator, and a copy of this report and appeal rights were provided to the facility. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *the state’s words, verbatim · CDSS document, Dec 11, 2023

Type of visit: Required - 1 Year

On 12/6/23 at 3pm, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA met with facility administrator, Bernadette Descargar and explained the purpose of today’s visit. The facility is currently licensed to serve 6 non-ambulatory elderly residents. Facility is currently not cleared for bedridden residents, per administrator. The facility is approved for 6 hospice residents. Currently, the facility has 2 hospice residents. Present during this visit, there were 5 residents in care with 3 staff on duty. At 3:15pm LPA and Administrator inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. There were no bodies of water on the premises. Outside of the facility was observed to be cleaned and clear of obstructions. Additionally, LPA observed outdoor furniture for residents’ use and for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 5 resident bedrooms and 2 bathrooms for resident use. Facility is also observed to have 1 staff bathroom and 1 staff room. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. The resident rooms were inspected. Bathrooms were operational and adequately supplied including with grab bars and non-skid flooring. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to residents in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 74 degrees F. Water temperature in one of the bathroom was measured at 119 degrees F. Fire extinguisher was serviced on 1/24/23. Smoke detectors and carbon monoxide were tested and found to be operable during this visit. Medication storage area was observed to be locked and inaccessible to residents in care. During this visit, LPA requested an updated copy of LIC 308, LIC 500 and liability insurance. Due to insufficient time, this annual will require a continuation visit. The Department will return at a later date to complete the annual inspection. An exit interview was held with Bernadette Descargar, Administrator, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Dec 6, 2023