The Taylor Cottage

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility today to conduct a required annual. LPA was greeted and granted entry by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents of which 1 may be bedridden. Facility has a hospice waiver for 3. The facility currently has 4 residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in bathrooms. The hot water temperature measured between 115.8 and 118.9 degrees Fahrenheit. Smoke detector located in facility living room was not operational as it was missing batteries. The fire extinguishers are charged and were serviced on March 14th 2025. The facility’s last fire drill was conducted on 01/28/2026. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed 2 dozen eggs stored in kitchen pantry, per review of box, eggs were to be refrigerated. LPA observed an unsecured lighter in kitchen drawer on the right hand side of stove. LPA observed medication storage in locked cabinet in facility living room. LPA observed emergency food in facility garage. LPA did not observe emergency water in facility. LPA observed dead roach and debris in the top right drawer on kitchen island. LPA observed missing screen in shared bathroom located in the rear of the home. LPA observed Resident 1 to be listed as bedridden based on LIC 602 Physician's report dated 1/15/2026 and 1/15/2025 and is living in a room that is not listed as cleared for bedridden resident. LPA observed unsecured medications in Resident 2 (R2) bedroom and LIC 602 dated 11/28/2024 stated R2 is unable to store their own medications. LPA observed unsecured medications left on kitchen island (photo taken). LPA observed R2’s toilet to have staining on toilet bowl and room had an odor present. LPA observed 2 mattresses, nightstand, tv, dresser and closet with clothes in a room listed as storage room. LPA did not observed assessments/appraisals for R1 and R3. LPA observed R1 to have their hair knotted and matted. LPA reviewed five of five staff training and fingerprint records. Staff do not have record of any training conducted within the last year. LPA Mendivil observed Staff 1 in kitchen, per review of Guardian S1 is not associated to the facility. S1 left the facility during visit. Per review of files of Staff 2- Staff 3 are not associated to the facility, Per licensee both staff have been present in the facility. S2 has worked 2 days and S3 has worked off an on for over 1 year, licensee stated over S3 has worked more than 5 days. LPA observed Staff 4 (S4) did not have a health screening on file. LPA observed LIC 610E Emergency and Disaster Plan for Residential Care Facilities for the Elderly had not been reviewed or updated as former Administrator and former employees are listed on document. Based on the observations made during today’s inspection deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Feb 13, 2026

Allegation investigated: Resident developed pressure injuries while in care.

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced continuation visit and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, was greeted, and granted entry by licensee (LE) Wennie Earwood. It was alleged that resident developed pressure injuries while in care. LPA Rodriguez conducted a total of 4 resident interviews, of which all 4 resident interviews did not corroborate with the allegation. LPA Rodriguez conducted a total of 2 staff interviews of which both interviews did not corroborate with the allegation by stating that there are no residents in the facility, who developed pressure injuries while in facility care. LPA Rodriguez conducted a file review and observed that resident 1 (R1) was admitted to the facility with a stage 2 pressure injury, was hospitalized on February 18, 2022 for a health condition unrelated to the pressure injury, however, developed a stage 4 pressure injury during R1's hospitalization, and was returned back to the facility. Unsubstantiated Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. A case management was conducted during this visit in conjunction with the complaint. An exit interview was conducted with LE Earwood. A copy of this report was explained and provided.the state’s words, verbatim · CDSS document, Jul 2, 2025 · control 22-AS-20220317132618

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced case management visit to the facility in conjunction to complaint: 22-AS-20220317132618. LPA Rodriguez explained reason for visit and met with licensee (LE) Wennie Earwood. During the course of the investigation for complaint 22-AS-20220317132618, it was revealed that resident 1 (R1) was admitted to the facility with a stage 2 pressure injury, was hospitalized for a health condition unrelated to the pressure injury, then returned back to the facility on March 2, 2022, with a stage 4 injury that was developed at the hospital, however, resided at the facility until March 14, 2022. During this visit, AD Earwood confirmed of retaining R1 at the facility with the stage 4 pressure injury. For today's visit a citation was issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Earwood. A copy of this report was explained, and appeal rights were provided during the visit.the state’s words, verbatim · CDSS document, Jul 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jul 2, 2025

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition.. shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on record review, resident 1 (R1) had a stage 2 pressure injury while at the facility, then was hospitalized. R1 returned to the facility, with a stage 4 pressure injury that was developed during hospitalization. Per interview, licensee admitted to retaining R1 from 3/2/22 to 3/14/22 with the stage 4 injury without an approved waiver from the department. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: As a plan of correction, licensee will review the regulation cited, and provide proof of understanding to the assigned LPA on or by 7/3/2025.

Allegation investigated: Resident was not protected from the injuries. Resident was not protected from not being hit. Licensee not properly addressing pests at the facility.

On June 25, 2025, at 12:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Licensee Wennie Earwood and explained the purpose of the visit. The investigation consisted of the following. On January 8, 2025, LPA Kim and LPA Eboni Bentley conducted an initial complaint visit. Records were obtained, four staff (S1-S4), three residents (R1-R3), and one witness were interviewed. LPA attempted to interview four other witnesses and one resident, but attempts were unsuccessful. The investigation revealed the following: Continued on LIC9099-C Unsubstantiated Allegation: Resident was not protected from the injuries. It is alleged the resident is being burned all over their body and their right foot is severely burned and bruised. LPA conducted interviews with three residents (R1-R3), four staff (S1-S4) one witness (W1), and attempted to interview four additional witnesses (W2-W5) and one resident who were unreachable. Based on interviews conducted, three residents, four staff, and one witness, they all denied any injuries or harm to R1. Two staff members noted a bruise on R1’s foot, which they believed could be due to a tight ring toe. A photo of R1’s foot was reviewed and showed no signs of burn injury. Two other staff members reported hearing R1 cry or scream during the night on several occasions. Each time staff entered the bedroom to check on R1, staff observed no injuries or other individuals present that pose threat to resident. The alleged victim was not present at the facility during the visits and therefore was not observed by the LPAs. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Allegation: Resident was not protected from being hit. It is alleged the resident is being pummeled on their head, neck, and shoulders causing excruciating headaches. LPA conducted interviews with three residents (R1-R3), four staff (S1-S4) one witness (W1), and attempted to interview four additional witnesses (W2-W5) and one resident who were unreachable. Based on interviews conducted, three residents, four staff, and one witness denied resident was not protected from being hit. All three residents stated they did not hear or witness any resident being hit at the facility. Two staff stated on several occasions they heard R1 cry and scream at night in their bedroom. Both staff checked on R1 and found R1 alone in the bedroom, with no other individuals present. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Allegation: Licensee not properly addressing pests at the facility. It is alleged the facility has been crawling with cockroaches for months. LPA conducted interviews with three residents (R1-R3), four staff (S1-S4) one witness (W1), and attempted to interview four additional witnesses (W2-W5) and one resident who were unreachable. Based on interviews conducted three residents, four staff, and one witness denied Licensee not properly addressing pests at the facility. Two residents stated they have heard there were cockroaches in the kitchen in the past, but they have not seen cockroaches anywhere in the facility. Two staff members reported occasional sightings of cockroaches in the kitchen area. Continued on LIC9099-C In response, the licensee promptly contracted with a licensed pest control agency. Since then, the agency has conducted regular inspections and treatments, with additional services provided as needed, to ensure ongoing pest management and compliance with health and safety standards. Licensee stated in an interview that they had a contract with Corky’s Pest Control and switched to Terminix in January 2025, maintaining the facility with a pest control to prevent reoccurring of cockroaches. Based on record review, the facility had a monthly contract with Corky’s Pest Control from June 2024 through December 2024 and switched to Terminix from January 2025. During a facility tour on June 25, 2025, LPA inspected the kitchen cabinets, bathroom cabinets, common areas, bedrooms, and the outdoor physical plant and did not observe any cockroaches. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Based on record reviews, interviews, and observations, LPA did not find sufficient evidence to support the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Exit interview was conducted and a copy of the report was provided to Licensee Wennie Earwood.the state’s words, verbatim · CDSS document, Jun 25, 2025 · control 22-AS-20250102163823

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by caregiver Mark Lopez after explaining the purpose of the visit. Licensee Wennie Earwood and Administrator(AD) Enkhtsetseg Bat-Amgalan were notified via telephone and later arrived to assist with the inspection. LPA observed the Administrator certificate was current and expires December 30,2026. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents, of which one may be bedridden, with a hospice waiver for three. The facility is a one story home with five resident bedrooms, three bathrooms, and an attached garage. During the inspection, LPA and caregiver Mark conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPA observed residents watching television and resting in their respective bedrooms. LPA observed four residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall by the entrance. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the garage. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 109.4- 114 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged and located by the kitchen. During inspection bedroom next to living room was observed to have an additional wall built that is not present in the facility sketch; a deficiency was cited on today’s date. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked in the garage and inaccessible to residents. Medication cabinet was observed to be locked and centrally stored in the living room. LPA observed the First Aid Kit had all the required components. LPA observed the facility conducted their last emergency disaster drill on February 05,2025 and is conducted every 3 months. LPA began review of the records. LPA Guillen reviewed four resident records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed three employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed had a current First Aid certificate. Licensee was notified of pending fees due. Based on the observations made during today’s inspection, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Feb 21, 2025

Type of visit: Case Management - Deficiencies

On January 8, 2025, at 4:01pm, Licensing Program Analysts (LPAs) Edward Kim, Eboni Bentley, and Licensing Program Manager (LPM) Lourdes Montoya conducted a case management deficiency visit observed during an unrelated complaint # 22-AS-20250102163823. During inspection visit, department observed the following deficiencies not related to complaint investigation. Per observation and interview with the Licensee Weenie Earwood, Staff #1, and Staff #2 that medications for three residents (R1-R3) were transferred from the original container to a different container. LPA observed the temporary containers with medications inside the kitchen drawer. In addition, per observation, record review and interview with Licensee, the facility does not have a certified administrator or a designee. Per the department’s interview with the listed administrator on file, former employee (S3) stated they have not been working for the facility at least for a year and a half and they have no intention to return to work as an administrator. Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with Licensee Earwood and copy of report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 8, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Jan 10, 2025

87465...(h)...(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: Based on observation and interviews, LPA observed that resident #1, resident #2, and resident#3 had medication transferred from original container into a different container for three out of four residents. This poses a potential health, safety, and personal rights risk to all persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee agreed to not to transfer medications from original container to a different container. Licensee will provide training to staff on the section cited above and will send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Jan 10, 2025

87405... (a) All facilities shall have a qualified and currently certified administrator… When the administrator is not in the facility, there shall be coverage by a designated substitute... This requirement was not met asevidenced by: Based on observation, record review, and interviews, the facility did not have an administrator or designee on premises for at least year and a half. This poses a potential health, safety, and personal rights risk to all persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee stated they agreed to submit the requirements for the change of administrator by POC due date January 10, 2025. Licensee will associated administrator upon approval of the documents..

Type of visit: Office

At this an informal conference present were Taylor Cottage Licensee Weenie Earwood, Taylor's Loving Care Applicant Nhut Thanh Nguyen, Regional Manager Marina Stanic, Licensing Program Manager (LPM) Lourdes Montoya, and Licensing Program Analyst (LPA) Edward Kim. The closure of the facility was discussed and the Licensee informed the department she will continue with the change of ownership and finalize the sale of the facility. Applicant stated they will continue with the pre-licensing process. Licensee will provide appropriate notice to the residents and their reporting party with a copy to the department. Licensee requested a permit from the city electronically to remove the wall and comply with the Fire Department. Licensee will notify the Department of the change of administrator. A copy of this report was provided to the Licensee Weenie Earwood.the state’s words, verbatim · CDSS document, Dec 27, 2024

Allegation investigated: Resident's bedroom is used as a passageway to another room at facility Licensee does not provide a resident privacy at the facility

On November 19, 2024, Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced subsequent complaint visit to deliver findings. LPA Tirre met with Caregiver Clavecilas. Licensee Weenie Earwood was unavailable during visit. The following items were revealed in complaint investigation: Regarding allegation: Resident’s bedroom is used as a passageway to another room at facility. During investigation, per record review, current facility sketch on file shows back room (bedroom #6) was a large room and did not indicate there are two separate rooms. Staff (S3) confirmed that bedroom used to be a large, shared room, however, the bedroom was converted into two bedrooms (#6A & 6B) with one main entry door. R1 occupies bedroom 6, staff (S4) sleeps in bedroom 6B Interviews were conducted with three (R1-R3) of five residents and three (S1-S3) staff. interviews with Resident 1 (R1) confirmed that three male staff (S1, S2 & S4) occasionally pass through R1’s bedroom CONTINUED ON 9099C Substantiated door to access the bedroom 6B for purposes of either sleeping, using restroom and or gathering personal staff belongings located in room. R2 and R3 stated they are not aware that R1’s bedroom is being used as a passageway to another bedroom. S1 and S2 confirmed that S4 sleeps in bedroom 6B. Based on the department’s observations, it was confirmed that only way through bedroom 6B is passing through Resident 1’s room 6A. The department also observed bedroom 6B has sheets and blankets on bunk bed as well as personal hygiene items located on dresser and clothing inside closet. Regarding allegation, Licensee does not provide a resident privacy at the facility. Interviews were conducted with three (R1-R3) of five residents and three (S1-S3) staff. Interviews with three residents (R1-R3) confirmed that staff enter resident rooms with or without notice. R1 stated S1, S2 and S4 enter R1’s bedroom 6A entrance to access bedroom 6B for the purpose of sleeping, using the bathroom or accessing their personal belongings not allowing resident privacy. Interviews with two staff (S1 & S2) revealed that they sometimes use the bathroom next to bedroom 6B and the only access is through R1’s bedroom 6A. Based on the department’s observations, it was confirmed that only way through bedroom 6B is passing through Resident 1’s room 6A. Based on observations, interviews and record review, the preponderance of evidence has been met, therefore the allegations, “Resident’s bedroom is used as a passageway to another room at facility and Licensee does not provide a resident privacy at the facility”, are deemed SUBSTANTIATED. The following is being cited on attached LIC 9099D. An exit interview was conducted with Caregiver Clavecilas and copies of this report along with Appeals Rights was provided. Regarding allegation: Staff do not ensure that food served to residents is free from contamination. During investigation, interviews were conducted with three (R1-R3) of five residents and three (S1-S3) staff. R1 stated they observed meat left out on stove all night and has observed staff re-use same pan with oil to cook other foods throughout day. Two residents (R2 & R3) stated they have no issues with food preparation at facility. Based on the department’s observations, facility staff wash their hands before prepping meals, staff use separate pans for cooking and staff wear gloves while cooking. Based on the information provided for investigation, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violations, “Licensee is not addressing pests at the facility and Staff do not ensure that food served to residents is free from contamination” did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Caregiver Clavecilas and copy of this report along was provided.the state’s words, verbatim · CDSS document, Nov 19, 2024 · control 22-AS-20241101102846

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(C) · Plan of correction due date: Dec 2, 2024

87307 (a) living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(2) resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement was not met as evidenced by: R1 bedroom 6A is a passageway to staff room 6B. Based on observation the licensee did not comply with section cited above. Interview conducted with Resident 1(R1) confirmed that three male staff (S1, S2 & S4) pass through R1’s bedroom 6A door to access 6B for purposes of either sleeping, using restroom and or gathering personal staff belongings located in 6B. S1 and S2 confirmed that S4 sleeps in 6B next to R1’s bedroom 6A and they also enter through 6A. Based on the department’s observations, it was confirmed that only way through the bedroom 6B is passing through 6A. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 19, 2024

Plan of correction: Licensee agreed to remove wall dividing bedroom #6. Licensee to transfer Resident 1 to bedroom 6Bon and use current 6A as common area until the wall is removed. Licensee agreed to obtain permit from City of Huntington Beach to remove wall inside bedroom 6 by POC due date 12/3/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1)(2) · Plan of correction due date: Dec 3, 2024

Personal Rights(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Staff (S1,S2 & S4) access Resident 1 (R1) bedroom 6A to get Room 6B not allowing R1 privacy. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 19, 2024

Plan of correction: Licensee agrees to conduct in service training with staff regarding personal rights of residents. Licensee provide proof of training by POC due date 12/3/2024

Type of visit: Case Management - Other

On today’s visit, Licensing Program Analysts (LPA’s) Jenifer Tirre, Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya made an unannounced visit to follow up on complaint investigation # 22-AS-20241101102846, and unrelated deficiencies were observed while touring the facility. During inspection visit, department noted the following deficiencies not related to complaint investigation. Per interview with the Licensee/Administrator Weenie Earwood and Staff #2 , a non-ambulatory resident (R# 3) occupies and sleeps in room #5 that is not fire clearance approved. Room does not have proper egress window for fire clearance posing a health and safety threat to resident in care. The above is being cited on attached LIC 809D and issued an Immediate Civil Penalty During visit the following items were also observed and to be addressed at another time due to time constraints. · Facility kitchen drawers were not closing properly · Facility Printer was non operational. · S1 & S2 stated they sleep in the living room An exit interview was conducted with Administrator/Licensee Earwood and copy of report, D page and appeal rights was provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Nov 15, 2024

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: Per interview with the Licensee/Administrator Weenie Earwood and Staff #2 , a non-ambulatory resident (R# 3) occupies and sleeps in room #5 that is not fire clearance approved. Room does not have proper egress window for fire clearance posing a health and safety threat to resident in care. This poses an immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Licensee agreed to move resident to shared bedroom number 1. Licensee providing proof via face time video call by POC due date 11/15/2024.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jenifer Tirre made an announced inspection visit to conduct a pre licensing visit for separate facility license Taylors Loving Care for a change of ownership. During inspection visit LPA observed Resident Room 5 is being used as a Passageway through to staff bedroom. This poses an potential health, safety and/or personal rights risk to persons in care. Based on the observations made during today's visit, deficiencies are being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided to staff.the state’s words, verbatim · CDSS document, Jun 13, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(c) · Plan of correction due date: Jun 21, 2024

87307 (a) living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accomodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(2) resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: resident's room is a passageway to staff room. Based on observation the licensee did not comply with section cited above in one resident room which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 13, 2024

Plan of correction: Licensee agree to correct access from resident bedroom to staff bedroom. by POC date 06/21/2024

Type of visit: Case Management - Annual Continuation

On 3/22/2024, Licensing Program Analysts (LPA) Jenifer Tirre, Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya conducted an unannounced required continued Annual visit using the CARE Inspection Tool. LPA’s & LPM were greeted by Staff and granted entry after stating the purpose of the visit. Administrator (Admin) Mary Jean Catacutan was not present to assist with the facility inspection on today's date. Licensee Weenie Earwood came to facility to assist with inspection visit. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for three (3) residents and (1) bedridden. Currently, there are three (2) Hospice residents present during today’s visit. This is a single story with a two-car garage facility. The facility has five resident bedrooms, one staff bedroom, and three full bathrooms. At around 9:15AM, LPA’s & LPM conducted a tour of the physical plant accompanied by Licensee Earwood, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 106.1 degrees F. A comfortable temperature of 69 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has one fire extinguisher which is fully charged and mounted. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, 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 the facility has supply of Personal Protective Equipment (PPE). LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on January 10, 2024. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 11/8/2023 - 11/8/2024. The facility is current on Community Care Licensing annual dues. A review of three residents (R1-R3) service files and one out of three staff (S1) personnel files revealed to be incomplete. The facility has the current administrator's certification on file for Mary Jean Catacutan # 6036186740 - Expiration 8/2/2025. Based on the observations made during today's visit, deficiencies are being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Weenie Earwood.the state’s words, verbatim · CDSS document, Mar 22, 2024

Type of visit: Required - 1 Year

On 3/6/2024, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit with Licensee Weenie Earwood. LPA conducted inspection tool and due to time constraints LPA was unable to continue annual visit. LPA will follow up at a later date to finish annual visit and complete Deficiencies. An exit interview was conducted, and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Mar 6, 2024

Allegation investigated: Facility is refusing to provide resident with a modified diet as prescribed by doctor's orders. Insufficient staff to meet residents' care needs.

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received January 30, 2024. LPA Haley was greeted by staff and explained the reason for the visit. Staff contacted licensee Wennie Earwood who arrived a short time later and was present for the remainder of the visit. Regarding the allegation: Facility is refusing to provide resident with a modified diet as prescribed by doctor's orders. During the investigation 3 of 3 individuals including the licensee and resident 1 (R1) denied the allegation. R1 has not been prescribed a special diet at this time. In preparation for a medical procedure to take place on a later date that has not been determined, R1 has been on a Low Carb/No Carb diet since November 2023. However, R1 acknowledged his current diet was not prescribed by his physician, but it was highly recommended. Continued on LIC9099C Unfounded After R1’s medical procedure, a special diet will be prescribed for six weeks. At this time, the medical procedure has not been scheduled. R1 expects the procedure to be scheduled in late March or early April. Regarding the allegation: Insufficient staff to meet residents' care needs. During the investigation 4 of 4 individuals interviewed including the licensee, facility staff, and a facility resident denied the allegation above. According to the Licensee Earwood, staffing is adequate, and the new caregivers are doing a good job. Staff 1 and Staff 2 both agreed that staffing is fine, and they have enough assistance from their partners. Resident 1 (R1) also denied the allegation and is pleased with the caregivers. During the visit, licensee Earwood provided copies of R1’s physician’s report, Preplacement appraisal, Resident Appraisal, and Postoperative diet instructions and information. The resident roster was emailed to LPA Haley during the visit. Based on the information gathered through interviews, observation, and document review the following allegations: Facility is refusing to provide resident with a modified diet as prescribed by doctor's orders, and Insufficient staff to meet residents' care needs is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 6, 2024 · control 22-AS-20240130111350