Tlc Home Care 2

Type of visit: Office

On 11/12/2025, a Non-Compliance Conference (NCC) was held to address concerns regarding the operation of the facility. During the NCC, the following citations were issued. On 11/5/2025, the Administrator was contacted via telephone due to not attending a scheduled in office meeting. During the call, the Licensee/Administrator stated that there are currently no residents present in the facility and the two residents that were residing there moved out “last week”. Licensee/Administrator stated that the facility is currently closed and only TLC Home Care 1 is operational. Licensee/Administrator stated that the residents were informed verbally that the facility is closing. Licensee/Administrator did not notify the Department of the closure and relocation of residents. During a Case Management inspection on 11/06/2025, the facility was found to be in operation with 1 resident present. Staff were present in the facility without a fingerprint clearance. Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was developed and reviewed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, whose signature confirms receipt of this document.the state’s words, verbatim · CDSS document, Nov 12, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Nov 13, 2025

87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility… This requirement was not met as evidenced by: Based on interview conducted, the Licensee did not comply with section 87207 when the Administrator stated that the facility was closed and there were no residents present when the facility was still in operation with 1 resident residing in the facility, which is an immediate health and safety risk to 1 out of 1 resident in care.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: Licensee agrees to provide a written statement to CCL to include what will be done going forward.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a) · Plan of correction due date: Nov 21, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following : (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified… Based on interview and record review, the Licensee did not comply with section 87211 when the Licensee did not report multiple events to the Fresno CCLD office.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: Licensee agrees to review regulation section 87211 reporting requirements and complete training with all staff. In service sign in sheet will be submitted to CCL. A statement will be provided by the Licensee to CCL to include what will be done moving forward.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Nov 21, 2025

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)... This requirement was not met as evidence by interview conducted. The licensee did not comply with the section cited above in that the Licensee moved residents without following the proper documentation and following Title 22 regulation. This poses a potential health, safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: Licensee stated they will review regulation section 87224 and send in a written statement of what the Licensee will be doing moving forward.

Type of visit: Case Management - Health Checks

On 11/06/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced visit. LPA met with Direct Care Staff, Luz Bella, explained reason for visit and was permitted entry into the facility. This visit is being conducted due to the Licensee/Administrator, Rodrigo failing to show up to a scheduled NCC meeting on 11/05/25. The Department was notified by the Licensee/Administrator, Rodrigo Arrieta that the facility was closed, all residents have moved out and would no longer be open. LPA arrived to conduct a final walk through. S1 was observed providing care and supervision to 1 resident found at the facility. There was no personnel file for S1 and S1 stated they were not fingerprint cleared. S1 stated they arrived to work at approximately 8am. During visit Licensee/Administrator stated they were unavailable to come to the facility as they were out of town in Los Angeles. A second staff arrived some time later stating S1 was covering for them while they were running an errand. ****An immediate civil penalty in the amount of $500 was assessed per California Code of Regulations, Title 22 for uncleared staff****. If not corrected, the deficiency has a direct impact to person(s) in care. Licensee was informed LPM will be contacting them and a meeting will be scheduled to discuss the false allegations made by Licensee/Administrator and the remaining resident. Exit interview conducted with Licensee/Administrator, Rodrigo via phone. A copy of this report, deficiency, civil penalty and appeal rights were provided to Licensee/Administrator via email. A delivered and read receipt serves as confirmation.the state’s words, verbatim · CDSS document, Nov 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 873555(e)(2) · Plan of correction due date: Nov 7, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidence by: S1 observed at the facility providing care and supervision to resident(s) in care without being fingerprint cleared/associated to the facility. This poses an immediate health safety and or personal rights risk to residents in care. ***Immediate civil penalty in the amount of $500 was assessed***the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: S1 was informed they needed to leave the facility and can not return to work until cleared. S1 immediately left the facility. Licensee was informed S1 could not return to work until they were fingerprint cleared. ***Deficiency cleared during visit***

Allegation investigated: Staff did not provide proper medication assistance to resident in care Staff did not provide proper supervision to resident in care

On 10/18/2025 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced complaint visit. LPA met with Direct Support Professional, Lourdisita Villancio, explained reason for visit and was permitted entry. Administrator, Rodrigo Arrieta was contacted and arrived some time later. LPA completed a tour of the facility inside and out and completed a health and safety check on residents in care. There are currently 3 residents residing at the facility. 1 is currently receiving hopsice services and bedridden. All residents are non-ambulatory. During complaint investigation documentation was requested and reviewed. Tour of facility was completed and interviews were conducted. R1's file disclosed R1 was bedridden and unable to leave the room without assistance. Interviews with staff disclosed R1 was "aggressive towards staff" and "required a lot of care". S1 further described R1's "behaviors throughout the night disrupted the other residents' sleep" and how they were handled. S1 stated R1 would bang something on the floor/walls to get staffs attention and would do this throughout the night because the door was closed. CONT... Substantiated CONT... Medication Administration Records (MAR) showed that R1 medications were being signed off by staff as prescribed for the months of May, June and July of 2025. However the facility does not have a MARS for the month of August 2025. Facility generated sign off book shows that R1 was receiving medication from 8/1/2025 through 8/6/2025 but does not show R1 received medications after 8/6/2025. LPA observed a container of medication in the master bedroom closet full of R1's medications that were not provided and without explanation from Administrator. The preponderance of evidence standard has been met. The allegations above have been SUBSTANTIATED. Deficiencies have been issued per California Code of Regulations, Title 22, on the attached 9099D. Deficiencies if not corrected will have a direct impact to residents in care. Exit interview completed with Administrator, Rodrigo. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 18, 2025 · control 24-AS-20250910142445

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Oct 20, 2025

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement was not met as evidence by: records reviewed and LPAs observations. The licensee did not comply with the section cited above in that Medication Administration Records for the month of August was missing. LPA observations of a large container full of R1s medications were in the master bedroom closet unused for several months. This poses an immediate health safety and or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administor stated they provided all medication to family of R1. A plan of correction will be submitted to CCL by POC date to include all staff training in medication management. In-service sign in sheets and training material will be provided to CCL once completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(1) · Plan of correction due date: Oct 31, 2025

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidence by: records reviewed, and interviews conducted with staff. R1 was bedridden and unable to get out of bed without assistance. Interviews disclosed bedroom door was kept closed and R1 was not provided a way to ask for help when needed. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administrator stated they were unaware that Preplacement appraisals, needs and services plans and reappraisals needed to be done annually and more frequently if needed. Administrator stated they will look and take additional training to assist them in assessing residents better at intake. Administrator stated they will provide verification of trianing completion to CCL by POC date.

Type of visit: Case Management - Deficiencies

On 10/18/2025 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced case management visit. LPA met with Direct Support Professional, Lourdisita Villancio, explained reason for visit and was permitted entry. Administrator, Rodrigo Arrieta was contacted and arrived some time later. LPA completed a tour of the facility inside and out and completed a health and safety check on residents in care. There are currently 3 residents residing at the facility. 1 is currently receiving hopsice services and bedridden. All residents are non-ambulatory. This case management visit is being conducted for issues observed during a previous complaint visits conducted on 09/13/25 and 10/18/25. During visit conducted on 9/13/25 and 1018/25 LPA observed the following issues: Master bedroom closet is being used to sleep in by staff/visitors. Extension cords being ran to areas not having electricity along or in the walls. Master bathroom shower molding falling off and in need of replacement. Chemicals observed throughout the facility unlocked and accessible to residents in care with dementia. Sharps observed in kitchen unlocked and accessible to residents in care. Chest freezer in garage in need of defrosting. Chain door lock observed on inside of laundry room near staff bedroom. Black mold observed around kitchen sink. Dry milk observed in pantry. Canisters in pantry and food in refrigerator not properly stored/dated. Kitchen refrigerator door shelves missing/broken and in need of replacement. Supplements observed in resident bedroom. Paper towels/toilet paper on bathroom counter. Front door weather stripping hanging and in need of replacement. Deficiencies have been issued per California Code of Regulations, Title 22, on the attached 9099D. Deficiencies if not corrected will have a direct impact to residents in care. Exit interview completed with Administrator, Rodrigo. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Oct 20, 2025

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidence by: LPA observation during visits conducted on 09/13/25 and 10/18/25. The licensee did not comply with the section cited above in that the master bedroom closet was being used to sleep in. Extension cords observed running in and along walls in areas not wired for electricity. Chain lock observed on the inside of the laundry room. This poses an immediate health safety and or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administrator stated they will submit a plan of correction in writting to include how these items will be corrected as proof of correction by POC date. A picture will be sent to CCL with corrections once completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Oct 31, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: LPA observation during visits conducted on 09/13/25 and 10/18/25. The licensee did not comply with the section cited above in that Master bedroom shower molding hanging in need of replacement. Black mold observed on countertop around kitchen sink. Weather stripping at front door hanging in need of replacement. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administrator stated items will be corrected and pictures will be sent to CCL by POC date as proof of correction.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a) · Plan of correction due date: Oct 31, 2025

87470 Infection Control Requirements (a) A licensee shall ensure that infection control practices are maintained as follows:… This requirement was not met as evidence by: LPA observations of paper towels and toilet paper on the bathroom counter and not on a stand. This poses a potential health safety and or personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administrator stated they will purchase stands for the paper towels and toilet paper. Pictures will be sent to CCL as proof of correction by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87309(a) · Plan of correction due date: Oct 31, 2025

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidence by LPA observations during visits conducted on 09/13/25 and 10/18/25. The licensee did not comply with the section cited above in that chemicals were unlocked and accessible to residents in care in the master bathroom sink cabinet, laundry room, linen room, staff bedroom, and in the kitchen. Sharps were observed unlocked and accessible to residents in care in the kitchen. Stove observed without locking mechanisms posing a danger to residents in care. Supplements in resident bedroom closet unlocked and accessible to residents in care. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administrator had staff immediately lock. Training will be compelted with all staff. In service sign in sheet and training material will be sent to CCL as proof of correction by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(9) · Plan of correction due date: Oct 31, 2025

87555 General Food Service Requirements (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidence by: LPA observations of visits conducted on 09/13/25 and 10/18/25. The licensee did not comply with the section cited above in that garage freezer observed with ice and in need of defrosting. Canisters in pantry and in food stored in kitchen refrigerator/freezer not properly stored/dated. Kitchen refrigerator door has missing/broken shelves in need of replacement. Dry milk observed in panty in need of disposal. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2025

Plan of correction: Administrator stated they will defrost chest freezer, clean out refrigerator/freezer and dispose of dry milk. Pictures will be sent to CCL once completed. Training will be completed with all staff. In service sign in sheet and training material will be sent to CCL by POC date as proof of correction.

Type of visit: Case Management - Deficiencies

On 9/13/25 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived at the facility for an unannounced case management visit. LPA met with Care Giver, Gladys Quiniones. Administrator, Rodrigo Arrieta was contacted and arrived some time later. LPAs toured the facility inside and out. A health and safety check on residents was completed. 3 residents present during time of visit. This case management visit is being conducted for deficiencies found during a complaint/annual visit conducted on todays date. During visit interviews with staff and Administrator disclosed that R1 was bedridden and required assistance getting in and out of bed. Records reviewed indicated R1 needed "total assistance with all ADLs". Records reviewed during visit also indicated R2 was admitted to the facility 7/25/25 from a Skilled Nursing Facility (SNF). R2 was admitted with a diagnosis of "fractured pelvis". LPAs observations of resident indicates R2 is bedridden and needs to be lifted in order to transfered. Deficiency cited on attached 809D per Title 22 for fire clearance violation. An immediate civil penalty in the amount of $500 is being assessed. If not corrected, the deficiency has an immediate and direct impact on residents in care. Exit interview conducted with Caregiver, Antonia Duadico. A plan of correction was developed by Antonia and reviewed with LPAs. A copy of this report, deficiency, civil penalty and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 13, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Sep 15, 2025

87202 Fire Clearance (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. (2) Bedridden persons This requirement was not met as evidence by: LPA observations, records reviewed, and interviews conducted, the licensee did not comply with the section cited above in that 2 of 2 residents were bedridden and resided at the facility without a bedridden fire clearance. R1 no longer residing at the facility.the state’s words, verbatim · CDSS document, Sep 13, 2025

Plan of correction: Licensee to immediately notify fire department of bedridden resident at the facility and submit a fire clearance request to CCL with the following forms (LIC 200, LIC 9054, LIC 610E, updated facility sketch. ***Immediate $500 civil penalty assessed****

Type of visit: Required - 1 Year

On 09/13/25, Licensing Program Analysts (LPAs), L. Salazar and M. Garza arrived at the facility unannounced to conduct the required annual visit. LPAs were greeted by staff, stated the purpose of the visit and were allowed entry into the facility. Staff called Administrator, who was available via telephone. LPAs toured the facility inside and out including entry, kitchen, dining, living room, bedrooms, bathrooms, and exterior. LPAs observed 3 residents in care at the time of visit. Facility is a 4 bedroom 2 bathroom home. Bathrooms were observed to have grab bars by the toilets and a grab bar in the shower used by residents. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction. Facility temperature was 76 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 110.4 degrees F. Smoke detectors were tested and observed to be operational. Fire Extinguisher was observed with a service date of 09/17/24. First aid kit was observed and contained all required items. Required postings were observed for Non-discrimination LGBTQ-A+, Personal Rights of Residents in RCFE and theft policy. No residents are receiving Hospice services residents or receiving Home Health care service. The following issues were observed during todays visit: LPAs did not observe posting of facility's visitation policy, LETUSNO Complaint Poster, (PUB475) and Ombudsman poster. A sample of 7-day food source was observe to be expired. Oxygen was observed in master bedroom closet, unsecured and not on a stand. R1's file showed R1 had a hospital visit on 08/20/25 that was not reported to CCL. There have been zero incident reports submitted by facility in 2025. Resident records were reviewed. 2 out of 2 files to have blank forms in the file. Blank forms were Identification & Emergency information (LIC601), Pre-admission appraisals (LIC603), Personal Rights of residents in care (LIC613C2), personal property and valuables (LIC621), Centrally stored medical and destruction record (LIC622), Appraisal/Needs service plan (LIC625), and Consent for medical treatment (LIC627C). Staff record were reviewed. 1 of 3 staff files was missing from facility. 2 of 2 staff files observed to be incomplete: Health screening report/TB testing (LIC 508), missing training hours (initial/ongoing). (Continued on LIC 809C) (continued from LIC 809) Based on LPAs observations and records review and per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiencies are being cited on the attached 809-D's. If not corrected, this poses a potential/immediate health, safety or personal rights to persons in care. LPA is requesting the following due by 09/26/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrative Organization (LIC 309), Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A), and current liability insurance. Exit interview was conducted with Antonia Duadico, A copy of this report and appeal rights were discussed and provided. A plan of correction was developed and reviewed with LPA.the state’s words, verbatim · CDSS document, Sep 13, 2025

The state marks this report as 25 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 09/11/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility by facility staff. Facility staff contacted Administrator, Rodrigo Arrieta (AD) via telephone. Administrator arrived a short time later. LPA reviewed resident records and found the following. Upon review of resident records, LPA observed that R2 needs an updated physician's report and R1 did not have a complete home health agreement on file. Upon review of staff files, LPA found that staff did not have annual training on file for dementia, medication, and restricted health care. LPA requested to review a staff file and AD was unable to provide the file. AD stated that the staff is no longer working for the facility. LPA reviewed facility emergency disaster plan. Per AD, the facility has not conducted a fire/disaster drill. LPA conducted a tour of the facility with the Administrator. LPA observed the living room/common areas to be clean and appropriately furnished. Dining area was observed to be adequately furnished. The facility kitchen observed to be clean and safe for food preparation. Food supply was checked. Resident bathrooms appeared to be clean. LPA observed securely fastened grab bars, and non-skid mats. Hot water measured 112.6 degrees F. LPA observed disinfectant wipes on the bathroom counter in bedroom 4 accessible to residents in care. Resident bedrooms were toured. LPA observed full bed rails on R3's bed. AD did not have a physician's order on file and R3 does not receive hospice services. CONTINUED TO 809C. LPA did not observe complaint poster (PUB 475) posted in the facility. Fire extinguisher was last serviced on 09/15/2023. Smoke detector and carbon monoxide detector observed to be operational during today's inspection. Exterior tour conducted. LPA observed the backyard lawn to be overgrown and in need of maintenance. LPA observed two large, sharp knives and multiple sharp gardening tools on top of a bucket in the backyard accessible to residents in care. Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and plan of correction was reviewed and developed with AD. A copy of this report and appeal rights were discussed and provided to Administrator, Rodrigo Arrieta, whose signature on this form confirms receipt of this document. LPA is requesting the following documents be submitted to the Fresno CCL office by 09/25/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bondthe state’s words, verbatim · CDSS document, Sep 11, 2024

The state marks this report as 14 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Allegation investigated: Facility staff did not respond to resident's ring bell

On 08/26/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to commence a complaint investigation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA spoke with Administrator via telephone and received verbal permission to meet with During the course of the investigation, LPA conducted a facility tour and interviewed staff. LPA confirmed did not hear the resident call button resulting in staff not responding timely to a residents call for assitance. Based on interviews the perponderance of evidence standard has been met therefore the allegation: Facility staff did not respond to resident's ring bell is SUBSTANTIATED. A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 9099D. Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to ************************, whose signature on this form confirms receipt of this document. Substantiatedthe state’s words, verbatim · CDSS document, Aug 26, 2024 · control 24-AS-20240816164101

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Aug 26, 2024

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... this requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when staff did not respond timely to a resident call for assistance, which posses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 26, 2024

Plan of correction: Licensee repaired the assigned bell. POC cleared.

Allegation investigated: Staff did not assist resident with obtaining medical care services Staff forced resident to take medication

On 08/07/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a complaint investigation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available to meet during this inspection. LPA contacted administrator via telephone and received verbal permission to meet with facility staff. LPA investigated the above allegations and found that the allegations are UNSUBSTATIATED. 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. No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to facility staff, whose signature on this form confirms receipt of this document. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 7, 2024 · control 24-AS-20240801145558

Type of visit: Case Management - Other

On 08/07/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available to meet during this inspection. LPA contacted administrator via telephone and received verbal permission to meet with facility staff. During the course of a complaint investigation, LPA requested to review resident and staff records. Facility staff were unable to provide records. LPA contacted Administrator via telephone, per Administrator, client and staff files are locked and inaccessible. Interviews with the administrator revealed that the facility does not have a facility manager designated by the licensee, to temporarily manage the facility while the administrator is absent. Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to facility staff, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 7, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Aug 23, 2024

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff..this requirement was not met as evidenced by: Based on interviews, the licensee did not comply with section 87506 when resident records were not available to review during a complaint investigation, which is a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: Licensee agrees to review section 87506 and submit a written statement detailing the steps the facility will take to ensure client records are readily available to the Fresno CCL office by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412 · Plan of correction due date: Aug 23, 2024

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying... this requirement was not met as evidenced by: Based on interviews, the licensee did not comply with section 87412 when personnel records were not available to review during a complaint investigation, which is a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: Licensee agrees to review section 87412 and submit a written statement detailing the steps the facility will take to ensure client records are readily available to the Fresno CCL office by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.618(a) · Plan of correction due date: Aug 23, 2024

§1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility... this requirement was not met as evidenced by: Based on interviews, the licensee did not comply with this section when the licensee did not have a facility to temporarily manage the facility while the administrator is absent, which is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: Licensee agrees to designate a facility manager to manage the facility while the licensee and administrator are absent. Licensee will submit the LIC308 to the Fresno CCL office by the POC due date.

Type of visit: Case Management - Annual Continuation

On 09/28/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management - annual continuation inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the home. Facility staff contacted Administrator, Rodrigo Arrieta, who arrived a short time later. During today's visit, LPA reviewed resident and staff records, and medications. Upon review of resident records, LPA found that 2 out of 4 residents files were missing an appraisal / Needs & Services care plan. Review of medications revealed that R4 has been receiving an over the counter medication that has not been prescribed by a physician. Based on record review, deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed, and provided to Administrator, Rodrigo Arrieta, whose signature on this form confirms receipt of this document. LPA is requesting the following documents be submitted to the Fresno CCL office by 10/12/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bondthe state’s words, verbatim · CDSS document, Sep 28, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.