Vita Bella Elderly Care II

Allegation investigated: Staff are forging resident documents.

On 06/16/2026, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Marie Taylor and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 6. Allegation: Staff are forging resident documents. It was alleged that staff are forging resident documents. This investigation consisted of resident records review. On 02/13/2026 LPA Hughes conducted a visit to the facility and obtained residents LIC 602 Physician’s Reports for 6 out of 6 residents in care. LPA Hughes reviewed the records and verified that 6 out of 6 resident LIC 602 Physician’s Reports contained physician signatures. LPA contacted the physician’s offices and confirmed that the signatures on the LIC 602 forms were authentic and consistent with the records maintained by the physicians. There is not enough evidence to corroborate that the facility forged or falsified documents. Therefore, this allegation is unsubstantiated. Unsubstantiated The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 27-AS-20260211132816

Allegation investigated: The facility allowed excluded individuals to work in the facility.

On 05/22/2026 Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Marie and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. Allegation: The facility allowed excluded individuals to work in the facility. It was alleged that the facility allowed excluded individuals to work in the facility. This investigation consisted of interviews with facility staff and residents. On 2/13/2026 LPA Hughes conducted a visit to the facility and spoke with the facility administrator who is aware of the excluded individuals, but stated that the individuals do not work inside of the facility. It was further stated that (1) excluded individual was present at the facility in February 2026 to drop of some supplies to the facility. Interview with resident (R1) revealed that (1) excluded individual was last seen in the facility three weeks prior to the visit, stating that the individual informed them that they will become the new owner of the facility. Continuation 9099-C Substantiated This was observed not in compliance with Title 22 regulation 87777(a) Exclusions as the facility did not ensure an excluded individual was not permitted to be present in the facility. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility. An immediate Civil Penalty of $500 was assessed during this visit. The Department may assess additional civil penalties at a later date. Records review of the facilities LIC 500 Personnel Report indicated that the facility administrator is presence in the facility for a sufficient amount of time. There is not enough information or evidence present to corroborate this allegation therefore the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, May 22, 2026 · control 27-AS-20260211132816

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87777(a) · Plan of correction due date: May 26, 2026

87777 Exclusions (a) The Department may prohibit an individual from serving as a board of directors, executive director, or officer; being employed or allowed in a licensed facility as specified in Health and Safety Code Sections 1569.58 and 1569.59. This requirement was not met as evidenced by: The facility did not ensure an excluded individual (E1) was prohibited from entering the facility. (E1) was observed entering the facility on multiple occassions interacting with residents and bringing items to the facility.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: Effective immediately excluded person will no longer be allowed to be present at a licensed facility.By POC due date, Administrator is to provide CCL with a written plan to ensure that the excluded person will not work or provide services to any of the residents or staff from any licensed facility. An immediate civil penalty of $500 was assessed during today's visit.

Type of visit: Case Management - Deficiencies

On April 22, 2026, Licensing Program Analyst (LPA) Arvin Villanueva conducted a case management visit at the facility. This visit was conducted concurrently with the pre‑licensing inspection. LPA met with facility representatives Diana Garcia and Marie Taylor and explained the purpose of the visit. During a Change of Ownership (CHOW) Pre-licensing visit on April 22, 2026, LPA observed the following deficiencies: Inspection of the kitchen, in one of the drawers, LPA found a resident medication (eye drop solution) that is accessible to residents in care. One resident was using their oxygen during this visit. LPA did not observe any "No Smoking - Oxygen in Use" sign anywhere in the facility. During a resident record review, LPA did not find restricted health care plan for residents with restricted health condition, including the one resident using oxygen concentrator during this visit. During resident record review, 6 of 6 residents did not have a signed PRN Authorization Letter or documentation that indicate whether resident is able to communicate their needs for PRN medication. Based on today's visit, deficiencies were cited and advisories were provided. Exit interview was conducted with Diana and Marie and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 22, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87611(b) · Plan of correction due date: Apr 30, 2026

General Requirements for Allowable Health Conditions: The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: This requirement is not met as evidenced by: Based on record review and interview, the facility did not develop restricted health care plan for residents with restricted health conditions. This poses a potential health, safety and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: Administrator agreed to develop restricted health care plan for all residents with restricted health condition. Submit each plan to the Department by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87618(b)(3)(B) · Plan of correction due date: Apr 30, 2026

"No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Based on observation, at least one resident was using an oxygen during this visit and LPA did not find any signage anywhere in the facility. This poses a potential health, safety and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: Corrected on cite: staff printed a signage during this visit and posted it in appropriate area of the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Apr 23, 2026

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on observation, LPA found a resident medication inside one of the kitchen drawer, accessible to residents in care. This poses an immediate health, safety and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: Corrected on site: staff removed the medication from the drawer and placed in the locked medication closet in the hallway.

Type of visit: Case Management - Other

On 2/17/2026 at 10:50 AM Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management visit. The facility is on a quarterly visit due to non-compliance concerns discussed during a Zoom meeting on 11/18/2025. LPA Hughes met with the facility administrator Marie Taylor and explained the purpose of the visit. The current census is (6) residents with (1) staff present. The purpose of today’s visit was to conduct a quarterly inspection. LPA followed up on the following areas: Incontinence care: LPA did not observe or detect any incontinence odors throughout the facility. Criminal record clearance and staff association requirements: LPA observed staff (S1), who is fingerprint cleared and currently associated to the facility. Additionally, LPA checked staff criminal record clearances for all staff currently working in the facility and all staff who require caregiver background checks are finger print cleared. Incidental medical and dental care services: LPA reviewed medications for 3 out of 6 residents and the Medication Administration Record (MAR) was observed complete. A review of the Centrally Stored Medication Destruction Record (CSMDR) showed start dates and expiration dates of all medications listed on residents Medication Administration Records. Food supplies: LPA observed that the facility had sufficient food supplies, meeting the requirements of two-day perishable and seven-day non-perishable supply at the time of the visit. No citations were issued during today's visit. A copy of the LIC 809 report was provided to the facility, at the end of the visit.the state’s words, verbatim · CDSS document, Feb 17, 2026

Type of visit: Required - 1 Year

On 2/17/2026 at 8:50am, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with the facility designated administrator Marie. The current census is 6 with 1 facility staff. This facility is a single story building licensed to serve (6) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 110.4 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. LPA inspected (5) Smoke and (2) carbon monoxide detectors observed in compliance with fire safety. The fire extinguisher is located in the entry way and was last serviced on 11/14/2025. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 74 degrees Fahrenheit. LPA observed toxins located in the kitchen cabinet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 6 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 6 out of 6 resident files and they were complete. LPA reviewed 3 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 02/18/2026 (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of the LIC 809 report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 17, 2026

Type of visit: Case Management - Legal/Non-compliance

A Non-Compliance Conference (NCC) follow-up was held on November 18, 2025, via Microsoft Teams with the Sacramento South Regional Office. The purpose of this meeting was to follow up on the NCC conducted on January 30, 2025, and its compliance and to address ongoing deficiencies and the facility’s continued inability to maintain substantial compliance with regulations over the past 11 months. Attendees included Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Analysts (LPAs) Pang Lee, Shakaricka Hughes, and Cynthia Tamayo, and Ombudsman Lisa Carrera. Facility representatives included Licensee Mark LaBella, Administrator Marie Taylor, and Administrator Sera Nakalevu. Administrator Aliti N Waqalala, could not attend the meeting. During the meeting, the Non-Compliance Follow-Up process was reviewed with the Licensee and Administrators. A Non-Compliance Follow-Up Meeting Summary (LIC 9111) was completed and provided to the Licensee along with a copy of this report. Since January 30, 2025, NCC, the facility has received 10 Type A citations and 15 Type B citations. Issues discussed included: · Incontinence care · Criminal Record Clearance and staff association requirements CONTINUED LIC 809-C · Fire clearance and fire safety (ensuring all exit doors and all emergency exits operate with a single-action mechanism and that residents are to be not locked within the facility and out of the facility; gates may not be difficult or hinged in a way that restricts exiting/entering) · Reporting requirements · Incidental Medical and Dental Care Services (including proper medication administration and internal medication audits) · Insufficient food supplies (7-day non-perishable and 2-day perishable requirements) · Dementia care, including wandering resident protocols and awake staff requirements · Basic Services (care and supervision) · Change in condition assessments and reassessments · Staff training and staff responsibilities · Door alarms and alert systems · Quality of food being provided · Personal rights (including the requirement that food, pantry items, and refrigerated items not be locked) · Communication and responsiveness with the Department · Oversight expectations when the Administrator is absent, including Licensee oversight, trained staff coverage, and conducting random evening and NOC shift visits/audits CONTINUED LIC 809-C The facility reported the following corrective actions and plans have been put in place: · Deadbolt removed from exit door · Lock removed from pantry · Training conducted on care and supervision · A new call system was purchased two weeks prior · Weekly routine established: full walk-through every Monday; full medication checks every Tuesday to verify new medications are on the MAR and CSDMR · Licensee visits the facility weekly · A stand-up freezer was purchased to increase food storage. · Staff from all three homes are submitting photos of every meal (breakfast, lunch, and dinner) to verify nutritional quality Change of ownership for three facilities was also discussed. Vita Bella Elderly Care and Vita Bella Elderly Care II have pending change-of-ownership applications. Vita Bella Elderly Care III has no pending application at this time. Licensing reported that Vita Bella Elderly Care II is pending fire clearance for sprinklers. Technical Support Program (TSP) engagement was offered and accepted by the Licensee. LPAs will submit the TSP referral, and the Regional Office will extend and increase quarterly monitoring for the next six months to assess the facility’s progress and compliance with issues identified during the NCC meetings on 01/30/2025 and 11/18/2025. The Regional Office will reassess compliance in six months and will initiate the legal process if the facility does is not in compliance. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Case Management - Health Checks

On 06/04/25, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to conduct a health and safety case management visit. The facility is on quarterly visit due to non-compliance concerns discussed during a Microsoft team meeting on 01/30/25. LPA Lee met with administrator Marie Taylor Trimmingham and explained the purpose of the visit. The census is 6 with 2 facility staff. LPA Lee and administrator toured the physical plant to ensure compliance with Title 22 regulations. LPA Lee observed 5 resident bedrooms, 2 resident bathrooms, common area, staff room, kitchen, laundry room and the courtyard. LPA Lee observed resident bedrooms to have necessary furniture and furnishings. Bedrooms were equipped with a bed, chair, dresser, and closet space. Bathrooms handrails and non-skid mats are in good repair. Fire extinguishers were up to date and fully charge. No emergency exits were obstructed. LPA Lee reviewed food supply to ensure that the facility had a 2-day perishable and 7-day nonperishable food supply. LPA observed laundry room where it was observed that detergent was locked and made inaccessible at this time. Knives were observed to be locked and made inaccessible. LPA Lee inspected the garage and observed the garage not locked and cleaning supplies are stored in the garage and multiple cleaning supplies was made accessible to residents in care. During today’s visit administrator removed the cleaning supplies from the garage to a locked cabinet. LPA Lee requested to review 3 resident files and 2 staff files, and they and it was observed to be current with up to date. LPA Lee reviewed 3 resident medications, and 2 out of 3 resident’s medication was incomplete. Resident 1 (R1)’s Docusate medication was not given per doctor’s order. R2 Losartan Potassium medication was also not listed in the MAR logs with R2’s other medications. An audit of R2’s Losartan medication revealed that R2’s Losartan medication is over by 1 count. As a result of this case management visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with administrator Marie and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Jun 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jun 11, 2025

87465(c)(2) Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication… (2) Once ordered by the physician the medication is given according to the physician's directions. This was not met as evidence by: Based on interviews, record review and auditing residents’ medications on hand there were multiple discrepancies. R1’s medication was not given per doctor’s order and R2’s medication was not documented in the MAR log and has a surplus of 1 pill, which indicates that R2 was not given his or her medication as prescribed. This posed an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2025

Plan of correction: Licensee/administrator will conduct in-service training to ensure that residents medications are given to residents per physician’s order. Licensee/administrator will also review licensing documents CSMDR and MARs to ensure that these documents are kept current and accurate. A statement of acknowledgement of understanding of the regulation along with documents of training materials used and staff sign in sheet will be email to LPA Lee. POC due by 06/11/25 end of day 5:00 PM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Jun 11, 2025

87309(a) Storage Space and Access (a) Except as specified in subsection, 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 was not met as evidence by: Based on observations LPA Lee inspected the garage and observed the garage not locked and cleaning supplies are stored in the garage and multiple cleaning supplies was made accessible to residents in care. his posed an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2025

Plan of correction: During today’s visit the cleaning supplies was removed to a lock cabinet. Licensee/administrator will conduct in-service training for storage and space access to ensure that all chemicals are locked up and inaccessible to residents in care. A statement of acknowledgement of understanding of the regulation along with documents of training materials used and staff sign in sheet will be email to LPA Lee. POC due by 06/11/25 end of day 5:00 PM.

Type of visit: Required - 1 Year

On 03/12/25, Licensing Program Analysts (LPAs) Pang Lee and Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPAs met with administrator Marie Taylor and explained the purpose of the visit. Administrator assisted with today’s visit. Administrator certificate # is 6070952740 and will expire on 06/23/26. The current census is 6 with 1 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents and hospice waiver for (1). LPAs inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPAs observed the facility to be free of odor, clean and in good repair. LPAs observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPAs toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 105.3 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in kitchen and was last serviced on 08/07/24. The last fire drill was conducted on 02/13/24. Administrator was aware that fire drill is conducted every 3 months. LPAs observed the facility has a has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 74 degrees Fahrenheit. LPAs observed toxins located in the garage and underneath the kitchen cabinet and kept locked and inaccessible to residents. LPAs observed sharp knives kept locked under the kitchen sink and inaccessible to residents. LPAs checked medication storage and found medication to be locked away and inaccessible to residents. LPAs reviewed 3 out of 6 resident medications and medication administration record (MAR) and it was complete. The first aid kit was checked and contained the required components. LPAs requested resident and staff files for review. LPAs reviewed 5 out of 6 resident files, and 2 out of the 5 resident files were missing TB documentation. Per administrator the two resident does have their TBs completed and are misfiled. During today's visit, administrator was working on locating the TB. Administrator will provided proof of TB by end of day today 03/13/25 5:00 PM. LPAs reviewed 2 staff files, and it was complete. LPAs reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents will be email to LPA by 03/20/25 end of day 5:00 PM: (1) Copy of Administrator Certificate (2) LIC 610 Current Emergency Disaster Plan (3) Proof of Current Liability Insurance (4) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with administrator, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Mar 13, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Legal/Non-compliance

A Non-Compliance Conference (NCC) was conducted today on January 30, 2025, via Microsoft Teams with the Sacramento South Regional Office. The purpose of this Non-Compliance Conference meeting to discuss compliance issues at the facility and the steps the facility is taking to address the Departments’ concerns. Present in the meeting is Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analysts (LPA) Pang Lee, Licensee Mark Labella, Administrator Cleopatra Gardiner, Staff Marie Ann Taylor, and Staff Aliti Wagalala. During this virtual meeting, the Non-Compliance Conference process was explained to the Licensee. A Non-Compliance Conference Summary (LIC 9111) was generated to document this office meeting. A copy of this report and the LIC 9111 was provided to the licensee. The facility has previously received 1 Type A citations and 6 Type B citations since 12/22/2021. Issues discussed during the meeting were: · Basic Services (care/supervision/elopement) · Administrator qualifications/duties and accountability/new potential administrator · Reporting requirements · Incidental Medical and Dental Care Services (resident not receiving medication as prescribed) · Fire clearance (adhering to fire clearance/submitted facility sketch) · Limitations capacity and ambulatory status (non-ambulatory resident cannot reside in an ambulatory room) · Plan of corrections (POCs) submitted in a timely manner. · Background/fingerprint clearance (volunteers) · Maintenance and building (self-latch and close gate) · Increased training for incidental medical and dental care (ensuring residents are given medications as prescribed) · Increased training for storage space (cleaning supplies/toxin needs to be inaccessible to residents) · Resident assessment prior to admission and appraisals based on residents change of conditions. The facility has stated they will agree to do the following: · Licensee agrees to ensure gates in the facility are self-latch/close by 02/06/25. · Licensee agrees to conduct incidental reporting training to all facility staff and provide CCLD training materials used for the training and training sign in sheets. Training will be conducted every 6 months. · Licensee agrees to conduct incidental medical training to all facility staff and provide CCLD training materials used for training and training sign in sheets. Training will be conducted every 6 months. · Licensee agrees to submit an addendum for volunteers in the facility. Notwithstanding the above statement, the Department will take the following actions: · The facility will continue to have additional monitoring and facility inspections to verify improvement in compliance. · Licensee stated that he will be meeting up next week with his administrator and potential administrators to discuss TSP and will reach out to LPA. Failure to maintain substantial compliance outlined on the LIC 809 reported will result in the Licensee/Facility being referred to the Legal Department for review and possible Administrative Action. The RO will revisit compliance in 9-12 months and begin the legal process if the facility is not in compliance. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 30, 2025

Type of visit: Case Management - Other

On 11/21/2024, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a case management visit. LPA were met by caregiver Marie Taylor and explained the purpose of this visit. The census is 5. Care staff Marie attempted to reached administrator Mark Labella via telephone.; however, administrator didn't answer the call. During today's visit administrator was not present. The purposed of today's visit is deliver the Order to Licensee/Facility of Immediate Exclusion and explained that staff (S1) is excluded from any involvement in the facility effective immediately. No citations were issued on today's date. A copy of this report and exclusion letter was provided to the facility care staff Marie Taylor at the end of this visit.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with direct care staff and explained purpose of visit. Administrator Certificate expires 1/3/2025. LPA and direct care staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, and outside backyard. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in resident's bathroom at 109.4 degrees Fahrenheit which is within the required range of 105 to 120 degrees. Fire extinguishers last inspected on 6/2/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 12/18/2023 . LPA reviewed six resident files and four staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents to be submitted via email to community care licensing by February 15, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited during this visit. Exit interview held with direct care staff. A copy of report and LIC 811 (Confidential Names) were left at facility.the state’s words, verbatim · CDSS document, Feb 8, 2024