Welcome Home II

Type of visit: Required - 1 Year

On 2/13/26, at 1:15pm, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required inspection visit to Welcome Home II. LPA met with Antonia Dionisio, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory elderly residents (age 60 and over). Approved hospice waiver for one (1). Hospice resident in bedroom #3 only. Currently, the home has (5) non-ambulatory residents. The facility’s annual fees are current. The facility is a single-story building located in a residential neighborhood. It consists of the following: four (4) bedrooms, two (2) bathrooms, dining room, living room, kitchen, laundry area, storage room, and a detached garage. At 1:45pm, LPA and staff toured the facility. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident’s personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries were accessible to clients. The water temperature measured 113.5F. A comfortable temperature is maintained in the facility. Report Continued on LIC809-C LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents. All food items were stored properly. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked with manual. The fire extinguishers were charged, and the smoke/ carbon monoxide detectors were operable. The facility’s administrator’s certificate (7009828740) was valid from 12/12/2025 through 12/11/2026. The facility’s liability insurance was valid from 01/12/2026 through 01/12/2027. LPA conducted a review of (5) resident records, (3) staff records, and reviewed the facility disaster plan. Resident and staff records were completed with required documents and training. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (5) resident medication administration records, and medication, and did not observe any discrepancies at the time of visit. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA advised the facility to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. No deficiencies were cited during this inspection visit. An exit interview was held, and a copy of this Facility Evaluation Report was provided to Antonia Dionisio, Administrator.the state’s words, verbatim · CDSS document, Feb 13, 2026

Type of visit: Required - 1 Year

On 03/12/2025 at 8:28am Licensing Program Analyst (LPA) Zina Brown arrived at the facility. At 8:45 am LPA entered the facility to conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. At 9:35 am, the administrator Antonia Dionisio arrived to the facility and met with LPA who discussed the purpose of the visit. Facility is licensed to serve six (6) non-ambulatory residents and an approved hospice waiver for 1 resident (in bedroom #3 only) with garage only for storage use. One (1) resident is diagnosed with (1) dementia, (1) resident is receiving hospice care services and (2) receiving home health. The facility does not handle any of the residents’ money. The facility fees are current. The facility has liability insurance with Kinsale Insurance Company (Policy # 0100278106-1) effective 01/12/2025 - 01/12/2026 with each occurrence is $1,000,000 and general aggregate is $3,000,000. The home is a single story which consist of: (4) resident bedrooms, (2) bathroom, a living room, a family room/activity area, a kitchen with dining area, a laundry room, a garage for storage and a backyard with an outdoor shaded patio area. Between the hours of 9:10am - 9:25 am, LPA conducted a records review of the Medication Administrator Records for (6) residents. Between hours of 9:55 am - 11:13 am, LPA conducted a records review for (6) resident records, (3) staff records and reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. Between the hours of 12:15pm - 12:28pm, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 111.0F, 114.6F, and 115.9 F. The resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Report continues on LIC 809-C. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8); LPA observed the following deficiencies: Between the hours of 9:55am - 11:13am, LPA conducted a record review and observed following: NO LIC 625: Appraisal and Needs/Service Plan for Resident #1 who is diagnosed with dementia. NO TB Test results on file for Administrator (A1). An exit interview was conducted, and a copy of Report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 12, 2025

Allegation investigated: Resident developed a pressure injury due to staff neglect. Staff did not ensure that resident's diapering needs were met while in care. Staff did not ensure that resident's hygiene needs were met while in care. Staff did not ensure that resident was provided an adequate amount of liquid(s) while in care.

On 10/23/2024 LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with /Administrator. LPA explained the purpose of this visit. Investigation Consisted of: Investigations Branch (IB) referral accepted dated 6/26/24 and completed investigation on 10/11/24. CCLD staff conducted the following interviews: Administrator Interview (A#1) 7/31/24, Facility Staff Interviews (S#1 and S#2) 7/31/24, Witnesses Interviews (W#1-W#6) 7/2/24, 8/27/24, 9/24/24, and 10/7/24, and Residents Interviews (R#1-R#3) 7/31/24 and 9/17/24. CCLD staff conducted the following records reviewed: (R#1)’s Hospice records dated:7/1/24 and copies of Wound Pros that treated (R#1)’s pressure injury. On 10/23/2024, the department conducted the following interviews: Administrator (A#1), facility staff (S#1-S#2) and residents (R#2-R#5). Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Resident developed a pressure injury due to staff neglect. The details of the complaint alleged that (R#1) developed a pressure injury due to staff neglect. During the records review gathered by CCLD staff, the department observed that (R#1) was admitted to Above and Beyond hospice on 6/4/24. The hospice prescribed and delivered a low-air mattress; when the prescribed mattress was delivered, the delivery person set it up and needed to share with facility staff how to operate the mattress. In addition, the department observed the records requested by CCLD staff regarding (R#1)’s wound care company “Wound Pros” Nurse Practitioner (NP) notes on 6/26/24, (NP) indicate that she provided education regarding the management of (R#1)’s air loss mattress to facility staff. Moreover, the department observed on the Physicians Certification for Hospice Benefit dated 6/11/24 from the hospice Registered Nurse (RN) that nothing is written about educating facility staff on operating new air mattresses (R#1). During an interview conducted by CCLD staff with facility administrator (A#1) on 7/31/24, she stated that when (R#1) moved into the facility on 3/30/24, they did not have any skin breakdown issues until transitioning to a new hospice agency (Above and Beyond Care) in 6/24/24. The new hospice agency provided a new air mattress that arrived on 6/5/24. When the delivery company dropped the bed off and, after setting it up, told the facility staff that the bed was ready for (R#1) to use. Neither the delivery company nor the hospice agency trained the facility staff to operate the mattress properly. (A#1) believes that the new air mattress was not set correctly and was too hard, causing (R#1) skin breakdown that led to a pressure injury. Moreover, (A#1) stated that on 6/26/24, a wound nurse from Wound Pros noticed the air mattress was not correctly adjusted and notified facility staff; the nurse properly adjusted the settings on the mattress and provided training to the facility staff on how to use the settings on the mattress properly. Evaluation Report continues LIC 9099-C During an interview conducted by CCLD staff with facility staff (S#1-S#2), (2) out of (2) facility staff stated that they deny the allegation of (R#1) getting a pressure injury due to their neglect, also (2) out of (2) indicated that they re-positioned (R#1) every two hours to prevent pressure injuries. In addition, (2) out of (2) facility staff indicated that the air mattress provided by the hospice company needed to be set up correctly despite the facility staff being told by the delivery person that the mattress was ready for (R#1) to use. During an interview conducted by CCLD staff with resident 1 (R#1), (R#1) was not able to answer (IB) investigator questions due to cognitive issues. During an interview conducted by CCLD staff with residents in care (R#2-R#3), (2) out of (2) residents stated that facility staff does a good job taking care of them and meeting their basis needs. During an interview conducted by CCLD staff with the son of (R#1) (W#3), they stated that when (R#1) lived at the facility, they never reported any complaints to them about the care they were receiving by the facility. In addition, (W#3) “think” (R#1)’s pressure injury started around the time the victim began using the new air mattress provided by the hospice company. (W#3) visited (R#1) regularly and did not see any neglect or lack of supervision on the part of the facility staff. During an interview conducted by CCLD staff with a Customer Service Representative with Horizon Oxygen Medical Supply Equipment (W#4), they stated that on 6/5/24, a new air mattress was delivered at the facility for (R#1)’s use. (W#4) stated that if the mattress was not set up correctly and the pump was off, the mattress could be under constant pressure, making it hard. In addition, (W#4) stated that no notes indicated that the facility staff had been shown how to use and adjust the mattress pressure. Evaluation Report continues LIC 9099-C During an interview conducted by CCLD staff with Wound Pro Nurse (W#5), they stated that they treated (R#1)’s pressure injury every week, and (R#1)’s wound was responding to treatment. In addition, (W#5) stated that when they saw (R#1) for the first time, they had an air-loss mattress that was set to static, which means it was fully inflated (firm); the mattress should not be set to static when trying to prevent pressure injuries. (W#5) spoke with facility staff (S#1-S#2) about the bed settings being static, and they informed them that the mattress was new and that they were not instructed on how to use or adjust it. (W#5) adjusted the mattress to the appropriate setting and provided training to (S#1-S#2) on how to properly adjust and use it. Allegation: Staff did not ensure that resident was provided an adequate amount of liquid(s) while in care. The details of the complaint alleged that (R#1) was not provided with fluids on a regular basis. During the records review, the department observed that in the facility's weekly menu, fluids are to be served as appropriate to each resident's needs. Also, the facility has a hydration plan that follows five steps: 1- give water at any time, 2—more often is much better, 3- they have a glass of water all the time beside their bed, and 4- give them water every day as requested. During an interview with the administrator (A#1), she stated that the facility offers enough water to the residents in care, and no resident has ever been dehydrated. During an interview with facility staff (S#1-S#2), (2) out of (2) stated that the facility provides enough water/liquids to residents in care, and no resident has ever been dehydrated before. During an interview with residents (R#2-R#5), (4) out of (4) stated that the facility provides water/liquids to them. Evaluation Report continues LIC 9099-C Allegation: Staff did not ensure that resident's diapering needs were met while in care. The complaint details alleged that facility staff did not regularly change (R#1)’s diapers. During the records review, the department observed that the facility has a diaper schedule with the following times: 7:00 AM, 11:00 AM, 3:00 PM, 7:00 PM, and 10:00 PM. During an interview with the administrator (A#1), she stated that the facility has a schedule for diaper changes, and no resident has ever been left with a soiled diaper for an extended period. During an interview with facility staff (S#1-S#2), (2) out of (2) stated that the facility has a diaper changing schedule and no resident has ever been left on a soiled diaper for an extended time before. During an interview with residents (R#2-R#5), (4) out of (4) stated that they have never been left on a soiled diaper for an extended period. Allegation: Staff did not ensure that resident's hygiene needs were met while in care. The details of the complaint alleged that facility staff did not ensure (R#1)’s hygiene needs were met. During the records review, the department observed that the facility has a shower/changing schedule and offers sponge baths to the residents almost daily. Evaluation Report continues LIC 9099-C During an interview with the administrator (A#1), she stated that the facility has a shower/changing schedule every day and as needed, and no resident has ever been left in soiled clothes for an extended period. During an interview with facility staff (S#1-S#2), (2) out of (2) stated that the facility has a bath/changing clothes schedule, and no resident has ever been left on soiled clothes for an extended time before. During an interview with residents (R#2-R#5), (4) out of (4) stated that they have never been left on soiled clothes for an extended period. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Antonia Dionisio /Administrator.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 11-AS-20240625160602

Type of visit: Annual/Random

On 3/26/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Antonia Dionisio/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above. Of which (6) may be non-ambulatory. Approved hospice waiver for (1) in bedroom #3. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (2) bathrooms, two (2) living areas, dining area, laundry room, and kitchen. LPA toured the physical plant with staff. There were no bodies of water or obstructions on the premises. A total of (4) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected the carbon monoxide detectors combo were in operable conditions. The water temperature properly measured :Kitchen 110.6°F, Bathroom #1:107.2°F and Bathroom #2:106.4°F. Evaluation Report Continues LIC 809-C LPA Iniguez observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed, cleaning agents, poisons, and sharps objects were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (3) residents' service files, (2) staff personnel files were checked. (3) Medication Administration Records (MAR) were reviewed discrepancies were found. First AID kit was checked. Last fire disaster drill was on:3/4/2024. LPA observed the facility's infection control practices. Liability insurance will be emailed to LPA. Facility Annual Fees Not Current. LPA gave to administrator PIN#602495 to pay fees online as soon as possible. Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8. See details below: -Documentation error on MARS for R#1. -Expired CPR card for S#2. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Antonia Dionisio/Administrator.the state’s words, verbatim · CDSS document, Mar 26, 2024