Well Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by licensee Ladana Luellen. Administrator certificate #7004459740 expired 4/10/26. However, licensee produced proof of mailing of Admin cert renewal with date stamp of 4/11/26. Facility currently has three (3) residents in care two (2) of which are currently on hospice. At approximately 2:15pm LPA toured the building and grounds. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be open, uncovered, and many items expired. Facility has a pantry in room #3 and food pantry in the kitchen. LPA observed expired food items in both. Expired items include: two 920 boxes of Stove Top expired 9/2/2022, two (2) boxes of Shake and Bake expired 2/9/2016, Betty Crocker Mashed potatoes expired 3/15/2015, sunflower seeds expired 3/4/2019, Jello pudding expired 7/16/2023, Jello gelatin expired 1/19/2019, Mrs. Grass noodles soup expired 8/9/2022, boiled oysters 7/4/2017, sardines expired 12/2024, luncheon loaf expired 3/15/2020, corn muffin mix expired 11/3/2018, salad dressings respective expired 10/30/2024, 3/2022, and 12/22/2021 (deficiency cited, see 809D). Freezer item of sausage links and hot dogs were stored open and uncovered in kitchen. Facility also has a freezer in the garage, almost all items in the freezer had ice and ice crystals forming on top and within packages of meat and other items. Open and uncovered was a bag of meat that was fatty and gray in color. LPA observed in pantry in room #3 open bag of grits not sealed or rolled shut, and one container of spicy ranch salad dressing 7/12/2025 and strawberry fruit spread 6/8/2019 open, not refrigerated and stored in pantry closet (deficiency cited, see 809D). LPA observed kitchen cabinet under sink to contain bucket to catch water. Sink leaks, per licensee they have to empty the bucket of water once a month. Sink in room #1 has two (2) buckets underneath to catch water. LPA observed water in both buckets as well as bowed/ballooning wood and gray and blue substance Continued on 809C... Continued from 809... present. Facility has three bathrooms: one (1) in resident room #1, one (1) in resident room #3 and a main bathroom in the hallway. Main bathroom has electrical outlet is disrepair (deficiency cited, see 809D).Additionally, per licensee resident has been using bathroom in room #3, which is not their room. The bathroom is the first door on the right when entering room #3. LPA advised of regulation 87307(a)(2)(c) which states: No bedroom of a resident shall be used as a passageway to another room, bath or toilet. All bedrooms were equipped with lighting, night stand, chair, but room #2 did not have chest of drawers (deficiency cited, see 809D). Window sill in room #3 has many dots of black and gray fuzzy substance (deficiency cited, see 809D). Extra hygiene products and linens were available. LPA discussed with licensee the use of resident rooms as storage for faclity supplies such a gauze, gloves, chucks, and personal items such as clothes. Room #1 has two large furniture items used to store the licensees' personal items. Additionally, LPA found closets in room #1 and room #3 to be locked, making them inaccessible to residents in care. Closet in room #3 also houses facility supplies. LPA discussed with licensee regulation 87308 pertaining to storage. Resident bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 108.6 degrees F in the kitchen and 107.4 in the bathroom used by residents, both of which are within the allowable range of 105 to 120 degrees F. Facility has another bathroom used by staff only. Fire extinguishers were last inspected 10/22/2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drill was conducted on 1/25/26. Facility has a backup generator for use during a power outage. At approximately 4:00pm LPA conducted a review of three (3) out of three (3) resident files. R1 did not have TB clearance file (deficiency cited, see 809D). At approximately 4:30pm LPA conducted a review of three (3) staff files. Staff S1 and S2 did not have 1st Aid (deficiency cited, see 809D), Health Screen with TB clearance (deficiency cited, see 809D), or required training current or on file (deficiency cited, see 809D). Continued on 809C(2)... Continued from 809C... At approximately 5:30pm LPA conducted a review of medication regulations including a PRN MAR requirement and Centrally Stored Medication Log requirements. Facility not using a PRN MAR. LPA discussed with licensee obtained PRN authorization letters for all residents in order to know if a PRN MAR is required for that resident. LA discussed with licensee activities in the facility, especially those suited for residents with cognitive impairment or dementia. LPA did not observe any activities. LPA and licensee discussed Emergency Disaster Plan. Licensee confirmed no updates needed. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Apr 14, 2026

The state marks this report as 17 pages; the online copy we transcribed has 11. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection visit of the facility. LPA was welcomed by Licensee/Administrator, Ladana Luellen. There is a total of 3 residents in care, 1 currently on Hospice, 3 with dementia. LPA toured the facility on 4/8/2025 at 1:45 PM with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Fire extinguishers were last checked 10/14/2024. Hot water temperature measured between 111.3 degrees F and 112.6 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility. Resident bathrooms had required slip resistant mats and grab bars. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the laundry room. Dangerous items were found stored inaccessible to residents with dementia. There was an ample supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. All bedrooms have lighting & appropriate furnishings. Medications were centrally stored in locked cabinet in facility office/kitchen. A review of three (3) resident & two staff records as well as medication audit was conducted. LPA reviewed resident’s files at 2:15pm on 4/8/2025 and learned that all residents have an appraisal or updated re-appraisals/needs & care plan and 3 out of 3 residents physician’s assessments (LIC 602A) are updated as required by Title 22 Regulations on file. Continue on LIC809-C Continued from LIC809 Medications were centrally stored in locked cabinet in the facility kitchen. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 4/8/2025. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed a sample of staff records at 2:45 PM on 4/8/2025 and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. LPA observed during staff file review that facility has proof on 4/8/2025 at 2:45 PM of direct care staff annual training requirements. LPA was presented with proof of CPR and 1st Aid certification for Licensee although staff does not have current 1st Aid. (see LIC 9102 Advisory Notes) Ladana Luellen Administrator Certificate # 7004450740 expires on 4/10/2026. Facility’s last recorded disaster drill was not recorded, licensee informed did not remember when, falling out of Title 22 Regulations (see LIC809-D).LPA advised to ensure that disaster drills are conducted quarterly in different shifts and log drill, as well review facility emergency plan to ensure accuracy according to the needs of facility residents. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided LPA Hansen is requesting Licensee to update the following documents by 4/25/2025: LIC 308 Designated (if changes) LIC 500 Personnel Summary (if changes) LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility /Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Apr 8, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual inspection visit of the facility. LPA was welcomed by Licensee/Administrator, Ladana Luellen. There is a total of 5 residents in care, 2 currently on Hospice, 1 with dementia. LPA toured the facility on 2/20/2024 at 8:45 AM with staff Arthur “Lee” Luellen; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices; (although they were not turned on during today’s visit (see LIC809-D). Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Fire extinguishers were last checked 10/13/2023. Hot water temperature measured between 114.9 degrees F and 118.5 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the laundry room. Dangerous items were found stored inaccessible to residents with dementia. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Medications were centrally stored in locked cabinet in facility office/kitchen. A review of five resident & two staff records as well as medication audit was conducted. LPA reviewed resident’s files at 10:00 AM on 2/20/2024 and learned that 1 of 5 residents (R1) do not have an appraisal or updated re-appraisals/needs & care plan (see LIC809-D) and 5 out of 5 residents physician’s assessments (LIC 602A) are updated as required by Title 22 Regulations on file. Continue on LIC809-C Medications were centrally stored in locked cabinet in the facility kitchen. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 2/20/2024 at 11:30 AM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed a sample of staff records at 11:45 AM on 2/20/2024 and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. LPA observed during staff file review that facility has proof on 2/20/2024 at 11:00 AM of direct care staff annual training requirements for 2023. LPA was presented with proof of CPR although 1st Aid certification for Licensee expired. (see LIC 9102 Advisory Notes) Ladana Luellen Administrator Certificate # 6015414740 expires on 4/10/2024. Facility’s last recorded disaster drill was 2/2/2023 falling out of Title 22 Regulations (see LIC809-D). LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided LPA Hansen is requesting Licensee to update the following documents by 3/20/2024: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Feb 20, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.