Wholesome Elderly on Kifisia

Allegation investigated: Staff leaves resident in soiled clothing/linens for an extended period of time Facility staff are violating residents' personal rights

Licensing Program Analyst (LPA) Michael Hood arrived at the care home and met with caregiver, Kristina Johnson, to deliver findings regarding the complaint allegations listed above. LPA spoke with Administrator, Shaine Swogger, via telephone call, who gave permission for caregiver to sign the report. During investigation, LPA conducted interviews, toured the premises, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Staff leaves resident in soiled clothing/linens for an extended period of time Interview with resident (R1) indicated that they had an incident in which their catheter leaked on their bed and floor and staff did not provide assistance with cleaning. LPA reviewed Charting Notes and Incident Reports for R1 and identified incident in which R1 reported to LPA. LPA did not observe any information from Charting Notes or Incident Reports indicating R1’s catheter leaked on their furniture. ** Report continued on 9099-C ** Unsubstantiated LPA observed R1’s Medical Assessment dated December 16, 2025 which indicates that R1 has a colostomy and suprapubic catheter. R1’s Medical Assessment states that R1 is able to care for their own toileting needs. Interviews conducted with residents (R2, R3, R4, R5, and R6) indicated that they felt their care needs are being met and they don’t have concerns regarding care staff. Interviews with residents indicated that they have never witnessed another resident in need of incontinence care and not receiving it. Interviews with staff members (S1, S2, and S3) indicated that they have never witnessed a resident in need of incontinence care and not receiving it. During visits conducted on January 23, 2026, June 18, 2026, and July 1, 2026, LPA did not observe any residents in need of incontinence care and not receiving it. During visits, LPA observed care home to be clean and free from odors. Allegation: Facility staff are violating residents' personal rights Interviews conducted with R2, R3, R4, R5, and R6 indicated that they have no concerns regarding staff. Interviews with residents indicated that they have not experienced their personal rights being violated and have never witnessed another resident’s rights to be violated. Interviews conducted with S1, S2, and S3 indicated that they have never violated a resident’s personal rights nor have witnessed another staff member violate a resident’s personal rights. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jul 1, 2026 · control 59-AS-20260121084853

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Juan Ramirez, to conduct a case management health and safety check. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. Hot water temperature was observed to be 111 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA checked one (1) resident's medications and observed medication to be locked and inaccessible to the residents in care. LPA reviewed five (5) resident records. LPA observed staff on the premises to have a criminal background clearance on file. As a result of today's inspection, no deficiencies are being cited. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on October 22, 2025 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 111.1 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed six (6) resident files and two (2) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA observed medication missing on site for one (1) resident and observed medication documented as given when not on site. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiency is listed on 809-D page. An immediate civil penalty in the amount of $250 was assessed for today's date due to a repeat violation. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with caregiver, Melissa Sanchez, to conduct a case management health and safety check. LPA spoke with Administrator, Juan Ramirez, via telephone call, who gave permission to have caregiver sign report. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 115 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA checked two (2) residents' medications and observed medication to be locked and inaccessible to the residents in care. LPA reviewed four (4) resident records. LPA observed staff on the premises to have a criminal background clearance on file. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8 due to LPA observing medication errors for 1 of 2 residents. A civil penalty in the amount of $250 was assessed for a repeat violation as a result of today's visit. Deficiency is listed on 809-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jul 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 16, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication review and records reviewed, the facility did not ensure that resident (R1) was receiving all medications prescribed as needed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: Facility will create a plan regarding when a resident is out of the facility or medications are not on cite to ensure that residents are obtaining medications as needed. Facility will submit plan to LPA by POC due date. A civil penalty assessment in the amount of $250 was assessed for today's date for a repeat violation.

Type of visit: Office

An informal conference was conducted at 8:00 AM on April 16, 2025, with Sacramento North Regional Office via Microsoft Teams. The purpose of this informal conference meeting is to address and discuss concerns regarding the most recent inspections conducted on September 20, 2024, January 7, 2025, and March 6, 2025, as well as the result of the two (2) most recent complaint investigations, including citations issued during visits. The Administrator was told that this Informal conference is a part of the Administrative Action process and that further noncompliance may result in an elevation to a formal noncompliance conference, which could lead to a referral to the Department's legal division for possible revocation of license. The following Licensing staff were present: Licensing Program Analysts (LPAs) Michael Hood and Licensing Program Manager (LPM) Anthony Perez The following facility representatives were present: Administrator Juan Ramirez The following topics were covered during today's meeting: · An overview regarding 6 Type A citations, 5 Type B citations, and 5 civil penalties · Pending plan of corrections Facility was notified that the Department may increase monitoring at the facility. Technical support was offered to facility representative during meeting. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.the state’s words, verbatim · CDSS document, Apr 16, 2025

Allegation investigated: Facility staff are not assisting residents with ADLs

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Juan Ramirez, to deliver findings into the complaint allegation listed above. During investigation, LPA conducted a tour of the care home, conducted interviews, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Facility staff are not assisting residents with ADLs ** Report continued on 9099-C ** Substantiated Relevant party reported that the facility staff are not providing assistance with activities of daily living (ADLs) for residents, including showering and incontinence care. LPA reviewed records on the premises for residents R1, R2, R3, R4, and R5, including medical assessments, appraisals, and needs and services plans. LPA observed inconsistencies amongst records reviewed. R1's appraisal dated 7/23/2024 indicated that R1 needs assistance with transferring, dressing, bathing, hair care, personal hygiene, incontinence care, and supervision moving about the facility. R1's medical assessment dated 4/17/2024 indicated that R1 does not have bowel or bladder impairment, is confused but able to communicate their own needs, and is able to bathe, dress, groom, feed, and toilet themselves. R2's appraisal dated 8/26/2022 indicates R2 does not use a wheelchair. LPA observed during multiple visits that R2 uses a wheelchair. R2's appraisal indicates R2 does not need assistance with transferring, bathing, hair care, hygiene, moving about the facility, or incontinence. R2's medical assessment dated 6/3/2022 indicates R2 has bladder and bowel impairment and needs assistance with bathing. Interview with staff member (S1) indicated that staff member (S2) was not providing proper assistance with R5 regarding showers. R5's medical assessment dated 9/29/2022 indicates that R5 needs assistance with bathing and dressing. Interview with S2 indicated that they were unaware that R1 was incontinent or needed incontinence care. Interview with staff member (S3) indicated that no residents at the facility are incontinent. S3 stated that they don't help R5 with showers and they don't assist with resident showers "at all." S3 stated that they were told to remind residents to take a shower. LPA determines that, with the inconsistencies amongst residents records and staff statements, residents are not receiving sufficient assistance with ADLs. Based on LPA's observations, interviews conducted, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 6, 2025 · control 59-AS-20250113131500

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Apr 7, 2025

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on LPA's observations, interviews conducted, and records reviewed, the facility did not ensure to provide proper assistance with ADLs for residents, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: Facility will updated all resident assessments, appraisals, and needs and services plans. Facility will also conduct an in-service training for all staff regarding updated assessments. Facility will submit updated assessments and proof of training by POC due date of 4/7/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Juan Ramirez, to conduct a case management visit in relation to a separate inspection conducted on today's date, 3/06/2025. LPA observed medications to be accessible to the residents in care with medication cabinet remaining unlocked upon entry of the care home. LPA also observed kitchen sink to be leaking, with water underneath the sink and a towel on the floor to soak up water coming from the kitchen sink. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties were assessed as a result of today's visit. Deficiencies are listed on 809-D pages. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Mar 7, 2025

87465 Incidental Medical and Dental Care Services (h) The following requirements shall apply to medications which are centrally stored: (2) 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. This requirement is not met as evidenced by: Based on LPA's observations, facility did not ensure that centrally stored medication was locked and inaccessible to the residents in care, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: Facility locked unlocked medication storage during visit. Facility will complete a statement of understanding and submit statement to LPA by POC due date of 3/07/2025. A civil penalty in the amount of $250 was issued for a repeat violation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Mar 21, 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 is not met as evidenced by: Based on LPA's observations, staff did not ensure facility was in good repair when kitchen sink was leaking, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 6, 2025

Plan of correction: Facility will hire services to fix kitchen sink. Facility will submit proof of services to LPA by POC due date. A civil penalty in the amount of $250 was issued for a repeat violation.

Allegation investigated: Facility staff are mismanaging residents' medications Facility is in disrepair

Licensing Program Analyst (LPA) Michael Hood met with Administrator, Juan Ramirez, to deliver findings regarding the complaint allegations listed above. During the course of the investigation, LPA conducted interviews, reviewed residents' medications, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Facility staff are mismanaging residents' medications ** Report continued on 9099-C ** Substantiated During visit conducted on 1/07/2025, LPA attempted to conduct a medication count. LPA observed that the facility is not documenting start dates to indicate when resident medications are started. LPA observed that they were unable to conduct a medication count of the residents' medications due to having insufficient information regarding medications. LPA also observed medications on cite for resident (R1) that did not have a doctor's order on file at the facility. During visit conducted on 1/15/2025, LPA conducted a medication count for R1 using information documented at the facility. LPA observed inconsistencies between medications counted and what was documented at the facility. LPA observed medications and doctor's orders on cite for residents R1, R2, and R3 at the facility. LPA observed doctor's orders for medications for R1, R2, and R3 that were not on cite. LPA observed medications for R1 and R2 on cite that did not have doctor's order on file. Allegation: Facility is in disrepair During visit conducted on 1/07/2025, LPA observed the entryway in R1's bedroom contained a plastic mat. LPA felt underneath the mat and observed that carpet underneath the plastic mat was damp. LPA observed soiled pee pads in the cabinets underneath the kitchen sink. During visit conducted on 1/15/2025, LPA observed plastic mat removed from R1's bedroom entryway. LPA felt carpet where plastic mat was and observed that carpet in R1's bedroom was still damp. LPA observed underneath kitchen sink and observed soiled pee pads to be damp. Based on medication review, LPA's observations, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. A civil penalty in the amount of $250 was assessed for today's date due to a repeat violation. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 16, 2025 · control 59-AS-20250106143751

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 17, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication review and records reviewed, the facility did not ensure that residents were receiving all medications prescribed as needed, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Facility will ensure that medications are being administered as prescribed. Facility will obtain medications that are missing on cite and doctor's orders for medications on cite. Facility will conduct an audit of medications bi-weekly for the next three months. Facility will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date. A civil penalty assessment in the amount of $250 was assessed for today's date for a repeat violation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 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 is not met as evidenced by: Based on LPA's observations, staff did not ensure facility was in good repair when carpet was soiled in resident's bedroom and kitchen sink had soiled padding, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Facility will hire services to assess kitchen sink and treat carpets in resident's bedroom. Facility will submit proof of services to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Juan Ramirez, to conduct a case management visit in relation to a separate inspection conducted on today's date, 1/07/2025. LPA observed medications to be accessible to the residents in care with key in medication cabinet. LPA observed a bedroom in the garage area. LPA observed facility sketch and observed that facility is not approved to have a bedroom in the garage area. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. A civil penalty was assessed as a result of today's visit. Deficiencies are listed on 809-D pages. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jan 8, 2025

87465 Incidental Medical and Dental Care Services (h) The following requirements shall apply to medications which are centrally stored: (2) 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. This requirement is not met as evidenced by: Based on LPA's observations, facility did not ensure that centrally stored medication was locked and inaccessible to the residents in care when key to medications was left in medication cabinet, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 7, 2025

Plan of correction: Facility locked unlocked medication storage during visit. Facility will complete an in-service training for staff regarding medications. Facility will submit date of training and training materials to LPA by POC due date of 1/08/2025. A civil penalty in the amount of $250 was issued for a repeat violation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a) · Plan of correction due date: Jan 22, 2025

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Based on LPA's observations, facility did not ensure that staff were not sleeping in an area designated for sleep when establishing a staff bedroom in a space designated as the garage, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 7, 2025

Plan of correction: Administrator will remove bedroom set up in garage by POC due date of 1/22/2025.

Allegation investigated: Staff sexually abused resident

Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility and met with Administrator, Juan Ramirez, to deliver findings into the complaint allegation listed above. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Staff sexually abused resident ** Report continued on 9099-C ** Unsubstantiated The Department received a report that staff member (S1) was sexually inappropriate with resident (R1) when S1 exposed themselves to R1. R1 was interviewed by the Department, LPA Michael Hood, and the Sacramento County Sheriff's Office and, in each interview, R1 provided inconsistent statements related to where the exposure happened. R1 has Alzheimer's Disease and was unable to provide additional information or details related to the allegation regarding sexual abuse other than S1 had exposed themselves to R1 on one occasion. Staff members (S2 and S3) were interviewed and stated that R1 has had abnormal interactions with males who come into the facility. R1 has been known to insert themselves into conversations with males and has been seen removing their clothing upon males entering the facility. Additionally, S2, S3, and R1's Power of Attorney reported that R1 had been messaging males online, discussing them picking R1 up from the facility, and possibly having romantic relationships. Staff mentioned R1 would often ask residents inappropriate personal questions about hygiene and needed to be redirected. R1 has also been known to yell curse words and say derogatory terms towards staff when R1 is not given what they want. All other facility residents were interviewed and no other residents reported any inappropriate behavior from S1, other staff, or other residents. All resident statements indicated that they are happy with the care provided at the facility. All staff interviewed did not report inappropriate behavior from S1. Facility Administrator, Juan Ramirez, stated, two weeks before R1's allegation, S1 was accused of inappropriately touching another caregiver on the back at a different facility. S1 admitted the behavior and agreed it was inappropriate. No other inappropriate behaviors were reported. S1 had previously worked at numerous facilities and two previous employers were interviewed. Both denied experiencing inappropriate behaviors from S1. Based on staff interviews, S1 covered three over night shifts as a caregiver between 8/03/2024 and 8/05/2024. S1 worked 1800-0700 hours and, during this time, was alone with R1. On 8/03/2024, around 2200 hours, S1 claimed R1 had an accident that required R1 to be showered and dressed in new clothes. Though all staff agreed this type of incident would have been documented immediately, S1 did not document the accident until 8/21/2024, which was after R1 made the allegation. ** Report continued on 9099-C ** S1 explained their delayed reporting was due to laziness and couldn't provide an explanation for the delayed reporting. However, S1 stated that other staff and R1's Power of Attorney knew about the accident. S1 provided their own written statement regarding their innocence, stating the only interaction they had with R1 alone was when they needed to assist R1 with showering on 8/03/2024. S1 provided screen shot images depicting their daily locations between 8/03/2024 and 8/19/2024. The images were consistent with staff and S1's statements. S1 also stated that they did not expose themselves to R1. Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 59-AS-20240918155401

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility unannounced on 10/2/24 to conduct an annual continuation visit utilizing the inspection tool following the Required-1 Year Inspection conducted on 9/20/2024. LPAs met with caregiver, Juliet Wilson, and spoke with Administrator, Juan Ramirez, by phone call. Administrator gave permission to have caregiver sign report. LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPAs observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 119.2 degrees F. LPAs checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPAs observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPAs observed the backyard and perimeter of the care home to be free of clutter and debris. LPAs observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D page. An immediate civil penalty in the amount of $500 was assessed for today's date due to a body of water being accessible to residents in care on the premises. Exit interview was conducted with caregiver. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 9/20/24 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with caregiver, Juliet Wilson, and spoke with Administrator, Juan Ramirez, by phone call. Administrator gave permission to have caregiver sign report. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA reviewed five (5) resident files and two (2) staff files. During visit, LPA interviewed four (4) residents and two (2) staff. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to complete a walkthrough of the home, review medications, and complete annual inspection. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Sep 20, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Caregiver, Que-Anna Richards, to follow-up on plan of corrections made to the facility on 10/30/2023 to be completed on 10/31/2023 and 11/30/2023. Administrator, Chris Faamausili, gave permission to have caregiver sign report. During today's visit, LPA took the temperature of the water and found temperature to be 116 degrees F. LPA observed that fire extinguisher was serviced and carbon monoxide detector was installed and operable. LPA observed carpets to be cleaned, trash compacter to be removed, backyard gate repaired, locks on drawers repaired, and the ability to provide ice to the residents. LPA cleared deficiencies during visit. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Dec 13, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 10/30/23 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA spoke with Assistant Administrator, Juan Ramirez, via telephone call, who gave permission to have caregiver, Geneva Campbell, sign report. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. Bathrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors to be operational in the care home. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and two (2) staff files. LPA requested a copy of the facility's certificate of liability insurance. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Section 87203 regarding fire extinguishers not being serviced and carbon monoxide detectors not being operational, Section 87303(e)(2) for hot water temperature being observed at 123 degrees F, and 87303(a) for disrepair of the facility. Deficiencies are listed on 809-D. An immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 for the date of 10/30/2023 is assessed for a violation that the department determines was a fire clearance violation. Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 30, 2023