Windrose Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Alviso conducted a Required- 1 Year visit, on 4/27/26 at approximately 9:45am, and was greeted by staff. There were two (2) staff on duty, lead caregiver Ana, and Brittany. Administrator Bana Solomon arrived shortly after to meet with the LPA. Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6) residents. Facility has a required infection control plan. Facility has a required emergency and disaster plan. Emergency disaster drills are being conducted as required; Last drill was conducted on 1/16/26 on Emergency Utility Shut Down The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Facility has a fire clearance approval for a total of six non-ambulatory, of which one (1) may be bedridden. Fire extinguishers, two (2), were charged, in the green. Facility has a working carbon monoxide detector. All smoke alarms are hard wired and working appropriately. All exits were clear and unobstructed. LPA reviewed five (5) resident files. Files were complete. LPA reviewed five (5) staff files; All staff have criminal record clearance. Staff have first aid certification and CPR certification. LPA reviewed staff training. Continued on LIC809C.. LPA toured the facility with the Administrator. All medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. Sufficient food supply. Sufficient linens, hygiene products, paper products, furnishings, cleaners/disinfectants, and personal protective equipment (PPE). LPA observed sufficient lighting in all resident rooms, common areas, bathrooms, and hallways. Bathrooms had grab bars, and non-slip flooring/mats for resident use. LPA is requesting the following documents be updated and submitted by 5/27/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E- Emergency Disaster Plan (ensure to review and update as needed/required-no changes submit copy of review page) If changes submit plan copy Infection Control Plan (ensure to review and update as needed/required- no changes submit copy of review page)- If changes submit plan copy LIC400- Handling of Client Cash Resources (include copy of surety bond if handling cash) Current Liability Insurance Resident Roster Copy of current Administrator Certificate There are no deficiencies cited today. Exit interview was conducted with Administrator Bana Solomon.the state’s words, verbatim · CDSS document, Apr 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Alviso conducted a Required- 1 Year visit, on 3/18/25 at approximately 10am, and was greeted by staff. There were three (3) staff on duty, lead caregiver Ana, and caregivers Roxanna and Yadira. Administrator was contacted by staff, and arrived shortly after to meet with the LPA. Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6) residents. Facility has a required infection control plan. Facility has a required emergency and disaster plan. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Facility has a fire clearance approval for a total of six non-ambulatory, of which one (1) may be bedridden. Fire extinguishers were serviced and tagged. Facility has a carbon monoxide detector that worked properly during the inspection. All smoke alarms are hard wired and worked properly during the inspection. All exits were clear and unobstructed. Per review of records, emergency disaster drills have been conducted as required; Last quarterly drills documented drills were conducted on 6/12/24 and 9/18/24. LPA toured the facility with the Administrator. The bathrooms had grab bars and non-slip mats/flooring for resident use. The hot water was checked at 116. degrees Fahrenheit, which is within regulation. There was a sufficient supply of furnishings for resident use. Sufficient supply of linens, cleaners/soap/disinfectants, hygiene products, paper products, and personal protective equipment (PPE) supplies. The LPA observed that the home was at a comfortable temperature for residents in care. There was sufficient lighting in all resident rooms, hallways, bathrooms, and common areas. Sufficient food supply. The facility was observed to be clean and orderly. Medications were centrally stored and locked making them inaccessible to residents in care. Disinfectants/cleaners were observed to be locked up and inaccessible to the residents in care. The backyard was observed to be clean, orderly, and all pathways clear and free of obstruction. Fire exit gate was clear and unobstructed. There is patio furnishing available in the backyard for resident use. Continued on LIC809C... LPA reviewed six (6) resident files, including medical assessments and medications. All files were complete. LPA reviewed five (5) staff files. All staff have required criminal record clearance. Staff have required training. Staff have required first aid and CPR certification. LPA is requesting the following documents be updated and submitted by 4/18/25. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required- submit copy of review page or if changes submit copy of the plan. Infection Control Plan (ensure to review and update as needed/required- submit copy of review page or if changes submit copy of the plan. Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate. There are no deficiencies cited today. Exit interview was conducted with Administrator Bana Solomon.the state’s words, verbatim · CDSS document, Mar 18, 2025

Allegation investigated: Residents are not served adequate portions of food

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 1/31/2025 at approximately 1:00pm, and was greeted by caregiver Ana Herron. LPA observd another caregiver, Yaddi, who was also on shift. Administrator Bana Solomon arrived within thirty minutes to meet with the LPA. Reporting party alleges that "residents are not served adequate portions of food". LPA toured the facility. LPA interviewed staff, and other related parties. The investigation revealed that there is a sufficient food supply for resident meals, snacks, and supplies for resident drinks/hydration fluids.. Per interviews with staff (S1, S2, S3), and otherrelated parties, meals are served with appropriate portions, and if a resident wants more they are able to have more. In summary, interviews with other related parties all stated the facility meals are very good, filling, and served in good portions; The related parties that were interviewed all stated, "there were no issues with the meals served at the facility". Per investigation, there was not sufficient information obtained to support violations had occurred. Based on interviews, LPA observations, and related information obtained during the investigation, the allegation "residents are not served adequate portions of food” is Unfounded". We have found that the complaint allegation (s) was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No Per investigation, there is sufficient information obtained to support a violation had occurred. LPA observed the door leading into the garage unlocked, leaving disinfectants, soaps, cleaners, accessible to residents in care. This deficiency will be cited, 87309(a) Storage Space and Access- Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage, see LIC9099D. During the LPA's tour with staff, the medication closet was observed by the LPA to be unlocked, and all medications were accessible to residents in care.This deficiency will be cited, 87465-(h)(1)(C) Incidental Medical and Dental Care-The following requirements shall apply to medications which are centrally stored: Medications shall be centrally stored under the following circumstances: Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others, see LIC9099D. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator/Licensee Bana Solomon regarding finding of the allegation and deficiency citations. Caregiver Ana Herron signed the report for the Administrator. Appeal Rights were provided to Anna Herron for Licensee Bana Solomon.the state’s words, verbatim · CDSS document, Jan 31, 2025 · control 21-AS-20250130104628

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465-(h)(1)(C) · Plan of correction due date: Feb 1, 2025

87465-(h)(1)(C) Incidental Medical and Dental Care-The following requirements shall apply to medications which are centrally stored: Medications shall be centrally stored under the following circumstances: Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, This requirement was not met as evidenced by: During the LPA's tour with staff, the medication closet was observed by the LPA to be unlocked, and all medications were accessible to residents in care. This is a risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2025

Plan of correction: Licensee/Administrator to ensure all the medications are locked and inaccessible to residents in care at all times. Licensee will hold an in-service training on"CentrallyStoring Medications". Submit plan of correction by 2/1/2025. Submit proof of training by 2/12/2025. Include trainer, topics, date/time spent, attendees. POC due 2/1/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Feb 1, 2025

87309(a) Storage Space and Access- Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: LPA observed the door leading into the garage unlocked, leaving disinfectants, soaps, cleaners, accessible to residents in care. This is a risk to the health & safety of all residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2025

Plan of correction: Licensee/Administrator to ensure all cleaner/disinfectants/soaps, items that pose a risk to residents in care are locked and inaccessible to residents at all times. Licensee will hold an in-service training on"Storage space for cleaners/disinfectants/soaps, such items of risk to residents". Submit plan of correction by 2/1/2025. Submit proof of training by 2/12/2025. Include trainer, topics, date/time spent, attendees. POC due 2/1/25.

Allegation investigated: Staff does not allow resident to watch television

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 1/9/2025 at approximately 9:40am, and met with Administrator Bana Solomon. LPA reviewed resident files, and staff files. LPA conducted interviews with staff, S1 S2 S3 S4, and other related parties. Reporting party alleges that “staff does not allow resident to watch television”. The investigation revealed that a staff/caregiver had put a resident’s television on a timer to shut off at a specific time in the evening. In summary, staff, S4, stated the resident watches television late into the night, and they are always tired the next day; Staff/S4 stated they weren’t told to do this by any other staff person, and they thought it was okay to do it. Per interviews, resident's television turned off by timer without resident's permission, resident had no knowledge the television having been put on a timer in the evening.LPA discussed regulations regarding resident rights/personal rights with staff interviewed. Per i nvestigation, there is sufficient information obtained to support a violation had occurred. Substantiated Per LPA’s investigation, including interviews with staff, S4, and interviews with other related parties, the allegation “staff does not allow resident to watch television” is Substantiated. This deficiency will be cited, 87468.2(a)(6) Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To make choices concerning their daily lives in the facility, see LIC9099D. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator Bana Solomon.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 21-AS-20241112160946

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(6) · Plan of correction due date: Jan 24, 2025

87468.2(a)(6) Additional Personal Rights of Residents in Privately Operated Facilities-In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: To make choices concerning their daily lives in the facility. This requirement was not met as evidenced by: LPA's investigation, review of records, including interviews with staff and other parties; The investigation revealed that a staff/caregiver had put a resident’s television on a timer to shut off at a specific time in the evening. In summary, staff, S4, stated the resident watches television late into the night, and they are always tired the next day;Resident had no knowledge the television having been put on a timer. This is a risk to personal rights of the resident.the state’s words, verbatim · CDSS document, Jan 9, 2025

Plan of correction: Licensee to ensure all staff obtain personal rights/residents rights training. Submit proof of training by 1/24/25, include trainers name, date/time spent, topics covered. POC due by 1/24/25.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Alviso and Mutialu conducted a Required- 1 Year visit, on 4/16/24 at approximately 8:40am, and met with Licensee/Administrator Bana Solomon. There currently are four (4) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for six (6) residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Facility has a fire clearance approval for a total of six non-ambulatory, of which one (1) may be bedridden. The LPAs reviewed four (4) resident files. All files were complete. The LPAs reviewed five (5) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. The LPAs toured the facility with the Administrator Bana. The hot water was checked at 114. to 116.6. degrees Fahrenheit , which is within regulation. The fire extinguishers were tagged and serviced as required- expires 2/2/25. All exits were unobstructed. Food supply was sufficient. All bathrooms have grab bars, and non slip flooring for resident use. The facility is well lighted, including all resident rooms and bathrooms. The facility was observed to be at a comfortable temperature. All medications were locked up and not accessible to residents in care. Facility had sufficient furnishings for client use. Continued on LIC809C.. The backyard has outside patio furnishings for resident use, table had a large shade umbrella. Fire exit and walkways in the backyard were clear and unobstructed. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. Facility has a sufficient supply of personal protective equipment(PPE). LPA observed sufficient supply of food, perishable and non-perishable food. LPA is requesting the following documents be updated and submitted by 5/16/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate. Per LPA record reviews, five staff out of five staff lacked completed care staff training, consisting of a total of forty hours, this will be cited, HSC 1569.625 (b)(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. see LIC809D. Per LPA record reviews, there was no documentation of quarterly drills being conducted, the Administrator was not able to provide any documentation of having held emergency quarterly drills, on every shift, as required. This deficiency will be cited, HSC 1569.695(c) A facility shall conduct a drill at least quarterly for each shift, see LIC809D. LPAs observed that a resident bathroom's sink had a leaking pipe underneath it, this will be cited, Maintenance and Operation 87303(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, see LIC809D. Continued on LIC809C... LPA's observed that the facility didn't have required "Oxygen in use"signage posted, and there is oxygen in use. This will be cited, Gas and Liquid 87618(b)(3)(B)- Oxygen, “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas, see LIC809D. LPAs observed that the front door and slider patio door's auditory alarms were not working properly. This will be cited, Care of persons with Dementia 87705(j) -The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident, see LIC809D. LPAs observed that the cleaners, disinfectants , and soaps, were in the garage, no lock on door and/or items listed in locked up, these items were left accessible to residents in care. Storage Space 87309(a)) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients, see LIC809D. LPAs reviewed records, two out of five staff lacked the required HSC medication training. HSC Medication Training 1569.69 (a)(3) An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications. The training and instruction described in this subdivision shall be completed, in their entirety, within the first two weeks of employment, see LIC809D. Deficiencies 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 with Lead Caregiver Ana Herron. Appeal rights given to the Lead Caregiver Ana Herron for the Licensee/Administrator.the state’s words, verbatim · CDSS document, Apr 16, 2024