Yokam's RCFE # 1N

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:10 am to conduct a 1-year annual visit to the facility above. LPA met with Back-Up Administrator, Cheryll Estacio, Administrator Yolande Kamto, and Licensee Alphonse Kamto and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 5 resident bedrooms, 2 bathrooms and currently occupies 3 residents. The facility has smoke and carbon monoxide detectors that were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats or textured bottoms. A schedule for resident’s showers was posted on the refrigerator door. All residents require assistance in bathing so a plan to ensure all residents receive their showers is tracked. The pathways are clear of any obstructions. Disinfectants, cleaning solutions and poisons are inaccessible to residents in care locked under sink and in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard with gates on both sides of the home. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on 01/07/27. The facility is approved for a capacity of six. The fire clearance is granted for 6 non-Ambulatory of which 4 may be bedridden. Hospice is approved for 4. There are currently 3 residents. Continued 809-C Staffing: The facility currently employes 6 full-time staff and 2 Administrators. Staff files were reviewed. All required personnel documents were noted, expiring 1st aid and CPR certificates will be sent to LPA to confirm renewal prior to expiration. LPA reviewed the health screening on staff and confirmed that administrator is reviewing and monitoring staffs’ continual ability to physically assist residents in care due to note by physician. Current Administrator Certificate expires 6/17/26. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training on various topics noted in their records. Training for 2025 was documented. Resident Records & Incident Reports: The facility keeps separate files on each resident confidential. LPA reviewed four resident files for signed Admission Agreements, Physician Reports, Annual Needs and Services Plans, and other required documents and found all required documents. In addition, LPA reviewed prior resident file to ensure Hospice paperwork and medication was documented as required. Medication Review: LPA conducted a medication review. Medication was documented on a Centrally Stored Medication Record as well as tracked on Medication Administration Records. All medication and records were found to be updated and in compliance with regulations. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. Kitchen was clean, safe and sanitary. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. At time of visit LPA observed individual meals being prepared for residents as they were ready for their meals. Disaster Preparedness: The current emergency disaster forms were posted. Emergency exits and telephone numbers were posted. Drills are conducted quarterly. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has residents receiving Hospice services. Facility has a planned activities schedule on the refrigerator door with various activities scheduled to engage residents. Exit door alarms are working. Exit interview conducted, copy of report, issued.the state’s words, verbatim · CDSS document, Jan 7, 2026

The state marks this report as 11 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff restrains resident

This is an amended report. Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with designated back-up administrator Cheryll Estacio and explained the purpose of the visit. During the initial visit on 11/21/24 LPA Rankin toured the facility interviewed staff and obtained relevant documents. Additional interviews were conducted with relevant parties on 11/20/24 and 1/2/25. On the allegation – Staff restrain residents: It was alleged a witness observed Resident 1’s (R1) arms were tied down to the arms of a wheelchair with white garbage bags and upper body was being supported/restrained on 11/18/24. Continued on 9099-C Substantiated LPA did a 10-day visit to the facility on 11/21/24 to gather records, interview staff, and observe residents. LPA conducted interviews with the Reporting Party (RP) on 11/20/24, a Family Member (F1) on 11/20/24, a credible witness (W1) on 1/2/25 and licensee on 11/20/24. F1 stated they visited the facility on 11/18/24 at approximately 4:40 p.m. F1 entered the facility and noted R1 was in the living room with other residents, immediately F1 noticed R1 appeared very agitated, this was noted because R1’s “eyes were wide” and was observed “slamming (their) wrist on arm rest, because that was the only part that was loose”. F1 saw that R1 had 4 “white plastic trash bags” which were wrapped, 2 on each arm, from the elbow to the wrist. F1 looked to Staff 1 (S1) and asked, “what is going on”, “why are (R1’s) arms tied down”? S1 stated “(R1) been very upset” “R1 very agitated”, S1 added they had just “gave (R1) Ativan.” F1 inquired into the reasoning for the restrains and S1’s replied, “I gave Ativan it’s going to work.” F1 told LPA that S1 immediately removed “white trash bags” and set them on a chair beside R1. F1 was unable to take photo before staff removed restraints from R1. F1 described the white trash bags as standard white bags with red ties. A box of these type of trash bags were observed during LPA’s visit on 11/21/24. LPA obtained and reviewed text communication between F1 and Licensee, who advised the Licensee will follow up with staff on proper procedures moving forward. Licensee does not deny the accusation of the restraints in the text and told F1 “I talked with (S1) today and (they) said it was the first time (S1) saw (R1) so agitated. I told (S1 they) cannot restraint (them) like that and instead will use medication like lorazepam to calm (them) down.” F1 moved R1 from the facility effective 11/23/24. During LPA interviews with Licensee, Licensee claimed that plastic white grocery bag, with red writing on it, were used to “keep the wheels of the wheelchair from moving”. Licensee got one of the grocery bags to show what the facility claims was used. This explanation is inconsistent, as the wheelchair has a built-in locking mechanism. W1 advised they directed staff to follow medication prescription, which allowed facility to give Lorazepam (aka Ativan) and Quetiapine (aka Seroquel). Continued on 9099-C After incident, during facility visit on 11/21/24, W1 provided caregivers additional education for R1’s agitation such as giving prescribed medication, chamomile tea, calming music, and advised that at no time were restraints acceptable. W1 further stated during the visit on 11/21/24 they spoke with a caregiver. W1 stated a caregiver advised that bags were used to prevent wheelchair from moving. W1 stated to LPA that they found the caregivers “explanation did not make sense” because the wheelchair locks work. Additionally, W1 provided LPA with a picture of bruises to R1’s hands, W1 stated R1 bruises easily, but usually it is on the forearm, this image was taken because the bruising was in between the fingers which W1 stated is not a common area for bruising on clients. During subsequent visit LPA reviewed Hospice notes, care plan, and medication list. LPA noted the plan of care and notices remind staff to contact Hospice agency if any questions, changes, or concerns. During evening event in question, licensee admits that resident was agitated, but no request was made to Hospice prior to family reaching out in the following days. Based on LPAs observations and interviews conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Health and Safety Code 1569.269 (a)(1)(10) are being cited on the attached LIC 9099D. Exit report given, copy of citation, and appeal rights printed. during LPA interview with F1, F1 stated that during the incident of agitation described in the allegation, F1 asked if R1 received Parkinson’s medication today, S1 stated “(R1) had all (their) medication.” This was at time of visit on 11/18/24 being around 4:40 p.m. F1 also stated they sat with R1 until they were calm and falling asleep. Caregivers put R1 to bed, which was before 6:00 p.m. During incident on 11/18/24, it was alleged that resident had received all medication by 4:40 p.m. and was put to bed around 6:00 p.m. The concern is medication is not given as directed and is given inconsistently between shifts. During interviews and records review regarding Parkinson’s medication Carbidopa-Levodopa the following was noted, on 01/7/25 during interview with Back-up Administrator the Medication Administration records (MAR) were reviewed and noted to have required administration times, back-up administrator stated the direction is for staff to wake up R1 in the evening around 8:00 p.m. to ensure the bedtime medication is given at the proper time. Back-up Administrator believes that S1 miss spoke when stating all medications had been given by 4:40 p.m. due to the incident that occurred when F1 arrived which worried S1. LPA reviewed and observed that the MAR was noted and initialed during the evening of the incident and that scheduled medication per the MAR was given as ordered. During interviews and record review regarding PRN medication the following was noted: On 11/20/24 during visit LPA obtained a copy of medication sign out sheets for Lorazepam and Quetiapine. Sign out sheet for Lorazepam and Quetiapine do not record more than one dose of each PRN’s given on 11/18/24. During medication review LPA did medication count for PRN medication and noted that Lorazepam was expired, and the count was off by 2 doses. Quetiapine count was off by 3 doses. On 1/7/25 LPA reviewed all available records from facility, LPA was able to find PRN orders stating orders for Lorazepam “give…every 4 hours as needed for…anxiety…” If the allegations of staff providing 3 doses is correct, this would be within the orders allowed. Based on LPAs medication review, interviews conducted and record review(s), although the allegations may have happened there is not a preponderance of evidence, therefore the above allegation(s) is found to be UNSUBSTANTIATED at this time. Exit interview conducted and copy of report given.the state’s words, verbatim · CDSS document, Jan 7, 2025 · control 29-AS-20241120121314

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(1)(10) · Plan of correction due date: Jan 9, 2025

This is an amendment. Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff... (10) To be free from neglect,... punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. Based on interviews and records obtained, the licensee did not ensure staff complied with the section cited above in which caregivers tied R1’s arms to a wheelchair and upper body, 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: Staff need training from CCLD Vendor on proper restraint alternatives and managing resident behaviors by an authorized vender of CCLD. Licensee must identify vendor by 01/09/25 and communicate with LPA in a timely manor as completion of all staff for all 4 hours of training required by this POC. Licensee to have training completed for all staff by 1/31/25.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 10:02 am to conduct a one-year annual visit to the facility above. LPA met with Back-Up Administrator, Cheryll Estacio and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 5 resident bedrooms, 2 bathrooms and currently occupies 5 residents. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. A schedule for resident’s showers was posted on the refrigerator door. All residents require assistance in bathing so a plan to ensure all residents received their showers is tracked. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked under sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard, LPA requested updates to the gate on the right front facing side of the facility to ensure it self-closes. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on 01/07/26. The facility is approved for a capacity of six. The fire clearance is granted for 6 non-Ambulatory of which four may be bedridden. Hospice is approved for four. Staffing: The facility currently employes four full time staff and two Administrators. Staff files were reviewed. LPA observed recent Health Screening done on 1/6/25 that stated “able to provide assistance without significant lifting/pushing/pulling” done for two staff, administrator will need to assess the support required to ensure the safety of residents in care. Current Administrator Certificate expires June 18, 2026. Continued 809-C Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training on various topics noted in their records. Training for 2024 needs to be updated. Licensee will provide LPA updated schedule of topics needing to be addressed to ensure staff are trained on all regulation required topics. Resident Records & Incident Reports: The facility keeps separate files on each resident confidential. Facility does submit incident reports to the department when required. LPA reviewed five resident files for signed Admission Agreements, Physician Reports, Annual Needs and Services Plans, and other required documents and found all required documents. In addition, LPA viewed Hospice binders for residents on Hospice which included care notes, plans, training's and orders. Medication Review: LPA conducted a medication review. Medication was documented on a Centrally Stored Medication Record as well as tracked on Medication Administration Records. All medication and records were found to be updated and in compliance with regulations. Training required for medication was not found in staff records and will be requested by LPA. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. At time of visit LPA observed individual meals being prepared for residents as they were ready for their meals. Disaster Preparedness: The current emergency disaster forms were posted. Emergency exits and telephone numbers were posted. Drills are conducted quarterly. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has residents receiving Hospice services. Facility has a planned activities schedule on the refrigerator door with various activities scheduled to engage residents. Exit door alarms are working. Exit interview conducted, copy of report, issued.the state’s words, verbatim · CDSS document, Jan 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 9:30 am to conduct a one year annual visit to the facility above. LPA met with Back-Up Administrator, Cheryll Estacio and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 3 resident bedrooms, 2 bathrooms and currently occupies 3 residents and employs five full time staff and one Administrator. LPA Miller was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked under sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on January 7, 2025. The facility is approved for a capacity of six. The fire clearance is granted for 6 non-Ambulatory of which four may be bedridden. Hospice is approved for four. Staffing: The facility currently employes five full time staff and one Administrator. Staff files were reviewed. LPA observed that one facility staff (S1) was not associated to work in the facility, but had fingerprint clearance prior to working in the facility. Current Administrator Certificate expires June 17, 2024. Continued 809-C Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed five resident files for signed Admission Agreements. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Disaster Preparedness: The current emergency disaster forms were posted. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has residents receiving Home Health services. Exit door alarms are working. LPA will return at a later date to continue the annual visit. Exit interview conducted, copy of report, citation, civil penalty, and appeal rights were issued.the state’s words, verbatim · CDSS document, Jan 11, 2024