Yuba Sutter Care Home

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Hiratsuka arrived unannounced at the facility to conduct a quarterly on-site visit regarding the Stipulation and Waiver and Order, effective three years from 06/30/2026 to 06/30/2029. LPA met with Administrator and explained the purpose of the visit. During today's visit, LPA reviewed staff training and observed some of the residents. LPA and Administrator also discussed several topics that are specific to the residents in care. No deficiencies cited.the state’s words, verbatim · CDSS document, Aug 13, 2026

Type of visit: Office

An office meeting was held on 07/21/2026 at 10:00 AM at the Community Care Licensing Division office to review the stipulation adopted on 06/30/2026 and the next steps. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period. The following were in attendance: Regional Manager Harpreet Humpal, and Licensing Program Analyst Kerry Hiratsuka. Representing the facility are Licensees Manpreet Dyal and Rajveer Kaur, and Administrator Esmeralda Negrete. Harpreet Humpal discussed the purpose and elements of this type of meeting. The Stipulation was reviewed with Administrator and Licensees who expressed their understanding. Items discussed at the meeting included, but not limited to: Stipulation contents · Findings · Revocation of License -Stayed with Probation · Limitations and conditions · Future Application for License, Registration, Certification or Approval · Licensure, Certification or Approval; Application Denial, Tolling of Probationary Period · Completion of Probation · Staff positions and duties · Staffing training and requirements · Basic Services/Incidental Medical care Violation of Stipulation Term · Monitoring Fee · Department's Authority · Waiver of Hearing Rights; Waiver of Appeal/Modification Rights/Waiver of Claims · Severable terms · Public Records · Signatures · Counterparts · Effective Date: (06/30/2026) LIcensee submitted staff duties and descriptions today. The Licensees/Respondents/Representatives stated they would abide by the following: · Abide by the contents/terms of the Stipulation (submit all documents timely) · Operate the facility in substantial compliance with the regulations and statues governing the operation of a residential care facility for the elderly. CCLD will do the following: · Increase monitoring Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. An exit interview was conducted, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. COMMENTS -LICENSE PROBATIONAL – EXPIRATION DATE: JUNE 30, 2029. PER STIPULATION WAIVER AND ORDER – PROBATION THREE (3) YEARS FROM JUNE 30, 2026, TO JUNE 30, 2029. AGE RANGE SIXTY (60) AND OVER. SIX (6) NON-AMBULATORY. HOSPICE WAIVER FOR TWO (2).the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kerry Hiratsuka arrived unannounced at the facility to conduct a required annual inspection utilizing the full care tool. LPA met with Administrator Esmeralda Negrete, and explained the purpose of the visit. This facility has a fire clearance for 6 non-ambulatory residents. LPA and Caregiver conducted a tour of the interior of the facility, areas toured included: residents bedrooms, bathroom, kitchen, garage and the common areas. LPA observed kitchen to have sharps to be locked. LPA observed facility to have ample food supply. LPAs conducted a file review of two (2) residents files and one staff files. LPA observed staff and residents file to be completed. Multiple topics were discussed during this visit. No deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 12, 2026

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst Hiratsuka, conducted this unannounced visit to ensure the licensee notified the responsible parties, and ombudsman that Department of Social Services, Community Care Licensing Division has commenced proceedings to suspend or revoke the license. LPA learned this has not occurred. Also during this visit LPA reviewed resident and staff files. LPA also discussed multiple topics with Manager Esmeralda Negrete. LPA has copied the California Health and Safety Code section that requires the licensee to post the legal proceedings against the facility. §1569.38 Posting of licensing reports; disclosure to new residents (a) Each residential care facility for the elderly shall place in a conspicuous place copies of all licensing reports issued by the department within the preceding 12 months, and all licensing reports issued by the department resulting from the most recent annual visit of the department to the facility. This subdivision shall not apply to any portion of a licensing report referring to a complaint that was found by the department to be unfounded or unsubstantiated. The facility, during the admission process, shall inform the resident and the resident’s responsible person in writing that licensing reports are available for review at the facility, and that copies of licensing reports and other documents pertaining to the facility are available from the appropriate district office of the department. The facility shall provide the telephone number and address of the appropriate district office. (b) A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days from the occurrence of either of the following events: (1) The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50. (2) A criminal action that relates to the health or safety of the residents is brought against the licensed residential care facility. (c) The notice provided to a resident and the resident’s responsible party, if any, shall include the name and contact information for the local long-term care ombudsman and for the Community Care Licensing Division of the department with a statement that directs the resident or the resident’s responsible party to contact the division for information on the license status of the facility. (d) The notice, described in subdivision (b), provided to a resident and the resident’s responsible party, if any, shall include the reason given for the commencement of proceedings to suspend or revoke the license of the facility, or the reason given for criminal action brought against the licensed residential care facility. (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license is posted, or any other easily accessible location in the facility. The posting shall include all of the following information: (1) The date of the notice. (2) The name of the residential care facility for the elderly. (3) A statement that a copy of the most recent licensing report prepared by the department, and any additional reports of facility evaluation visits, within the preceding 12 months, may be obtained at the facility. (4) The name and telephone number of the contact person designated by the Community Care Licensing Division of the department to provide information on the license status of the facility. (f) The notice required to be posted pursuant to subdivision (e) shall remain posted until the deficiencies that gave rise to the notice are resolved. Failure to following the California Health and Safety Code shall result in a citation and civil penalties be issued.the state’s words, verbatim · CDSS document, Oct 23, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst, [LPA] Hiratsuka, arrived on September 26, 2025, for an unannounced inspection to follow up on a substantiated complaint investigation. LPA met with Licensee Manpreet Dyal and explained the purpose of the visit. On November 15, 2023, the Department concluded a complaint investigation regarding the following allegations: Resident sustained severe pressure injury due to staff neglect, facility failed to seek medical attention, and staff left resident in soiled diaper for an extended period. The licensee was cited for the following: California Code of Regulations (CCR), Title 22, § 87466 Observation of the Resident, CCR, Title 22, § 87411(a) Personnel Requirements, and CCR, Title 22, § 87468.1(a)(2) Personal Rights of Residents in All Facilities. At the time of the complaint visit on November 15, 2023, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section § 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing proper care, supervision, and delaying timely medical care, resulting in the deterioration of pressure injuries leading to hospitalization with wound infection, requiring pain control and two wound debridement surgeries. Today, September 26, 2025, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as a serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on November 15, 2023, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided. Licensee Manpreet Dyal, who's name and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Sep 26, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst, [LPA] Hiratsuka arrived on September 26, 2026, for an unannounced inspection to follow up on a substantiated complaint investigation. LPA met with Licensee Manpreet Dyal and explained the purpose of today’s visit. On December 12, 2024, the Department concluded a complaint investigation regarding the following allegations: Staff did not seek medical attention for resident (R1) in care in a timely manner, staff did not report incident(s) involving R1, and staff are not adequately trained. The licensee was cited for California Code of Regulations (CCR), Title 22, § 87466 Observation of the Resident, and CCR, Title 22, § 87211(a)(1) Reporting Requirements. At the time of the complaint visit on December 12, 2024, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section § 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by facility staff not notifying medical personnel of R1’s loss of appetite, increased weakness, and R1’s vomiting, which resulted in R1’s hospitalization. Today, September 26, 2025, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as a serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on December 12, 2024, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided. Licensee Manpreet Dyal, who's name and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Sep 26, 2025

Type of visit: Case Management - Other

LPA Hiratsuka conducted this unannounced case management visit. LPA met with Licensee Manpreet Dyal to discuss several issues that do not affect the residents. LPA left several documents with Licensee. No deficiencies cited.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kerry Hiratsuka arrived unannounced at the facility to conduct a required annual inspection utilizing the full care tool. LPA met with caregiver, and explained the purpose of the visit. This facility has a fire clearance for 6 non-ambulatory residents. LPA and Caregiver conducted a tour of the interior of the facility, areas toured included: residents bedrooms, bathroom, kitchen, garage and the common areas. LPA observed kitchen to have sharps to be locked. LPA observed facility to have ample food supply. LPAs conducted a file review of five (5) residents files and two staff files. LPA observed staff and residents file to be completed. Multiple topics were discussed during this visit. No deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 12, 2025

Allegation investigated: Staff did not safeguard resident's personal belongings.

LPA Hiratsuka conducted this visit to deliver the results of the investigation above. LPA met with During the investigation the administrator, licensee, caregivers, and a witness were interviewed. LPA reviewed the file of the former resident in question. Witness stated the belongings of a former resident were never returned. LPA reviewed the file and the former resident waived the inventory of their belongings when they moved in. Licensee and Administrator stated they have one large piece of furniture that belongs to the former resident and have not received any responses from the former resident in regards to what to do with the furniture. The caregiver interviewed stated she packed up all of the former resident's belongings into three boxes and someone came and picked up all three boxes. Witness stated the former resident has moved several times since the former resident left the facility. Unsubstantiated Because the former resident waived the inventory of their belongings upon move in and never updated the list, moved several time since moving out of this facility, and interviews, LPA cannot prove or disprove the facility did not safeguard the former resident's belongings. Due to the information gathered, LPA cannot determine the allegations: Staff did not safeguard resident's personal belongings. LPA finds allegation to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 59-AS-20241022143723

Allegation investigated: Staff did not seek medical attention for resident in care in a timely manner and Staff did not report incident(s) involving resident as required. Staff are not adequately trained.

Licensing Program Analyst (LPA) Kerry Hiratsuka, conducted this unannounced complaint visit to deliver the results of the allegations above. The Department conducted an investigation into allegation that staff did not seek medical attention for resident in care in a timely manner and Staff did not report incident(s) involving R1 as required. On November 22, 2023, R1 was admitted to the hospital with a chief complaint of increased weakness over the past three days. Medical records indicated that R1 was diagnosed with possible aspiration pneumonia, failure to thrive, generalized weakness, and overall physical decline. Staff at the facility acknowledged observing R1’s increasing weakness and decreased mental alertness during this time. Additionally, staff reported that R1 required assistance with ambulation due to their weakened condition. However, these concerns were not escalated to licensed medical personnel. Substantiated The investigation also determined that the facility failed to notify the Community Care Licensing Division of R1’s hospitalization, as required by regulations. As a result of these failures, R1’s medical care was delayed, leading to their hospitalization for conditions that could have been addressed sooner with timely intervention. R1 remained in the hospital until December 2, 2023, after which they were discharged to a skilled nursing facility. The facility has a meal log that documents the approximate amount of food eaten per meal. It shows a decline in the amount of food the resident was consuming three days prior to the resident being sent out to the hospital. Facility also did not report to Community Care Licensing Division that the resident was sent to the hospital due to decline. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met that the facility failed to seek timely medical care, notify the physician, and the Department that resident’s health was in decline. 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. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency and civil penalty are being issued An immediate civil penalty in the amount of $500.00 is to be assessed for a resident sustaining a serious bodily injury while in care at this facility. As a result of resident’s injury, the violation warrants a civil penalty assessment based on Health and Safety Code §1569.49. At this time, the civil penalty assessment is under review. LPA will return at a future date to assess a civil penalty, if warranted. Staff did not seek medical attention for resident in care in a timely manner. Appeals rights issued. The Department investigated an allegation that staff at the facility were not adequately trained. The investigation focused on the period from the facility’s opening to November 2023. A review of staff training records revealed that, during this time, two staff members had only completed the initial required training under Title 22 regulations and the California Health and Safety Code in 2021, with no evidence of the mandatory annual training. Additionally, one staff member had no training documented. A deficiency related to this issue was cited during a case management visit on November 22, 2023. Following the citation, the licensee took corrective action, and as of November 2023, all staff have completed the required training in compliance with Title 22 regulations and the California Health and Safety Code. As the licensee addressed the prior deficiency, the current allegation is substantiated, but no additional deficiency is being issued. The administrator denied the presence of a staff member by the alleged name working at the facility. Additionally, the licensee and administrator both stated they were not informed of any incidents of staff abusing R1. The department attempted to identify the caregiver accused of the abuse but was unable to verify the identity of the individual. Interviews with a second staff member and other residents present during the time frame provided no corroboration of the abuse. One resident declined to participate in the interview process. The department reviewed all available information, including conflicting statements from the involved parties. Due to the inability to verify the identity of the alleged caregiver, corroborate the abuse claims, or obtain additional evidence, the department is unable to substantiate or refute the allegation therefore the above allegation is unsubstantiated. The Department conducted an investigation into the allegation that staff failed to ensure R1’s grooming needs were met while in care. As part of the investigation, the Department conducted interviews with residents and staff. Unfortunately, Resident 1 (R1) could not be interviewed or observed regarding their grooming care, as R1 had passed away before the investigation. Staff members interviewed denied the allegation, asserting that R1’s grooming needs, including nail care, had been appropriately addressed. The allegation included claims that R1’s toenails were not maintained and that a witness had to provide nail care for R1. However, during observations of other residents in care, there were no indications of neglect or unmet grooming needs. Based on the available evidence, the Department did not find corroboration of the alleged failure to meet grooming standards. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated. The Department investigated an allegation that staff failed to ensure Resident 1 (R1) received their medications as prescribed. As part of the investigation, the Department obtained and reviewed R1’s medication administration records (MARs). The records indicated that medications were administered as prescribed while R1 was at the facility. Staff reported that on the R1’s final day at the facility, R1 refused to take their medication. The Department was unable to verify the condition of the medication containers, as they were no longer at the facility at the time of the investigation. The allegation also included claims that the medication bottles were either full or contained an excessive number of pills when R1 moved out. However, without access to the medication containers during the investigation, the Department could not confirm this claim. Based on the evidence available, the Department was unable to substantiate or refute the allegation that R1 was not provided their medications as prescribed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated. The Department investigated an allegation that staff at the facility were unable to communicate effectively with R1 due to a language barrier, potentially impacting the quality of care. It was alleged on November 21, 2023, R1 was feeling unwell required assistance from staff and that the resident’s condition had been worsening over several days, yet staff failed to take appropriate action. It was further alleged that a primary caregiver’s inability to speak English contributed to the lack of care provided. Based on a review of staff records and interviews conducted with residents, the Licensee, the Administrator, and staff working during the specified time frame it was discovered that there were several caregivers with limited English proficiency. However, the investigation was unable to substantiate whether the language barrier directly interfered with the care provided to R1. Based on the evidence gathered, the Department finds that the allegation is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated. 2. The Department conducted an investigation into the allegation. The investigation included a review of R1’s medical records, hospital records, and interviews with relevant parties. Based on a review of the medical and hospital records, there was no documentation or indication in these records that R1 was dehydrated upon admission or during care. Interviews conducted during the investigation included staff members, facility management, and other relevant parties. A witness stated that R1 appeared severely dehydrated on the day they were sent to the hospital. However, the facility staff denied this claim, indicating that R1’s condition was regularly monitored, and no signs of severe dehydration were observed prior to the transfer. The Department noted that the accounts provided during interviews were inconsistent. The witness’ assertion of severe dehydration conflicts with the medical documentation reviewed, which did not support this claim. Based on the evidence gathered, the Department finds that the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. 3. The Department investigated an allegation that the Licensee accepted a resident whose care needs exceeded the level of care the facility could provide during the time frame from the facility’s opening to November 2023. Based on the investigation, the Department reviewed R1’s file, including the pre-admission appraisal. Pre-placement admission appraisal indicated that R1 was able to walk with a walker, able to eat with minimal assistance and supervision, required assistance with showering and using the bathroom, assistance with preparing medication and supervision when taking medication, and required a special diet. Based on the documentation at the time of admission, R1 was assessed to require assistance that fell within the facility’s capabilities under Title 22 Regulations. Based on the evidence gathered, the Department finds that the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 59-AS-20240129085315

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Dec 13, 2024

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above because the staff did not seek medical attention and waited to be instructed to which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: By 12/13/2024, the licensee shall submit a written plan of correction on they shall ensure staff will seek medical attention when required. $500 immediate civil penalties assessed

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jan 10, 2025

Reporting Requirements: Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident and to the person responsible for the resident within seven days of the occurrence This was not met as evidenced by: Based on file review the licensee did not submit a written notice regarding the resident being hospitalized. This poses a possible risk to residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: By 01/10/2025, the licensee shall submit a written report regarding their understanding of when to report incidents to Community Care Licensing Division

Type of visit: Office

This office meeting was conducted at the request of Licensees Rajveer Kaur and Manpreet Dyal. They wanted to review floor plans for their new location and discuss change of location. Present from Community Care Licensing were Licensing Program Analysts Hiratsuka and Gunby and Licensing Program Manager Troy Ordonez. Discussed was change of location procedures and the floor plan. Licensees were advised to reach out to the Central Application Bureau for more information. Licensees are also to keep LPA Hiratsuka updated on the progress.the state’s words, verbatim · CDSS document, Aug 20, 2024

Allegation investigated: Facility is in disrepair. Licensee does not ensure a safe environment for residents in care. Licensee does not ensure a sanitary environment for residents in care

LPA Hiratsuka conducted this visit to deliver the results of the investigation above. LPA met with Manpreet Dyal. During the investigation the administrator, licensee, caregivers, and residents were interviewed. LPA also toured facility on three separate visits. 1. LPA interviewed residents and staff. Complainant alleged the heater for the facility wasn’t working. LPA did not have any complaints from the residents. Complainant stated a toilet in one of the resident’s rooms plugged and overflowed with sewage. One resident who does not reside in the room stated it was small leak from the toilet that was fixed quickly and doesn’t recall hearing about any of the toilets plugging and overflowing. Two resident rooms have full bathrooms and LPA was informed they have not plugged or overflowed during the interviews. LPA was told the common bathroom has not had any issues. LPA toured the facility three times. LPA did observed marks on the hallway walls that could be caused by wheelchairs or walkers bumping in the walls, the doorways to the bedrooms have marks on the floor that was left over from the doors being widened but none of that poses any risks to residents. Unsubstantiated There is a walkway from the front of the facility to the back that has steps on one side and a ramp on the other. The steps are marked with tape and the tape was peeling, but it does not pose a risk because the steps were still clearly marked. LPA cannot prove or disprove the allegation. 2. Complainant stated the stove top vent above the stove tops and the clothes dryer were not ventilated and emitted toxic fumes or did not ventilate toxic fumes. LPA contacted Sutter County Building Inspector and Sutter County Fire Inspector. The stove top itself is electric and does not emit toxic fumes. The fan over the stove top is a fan that blows air away from the food and is not required to vent to the outside. The clothes dryer at the time of the complaint being made was installed in the garage was electric and not vented to the outside because the person who delivered the unit did not install it properly. LPA contacted the company that built the clothes dryer and the Sutter County Building Inspector, and both stated the clothes dryer does not emit toxic fumes. The only concern was lint build-up and damp air being emitted from the clothes dryer. The licensee has since switched it to a ventless clothes dryer. However, based on the above the two issues do not pose a danger to residents. Complainant stated caregivers would leave the sharp knives in the kitchen unlocked and one of the residents was able to get into the drawer. LPA was given a time frame ending roughly April 2024. LPA was unable to confirm the events. Complainant alleged the hot water heater was dangerous and Licensee stated she has not had any issues with the hot water heater, nor has she had any complaints about the hot water heater. LPA did not receive any complaints about the hot water heater from the residents who were interviewed. LPA did not observe any issues with the hot water heater. LPA cannot prove or disprove the above. 3. Complainant stated the toilets plugged all the time and overflowed and the caregivers didn’t clean any of it up. Interviews all stated that didn’t happen. LPA was unable to interview past caregivers. LPA cannot prove or disprove the allegation. Due to the information gathered, LPA cannot determine the allegations: 1 Facility is in disrepair; 2. Licensee does not ensure a safe environment for residents in care; 3. Licensee does not ensure a sanitary environment for residents in care. LPA finds allegation to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.the state’s words, verbatim · CDSS document, Jul 31, 2024 · control 59-AS-20240311161504

Type of visit: Required - 1 Year

On 3/20/2024, Licensing Program Analysts (LPAs) Cassie Yang and Kerry Hiratsuka arrived unannounced at the facility to conduct a required annual inspection utilizing the full care tool. LPAs met with caregiver, and explained the purpose of the visit. Licensee arrived to facility after tour was conducted. This facility has a fire clearance for 6 non-ambulatory residents. LPAs and Caregiver conducted a tour of the interior of the facility, areas toured included: residents bedrooms, bathroom, kitchen, garage and the common areas. LPAs observed kitchen to have sharps to be locked. LPAs observed facility to have ample food supply. LPAs conducted a file review of four (4) residents files and nine (9) staff files. LPAs observed staff and residents file to be completed. The following items were discussed: -one of the resident rooms has a private shower and it appeared to be dark inside the shower when the shower curtain is closed even with the bathroom lights on. LPAs and Licensee discussed ways to brighten the inside of the shower -the resident room with the shower has a smoke detector that gets set off when the resident opens the bathroom door after a shower due to the steam from the shower. Several suggestions were discussed to prevent the alarm from going off which includes installing a fan in the bathroom and moving the smoke detector to another part of the room. -LPAs suggested installing window curtains for the bathrooms. The windows are frosted over for privacy but when the windows are open the windows do not provide privacy. No deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 20, 2024

Allegation investigated: . Facility staff ignored resident's calls for assistance. 2. Facility staff did not assist resident with using the restroom. 3. Facility staff left resident on the floor.

LPA Hiratsuka conducted this visit to deliver the results of the investigation above. LPA met with During the investigation the administrator, licensee, caregiver, and resident in question were interviewed. LPA also reviewed R1’s file 1. Resident (R1) stated staff do not answer calls for assistance. Administrator, Licensee, and Caregiver stated R1 has told them R1 is not receiving responses from agencies and companies R1 makes personal calls to. All three stated they answer R1's calls for assistance within five to ten minutes. LPA interviewed a second resident and the resident stated they receive assistance when requested. LPA cannot prove or disprove the allegation. Unsubstantiated 2. R1 stated the staff do not help them to the bathroom. R1 stated R1 will have accidents because no one assists R1 to the bathroom. Licensee, Administrator and Caregiver stated R1 tells them R1 is unable to urinate but refuses to go to the hospital. They stated R1 would refuse assistance to the bathroom and R1 was able to use the bathroom by themselves. LPA did not observe any urine smell during an interview on 12/13/2023. LPA interviewed a second resident who stated they get assistance when requested. 3. R1 stated R1 was left on the floor for hours up to 24 hours several times and was only given a pillow and not assisted up and staff did not call emergency services to assist in getting up. Staff stated they responded within ten minutes to assist R1 up from the floor. Staff stated they did call twice to emergency services to pick up R1 up. Staff stated R1 refused to get up from the floor until the administrator and licensee arrived. LPA cannot prove or disprove because there were no other witnesses. Due to the information gathered, LPA cannot determine the allegations: 1. Facility staff ignored resident's calls for assistance; 2. Facility staff did not assist resident with using the restroom; 3. Facility staff left resident on the floor. LPA finds allegation to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 30, 2024 · control 59-AS-20231206135339

Type of visit: Case Management - Legal/Non-compliance

A Non-Compliance conference was conducted today in the Sacramento Regional Office. The purpose of this meeting is to discuss the high volume of citations and a substantiated complaint. Present in the meeting is Regional Manager Alycia Berryman, Licensing Program Manager Laura Munoz, Licensing Program Analyst Kerry Hiratsuka, Licensing Program Analyst Bethany Mirlohi, and Licensee Manpreet Dyal and Administrator Rajveer Kaur, and Licensee Attorney Michael Benavides. The non-compliance conference process was explained during this meeting. The facility has been cited 29 times in the last year. The facility was cited for the following issues. The facility was cited for 15 Type A citations, and 14 Type B citations. Issues discussed during the meeting were: • High volume of Type A citations • Substantiated Complaint • Staffing issues and training • Communication Breakdown • Administrators lack Oversight. • Insufficient supplies for wound care and resources. • caregivers not addressing residents care needs adequately. • Facility failed to seek medical attention. • Night Supervision • Lack of Incontinence Care Plans • Personal Rights • Licensee/Administrator accountability The facility has stated they will do the following to achieve continued and substantial compliance: • Increase the amount of training each staff • Create policies and procedures to ensure compliance with staff training • Who is responsible for staff and resident records and training No deficiencies cited.the state’s words, verbatim · CDSS document, Dec 27, 2023

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPA) Kerry Hiratsuka and Bethany Mirlohi, conducted this case management visit. LPAs reviewed staff and resident files. LPA Hiratsuka also conducted a walk through. LPA Mirlohi conducted a file review for 3 of 3 residents in care. LPA observed R1 and R2 had an outdated needs and service plan and it had not been updated yearly. In addition, LPA reviewed 3 of 3 resident medications comparing with resident's physician orders. LPA observed R1, R2, and R3 had medications orders however several medications were missing and unavailable to residents. LPA observed R3 had medication orders for glucose testing and insulin injections. Administrator stated caregiver performs the glucose testing and resident performs her own insulin injections. R3's LIC602, Physician's Report states resident is unable to perform glucose testing and insulin injections. LPA Hiratsuka conducted a file review for four of four staff. One licensee is registered nurse and the other is a licensed vocation nurse. The training for the two remaining staff was done in November 2023 and is continuing. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights leftthe state’s words, verbatim · CDSS document, Dec 5, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Dec 6, 2023

Diabetes. The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. Based on record review and interview, the licensee did not comply with the section cited above because the resident is not capable and a caregiver who is not an appropriately skilled professional is doing it, which poses/posed an immediate risk to persons in care.the state’s words, verbatim · CDSS document, Dec 5, 2023

Plan of correction: By 12/06/2023, licensee shall submit in writing how they shall meet the needs of the resident and also how they shall screen residents in the future to ensure they can meet the needs.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(4) · Plan of correction due date: Dec 6, 2023

Incidental Medical and Dental Care. A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. Based on record review, the licensee did not comply with the section cited above because the medication lists did not match the medications present in the facility which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 5, 2023

Plan of correction: By 12/06/2023, the licensee shall ensure all medications prescribed to the residents match the medications present in the facility and how they shall ensure this happens.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: Dec 22, 2023

Reappraisals. The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first... Based on record review, the licensee did not comply with the section cited above because two of three residents have them over 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 5, 2023

Plan of correction: By 12/22/2023, the licensee shall come up with a written plan of correction how they shall ensure all reappraisals shall be done, meeting with resident and responsible party, and update the written plan of care.

Allegation investigated: Facility staff are not assisting with incontinence care

LPAs Hiratsuka and Yang, conducted this visit to deliver the results of the investigation above. LPA Hiratsuka investigated the allegation “Facility staff are not assisting with incontinence care." LPA Hiratsuka interviewed staff, complainant, resident, and reviewed resident’s file. The staff stated the resident (R1) refused to have someone change them and had to call the responsible party to have the responsible party talk R1 into getting changed. R1 stated the staff refused to change them most of the time. Home Health Care agency staff have found R1 in soiled clothing and soiled diapers on several occasions. Another Community Care Licensing Division (CCLD) employee interviewed one caregiver(S1) and that S1 stated they don’t change residents and S1 works the overnight shift. LPA reviewed the R1's file. There was no written record at all regarding the incontinent needs of the resident. Substantiated Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22) and California Health and Safety Code, is being cited on the attached LIC9099D. Appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 15, 2023 · control 59-AS-20230717132508

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87611(b)(1)(D) · Plan of correction due date: Nov 16, 2023

General Requirements for Allowable Health Conditions. The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: Documentation from the physician of the following: Documentation from the physician of the Resident's ability to perform the procedure; Based on record review, the licensee did not comply with the section because there was no incontinent care plan for any of the residents which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, the licensee shall submit a written plan of correction on how all resident incontinent needs are met

Allegation investigated: Resident sustained severe pressure injury due to staff neglect. Facility failed to seek medical attention. Staff left resident in soiled diaper for extended period. Staff unable to communicate with medical personnel.

Licensing Program Analysts (LPA) Hiratsuka and Yang, conducted this visit to deliver the results of the allegations above that were investigated by Community Care Licensing Division (CCLD). The department conducted interviews, reviewed facility files, and reviewed resident medical records. File review indicate the resident in question (R1) developed a pressure injury during a stay at the hospital and home health care was prescribed to heal the pressure injury. The facility did not provide the care required to heal the pressure injury resulting it starting at a stage two pressure injury from the hospital and led to it developing to an unstageable pressure wound while R1 was at the facility. Interviews revealed R1 is incontinent and required staff to assist changing the resident. Interviews conducted indicates Staff 1 (S1), who works overnight does not perform any incontinent care for the residents who are incontinent. S1 also stated they do not perform any activity of daily living care of the residents. R1 was not checked on during the overnight hours and not changed out of soiled diapers. Interviews also identified a second resident (R2) who stated they try not to urinate during the overnight hours because S1 does not change them. Substantiated R1 was also left in soiled diapers during the day. Staff stated R1 refused to be changed and the R1 stated that is not true. R1 stated they were not changed on a regular basis and R1 also stated R1 said “yes” to staff when staff asked R1 if they needed to be changed but was not changed. No written incontinent care plan was found in R1's file at the facility during a file review. Home health agency staff stated they found R1 in soiled diapers when they visited R1. Staff 2 (S2) also did not seek medical attention when the pressure injury on R1 worsened. S2 stated they were instructed to put cream on the pressure injury and to put a bandage on it if it fell off between the home health care agency checks. S2 stated they contacted the administrator and the responsible party when they noticed the pressure injury smelled bad and did not send R1 to the hospital until being instructed to do so by the responsible party. R1 was sent to the hospital 07/26/2023 and has not returned. Title 22 regulations and California Health and Safety Code do not require staff to speak English. However, the regulations do require staff to be competent to provide services necessary to meet resident needs. LPA Hiratsuka was unable to communicate with two separate staff members. The first time was on 08/02/2023, and that staff member (S3) called S2 who showed up and LPA was able to communicate with S2. During the visit LPA met S1 and LPA was unable to communicate with S1 either. LPA found both S1 and S3 working by themselves. S2 stated they live a couple of minutes away and the others can call S2 at any time. Home health agency staff stated they were unable to communicate with S1 when they had questions and S1 had to call S2 and S2 arrived to finish the visits. S1 is also the overnight staff member. There is no proof S1 can call for emergency services by themself. As a result of this investigation, the Department finds the allegations above to be Substantiated. A finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. At the time of the complaint visit, an immediate civil penalty of $500 shall be assessed for a violation of California Code of Regulations Section 87463(a). The licensee was informed that a civil penalty was under review and may be assessed at a future date according to Health and Safety Code 1569.49. Exit interview conducted. A copy of the report has been issued. Appeal Rights provided. signature on this report acknowledges receipt of the Appeal Rightsthe state’s words, verbatim · CDSS document, Nov 15, 2023 · control 59-AS-20230731122901

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Nov 16, 2023

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above because the staff did not seek medical attention and waited to be instructed to which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, the licensee shall submit a written plan of correction on they shall ensure staff will seek medical attention when required. $500 immediate civil penalties assessed

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Nov 16, 2023

Personnel Requirements – General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… This requirement is not met as evidenced by: Based on interviews and record reviews, the Licensee did not compy with the section cited above because the staff did not seek medical attention and waited to be instructed, nor did the provide incontinent care to residents overnight, and cannot communicate with home health agency staff and CCLD staff which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, the licensee shall submit a written plan of correction on how they shall ensure staff are meeting the resident needs 24/7 and how they shall ensure a staff member is on duty at all times who can communicate with residents, home health care agency staff, and others.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 16, 2023

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above because S1 stated they do not change residents during the overnight shift out of soiled clothes and diapers which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, Licensee shall submit a written plan of correction on how they shall ensure staff meet the resident needs.

Type of visit: POC

Licensing Program Analysts (LPA) Hiratsuka and Yang, conducted this visit to discuss deficiencies cited on 11/02/2023. LPA Hiratsuka issued a citation because staff did not have medication training as required by California Health and Safety Code §1569.69(a)(2) Employees assisting residents with self-administration of medication; training requirements:. The plan of correction for the licensee was required to be submitted on 11/03/2023. Licensee submitted it on 11/10/2023. Civil penalties issued because the plan of correction wasn't submitted until 11/10/2023. California Health and Safety Code section §1569.625(b)(2), was cleared as of 11/10/2023, because Licensee submitted proof of purchasing training.the state’s words, verbatim · CDSS document, Nov 15, 2023

Type of visit: Case Management - Deficiencies

While investigating Complaints 59-AS-20230731122901 and 59-AS-20230717132508, the following deficiencies were observed: 1. The facility staff (S1) that works overnight does not provide any incontinent care to the residents. S1 stated they do not check to see if a resident who requires assistance with incontinence care nor does S1 change the resident out of soiled clothes and briefs. Interviews show S1 does not respond to residents who request assistance during the overnight hours. The facility file does not have any staff training required by Title 22 regulations regarding night supervision. There is no proof S1 has first aid training and training to assist in caring for residents in the event of an emergency. California Health and Safety Code states the licensee may designate a qualified substitute in place of the administrator who has to be present on the premises 24 hours per day and that qualified substitute shall have qualifications adequate to be responsible and accountable for the management and administration of the facility. The staff member on duty overnight does not meet these requirements. There is no proof of any training to ensure the person is qualified. 2. A resident (R1) was on home health during the resident’s stay. The facility is required to have a copy of a written agreement of what the facility staff are to do and what the home health care agency is supposed to do. That was not found in the resident’s file. 3. The facility is required to have ongoing communication between themselves and the home health care agency. That was not found in R1’s file. 4. R1 developed a pressure injury during a hospital stay and was admitted with the pressure injury. The facility did not document R1 had a pressure injury. The licensee is required to do a preappraisal and a reappraisal when there is a change in condition. There is no documentation stating R1 had a pressure injury and what was being done about it. 5. Prior to accepting a resident the licensee is required to do a functional capability assessment. There was no document in R1’s file stating it was done. 6. Title 22 regulations requires certain documentation to be in a resident’s file. A medical assessment is required to be in the resident’s file. S2 stated one was completed but was given to emergency personnel who took R1 to the hospital and it was not replaced. LPA was unable to review a medical assessment of the resident due to it not being in the file and not replaced. 7. Title 22 regulations requires a centrally stored medication log or list of medications the resident is prescribed to take. S2 stated she gave the list to the emergency personnel who took R1 to the hospital and did not replace it. 8. The administrator has demonstrated they do not have the knowledge to operate a facility based on the above issues that are being cited. The administrator also is being cited because a pressure injury that occurred at a hospital became worse while the resident was at the facility due to neglect of the staff. The staff did not change the resident out of soiled clothing and diapers. Licensee did not ensure staff who work the overnight shift check and change residents who require incontinent care. Licensee does not ensure there is a staff person working on each shift that is capable of communicating with home health agency staff, Community Care Licensing staff, and emergency personnel. S1 has to call another staff person when they are left alone for someone to come to the facility to communicate with others. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights leftthe state’s words, verbatim · CDSS document, Nov 15, 2023

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.618(b) · Plan of correction due date: Nov 16, 2023

, Administration and management of residential care facilities; substituted qualifications; employee scheduling. At least one administrator, facility manager, or designated substitute who... has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above because current staff did not/does not proof of required training which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, Licensee shall submit a written plan of correction on how they shall ensure the staff working meet this health and safety code requirement

From the deficiency page — Deficiency type: Type A · Section cited: CCR87415(a) · Plan of correction due date: Nov 16, 2023

Night Supervision The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services and shall be available as indicated below to assist in caring for residents in the event of an emergency. This requirement is not met as evidenced by: Based on record and interviews the licensee did comply with this section because S1 stated they do not change residents nor is there proof of emergency training which poses an immediate risk to residentsthe state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, Licensee shall ensure staff working overnight have emergency procedure training and changing residents.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.725(a)(3) · Plan of correction due date: Dec 1, 2023

Incidental medical care; residential care facility. A residential care facility for the elderly may permit incidental medical services to be provided through a home health agency, licensed pursuant to Chapter 8 (commencing with Section 1725), when all of the following conditions are met: There is evidence of an agreed-upon protocol between the home health agency and the residential care facility for the elderly... Based on record review, the licensee did not comply with the section cited above because there was no written contract or paperwork between the resident and home health agency, which poses a potential, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, the licensee shall submit a written plan of correction on how they shall ensure the resident's file has all the required paperwork when a resident uses a home health care agency.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.725(a)(4) · Plan of correction due date: Dec 1, 2023

Incidental medical care; residential care facility. A residential care facility for the elderly may permit incidental medical services to be provided through a home health agency, licensed pursuant to Chapter 8 (commencing with Section 1725), when all of the following conditions are met: There is ongoing communication between the home health agency and the residential care facility for the elderly about the services provided to the resident by the home health agency and the frequency and duration of care to be provided. Licensee did not comply because there were no records of communication between the facility and the home health care agency.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, the licensee shall submit a written plan of correction on how they shall ensure the resident's file has all the required paperwork when a resident uses a home health care agency.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87505 · Plan of correction due date: Dec 1, 2023

Documentation and Support Each facility shall document in writing the findings of the pre-admission appraisal and any reappraisal or assessment which was necessary in accordance with Sections 87457, Pre-admission Appraisal, and 87463, Reappraisals... Based on record review, the licensee did not comply with the section cited because there was no appraisal or reappriasal done on the resident indicating R1 had a wound which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, the licensee shall submit a written plan of correction on how they shall ensure the resident's file is complete

From the deficiency page — Deficiency type: Type B · Section cited: CCR87459(a) · Plan of correction due date: Dec 1, 2023

Functional Capabilities The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited- Based on record review, the licensee did not comply with the section cited because there was no functional capability conducted on any of the residents in care poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, the licensee shall submit a written plan of correction on how they shall ensure the resident's file is complete

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(2) · Plan of correction due date: Nov 16, 2023

Managed Incontinence. In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above because S1 stated they do not change residents during the overnight shiff which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 11/16/2023, the licensee shall submit a written plan of correction and immediately ensure there are staff who work overnight check on residents and change them if need be.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(10) · Plan of correction due date: Dec 1, 2023

Resident Records. Each resident’s record shall contain at least the following information: Reports of the medical assessment specified in Section 87458, Medical Assessment, and of any special problems or precautions. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above because R1 went to the hospital and the medical assessment was sent with the resident and not replaced. which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, Licensee shall submit a written plan of correction on how they shall ensure resident files are complete.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(14) · Plan of correction due date: Dec 1, 2023

Resident Records Each resident’s record shall contain at least the following information: Current centrally stored medications as specified in Section 87465, Incidental Medical and Dental Care Services. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above because R1 went to the hospital and the list of medications was sent with the resident and not replaced. which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, Licensee shall submit a written plan of correction on how they shall ensure resident files are complete.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(h)(8) · Plan of correction due date: Dec 1, 2023

Administrator - Qualifications and Duties The administrator shall have the responsibility to: Have the personal characteristics, physical energy and competence to provide care and supervision and, where applicable, to work effectively with social agencies. Based on record review, the licensee did not comply with the section cited above because staff don't have the required training, do not check residents who require incontinent assistance, employing staff who are qualified which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2023

Plan of correction: By 12/01/2023, Licensee shall submit a written plan of correction on how they shall ensure the administrator is competent to operate the facility.

Type of visit: Case Management - Deficiencies

While investigating a complaint LPA Hiratsuka observed the following deficiencies: California Health and Safety Code Section §1569.69(a)(2) Employees assisting residents with self-administration of medication; training requirements: In facilities licensed to provide care for 15 or fewer persons, the employee shall complete six hours of initial training. This training shall consist of two hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and four hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. No proof have had the required medication training as well as the required annual training. California Health and Safety Code section §1569.625(b)(2) Staff training; legislative findings; contents:(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. File reviews for two staff show they have the initial training required per the Health and Safety Code, but do not have any annual training since 2021. Licensee has not paid their annual fees. The annual fees are due by March 19th of each year. The licensee owes $716.50, which includes overdue fees. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights leftthe state’s words, verbatim · CDSS document, Nov 2, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Nov 17, 2023

Staff training; legislative findings; contents. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospicecare, as required by subdivision (a) of Section 1569.696. Based on record review, the licensee did not comply with the section cited above because two current staff did not/does not have the initial training which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2023

Plan of correction: By 11/17/2023, licensee shall submit a written plan of correction how they shall ensure all staff have the required training and ensure the current staff have the required training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87156(b)(1)(F) · Plan of correction due date: Nov 10, 2023

Licensing Fees. In addition to fees set forth in subdivision (a), the department shall charge the following fees: A late fee that represents an additional 50 percent of the established annual fee when any licensee fails to pay the annual licensing fee on or before the due date as indicated by postmark on the payment. Based on record review, the licensee did not comply with the section cited above because the annual fees are overdue which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2023

Plan of correction: By 11/10/2023, licensee shall pay their annual fee and overdue fee and shall submit a written plan of correction stating how they shall ensure their annual fees are paid by the due date each year.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.69(a)(2) · Plan of correction due date: Nov 3, 2023

Employees assisting residents with self-administration of medication; training requirements. In facilities licensed to provide care for 15 or fewer persons, the employee shall complete six hours of initial training... Based on record review, the licensee did not comply with the section cited above because there is no proof staff have had medication training which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2023

Plan of correction: By 11/03/2023, the staff who prepare and distribute medication shall have the required medication training which includes shadow training. Licensee shall submit a written plan of correction how they shall ensure staff are trained per the California Health and Safety Code each year.