Shamrock Residential Care Home

On 12/1/2025 LPA Tarin interviewed R1. R1 states he/she did not know how long he/she lived at the facility, stating "I think it was about 2 weeks ago." R1 stated he/she remembers signing the Admission Agreement and 'went willingly with the Administrator to the bank and I knew it was so that I could live here (facility)." R1 states he/she is responsible for his/her own money. R1 stated he/she did not have bank records or do online banking. R1 stated he/she goes into the bank to conduct all his/her finances. R1 showed LPA an envelope that contained the Admission Agreement dated and signed on 11/18/2025. On 12/1/2025 LPA interviewed Licensee (LIC). LIC states R1 moved into the facility on 11/18/2025 and signed the facility agreement. LIC states R1 handles his/her own fiances. LIC states he/she was not aware of any financial abuse of R1 since moving into the facility. LIC states R1 is current with his/her facility payments through 12/2/2025. Review of R1's Admission Agreement, R1 signed the Admission Agreement on 11/18/2025, agreeing to $300 a day for 15 days, tota ling $4,500. LPA also reviewed an invoice dated 11/18/2025 for R1 in the amount of $4,500 for 11/18/2025 to 12/2/2025 (15 days), and a payment made by R1 by 'Chase Counter Check' on 11/19/2025. Review of R1's Physician's Report dated 11/18/2025, R1 does not have neurocognitive disorder. This agency has investigated the complaint alleging s taff financially abused resident in care, and staff did not provide resident with a copy of the Admission Agreement. We have found that the complaint was UNFOUNDED , meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Page 2 of 2. END OF REPORT

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Vicky Ablao. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 20F and Freezer at -10F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 5/16/2025. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed, drills are being conducted quarterly. The facility's last drill was on 7/14/2025. LPA toured 4 resident rooms. All 4 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. Page 1 of 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA toured 2 resident bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range from 110.4F to 119.3F. LPA reviewed 2 resident records. Resident records included current physician's report and service plans. LPA reviewed 2 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 2 staff records. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator Vicky Ablao and a signed copy of this report was provided.

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 08/04/2022 at 10:53am. LPA met with facility Administrator Vicky Ablao (Admin). At 10:56am, LPA began touring the facility inside and out including living room, kitchen, dining room, garage, family room/activity room, 3 bathrooms, 6 bedrooms including staff bedrooms, storage room, back yard, and side walkways. All staff members observed to be wearing masks. Admin confirmed that all staff and residents have been vaccinated. Facility infectious control plan has already been submitted. No prohibited items noted in resident rooms. All emergency exits noted to be clear of obstruction. All rooms in facility noted to be clean and well maintained. Hand sanitizers, soap, and paper supplies were observed to be available. All restrooms stocked with paper towels. Facility water temperature measured to be 110.1*F. Hand washing signs observed in all bathrooms. Social distancing signs observed to be posted in all public areas. Facility observed to have designated entry point. Staff took LPA's temperature, screened for symptoms, and recorded information in visitor log. At least 2 days' supply of perishable food and at least 1 week's supply of non-perishable food was observed on the premises. 30 day supply of PPE observed. Fire extinguisher tags indicate it was last inspected in May of 2022. 8 Carbon monoxide/smoke were observed throughout the facility. No deficiencies cited during today's visit. This report was reviewed with Administrator Vicky Ablao and a copy of the signed report was provided.