Hm Love & Care Home

On 07/02/25 around 10:25 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Maria Riformo, Administrator (Licensee) arrived about 10 minutes later who currently holds a standard certificate (#7001621740 ) exp. 04/06/25. The facility’s fire clearance was approved for six (6), four (4) may be non-ambulatory residents. Upon entry, LPA observed one (1) resident in the dining area having a telephone conversation. LPA and Licensee toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. The hot water temperature in the shared residents' bathroom measured at 105.3 degrees Fahrenheit (F) and the facility's temperature was 68 degrees F. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. continued on LIC809C... 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 ...continued from LIC809. Fire extinguisher was observed full and tagged with receipt and expires 07/05/24. Emergency Disaster Plan is updated. Last safety drill conducted 03/08/25 and is rotational between AM and PM schedules quarterly. LPA reviewed three (3) staff files with criminal record clearances, and three (3) resident files; all files were incomplete. -At 11:30 AM: Facility Administrator records have not been updated with CCLD. -At 11:35 AM: Residents files are not updated with a current Appraisal Needs and Services Plan. -At 11:35 AM: Personnel files are not updated with Heath Screening, TB testing and Training records. -At 12:20 PM: PUB 475 regulatory size not posted in the facility. The following forms are to be updated and submitted to CCLD by 07/23/25: -Resident Roster (Reviewed) -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan (Reviewed) -Administrator Certificate(s) (Reviewed) -Infection Control Plan (Reviewed) -Liability Insurance (Reviewed) -Written plan for repairing or removing the patio lattice. Exit interview conducted and a copy of this report provided to Maria Riformo, Licensee.

Continued from LIC9099. once a week or as often as needed. Based on observation, besides the sheets that were on the beds, the facility owned five (5) fitted sheets, several flat sheets, and two (2) of the fitted sheets was for a bed size that wasn’t present at the facility. LPA observed one (1) sheet that was stained and had to be discarded. Allegation: Staff do not assist resident with grooming R1 was admitted into the facility 2/13/2013. Review of the admission agreement indicated that at the time of admission R1 was able to self-groom. RP stated during interview that R1’s hair was not washed and R1 was wearing a dirty shirt. On the functional capability assessment and the appraisal needs and services plan dated 8/2/2023 it indicated R1 was not capable of self-grooming. S1 stated that a caregiver would groom R1. LPA reviewed pictures that were submitted and observed R1’s nails were long and had dirt underneath. The pictures also displayed R1’s hair unkempt. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. A copy of the appeal rights and this report provided. 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 Continued from LIC9099. Costa Regional Medical Center dated 7/31/2023 indicates bruising but not from abuse or neglect. Allegation: Staff do not meet residents' dietary needs. During initial interview with RP it was stated that R1 had lost a significant amount of weight between 2020-2023. S1 stated a weight loss log is not kept unless it is noticeable. Review of the physician’s report dated 09/27/2019 did not have R1’s weight listed but did state that R1 was a 2000 ADA calorie diet. Allegation: Staff do not assist resident with bathing Based on initial interview with RP it was stated R1 was wearing a dirty shirt, hair was not washed, and she was unkempt. S1 stated that R1 was given a bath every other day and more if needed. Allegation: Facility is not maintained clean and sanitary at all times On 6/16/2023, the RP visited the facility and stated during interview the floors were “dirty”. Pictures with unknown dates were also submitted showing the floor underneath a bed was unsanitary. LPA L. Holmes toured the facility during visit on 8/02/2023 and observed the facility to be sanitary. Allegation: Staff do not allow resident to keep and use their own personal possessions During record review it indicated that on the functional capability assessment and the appraisal needs and services plan dated 8/2/2023 that R1 is not capable of self-grooming. RP stated a brush was requested for R1 and staff brought a Continued on LIC9099C. 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 Continued from LIC9099C. “community brush” and someone removed R1’s hygiene products from her room. S1 stated during interview that R1’s brush is kept in the bathroom, however, when LPA L. Holmes toured facility she observed the brush sitting on R1’s night stand along with personal hygiene products in R1’s room. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted and a copy of report was given .

On 08/20/24 around 08:45 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Maria Riformo, Administrator (ADM) arrived about 10 minutes later. Co-Licensee currently holds a standard certificate (#6006016740 ). The facility’s fire clearance was approved for six (6), four (4) may be non-ambulatory residents. Upon entry, LPA observed one (1) resident sleeping and later going to the bathroom. LPA and ADM toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. Licensee to increase the surplus of PPE that is centrally stored in the facility and accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 107.8 degrees Fahrenheit (F) and the facility's temperature was 69 degrees (F). Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. continued on LIC809C... 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 ...continued from LIC809. Fire extinguisher was observed full and tagged with receipt on 07/05/24. Emergency Disaster Plan is updated. Last safety drill conducted 07/15/24 and is rotational between AM and PM schedules quarterly. LPA reviewed three (3) staff files with criminal record clearances, and four (4) resident files. After repairs are completed, licensee to remove 3-4 wooden boards, 2 shower glass doors, and a screen in disrepair at the sliding door of the dining room. The following forms are to be updated and submitted to CCLD 09/03/24: -Resident Roster -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) -Infection Control Plan (Reviewed -Removal of debris Exit interview conducted and a copy of this report provided to ADM.

O n 9/5/2023 at 12:10pm, Licensing Program Analysts (LPA) L. Hall and L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Maria Riformo, Licensee and explained the reason for the visit. While LPA L. Hall was conducting a complaint investigation ( 15-AS-20230901131403 ) on 9/5/2023. During visit LPAs were informed that the file for R1 was not available on the premises for review. The deficiency was observed (see LIC809D) and cited per Title 22 California Code of Regulations. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiency within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided