Continuance Care Home Llc

On 2/09/2023 at 9:50 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct an annual Infection Control Inspection. LPA met with Administrator Shirley Marshall and explained the purpose of the visit. Administrator asked Caregiver, Wyrek Fagin to continue the visit around 10:30 AM and sign the report due to them having to leave for an appointment. During the Infection Control Inspection, LPA toured facility with Shirley including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and front yard. Facility has a sufficient 2 day perishable and 7 day non-perishable food supply. Visitors policy is posted on the front entrance. A sign-in policy and hand sanitizer were observed at screening station. Hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap hand dryers and trash bins with touchless lids. Facility has a 30 day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan. Smoke and carbon monoxide detectors were observed and are connected to the sprinkler system. First Aid kit was complete . Fire extinguisher was observed serviced. LPA observed facility passages inside and out free of obstruction. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 5/19/25 during a pre-license LPA observed the following deficiencies: At around 10am, LPA observed trash bins on driveway is overflow with trashed and on the ground At around 10:10am, LPA observed pizza slicer inside the dishwasher. Dishwasher used as storage. At around 10:33am, LPA observed shared bathroom are not clean At around 10:35am, LPA observed broken title in the share bathroom At around 10:40am, LPA observed in resident room contain a Corinz and cleaning product on top of the drawer (Shared room) At around 10:45am, LPA observed Isopropyl Alcohol and dry shampoo in resident drawer (shared room) At around 10:50am, LPA observed one nail polished inside the med chart, and multiple nail polishes left unlock on the shelve At around 10:51am, LPA observed resident medication left unlocked in the drawer At around 10:50am, LPA observed Lysol cleaning wipe outside in the back of the facility At around 10:55am, LPA observed room 3 shared closet is being used as a storage At around 10:55am, LPA observed room 7, 6, and 4 have a strong odor At around 10:55am, LPA observed chemical left unlock in the drawer near the laundry room At around 11:am, LPA observed the wood on the pouch have a whole and lift up Civil Penalty is being assess of $250 Exit interview conducted and a copy of appeal right, LIC 421FC(7/17), and report is provided.

On 10/15/2025, LPAs K. Nguyen and L. Alexander arrived unannounced to conduct a case management and explained the purpose of the visit to Administrator Shirley Marshall. Based on the record reviewed, LPAs K. Nguyen and L. Alexander confirmed that Administrator Shirley Marshall currently has an active administrative certificate #703581740, effective 6/27/2025 – 6/26/2027. No deficiency issue on today's dates. An exit interview is conducted copy of this report is provided.

On 9/16/2022 at 2:00PM, Licensing Program Analysts (LPAs) G. Luk and P. Watson arrived unannounced to conduct a Case Management visit. LPAs met with assistant, Wyrek Fagin. Administrator, Shirley Marshall was unable to stay to sign the reports. While LPAs was at the facility for another visit, LPAs observed the following deficiencies: - LPAs observed S1 was not fingerprint cleared or associated to the facility. LPAs check on Guardian and observed S1 was last associated to a different facility in 2016. - LPAs observed back door had chain lock located near the top of the door and wooden rod put across the door that blocks the door handle. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights was provided.

At around 8:30 am, Licensing Program Analyst (LPA) K. Nguyen arrived to conduct POC visit inspection and met with Administrator, Shirley Marshall explained the purpose of the visit. LPA checked: - trash bins on driveway is not overflow with trashed - inside the dishwasher and are not being used as storage. - Activities and resident drawer handle have been fix/ replaced - observed shared bathroom are clean - observed broken title in the share bathroom - observed in resident room that Corinz and cleaning product on top of the drawer (Shared room) have been removed - observed Isopropyl Alcohol and dry shampoo in resident drawer (shared room) is removed and cleared - observed one nail polished inside the med chart, and multiple nail polishes left unlock on the shelve have been cleared and removed Report Continued on LIC 809c... 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 -observed resident medication are locked in the drawer - observed that Lysol cleaning wipe are locked in cabinet - observed room 3 shared closet is clear - observed room 7, 6, and 4 have do not have a strong odor - observed chemical lock in the drawer near the laundry room - observed the wood on the patio have a whole and lift up have be fix - observed that all the piles of wood in between the two building have been removed LPA cleared deficiencies. Copy of report provided to the Administrator.

Allegation: Staff prevented residents from attending a scheduled dental appointment- Unsubstantiated It was alleged that staff prevented residents from attending a scheduled dental appointment. Based on interviews and record review, R1 stated that R1 didn’t want to go to the dentist’s appointment because R1 didn’t know that R1 had a dental appointment. The record showed that POA did not notify of the R1 dental appointment. S4 stated S4 confirmed with POA that there was no notification of R1 dental appointment. Allegation: Staff did not provide facility contact information to the resident’s representative when requested- Unsubstantiated It was alleged that staff did not provide facility contact information to the resident’s representative when requested. Based on the record review and interview staff provided the facility contact information to the resident’s representative via the contact log. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted, and a copy of this report provided.

On 11/29/23 at 09:15 am Licensing Program Analyst (LPA) J. Clancy-Czuleger conduct a case management visit. LPA met with Staff member Wyrek Fagin and explained the reason for the visit. Administrator Sherley Marshall was called to be informed but was unable to come to the facility and Licensee Mandar Kulkarni was called and joined later. While at the facility to deliver findings for a complaint investigation (15-AS-20230522092645), LPA observed the following; Medication unlocked Laundry soap and cleaning supplies unlocked Lighter accessible to residents Expired fire extinguisher Smell of urine in room 7, and Urine left in bathroom toilet. Emergency food supply Sticky cabinets and drawers in kitchen Fruit flies in dining area Water damage under the kitchen sink The deficiency were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.

...Continued from LIC 9099 R1 was admitted to this facility in October 2021. On May 18, 2023, R1 was brought to the hospital after the family was notified by licensee that R1 had pressure injuries. R1 was diagnosed with an unstageable pressure injury to his hip, a stage three pressure injury to his left heel and a stage four pressure injury to his right heel. Staff (S1) reported she was caring for the wounds by copying what she had seen other Home Health nurses do. S1 reported she has never received formal training on how to care for wounds and never notified the family of the progressing wounds or sought medical attention. S1 believed the wounds were a result of R1 not being able to move and because he would “stay in one spot all the time”. Administrator, Shirley Marshall, never notified the family or sought medical attention, stating the wounds “got away from me”. Based on interviews and records review, S1 stated she would not seek medical attention or notify the family, regardless of how bad the wound was, as that was administrator’s responsibility. Facility administrator acknowledged R1 was not receiving appropriate care for his progressing wounds. Staff interviewed confirmed no medical attention was sought prior to May 15, 2023. Allegation: Facility administrator is not present in the facility due to illness Based on interviews, records review and observations, licensee did not comply with the above regulations. Facility administrator, Shirley Marshall, has not been involved in her daily administrative duties at least since March 2023. Ms. Marshall as confirmed this is due to her own ongoing medical issues and/or chronic illness, requiring treatments and routine medical appointments. Staff and family members of the residents have observed the absence of the administrator. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099D . A $500.00 immediate civil penalty is assessed today, Licensee was informed that an additional civil penalty is still being determined based on Health & Safety Code 1569.49(f).

At around 2:25 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct a POC visit and met with Shirley Marshall. LPA explained to Administrator purpose of the visit. LPA and Administrator reviewed updated medication list and medicine. LPA observed Vit D3 order is 25 mcg but the supply is 10 mcg. And a new prescription, Vit D2 was added to the list. Administrator states the new prescription is waiting for order from the doctor. One of the staff went to the pharmacy to pick up correct dose of Vit D3. Additional civil penalty of $600 from 4/6 - 4/11, 2023 (6) days is being assessed. Administrator will notify LPA once Vit D2 is received. The deficiency related to ongoing civil penalties is cleared. A copy of this report was provided to Administrator.

On 4/6/2023 at approximately 9:30 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct Plan of Correction (POC) visit. LPA met with Shirley Marshall, Administrator and explained the purpose of visit. Administrator authorized staff Wyrek Fagin to sign the report on her behalf.. On 3/29/2023, a Type A citation CCR (c)(2) was issued to the facility regarding medications not being given to resident as ordered by physician. Plan of Correction (POC) is for facility to order medications missing from the list and submit proof to CCL by 3/30/2023. Facility has not completed POC. During the visit, Administrator contacted Resident 1 (R1) doctor and requested for a complete list of R1's medicines and called pharmacy. Administrator placed the order for 2 of R1's medications. Civil penalty in the amount of $ 600.00 is assessed for the period 3/31/2023-4/5/2023. Facility is subject to ongoing penalties until deficiency is corrected. Exit interview was conducted with Administrator and Appeal Rights was provided.

On 11/29/23 at 09:15 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a case management visit. LPA met with staff member Wyrek Fagin to address violations that were found during an investigation conducted by the Department. Administrator Sherley Marshall was called to be informed but was unable to come to the facility and Licensee Mandar Kulkarni was called and joined later. During the course of the complaint investigation, Complaint Control No. 15-AS-20230522092645, the following additional information and deficiencies were identified. Resident 2 (R2) was discovered to have had an unstageable pressure injury to his coccyx. R2 was sent to the hospital same day as R1 (05/18/2023), stating the facility could not provide the level of care that was needed for the wound. Staff (S2) interviewed acknowledged that she was caring for the wounds by copying what she had seen other home Health nurses do. S2 reported she has never received formal training on how to care for wounds. Based on interviews and records review the facility did not report to the department that R1 and R2 developed pressure injuries and that R2 went to the hospital as a result of the pressure injuries. Based on interviews and records review the facility did not report to R1 and R2’s families the residents change of condition of pressure injuries and hospital visits as a result of the pressure injuries. In an interview with Reporting Party (RP) they state that she and other family members visited on a regular visits and were not notified of the change in condition of the resident. A $500.00 immediate civil penalty is assessed on this day. Licensee was informed that an additional civil penalty is still being determined based on Health & Safety Code 1569.49(f) The following deficiency observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.