Montgomery Springs Manor.
Montgomery Springs Manor is Ranked in the bottom 9% of California memory care with 64 CDSS citations on record; last inspected Jul 2026.
15-Bed Memory Care Home in Hayward's Montgomery Street Neighborhood, reviewed on public record.
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Compared to 152 California facilities with a similar number of beds.
RCFE memory care · 36-month window. Higher percentile = better performance on inspection record. Source: California Dept. of Social Services · Community Care Licensing.
Rankings based on 36-month CDSS inspection data. Severity and frequency: fewer citations = higher percentile. Repeat rate: lower repeat citation share = higher percentile.
FACILITY WATCH · FREE
Montgomery Springs Manor has 64 citations on record. Know the moment anything changes.
New findings, complaint investigations, or status changes — emailed to you free.
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Citation history, plotted month by month.
64 deficiencies on record. Each bar is a month with a citation.
Finding distribution
64 total · 36 monthsScope × Severity (CMS A–L)
The rules that apply to this facility.
State requirements with the exact regulation citation, plain-language explanation, and a question to ask on tour. Rules this facility has been cited for appear first.
Plain language
Because a facility markets dementia or Alzheimer's care, state law mandates higher training standards: 12 hours of initial dementia training (6 hours before a staff member works independently with residents, 6 more within the first 4 weeks), 8 hours of annual dementia in-service every year thereafter, and an administrator must include 8 hours of dementia-specific continuing education in every 2-year recertification cycle. Training must cover individualized care plans, behavioral expressions, appropriate supervision, and the facility's dementia care philosophy.
Ask on tour
“Can you show me each direct-care staffer's most recent dementia training certificate, and tell me when their next refresher is due?”
Questions to ask before you visit.
A short pre-tour checklist tailored to Montgomery Springs Manor's record and state requirements.
The facility has 12 Type A deficiencies on record, indicating citations where actual harm occurred — can you describe what incidents led to these citations and what corrective actions were implemented?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Twelve complaints have been filed with CDSS during the inspection period — how many were substantiated, what were they about, and what changes resulted from the investigations?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
CDSS records show a citation under §87705 or §87706 related to dementia care requirements — what was the specific deficiency, and how has the facility addressed it?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Every inspection visit, verbatim.
23 inspections in the public record, most recent first. Click any row to expand — cited rows open automatically.
2026-07-02Other VisitType A · 2 findings
“-Based on review of records and inspection, the licensee did not comply with the section above in having R1 who is non-ambulatory in the bedroom fire cleared for ambulatory only which poses an immediate safety risk to person in care”
“-Based on interviews, the licensee did not comply with the section above when R1 and R2 had incident and report not submitted which posed a potential health, safety and/or personal rgihts risks to persons in care.”
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On this day, July 2, 2026, at 1:50 pm, Licensing Program Analyst (LPA) Delmundo conducted case management inspection to ensure the health and safety of residents as a result of the Department receiving a Priority 2 complaint (Complaint Control Number: 15-AS-20260630155242). LPA met with Mirriam Paras, administrator (ADM), and informed the reason for visit. LPA toured the facility with ADM. LPA inspected the living and dining rooms, kitchen, bathrooms and residents' bedrooms on the first and second floors. LPA reviewed resident records. LPA observed and learned about the following: R1 and R2 had an incident. LPA observed R1 with bruises and wounds/lacerations, and when verified, ADM stated she did not submit incident report. R2's Physician's Report indicated R2 has advancing neuro cognitive disorder and non-ambulatory and R2 is in the bedroom not cleared/approved by the fire department for non-ambulatory. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. An immediate $1,000.00 civil penalty is assessed for repeat violation within 12 month of deficiency section 87202(a)(1) and will continue for $100.00/day until corrected. Deficiencies, plan and proof of corrections and civil penalty assessment were discussed with ADM. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty assessment and copy of this report provided.
2026-06-18Annual Compliance VisitType A · 2 findings
“-Based on review of records and inspection, the licensee did not comply with the section above in having R1 who is non-ambulatory in the bedroom fire cleared for ambulatory only which poses an immediate safety risk to person in care”
“-Based on observation, the licensee did not comply with the section above in vitamins and razor in the closet in resident's room which pose an immediate health, safety and/or personal rights risks to persons in care.”
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While at the facility conducting pre-licensing inspection for change in ownership of this facility and upon review of resident's (R1) record, Licensing Program Analyst (LPA) Delmundo observed the following: -at 12:30 pm, vitamins and razor in the closet in the resident's room. -at 1:30 pm, resident (R1) whose LIC602A Physician's Report indicated major neurocognitive impairment and non-ambulatory is in the bedroom fire cleared for ambulatory only. The above deficiencies were discussed with Mirriam Paras, administrator (ADM). Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalties for section # 87202(a)(1) and will continue for $100.00/day until corrected. A $250.00 civil penalty is also assessed for section # 87309(a) for repeat violations within 12 month period and failure to submit proof of correction may result in additional civil penalty. Deficiencies and plan and proof of corrections were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC421IM and LIC421FCs Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.
2026-03-24Other VisitType A · 9 findings
Plain-language summary
During an unannounced annual inspection on March 24, 2026, inspectors found multiple violations including medications stored in unlocked cabinets and refrigerators, hazardous materials like bleach and cleaning supplies in accessible areas, bed rails in use without doctor's orders, broken windows and furniture, staff files missing required documentation, and no doctor's orders on file for any resident's current medications. The facility also failed to report a resident's hospitalization on March 3, 2026, and did not conduct required quarterly disaster drills. The facility has been ordered to submit corrections by April 7, 2026, and faces civil penalties for repeat violations.
“Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate health, safety and/or personal rights risks to persons in care: Neosporin and muscle rub in resident's room; unlocked gate leading to storage where cleaning and laundry supplies are kept; Clorox bleach in the backyard; rubbing alcohol, rust remover and hammer in unlocked basement room; unlocked peritoneal cleanser and medications POC Due Date: 03/25/2026 Plan of Correction 1 2 3 4 Staff locked the medications and gate. Administrator have the basement cleaned and discarded the items in the basement. In addition, administrator to in-service the staff and submit copy of training topics with attendees signatures by 3/25/26.”
“Based on records review, the licensee did not comply with the section cited above in residents current medications not having doctor's orders on file which pose an immediate health and/orr personal rights risks to persons in care. POC Due Date: 03/25/2026 Plan of Correction 1 2 3 4 Administrator stated she'll obtain doctor's orders. Copies to be submitted by 3/25/26.”
“Based on interview, the licensee did not comply with the section cited above in not submitting incident report when one of the residents was sent out to the hospital which posed a potential personal rights risk to person in care. POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator to submit incident report by POC date.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose a potential health, safety and/or personal rights risks to persons in care: broken glass window; cat's feces, rusted paint pan, paint roller, piece of wood and metal on top stairs; rusted sink in area adjacent to kitchen; broken drawer knob in residents' room; pieces of metal and pieces of wood, rusted grills, soiled placemat, empty milk container on the backyard ground POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator to do the following. Pictures to be submitted by 4/07/26: (1) Stated she'll have the sink remove. (2) Replace the glass window. (3) Replace the drawer knob. (4) Clean the yard and stair. A $250.00 civil penalty is assessed for repeat violation.”
“Based on record review, the licensee did not comply with the section cited above in S3, a cook, not having food preparation training on file which poses a potential health and/or personal rights risks to persons in care. POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator to have S3 trained and submit copy of training certificate.”
“Based on records review, the licensee did not comply with the section cited above in residents' (R1 and R2) LIC602A Physician's Report/medical assessments over a year old which pose a potential health, safety or personal rights risks to persons in care. POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator to call the residents' doctor to schedule assessment and submit copies of LIC602A by 4/07/26.”
“Based on record review, the licensee did not comply with the section cited above in not conducting the required drills at least every quarter which poses a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator to read the Regulation and self-certify that drills are conducted as required.”
“Based on records review, the licensee did not comply with the section cited above in not having doctor's orders for half bed rails for 2 residents which pose a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator stated she'll obtain doctor's orders. Copies to be submitted by 4/07/26.”
“Based on record review, the licensee did not comply with the section cited above in S2 not having LIC501 on file which poses a potential safety and/or personal rights risks to persons in care. POC Due Date: 04/07/2026 Plan of Correction 1 2 3 4 Administrator to have the LIC501 completed and submit copy by 4/07/26.”
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On this day, March 24, 2026, at 11:20 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Jonalyn Legarto, and informed the reason for visit. LPA called and left message on Mirriam Paras', administrator (ADM), voicemail. ADM arrived at around 12:06 pm. LPA also met with other staff, Charlaine Rose De Leon and Melody Tria. LPA started the inspection with Jonalyn Legarto and continued with ADM. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was locked. Hot water temperature in one of common bathrooms was tested and measured at 117.8 degrees Fahrenheit. Fire extinguishers were observed fully charge with tags showed serviced September 24, 2025. Carbon monoxide and smoke detectors were tested and observed in operating condition during today's visit. Facility only conduct fire drills and records showed conducted January 16, 2025 and February 8, 2026. LPA reviewed 5 residents and 5 staff files and interviewed 1 resident. Residents medications were checked. Facility does not handle residents' cash resources and/or P&I. .....continued on 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 LPA learned that one of the residents (R6) was sent out to the hospital on March 3, 2026 but the facility did not submit incident report. LPA observed the following: -at 11:37 am, unlocked cabinet where peritoneal cleanser are kept. -at 11:40 am, half bed rails of 2 residents have no doctor's order on file. -at 11:45 am, broken drawer knob in residents' room. -at 11:58 am, broken glass window in resident's room; cat's feces, rusted paint pan, paint roller, piece of wood and metal in top stairs leading to the backyard. -at 12:04 pm, Neosporin and muscle rub in resident's room. -at 12:09 pm, unlocked gate leading to storage where cleaning supplies are kept and Clorox bleach in the backyard. -at 12:15 pm, pieces of wood, rusted grills, soiled placemat, empty milk container on the backyard ground. -at 12:17 pm, rubbing alcohol, rust remover and hammer in unlocked basement room. -at 12:30 pm, rusted sink and medications in unlocked refrigerator in area adjacent to the kitchen -at 1:00 pm, two residents' beds with half bed rails but no doctor's order on file. -at 3:00 pm, staff (S2) has no LIC501 Personnel Record on file. -at 3:15 pm, staff (S3), a cook, does not have food preparation training on file -at 3:30 pm, records showed facility does not conduct disaster drills every quarter and only conducted fire drills. -at 4:15 pm, residents' (R1 and R2) LIC602A Physician's Report/medical assessments on file are over a year old. -all 5 residents have no doctor's orders for current medications. .......continued on 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 Administrator to submit updated/current copies of the following by April 7, 2026: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610D Emergency Disaster Plan (9 pages) 4. Proof of $3M Liability Insurance coverage Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. A $250.00 civil penalties for each of section # 87303(a), 87463(h) for repeat violations within 12 month period and will continue for $100.00/day until corrected. Failure to submit proof of corrections for other deficiencies may also result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC421FCs Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.
2025-08-14Other VisitType B · 3 findings
Plain-language summary
This was a complaint investigation visit where inspectors found that two residents' physician reports were outdated and no longer reflected their actual abilities—one resident's report was from 2017 and didn't account for their now-total dependence on staff for daily activities, while the other's was from 2024 but didn't note that they now use a walker. The facility has been cited for these deficiencies and must submit a plan to correct them by a deadline set by the state.
“-Based on record review, interviews and observation, the licensee did not compy with the section above for not having R1's LIC602A updated when R1's conditions changed which poses a potential health and/or personal rights risks to person in care.”
“--Based on record review, interviews and observation, the licensee did not compy with the section above in retaining R1 who is dependent on all ADLs which poses a potential health and/or personal rights risks to person in care,”
“-Based on record review and observation, the licensee did not comply with the section above in R2's LIC602A not consistent with R2's ambulatory status”
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While at the facility investigating a complaint (Control # 15-AS-20250808113155) and upon review of residents' files and interviews, Licensing Program Analyst (LPA) Delmundo learned that resident (R1 and R2) LIC602A Physician's Reports are outdated. R1's LIC602A was dated 1/09/17 and showed R1 able to bathe, dress/groom and feed self and care for own toileting needs; however, R1's condition has changed and is now dependent on the staff on all activities of daily living. R2's LIC602 dated 4/14/24 indicated ambulatory but R2 uses walker to ambulate. Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates and any repeat violations within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
2025-08-14Complaint InvestigationUnsubstantiatedNo findings
Plain-language summary
This was a complaint investigation into whether staff failed to provide appropriate care and follow the resident's diet plan. Inspectors reviewed meal records, observed meals served, interviewed the resident and staff, and found the facility was following the resident's approved diet and assisting the resident when needed. No violations were found.
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Page 2 Review of R1's record showed request to update R1's diet order to reflect R1's preference which the doctor approved. Approved order showed low-fat diet, cut-up texture, thin liquid with special instruction of no milk, apples, nuts and to provide R1 softer food and food preferred by R1 such as tender meat with sauces, soft fruits such as bananas, fruit cups, apple sauce and soft vegetables. LPA observed the meal served for lunch on this day consisted of pasta with ground meat, steamed vegetables and fresh fruit for dessert. LPA observed the dinner prepared by S1 consisted of mash potato, tender chicken with sauce and steamed vegetables. Food supplies were inspected and observed of different varieties which includes apple sauce, fruit cups, canned mixed fruits, fresh bananas and other fresh fruits. Review of other resident's LIC602A showed R2 and R3 with special diet. R2 stated the staff does not give R2 food that is indicated in LIC602A not to be given to R2. R2 stated she can not have food with tomato and tomato sauce and that she is given other meal option when food to be served has tomato and/or tomato sauce. R3 stated she is happy with the food serve. R4 who is not on special diet stated he is given option when the meal is that of R4's preference. R1 stated staff cut the food serve to her to small pieces. All staff interviewed stated R1 is served soft food. S2 and S3 stated R1 is served food cut into pieces. S1 also stated she cuts the food served to R1 except burrito because R1 does like it to be cut. R1 has fruit cups. Based on information obtained, the allegation is unsubstantiated. Allegation: Staff do not provide appropriate care to the resident. RP stated that R1 feels that R1's care needs are neglected by staff. The 2 staff who are providing assistance to R1 denied the allegation and stated that whenever R1 calls for help, they assist. They assist other residents who need assistance. ......continued on 9099C (page 3) 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 Page 3 R1 stated staff assist her with activities of daily living (ADLs) and when she calls for help. Two of the other 3 residents stated the staff assist them whenever they need help while one of these 3 residents stated not needing assistance with ADLs. One of these 3 residents stated not observing staff not providing assistance whenever R1 calls for help. Therefore, the allegation is unsubstantiated. Based on interviews, inspection, observation and records review, the 2 allegations are unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2025-05-01Annual Compliance VisitType B · 1 finding
Plain-language summary
During a complaint investigation, inspectors found that two residents' physician reports required by state law were more than a year old and did not reflect their current medical status. The facility was cited for this violation and given a deadline to correct the problem and provide proof of the correction. The administrator was notified of the deficiency and the facility's appeal rights.
“-Based on records review, the licensee did not comply with section above in R1 and R2's LIC602A more than a year old which pose a potential health and/or personal rights risks to persons in care.”
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While at the facility investigating a complaint (Control # 15-AS-20250430080657) and upon reviewing residents' records, Licensing Program Analyst (LPA) Delmundo observed the two residents' (R1 and R2) LIC602A Physician's Reports were over a year old. LIC602As showed they have major neuro cognitive disorder. The above were discussed with MIrriam Paras, administrator. Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date may result in civil penalty. Deficiency, plan and proof of correction were discussed. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
2025-05-01Complaint InvestigationUnsubstantiatedNo findings
Plain-language summary
This was a complaint investigation that found no violations. A resident made allegations about food quality, diaper changes, hydration, privacy, supervision, meal substitutions, food supply, and CPR training; however, interviews with staff and other residents, facility inspections, and record reviews did not support these claims.
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Page 2 Allegation: Staff does not ensure food is of good quality for residents in care. All 4 staff interviewed stated residents are never serve hard bread and/or stale food. LPA inspected the food supplies and didn't observed stale and/or expired food. Resident (R1) stated the staff serve bread that is hard and stale. Three out of the 5 other residents stated food serve is good and that staff never serve stale food. Due to medical diagnosis, LPA was not able to obtain information from the other 2 residents. Therefore, the allegation is unsubstantiated. Allegation: Staff allow residents to be left in soiled clothing for extended periods of time. R1 stated staff do not change residents out of their urine filled diapers and will leave them in soiled diapers all day. LPA conducted inspection and did not observed any resident smelling urine or soaking wet. The 3 staff stated they change residents who need assistance in changing diapers at least 3x during their shift. ADM stated residents are changed 9x in 24 hours and as needed. Two out of the 5 other residents can toilet on their own. One of these 5 residents stated wearing diaper but does not need assistance in changing. Due to medical diagnosis, LPA was not able to obtain information from the other 2 residents. Therefore, the allegation is unsubstantiated. Allegation: Staff does not ensure residents receive adequate hydration. R1 stated that the staff do not provide water or other fluids to residents to drink throughout the day except during meal time. All four staff interviewed stated residents are provided water, juice, coffee and/or tea during meals. Water is also provided during snacks time and when medications are administered. Three out of 5 residents stated they are provided water and juice during meals. They also stated they have water containers in their rooms which the staff filled regularly. Due to medical diagnosis, LPA was not able to obtain information from the other 2 residents. Therefore, the allegation is unsubstantiated. Allegation: Staff do not ensure resident has personal privacy. R1 stated that R1's room mate has dementia and wakes up R1 constantly when R1 tries to sleep. .....continued on 9099C (page 3) 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 Page 3 Two of the 4 staff stated when R1 has a visitor, the visitor comes inside R1's room shared with R5. R1 would not want R5 to be inside the room so they keep R5 in the living room. One of these staff stated R1 stays outside the room, however, when R5 is already sleepy, she asks R1 and tell that R5 wants to sleep. Three out the other 5 residents stated staff accord them privacy. Due to medical diagnosis, LPA was not able to obtain information from R5. Therefore, the allegation is unsubstantiated. Allegation: Staff do not ensure residents are provided supervision. R1 stated that another resident grabbed R1's arm hard a month ago and that R1 called the staff but the staff did not come to help. All four staff and 3 out the other 5 residents stated not observing the incident. Due to medical diagnosis, LPA was not able to obtain information from the other 2 residents. Therefore, the allegation is unsubstantiated. Based on interviews, inspection, observation and records review, the 5 allegations are unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of 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 Page 2 Allegation: Staff do not provide meal substitutions for residents in care. R1 stated that R1 has a hard time eating and cannot eat the meat but the staff do not offer substitute. LPA reviewed R1's file which didn't indicate R1 cannot eat meat. Progress Notes from medical provider dated 9/30/24 showed approved diet order which includes food minced and soft. LPA observed during lunch other residents were served fried chicken, mixed vegetables, potato salad and fresh fruit while R1's was served fish fillet cut into small pieces served with tartar sauce, mixed vegetables, potato salad and fresh fruits. R1 told LPA that the fish fillet were hard; however, when LPA tested in front of R1, the fish fillets were soft. The 4 staff interviewed stated they provide substitute. One of these 4 stated stated that R1 began complaining of not wanting to eat meat about 4, 5 days ago, but R1 ate hamburger 2 days ago. R1 wants R1's food cut into pieces in front of R1, which the staff do. Therefore, the allegation is unfounded. Allegation: Staff does not ensure facility has adequate food supply for residents in care. The 3 staff stated that ADM does food shopping 2x a month which LPA confirmed with ADM. All these 4 staff stated they never run out of food supplies. LPA inspected the food supplies and observed more than adequate. Therefore, the allegation is unfounded. Allegation: Licensee does not ensure staff receive training in CPR. R1 stated the staff are not CPR certified and don't do anything when a resident is choking on food and will only give the residents water. All staff interviewed stated there was no incident of resident choking. LPA has not received incident report from the facility indicating resident(s) choked. The staff interviewed stated that R1 thinks that when R5 coughs, R5 is choking. R5 observed R5 wearing mask and R5 stated she's coughing. During investigation, LPA heard R5 coughing. LPA checked the 5 staff records which showed all of them have current First Aid certificate. There fore, the allegation is unfounded. Based on interviews, records review, inspection and observation, the 3 allegations are closed as 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. No deficiency cited. Exit interview conducted and copy of this report provided.
2025-03-05Other VisitType A · 15 findings
Plain-language summary
This was a routine annual inspection conducted on March 5, 2025. Inspectors found multiple maintenance and safety issues, including a utility knife and razor left in unlocked, accessible areas; spoiled food and improperly stored items in refrigerators; rusted and broken furniture and fixtures throughout the facility; unlocked cleaning supplies and construction materials in the side yard; and staff missing required training certifications and health clearances, along with incomplete medication records and missing resident assessment documents. The facility was issued citations for repeat violations and given until March 19, 2025 to submit proof of insurance and corrective actions.
“Based on observation, the licensee did not comply with the section cited above in the following which poses an immediate health and/or personal rights risks to persons in care: food items in the refrigerator still in the shopping bags and box packaging materials; sausage links and Bologna in open plastic packaging material. POC Due Date: 03/06/2025 Plan of Correction 1 2 3 4 Staff removed the shopping bags and put the sausage links in a Ziplock and threw away the Bologna. In addition, administrator to in-service the staff and submit proof by 3/06/25.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose a potential health, safety and/or personal rights risks to persons in care: rusted dirty dining chairs and trash cans; cracked cement in between transition and heavily scratched door post in the common bathroom; broken night stand door & heavily soiled upholstered chair in resident's room; stained stairs carpet covering; shower door with mildew and water damaged lavatory with stained faucet; debris/garbage in the backyard and ramp; dusty exit door. A $250.00 civil penalty assessed for repeat violation. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to have following done and submit proof by 3/19/25: (1) Purchase trash cans and dining chairs; (2) Repair/fixed the cement cracks; (3) Repaint; (4) Repair or replace the night stand; (5) Purchase and replace the chair in the resident's room; (6) Deep cleaned the stairs's steps; (7) Clean the shower; (8) Replace/repair the lavatory; (9) Clean the yard, ramp and door.”
“Based on record review, the licensee did not comply with the section cited above in not having CPR certified staff which poses a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator stated she'll have the staff complete CPR training. Proof to be submitted by 3/19/25.”
“Based on records review, the licensee did not comply with the section cited above in S3 and S5 not having restricted health conditions training for 2024 which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator stated she'll have the staff complete the training. Proof to be submitted by 3/19/25.”
“Based on records review, the licensee did not comply with the section cited above in S3 and S5 not having the required/ complete number hours of medication training which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator stated she'll have the staff complete the training. Proof to be submitted by 3/19/25.”
“Based on record review, the licensee did not comply with the section cited above in R1 not having a pre-placement appraisal which posed a potential health, safety and/orr personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to complete the appraisal and submit copy by 3/19/25.”
“Based on record review], the licensee did not comply with the section cited above in R1 not having a LIC9172 Functional Capability Assessment which poses a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to complete the LIC9172 and submit copy by 3/19/25.”
“Based on records review, the licensee did not comply with the section cited above in R3, R4 and R5's LIC625 missing 2 pages and R3 and R4's not signed by the residents and/or residents's responsible person which posed a potential health, and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to complete the LIC625s, review with the resident and/or residents' responsible person and have the documents signed. Self-certification to be submitted by 3/19/25.”
“Based on record review, the licensee did not comply with the section cited above in S5 not First Aid certified which poses a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator stated she'll have the staff trained. Copy of certificate to be submitted by 3/19/25.”
“Based on record review, the licensee did not comply with the section cited above in not having doctor's orders for R1 and R3's bed rails which pose a potential safety and/or personal rights risks to persons in care. This is a repeat violation. A $250.00 civil penalty is assessed. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator stated she'll obtain doctor's orders. Copies to be submitted by 3/19/25.”
“Based on record review, the licensee did not comply with the section cited above in R5's two medications incorrectly recorded on LIC622 which pose potential health and/or personal rights risks to persons in care. This is a repeat violation. A $250.00 civil penalty is assessed. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to have the record corrected and in-service the staff. Proof to be submitted by 3/19/25.”
“Based on record review, the licensee did not comply with the section cited above in S4, a cook, not having the required training which poses a potential health and/or personal rights risk to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to have the staff trained and submit proof by 3/19/25.”
“Based on record review, the licensee did not comply with the section cited above in S4 not having LIC503 and S3's LIC503 incomplete which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 03/19/2025 Plan of Correction 1 2 3 4 Administrator to have the staff health screened and submit copies of LIC503 by 3/19/25.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate health, safety and/or personal rights risk to persons in care: unlocked pocket utility knife, skin protector, razor, cleaning supplies, construction tool, pails and gallons of paint and staff medications. This is a repeat violation. A $250.00 civil penalty is assessed. POC Due Date: 03/06/2025 Plan of Correction 1 2 3 4 Staff locked the items and the gate to the side yard. In addition, administrator to in-service the staff and submit proof by 3/07/25.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate health and/or personal rights risks to persons in care: rotten mushrooms, Serrano peppers, radish, celery and carrots with mold in the refrigerator POC Due Date: 03/06/2025 Plan of Correction 1 2 3 4 Administrator discarded the items. In addition, administrator to do the following and submit proof by 3/07/25: 1. Have all the food supplies checked. 2. In-service the staff.”
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On this day, March 5, 2025, at 12:00 noon, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Charlainerose De Leon, and informed the reason for visit. LPA called and spoke over the phone with Mirriam Paras, administrator (ADM). ADM arrived at around 12:20 pm. LPA also met with other staff, Jonalyn Legarto, Melody Tria and Medelmira 'Mira' Cloma. LPA started the inspection with Charleinerose De Leon and continued with ADM. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was locked. Hot water temperature in common bathroom was tested and measured at 111.9 degrees Fahrenheit. Fire extinguishers were observed fully charge with tags showed serviced 9/03/24. Carbon monoxide and smoke detectors were tested and observed in operating condition during today's visit. Facility conducts disaster drills and records showed last conducted 1/16/25. LPA reviewed 5 residents and 5 staff files and interviewed 1 resident. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. LPA observed the following: -at 12:09 pm, pocket utility knife in unlocked in the drawer adjacent to the kitchen. -at 12:11 pm, food items in the refrigerator still in the shopping bags and box packaging materials. Sausage links and Bologna in opened plastic packaging material. -at 12:13 pm, rotten mushrooms, Serrano peppers, radish, celery and carrots with mold in another refrigerator. .....continued on 809C (page 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 Page 2 -at 12:27 pm, rusted dirty dining chairs. -at 12:32 pm and 1:02 pm, rusted trash cans on the 1st and 2nd floor bathrooms. -at 12:40 pm, cracked cement in between transition and heavily scratched door post in the common bathroom on the 1st floor. -at 12:45 pm, skin protector in the common bathroom. -at 12:47 pm, razor and skin protector in unlocked closet by the hallway adjacent to the common bathroom. -at 12:49 pm, rusted broken trash can, empty box, heavy stained non-skid mat, box with toilet seat and radio, bag of garbage, hoyer lift and bed with mattress in the ramp leading to the backyard. -at 12:54 pm, broken night stand door and heavily soiled upholstered chair in one of the resident's room. -at 1:00 pm, stained stairs steps' carpet covering. -at 1:02 pm, shower door with mildew and water damaged lavatory with stained faucet in the common bathroom on the 2nd foor. -at 1:15 pm, dusty exit door on the 2nd floor. -at 1:24 pm, worn out dirty and ripped patio chair cushions, rusted shopping cart, broken dishwasher, rusted broken trash can, broken construction cones and equipment boxes with trash in the backyard. -at 1:26 pm, unlocked cleaning supplies storage, construction tool, burnt out light bulbs, pails and gallons of paint in the side yard with unlocked gate. -at 1:29 pm, staff medications in unlocked small refrigerator in the area adjacent to the kitchen. -at 4:30 pm, S4, a cook, does not have food preparation training on file. S4 does not have LIC503 Health Screening Report on file. S3's LIC503 incomplete. -at 5:00 pm, staff, S5,does not have First Aid training. S5's required training for 2024 (first year of employment) incomplete. S3 and S5 do not have restricted health conditions training and have only 2 hours of medication training for 2024. -at 5:30, staff not CPR certified. -at 5:45 pm, resident (R1) has no pre-admission appraisal and LIC9172 Functional Capability Assessment. R1 and R3's bed rails have no doctor's order on file. .....continued on 809C (page 3) 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 Page 3 -at 6:00 pm, residents' (R3, R4 and R5) LIC625 missing 2 pages. R3 and R4's LIC625 not signed. -at 6:40 pm, R5's two medications frequency of administration and date filled were incorrectly recorded on LIC622. Administrator to submit updated/current copies of the following by March 19, 2025: 1. Proof of $3M Liability Insurance coverage 2. Proof of Control of Property/Lease Agreement Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. A $250.00 civil penalties for each of section # 87309(a), 87303(a), 87608(a)(3) and 87506(a) for repeat violations within 12 month period and will continue for $100.00/day until corrected. Deficiencies and plan and proof of corrections were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC421FCs Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.
2025-02-14Other VisitType B · 1 finding
Plain-language summary
During a complaint investigation, inspectors found that the facility received and gave a resident antibiotics three times daily for three days starting February 6, 2025, but failed to document the medication receipt or any of the doses given in required records. The administrator was notified of this medication record-keeping failure and given instructions to submit a correction plan.
“-Based on record review and interview, the licensee did not comply with the section above in not completing the record when R1's medication was received and administered which posed a potential personal rights risk to person in care.”
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While at the facility investigating a complaint (Control # 15-AS-20250206094236) and upon review of resident's (R1) file, Licensing Program Analyst (LPA) Delmundo observed R1 has prescribed antibiotics medication to be administered 3 times a day for 3 days. The medication was received by the facility on 2/06/25 and administration was started same day; however, the medication was not recorded on LIC622 Centrally Stored Medication and Destruction Record nor administration of this medication recorded on Medication Administration Record (MAR). Staff (S1) stated the medication was received and administered but she didn't record. These were discussed with Mirriam Paras, administrator (ADM). Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date may result in additional civil penalty. Deficiency, plan and proof of correction were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.
2025-02-14Complaint InvestigationUnsubstantiatedNo findings
Plain-language summary
A complaint investigation looked into three allegations: delayed antibiotic delivery, toilets in disrepair, and disrespectful staff conduct. The inspector found that all toilets were draining properly, confirmed the antibiotic was prescribed and delivered as expected, and found no corroborating evidence for the claim about disrespectful language—all three complaints were unsubstantiated.
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Review of records showed facility has copy of ePrescription dated 2/01/25 with antibiotics prescribed 3 times a day for 3 days with out-of-state pharmacy listed and with comments 'deliver by CPN tomorrow'. This document showed received 2/06/25. PCP1 stated that PCP1 prescribed the antibiotics on 1/31/25 and that if the medications need to be delivered immediately, it should be delivered by the local pharmacy. PCP1 stated that it could be pharmacy issue that the medication was not delivered the following day the prescription was written. S1 stated she only came to know about the prescription and was only informed by R1 once. S1 and ADM stated they called the Center for Elder's Independence to follow-up. S1 stated the medication was received on 2/06/25 and started the administration dinner time on 2/06/25. Based on information gathered, the allegation is unsubstantiated. Allegation: Facility is in disrepair. R1 stated that residents have to put their used (soiled) toilet paper in the garbage because they are not allowed to flush the toilet paper in the toilets. R1 also stated that staff tell residents to use the garbage because if they flush the toilet paper the toilets get clogged up. LPA conducted inspection and flushed all the toilets. LPA observed all the toilets draining properly. The 3 staff, ADM and R2 stated the toilet in the big bathroom was not draining properly but did not overflow, and was replaced with a new one recently. Therefore, the allegation is unsubstantiated. Allegation: Staff not treating resident with respect and dignity. R1 stated that when R1 was asking S1 about R1's antibiotics medication, S1 told R1 to shut up. S2 and S3 stated not hearing S1 and denied telling R1 such. R2 stated not hearing S1 or other staff respond to any residents inappropriately. Therefore, the allegation is unsubstantiated. Based on review of records, interviews and inspection, the 3 allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2024-11-21Complaint InvestigationUnsubstantiatedNo findings
Plain-language summary
This complaint investigation examined five allegations about staff responsiveness, resident safety, food service, and room temperature. Inspectors interviewed staff and residents, observed conditions at the facility, and found no evidence to support any of the complaints—while some concerns were raised by one resident, other residents and staff accounts did not corroborate the allegations, and facility conditions (temperature, food variety, and dining observations) appeared adequate.
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Page 2 R1 stated S1 yelled at R1 when R1 asked for help. R1 also stated when she asked S2 for lighter because her lighter is broken, S2 did not provide and instead laughed at her. Both S1 and S2 denied the allegation. W1 stated he was at the facility when the incident happened and it was R1 who yelled at the staff. Five out of 8 residents interviewed stated not observing staff yelled nor dis-respected R1. One out of the 8 residents stated hearing S1 screamed back when R1 screamed at S1 but does not know what transpired and where it happened. The other resident stated he maybe in his room when the incident about the lighter happened. Due to the medical diagnosis of the other resident, LPA was not able to obtain information. Based on information obtained, there's not enough preponderance of evidence to prove that a violation occurred, therefore the allegation is closed as unsubstantiated. Allegation: Staff does not respond to resident's request in a timely manner. R1 stated when R1 called S1 to help care for her room mate, S1 will not come. R1 also stated when she had something red on her ear and thought it was blood, S1 provided R1 a napkin to blot her ear. S1 did not call 9-1-1 and R1 called 9-1-1 herself. R1 stated it was not blood but a piece of red plastic of unknown origin. S1 stated she attended to R1 when R1 called her about the blood in R1's ear. S1 stated she checked R1's ear and observed a red dot on the middle outside part of R1's left ear and it's not blood so she gave R1 a napkin but R1 scolded her and called 9-1-1 herself. ADM stated the incident was reported to her by S1. All staff interviewed stated R1 does not provide care to R1. One of the resident (R6) stated he does not think R1 takes care of R1 and that what R1 thinks of care is down playing others. Due to medical diagnosis, LPA was not able to obtain information from R1's room mate. Based on information obtained, there's not enough preponderance of evidence to prove that a violation occurred, therefore the allegation is closed as unsubstantiated. ....continued on 9099C (page 3) 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 Page 3 Allegation: Staff does not provide resident a safe environment. R1 stated R2 makes R1 feel threatened, R3 does not allow R1 eat with the rest of the residents and staff are not doing anything about it. R1 also stated that she is not allowed to eat in her room. All staff interviewed stated not observing R2 and R3 threaten and prevent R1 from eating with the rest of the residents. All the staff also stated residents are allowed to eat in their room. LPA observed R1 eating in the dining room with other residents. LPA also observed during investigation 2 residents eating in their rooms. LPA was not able to get information from R2 and R3 regarding the allegation. Therefore, the allegation is unsubstantiated. Allegation: Staff does not provide adequate food service to resident. R1 stated S1 would not provide alternative food options and serves certain foods S1 cannot eat. R1 also stated that on 11/19/24, she asked S3 for sandwich because she can not eat meat and S3 did not give her sandwich. S1 stated residents are given substitute if they do not want the food served. S3 stated when R1 asked for sandwich on 11/19/24, she gave R1 peanut butter sandwich and R1 ate the sandwich, pork stroganoff and half of the pasta that was served to R1 that day. Six out of 8 residents interviewed stated there's no issue on the food serve. R4 stated if she does not like the food serve, she is offered substitute. One of the 8 residents stated being serve small servings of salad but didn't ask for seconds. Due to medical diagnosis of one of the resident, LPA was not able to obtain information. LPAs inspected the food supplies which were observed sufficient and different varieties. LPA Delmundo observed staff served dinner which consisted of pasta with ground pork, salad and fita bread which LPA observed R1 ate. Based on information obtained, the preponderance of evidence is not met, therefore, the allegation is unsubstantiated. Allegation: Facility failed to maintain a comfortable room temperature. R1 stated it's cold in her room. LPAs conducted inspection and observed a portable heater in R1's room. LPA Delmundo tested the temperature at R1's room which was measured at 69.8 degrees Fahrenheit. ....continued on 9099C (page 4) 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 Page 4 All staff interviewed stated the facility has centralized heater which LPA Gharachorloo checked with ADM and observed the temperature at 72 degrees Fahrenheit. However, one of the residents stated it's cold. The other 5 residents stated temperature is comfortable. Due to medical diagnosis, LPA was not able to obtain information from 1 of the resident. Therefore, the allegation is unsubstantiated. Based on interviews, inspection and observation, all 5 allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2024-09-04Other VisitIJ · 2 findings
Plain-language summary
During an investigation of a complaint on September 4, 2024, inspectors found that one staff member was not fingerprinted and cleared to work at the facility, flies were present in residents' rooms and common areas, a bathroom sink was not draining properly, and the refrigerator was untidy. The facility was assessed civil penalties including $100 per day until the staffing clearance issue is resolved, and $250 for a repeat violation within the past year. The administrator was notified and given the opportunity to correct these deficiencies.
“-Based on observation and interviews, the licensee did not comply with the section in S1 working without fingerprint clearance which poses an immediate risk to persons in care. Civil penalty assessed.”
“-Based on observation, the licensee did not comply with the section above in the following which pose a potential health and/or personal rights risks to persons in care: untidy refrigerators; bathroom cabinet in disrepair; clogged lavatory; flies. This is a repeat violation within 12 month.”
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On this day, September 4, 2024, while at the facility investigating a complaint (Complaint Control # 15-AS-20240830112641), Licensing Program Analyst (LPA) Delmundo observed the following: 1. Staff (S1) is not fingerprinted and cleared. 2. Flies flying around the residents' rooms, kitchen area, bathroom and living room. 3. Lavatory in the common bathroom not properly draining and cabinet in this bathroom in disrepair. 4. Inside of the refrigerator untidy. Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. Civil penalties were assessed on this same day for the following: 1. Deficiency section 87355(e)(1) - $100.00 and will continue for $100.00/day until corrected. 2. Deficiency section 87303(a) - $250.00 for repeat violation within 12-month period. Failure to submit proof of corrections may result in additional civil penalties. Deficiencies, plan and proof of corrections, and civil penalties were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421IM and LIC421FC Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.
2024-09-04Complaint InvestigationMixedNo findings
Plain-language summary
An investigator responded to a complaint about staff conduct and found that a staff member told a resident she was heavy when asking her to help get up from a bathing chair — this violation was substantiated and resulted in a $250 civil penalty. Three other allegations were investigated (staff not responding to requests, not providing privacy, and inadequate food service) and found to have no evidence supporting them. The facility was told to submit a plan correcting the substantiated violation.
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Page 2 One of the staff stated not working on the day the incident happened while the other one indicated not working on the same shift S1 worked. One of the four staff stated R1 told her about S1 telling R1 she's heavy. ADM stated S1 told her that she (S1) told R1 to help out in getting up from the bathing chair because she's heavy. Based in interviews conducted, the preponderance of evidence has been met, therefore the allegation is found to be substantiated. Deficiency is cited from Title 22 California Code of Regulations, and listed on 9099D. A $250.00 civil penalty is assessed for repeat violation within 12 month of section 1569.269(a)(1). Failure to submit proof of correction by plan of correction due date may result in additional civil penalty. Deficiency, plan and proof of correction, and civil penalty were discussed with ADM. Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of 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 Page 2 Allegation: Staff do not answer resident's (R1) request. R1 indicated she requested the staff to move the wheelchair away from the door and staff did not answer the request. All the staff interviewed indicated not observing wheelchair blocking the door nor R1 requesting to remove the wheelchair. R2 and R3 stated not observing a wheelchair blocking the door. Allegation: Staff does not ensure resident (R1) is accorded privacy. R1 indicated she needed to use the bathroom and was not accorded privacy. One of the staff interviewed stated she was to give R1 eye drops and looked for R1 by calling her who was at the time was in the bathroom. The other staff indicated there are times when R2 will knock when R1 is in the bathroom to check first if someone is inside and that there's another toilet but these 2 residents prefer to use the big bathroom. The other residents interviewed stated being accorded privacy and staff are respectful. Allegation: Staff does not provide adequate food service. It was alleged that R1 had diarrhea for several days and was told by a nurse that it's due to the food. R1 was interviewed who stated she's having diarrhea for days and her doctor told her it's because of the abscess tooth and that she was referred to the dentist. Copy of documents obtained by LPA showed R1 is prescribed anti-biotics. The other 2 residents interviewed stated food serve is always good. All the staff interviewed indicated not serving stale food. LPA conducted inspection and didn't observe any expired food. Based on information gathered, the above allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2024-08-06Other VisitIJ · 2 findings
Plain-language summary
During an investigation on August 6, 2024, inspectors found that one staff member had not completed required fingerprinting and background clearance, and that staff personal belongings and beds were stored in a resident's room. The facility was assessed civil penalties totaling $200 initially plus $100 per day until the staffing issue is corrected, and an additional $250 penalty for a repeat violation within the past year.
“-Based on observation and interviews, the licensee did not comply with the section in S1 working without fingerprint clearance which poses an immediate risk to persons in care. Civil penalty assessed.”
“-Based on observation and interviews, the licensee did not comply with the section above in making the resident's room storage for staff's belongings/beds. This is a repeat violation within 12-month period. The first citation was issued 3/08/24.”
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On this day, 8/06/24, while at the facility investigating a complaint (Complaint Control # 15-AS-20240731080957), Licensing Program Analyst (LPA) Delmundo observed the following: 1. Staff (S1) is not fingerprinted and cleared. 2. Portable bed in resident's room and foldable bed in the closet in this resident's room. LPA verified, and according to the administrator, the beds are that of the staff. LPA also observed staff's personal stuff in the same room. Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. Civil penalties were assessed on this same day for the following: 1. Deficiency section 87355(e)(1) - $200.00 and will continue for $100.00/day until corrected. 2. Deficiency section 87307(a) - $250.00 for repeat violation within 12-month period. Failure to submit proof of corrections may result in additional civil penalties. Deficiencies, plan and proof of corrections, and civil penalties were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421IM and LIC421FC Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.
2024-08-06Complaint InvestigationUnsubstantiatedNo findings
Plain-language summary
A complaint alleged that staff don't meet a resident's dietary needs and serve meat without offering alternatives. The facility's records showed this resident is not on a special diet and eats meat, and staff confirmed they offer substitutes when residents request them; other residents also reported that food is good and substitutes are available. The complaint was found to be unsubstantiated, and no violations were cited.
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R1 confirmed that staff gave R1 chicken broth and juice. The two staff interviewed stated that on 7/31/24, R1 had a procedure and there's instruction that R1 should not be given solid foods day before the procedure which LPA confirmed from the document obtained during investigation. The other staff was not able to provide information as this staff is new and was not working yet at the time of the said incident. Allegation: Staff do not meet resident's dietary needs. It was alleged that staff serve meat a lot and that R1 can not eat meat and staff does not offer substitute. LPA observed during inspection that residents were served barbecued meat during lunch. R1 stated she ate the barbecue and is not on special diet. Review of records showed R1 is not on special diet nor on diet restrictions. Two of the staff stated R1 eats meat and there are times when R1 does not want to eat meat but is not on special diet. These 2 staff stated facility offers substitute. The other four residents stated the food served is good. Three out of these 4 residents stated staff provides substitute if they don't want what is served. Based on information gathered, the above allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2024-05-01Other VisitNo findings
Plain-language summary
This was a follow-up visit to verify that a previously cited problem had been corrected. The facility had been cited for housing two non-ambulatory residents in bedrooms that were not fire-cleared for their needs, and the administrator's plan was to move these residents out; during the follow-up visit on May 1, 2024, the inspector confirmed both residents had been relocated and the deficiency was resolved.
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a proof of correction (POC) visit. LPA met with Jonalyn Legarto , staff, and informed the reason for visit. LPA called and spoke over the phone with Mi rriam Paras, administrator, who authorized to sign and receive this report. On 4/26/24, LPA continued the annual inspection and issued citation section 87705(c)(1) for having residents (R3 and R4) in bedrooms not fire cleared for non-ambulatory. For plan of correction, the administrator stated she'll have the residents move-out. The administrator submitted the POC;however, the POC didn't indicate when the residents moved-out. On this day, 5/01/24, LPA toured the facility with staff (S1). and didn't observed R3 and R4. LPA interviewed S1 who confirmed R3 and R4 were moved-out. Deficiency is cleared. Exit interview conducted, and copy of this report provided.
2024-04-26Other VisitType A · 3 findings
Plain-language summary
This was a follow-up inspection on April 26, 2024, to check whether the facility had corrected three violations found during a previous inspection. The facility failed to properly address any of the violations: a storage area on the second floor was not converted back to its original use as required, and required staff training documents related to two other violations were either missing or not relevant to the cited deficiencies. The state re-cited these same violations and warned that failure to submit corrections could result in civil penalties.
“-Based on observation, the licensee did not comply with the section cited above in converting the storage into staff bedroom which poses an immediate safety and/or personal rights risk to persons in care.”
“-Based on observation, the licensee did not comply with the section cited above in stairway on the second floor from resident's room going to the backyard blocked with rusted lamp and commode which poses an immediate safety and/or personal rights risk to persons in care.”
“.... the following: unlocked staff medications, scissors, razors, cleaning supplies, tools cart, shovel, pails of paint, bleach, rubbing alcohol, Hydrogen Peroxide; bread toaster in one of the residents' rooms, These pose an immediate health, safety and/or personal rights risks to persons in care.”
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Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a proof of correction (POC) visit. LPA met with Mirriam Paras, administrator, and informed the reason for visit. On 3/08/24, LPA issued citations for the following deficiencies with POCs to be submitted by 3/09/24. On 3/09/24, the administrator submitted the LIC9098 Proof of Correction form, however, the POCs submitted were either missing or the in-service training do not pertain to the deficiencies cited. LPA informed the administrator about these on 4/17/24 and requested to submit the POCs before the end of the day that day, but the POCs were not submitted up to this date, 4/26/24: 1. Section 87202(a) – picture showing the storage on the 2 nd floor is converted back to it’s original use. 2. Section 87309(d)(6 ) - in-service pertaining to the cited deficiency is missing. The in-service training submitted is not related to the cited deficiency. 3. Section 87309(a) - in-service pertaining to the cited deficiency is missing. The in-service submitted is also not related to the cited deficiency. On this day, 4/26/24, the above deficiencies are re-cited. On this same day, LPA toured the facility with the administrator. LPA observed the storage on the 2nd floor is converted back to it's original use. Deficiencies and proof of corrections were discussed with the administrator. Failure to submit proof of corrections by plan of correction due dates may result in civil penalties. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.
2024-04-26Annual Compliance VisitType A · 8 findings
Plain-language summary
During a continued annual inspection, inspectors found multiple serious compliance gaps: five staff members lacked current First Aid certification, required training records were missing or incomplete for several staff, three residents' physician reports were over a year old, and doctor's orders were missing for numerous medications and medical equipment including bed rails. Additionally, two non-ambulatory residents were housed in bedrooms that were not fire-cleared for their mobility status. The facility was assessed a $500 penalty with additional daily penalties until corrections are made.
“Based on records review, interviews and observation, the licensee did not comply with the section cited above in 2 residents (R3 and R4) in bedrooms not fire cleared for non-ambulatory which poses an immediate safety and/or personal rights risks to persons in care. A $500.00 civil penalty is assessed. POC Due Date: 04/27/2024 Plan of Correction 1 2 3 4 Administrator contacted the residents' responsible persons and stated she will have the residents move out. Proof to be submitted by 4/27/24.”
“Based on records review, the licensee did not comply with the section cited above in staff (S2, S3, S4, S5) not having the complete required number of hours of annual training which poses potential health, safety and/or personal rights risks to persons in care. POC Due Date: 05/10/2024 Plan of Correction 1 2 3 4 Administrator to have the staff complete the required training and submit self-certification by 5/10/24.”
“Based on record review, the licensee did not comply with the section cited above in R5 not having medical assessment (LIC602A) which poses a potential health and/or personal rights risks to persons in care. POC Due Date: 05/10/2024 Plan of Correction 1 2 3 4 Corrected.”
“Based on observation, interviews and record review, the licensee did not comply with the section cited above in R3 and R4's ambulatory status not consistent with mental/medical condition (non-ambulatory) which pose a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 05/10/2024 Plan of Correction 1 2 3 4 Administrator to obtain updated LIC602A and submit copies by 5/10/24”
“Based on record review, the licensee did not comply with the section cited above in not having doctor's order for R1, R3 and R5's bedrails which pose a potential safety and/or personal rights risk to persons in care. POC Due Date: 05/10/2024 Plan of Correction 1 2 3 4 Administrator to obtain doctor's order and submit copies by 5/10/24.”
“Based on record review, the licensee did not comply with the section cited above in R1,R2 & R3’s LIC602A Physician's Reports over a year old which pose a potential health and/or personal rights risks to persons in care. POC Due Date: 05/10/2024 Plan of Correction 1 2 3 4 Administrator to have the residents medically assessed and submit self-certification by 5/10/24 that LIC602As are obtained.”
“Based on record review, the licensee did not comply with the section cited above in S1's first aid certificate expired and S2, S3, S4 & S5 not having first aid certificates on file which pose a potential health, safety and/or personal rights risks to persons in care. POC Due Date: 05/10/2024 Plan of Correction 1 2 3 4 Administrator to have the staff register and complete the training and submit copies of certificates by 5/10/24.”
“Based on records review, the licensee did not comply with the section cited above in not having doctor's order which pose an immediate health, and/or personal rights risks to persons in care for the following: R`1's 10 medications; R2's 5 medications; 2 of R5's medications; POC Due Date: 04/27/2024 Plan of Correction 1 2 3 4 Administrator stated she'll obtain doctor's orders. Copies to be submiitted by 4/27/24.”
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On this day, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on 3/08/24. LPA met with Mirriam Paras, administrator, and informed the reason for visit. LPA reviewed 5 staff and 5 residents files, and interviewed 2 staff. Residents' medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA obtained updated/current copies of the following documents: 1. LIC308 Designation of Facility Responsibility 2. LIC610E Emergency Disaster Plan (9 pages) 3. Proof of $3M liability Insurance coverage 4. Proof of Control of Property/Lease Agreement (expiration: 1/31/25) LPA observed the following: -at 1:35 p.m., S1 has no First Aid certificate on file (expired 6/2017). -at 1:45 p.m to 2:35 p.m., staff (S2, S3 and S5) do not have First Aid certificate. Required training for 2023 for postural support/restricted health condition/hospice care and medication training incomplete - only 2 hours medication, 2 hours postural support on file. -at 2:40 p.m., staff (S4) no training record on file for 2019, 2020, 2021. No First Aid certificate on file. -at 2:45 p.m., residents' (R1, R2, R3) LIC602A Physician's Report over a year old (on file dated 8/05/21 for R1, 2/20/23 for R2, 7/08/22 for R3). .....continued on 809C (page 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 Page 2 -no doctor's order on file for R1, R3 and R5's half bed rails. -residents (R3 and R4) who are not able to exit on their own due to medical diagnosis/condition (non-ambulatory) are in bedrooms not fire cleared for non-ambulatory. -at 3:40 p.m., resident (R5) has no medical assessment (LIC602A) on file. -at 5:00 p.m., no doctor's order on file for the following: R1's 10 medications; R2's 5 medications; 2 of R5's medications. Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section 87705(c)(1) and will continue for $100.00/day until corrected. Any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.
2024-04-19Complaint InvestigationMixedType A · 1 finding
Plain-language summary
A complaint investigation found that the facility ran out of a prescribed fungus cream for a resident and did not refill a scalp cream ordered by the resident's doctor, which was cited as a violation. Six other allegations—including claims about lack of hot water, delayed personal care, inappropriate behavior by other residents, comments from the administrator, dirty furniture, and bed bugs—were investigated but not substantiated by the evidence gathered. The facility was given a plan of correction deadline for the medication/cream issue.
“-Based on review of records and interviews, the licensee did not comply with the section above when R1's cream run out and did not obtain nor follow-up with the doctor for the other cream.”
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Although 3 of the 4 staff interviewed stated they check R1's BP when requested and put cream on R1's forehead, ears and on the back of R1's ears, the fungus cream run out which was confirmed by LPA with the administrator. MAR showed R1 is given eye drops. Review of records showed R1 has doctor's order for other cream for the scalp in August 2023, however, this particular cream was never refilled, and administrator admitted to not following-up with the doctor. Based on records review and interviews, the preponderance of evidence is met, therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations, and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of 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 Page 2 Allegation: Staff did not ensure the bathroom has hot water. R1 stated the bathroom has no hot water. All 4 staff, administrator and 2 other residents interviewed stated the facility never run out of hot water. LPA tested the water temperature which was measured at 105.2 degrees Fahrenheit. Allegation: Staff are not meeting residents needs. R1 stated when R1 wet self and asked to be changed, staff told her she'll come back and it took more than 1 hour to be changed. R1 futher stated that the bedsheet was not changed. Staff (S3) stated that on the date of incident, she was assisting other resident in the bathroom and told R1 to wait. S3 stated she came back in less than 20 minutes and assisted R1 to the bathroom and changed her. All 4 staff stated they change residents bed covers daily. During today's inspection, LPA observed the residents beds clean and R1's bed with 2 chux on top of the bed cover. None of the beds were observed wet. Allegation: -Staff did not prevent resident from engaging in inappropriate behaviors. R1 stated resident R4 laughs and stares at her , R2 grabbed her water bottle and R3 stares at her. All 4 staff interviewed confirmed the incident happened but the other 2 residents who were laughing were talking to each other. Staff also confirmed R2 grabbed R1's water bottle; however the R4 and R2 have dementia and they separate and redirect residents when incidents happen. Allegation: Staff made inappropriate comments towards resident. R1 stated when R4 made fun of her and reported the incident to the administrator, the administrator told her to be nice and mind her own business. Although the administrator stated saying to R1, "Be nice, because the residents have dementia", she denied saying 'Mind your own business." All 4 staff and other 2 residents stated not hearing the administrator made inappropriate comments to R1. LPA was not able to obtain information from other 3 residents either due to residents' medical condition/diagnosis or resident was not at the facility. .....continued on 9099C (page 3) 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 Page 3 Allegation: Staff did not ensure facility furniture was clean. R1 stated chairs in the living room never get washed. LPA interviewed 4 staff who stated the chairs and couches in the living room have covers and at times get soiled when residents spill food or have accidents but when these happen, they removed the covers, and covers are washed. The administrator stated the couches have covers and when get soiled, one of the staff does the washing. LPA conducted inspection and didn't observed any of chairs and couches soiled or dirty. Allegation: Facility has bed bugs. R1 stated she has bed bugs in her body. LPA interviewed 4 staff and 2 residents who all stated not observing bed bugs. LPA conducted inspection and didn't observed any. Based on information obtained and LPA unable to obtain information from 3 residents, all 7 allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2024-03-08Other VisitType A · 10 findings
Plain-language summary
During a routine annual inspection on March 8, 2024, inspectors found hazardous items stored unsafely throughout the facility, including medications, cleaning chemicals, razors, and scissors left accessible in resident rooms and common areas; they also observed broken bathroom fixtures, mildew, unlocked storage containing bleach and tools, staff belongings and clothing in resident rooms, and a converted storage room being used as a staff bedroom. Hot water in one bathroom tested at 137.8 degrees Fahrenheit (above the safe limit), and the facility had no disaster drill plan on file despite this being required. The facility was issued citations and a $500 civil penalty for the fire safety violation of converting storage into a staff bedroom, with additional daily penalties until corrected.
“Based on observation, the licensee did not comply with the section cited above in converting the storage into staff bedroom which poses an immediate safety and/or personal rights risk to persons in care. At $500.00 civil penaty is assessed. POC Due Date: 03/09/2024 Plan of Correction 1 2 3 4 Administrator stated she'll have the room converted to it's original use as storage. Picture to be submitted by 3/09/24.”
“Based on observation, the licensee did not comply with the section cited above in 2 exit doors with no auditory signals which pose an immediate health, safety and/or personal rights risk to persons in care. POC Due Date: 03/09/2024 Plan of Correction 1 2 3 4 Administrator to have signals installed, and submit pictures by 3/09/24.”
“Based on observation, the licensee did not comply with the section cited above in stairway on the second floor from resident's room going to the backyard blocked with rusted lamp and commode which poses an immediate safety and/or personal rights risk to persons in care. POC Due Date: 03/09/2024 Plan of Correction 1 2 3 4 Staff removed the items. In addition, administrator to in-service the staff, and submit proof by 3/09/24.”
“Based on observation, the licensee did not comply with the section cited above in the following: unlocked staff medications, scissors, razors, cleaning supplies, tools cart, shovel, pails of paint, bleach, rubbing alcohol, Hydrogen Peroxide; bread toaster in one of the residents' rooms, These pose an immediate health, safety and/or personal rights risk to persons in care. POC Due Date: 03/09/2024 Plan of Correction 1 2 3 4 Staff locked the items.. In addition, administrator to in-service the staff, and submit training topic with attendees signatures.”
“Based on observation, the licensee did not comply with the section cited above in the following which pose a potential personal rights risks to persons in care: toilet paper holder in 2 bathrooms broken; 2 bathroom doors with dilapidated paint; wood transition in bathroom flooring rotten. POC Due Date: 03/22/2024 Plan of Correction 1 2 3 4 Administrator to do the following, and submit pictures by 3/22/24: 1. Replace the toilet paper holder. 2. Repaint the bathroom doors. 3. Replace the wood transition.”
“Based on observation, the licensee did not comply with the section cited above in trash cans in residents' rooms with no lids which pose a potential health and/or personal rights risk to persons in care. POC Due Date: 03/22/2024 Plan of Correction 1 2 3 4 Administrator to purchase trash bins with foot pedal operated lids, and submit proof of purchase and pictures by 3/22/24.”
“Based on interviews, the licensee did not comply with the section cited above in not conducting drills which poses a potential safety risk to persons in care. POC Due Date: 03/22/2024 Plan of Correction 1 2 3 4 Administrator to have drills conducted, and submit proof by 3/22/24.”
“Based on observation, the licensee did not comply with the section cited above in not having evacuation chair which poses potential safety risk to persons in care. POC Due Date: 03/22/2024 Plan of Correction 1 2 3 4 Administrator to purchase evacuation chair, and submit proof of purchase by 3/22/24.”
“Based on observation, the licensee did not comply with the section cited above in hot water at 137.8 degrees Fahrenheit. which poses an immediate health, safety and/or personal rights risk to persons in care. POC Due Date: 03/09/2024 Plan of Correction 1 2 3 4 Administrator to have the temperature adjusted within Regulations range, and submit proof by 3/09/24.”
“Based on observation and interview, the licensee did not comply with the section cited above in staff sleeping in the resident's room which poses a potential personal rights risk to persons in care. POC Due Date: 03/22/2024 Plan of Correction 1 2 3 4 Administrator to have the staff stop sleeping in resident's room immediately. In addition, administrator to in-service the staff, and submit proof by 3/22/24.”
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On this day, March 8, 2024, at 10:45 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Jonalyn Legarto and Medelmira Cloma. LPA called and spoke with Mirriam Paras, administrator, who stated she can not come to the facility, and authorized Jonalyn Legarto to sign and receive this report. Facility has LIC808 Mitigation Plan. Administrator submitted the LIC9282 Infection Control Plan on March 5, 2024. LPA toured the facility inside out with Jonalyn Legarto. Facility is a two level home. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Hot water temperature in one of the bathrooms on the ground floor was tested. Fire extinguisher was observed fully charge with tag showed serviced 9/22/23. LPA interviewed 2 residents. LPA observed the following: -at 11:15 a.m., staff medications and vitamins, scissors and disinfecting spray in area adjacent to the kitchen. -at 11:21 a.m., cleaning agents in kitchen cabinet under the sink without lock. -at 11:23 a.m, rubbing alcohol, medications and scissors in resident's room. Razors in the ensuite bathroom in this resident's room. .continued on 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 CONTINUATION: -at 11:34 a.m., Icy Hot pain reliever ointment in another resident's room on the ground floor. -at 11:35 a.m., Lysol toilet bowl cleaner in the common bathroom on the ground floor. Toilet paper holder in this bathroom broken and door paint dilapidated. -at 11:42 a.m., Tums, motor oil for shredder in another resident's room. Trash can in this room and rooms on the second floor without lids. -at 11:46 a.m., toilet paper holder in another common bathroom on the first floor broken, dilapidated door paint and rotten wood transition on the flooring. - at 11:49 a.m., storage on the second floor converted into staff's room. -at 11:50 a.m., mildew on the shower door in second floor bathroom. - at 11:52 a.m., bread toaster. Hydrogen Peroxide and medications i n one of resident's room on the second floor. -no auditory signals on the exit doors of 2 residents rooms. -at 12:01 p.m., staff clothing, personal belongings, medications and scissors in other residents' room on the second. Two staff were interviewed who stated staff sleeps and use the resident's bed. -at 12:19 p.m., tools in unlocked tool cart. bleach, shovel, pieces of wood, Pine Sol cleaning agent in the backyard. -at 12:34 p.m., hot water temperature in one of the common bathroom was measured at 137.8 degrees Farenheit. -at 2:50 p.m., cleaning supplies, pails of paint and pieces of wood in the side yard. -no disaster drill on file. LPA interviewed 2 staff and administrator who all stated they don't do disaster drill. Deficiencies are cited from Title 22 California Code of Regulations, and cited on 809Ds. A $500.00 civil penalty is assessed for fire safety violation in converting the storage into staff bedroom, and will continue for $100.00/day until corrected. Deficiencies, plan and proof of corrections and civil penalty was discussed with administrator over the phone. Due to time constraint, LPA will come back to continue inspection. Exit interview conducted. Appeal Rights, LIC421IM, LIC9098 Proof of Correction form and copy of this report provided.
2024-03-08Complaint InvestigationMixedType B · 2 findings
Plain-language summary
This complaint investigation found two violations: staff made inappropriate comments to a resident, including telling the resident "it's your problem" during a request for help, and staff failed to adequately supervise a resident with wandering behavior who frequently entered other residents' rooms and dining areas—the facility had only one caregiver on duty during most daytime hours, limiting their ability to redirect the wandering resident. Three other allegations—about room temperature, dirty furniture, and providing a comfortable environment—were not substantiated by the evidence found during the inspection. The facility must submit a plan to correct the two substantiated violations.
“-Based on interviews, the licensee did not comply with the section when staff made an inappropriatec comment toward resident which posed personal rights risk to person in care.”
“-Based on interviews, observation and records review, the licensee did not comply to the section above in not having sufficient staffing to be able to redirect resident timely and properly which poses potential personal rights risks to persons in care.”
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Allegation: Staff made inappropriate comments towards resident. It was alleged that staff (S1) tells R1 "that's your problem" and call R1 "bitch". Although 4 of the staff stated it was R1 who always say "bitch" to the staff and other residents, S1 admitted to telling R1 "it's your problem if you don't ignore e R1" when R1 called S1 when R2 was bothering R1. Allegation: Staff did not prevent resident from engaging in inappropriate behaviors. It was alleged that R2 keeps on following resident (R1) around and barging into residents rooms and staff is not doing anything. It was further alleged that R1 was upset due to staff sitting R2 next to R1 in the dining table. Four of the staff stated R2 has wandering behavior. One of the two residents interviewed stated staff do nothing to get R2 out of his room while the other one stated the staff yells at R2 to have R2 go out from the residents' room but most of the time, do nothing at all and R1 gets agitated when R2 goes to R1's room. Review of R2's record showed R1 has wandering behavior which LPA observed R2 wandering and going in and out of residents' rooms, kitchen, dining and hallways the whole time LPA was conducting investigation. LPA further observed and upon interview learned that there's only caregiver on duty from 6:00 a.m. to 3:00 p.m., and 1 caregiver from 3:00 p.m. to 11:30 p.m. and most of the time not able to redirect R2 right away when R2 goes to residents' rooms. Based on the information obtained, the preponderance of evidence has been met, therefore the allegations of "Staff made inappropriate comments towards resident" and "Staff did not prevent resident from engaging in inappropriate behaviors." are substantiated. Deficiencies are cited from Title 22 California Code of Regulations, and listed on 9099Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Mirriam Paras over the phone. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of 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 All 3 staff interviewed stated they check R1's blood pressure when requested and record the reading, All 3 staff confirms R1's roommate (R5) screams when being changed; however, they try to calm R5 down. LPA was unable to interview R5. There was record of R1's blood pressure but only for 1 day. Allegation: Staff are not providing a comfortable environment for resident. R1 stated that her room is cold at night. All 3 staff interviewed stated that R1 complained about R1's room being cold. Facility has centralized heater but when R1 complained about the room being cold, R1 was provided a portable heater. LPA observed a portable heater in R1's room and the room's windows with coverings/curtains. LPA also checked the room temperature at around 4:00 pm which was measured at 68.7 degrees Fahrenheit. LPA was not able to obtain information from R1's roommate. Two other residents were interviewed who stated the temperature is at comfortable level. Allegation: Staff did not ensure facility furniture was clean. It was alleged that chairs in the living room are not clean. LPA interviewed 4 staff who stated the chairs and couches in the living room have covers and at times get soiled when residents spill food or have accidents but when these happen, they removed and wash the covers. LPA conducted inspection and didn't observed any being soiled or dirty, Based on information obtained and LPA unable to obtain information from R1's roommate, all 3 allegations are closed as unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.
2024-02-23Other VisitType A · 2 findings
Plain-language summary
On February 23, 2024, an unannounced inspection found that residents' beds lacked proper bedding—some had no mattress covers or top sheets, and some had no blankets—though staff said beds are changed weekly or as needed. The facility also had two slide latch locks on the front entry door, which staff said were used at night for a resident who wanders. These issues were cited as violations of state regulations.
“This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in have appropriate linen on bed, which poses a potential health and safety risk to persons in care.”
“Based on observation the Licensee did not comply with the section cited in using a lock on entry/exit door for wander residents, which poses an immediate health and safety risk to persons in care.”
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On 2/23/2024 at 1:20pm Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Mirriam Paras, Administrator, and explained the purpose of the visit. While LPA L. Hall was conducting a complaint investigation (15-AS-20240221085509) on 2/23/2024. While touring facility LPA observed residents' beds did not have a mattress cover, top sheet, and some did not have a blanket. Staff stated beds are changed weekly or more often if necessary. LPA also observed two (2) slide latch locks on front entry/exit door. Staff 1 (S1) stated during interview that facility uses lock at night for a resident that wanders. The deficiencies 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
2024-02-23Complaint InvestigationSubstantiatedType B · 1 finding
Plain-language summary
An investigator found droppings in a cabinet under the kitchen sink during this complaint investigation, indicating a pest control problem. The facility had called Terminix for pest treatment in August and September 2023 but failed to maintain adequate pest control measures. The facility must submit proof of corrective action or face potential financial penalties.
“Based on observation and interview the Licensee did not comply with the section cited above in having facility free of rodents, which poses a potential health and safety risk to persons in care.”
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Continued from LI9099. it was last year and Terminix came out. LPA obtained a Terminix invoice dated 8/2/2023 and 9/7/2023. LPA observed droppings in cabinet underneath kitchen sink, Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided
3 older inspections from 2021 are not shown above.
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