Cedar Creek Alzheimer's & Dementia Care Center

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Debbie Cota. ADM informed that 45 residents and 20 staff in the facility. LPA reviewed 5 resident files and 5 staff files. LPA toured the facility with ADM. Lobby, common area, activity room, kitchen, dining room, laundry room, salon room, break room, storage room, and restrooms were inspected. 29 shared resident bedrooms were inspected. 2 bedrooms shared with one restroom and 1 single room with restroom, 3 common shower rooms and common restrooms were inspected. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of refrigerator was observed at 40 degree F and the temperature of the freezer was observed at -5 degree F. Medication room was observed locked. Cleaning product room was observed locked. Room temperature was at 73 degree F, and hot water temperature was at 106 degree F in facility. The fall prevention alarm system was tested and was working. First aid boxes were observed in the facility. Fire extinguisher was serviced on 9/24/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. carbon monoxide detector were tested and were observed working. The courtyard and backyard were toured. The last time the facility conducted the fire drill was on 6/12/2025. ADM stated the facility conducts fire drill every quarter. No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of the reports was provided to ADM.

Licensing Program Analyst (LPA) Steve conducted a case management visit to assess resident R1 and R2 for total care exception request. LPA met with Administrator Debbie Cota (ADM) and stated the purpose of today's visit. During today's visit, LPA met resident R1. Resident R1 is dependent on staff to care and supervise R1's activity's of daily living (ADLs). LPA introduced self to R1. LPA asked R1's name but R1 did not reply. ADM asked if R1 wants to eat something and R1 replied yes. ADM gave a spoon of pudding to R1 to eat and asked if R1 likes it. R1 replied yes. ADM asked R1 if R1 needs more pudding and R1 replied yes. ADM gave more spoons of pudding to R1 and asked R1 if R1 likes it. R1 replied yes. ADM asked R1 if R1 is happy and R1 answered yes. ADM asked R1 if R1 needs some water and R1 shook his head no. LPA asked R1 if R1 is happy. R1 smiled and replied yes. Based on the observation, R1 is able to communicate his/her needs/likes by verbal communication and shaking head. Based on the observation, total care exception is not needed at the time for R1. The facility staff shall continue to document R1’s condition and care provided should be kept in R1's files. Any changes in R1’s condition should be reported immediately to R1's primary care physician, responsible party and licensing agency. Facility staff will monitor R1's health care needs and collaborate with R1's primary physician regarding care. Facility staff shall ensure R1's Appraisal Needs and Services Plan is updated annually or as needed if the resident experiences significant physical or mental changes. Facility shall provide ongoing annual staff training specific to the needs of resident and shall be documented in facility records. Continue on LIC809-C, page 1 of 2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Administrator shall notify the Department if there are any changes to R1 wherein R1 is not able to communication his/her needs and Administrator can submit total care exception to retain resident at the facility at that time. LPA met resident R2. Resident R2 is dependent on staff to care and supervise R2's activity's of daily living (ADLs). LPA introduced self to R2 and asked R2 question. R2 had no response. ADM asked R2 if R2 needs anything to eat. R2 had no response. ADM asked if R2 wants to eat pudding and R2 had no response. ADM gave couple spoons of pudding to R2 and R2 ate it. ADM asked if R2 likes it. R2 had no response. A caregiver S1 asked R2 if R2 wants to eat anything. R2 had no response. S1 gave spoons of pudding to R2 and R2 ate it. S1 asked if R2 needs to drink some water. R2 had no response. S1 gave R2 some water to sip. S1 asked if R1 likes it. R1 had no response. Based on the observation, R2 is unable to communicate his/her needs. Based on the observation, total care exception is needed at the time for R2. The Department will proceed to process the total care exception request for R2. ADM will provide documents if needed. No deficiencies were cited per California Code of Regulations, Title 22. Exit interview was conducted with ADM. This report was reviewed with ADM and a copy of the report was provided.

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit in regards an incident report, which stated a resident had struck another resident. LPA's met with Administrator Administrator Debbie Cota. LPA's explained the purpose of the visit. On October 23, 2024, the Department received an incident report, regarding resident R1. The incident report stated on October 22, 2024, at approximately 7:15pm, resident R2 was upset at the front desk. R2 was pushing the front desk computer and was aggressive with staff when re-direction was attempted. Resident R1 was nearby and saw what was happening and became upset. R1 got up and slapped R2 in the face. Both residents were separated. No physical harm was note on R2's face. The incident report states that staff S1 and S2 were present during the alleged slap. On October 25, 2024, LPA Manuel Monter interviewed resident R1 and R2. Resident R1 was asleep and could not be interviewed during LPA's visit. Resident R2 stated he/she does not remember the slapping incident that occurred on October 22, 2024. LPA interviewed staff S1. S1 stated he/she was getting ready to clocked out and was at the front desk, while staff S2, was working at the front desk. S1 stated resident R1 was sitting on a grey chair, 5 feet away from the front desk. S1 stated he/she observed resident R2 walk from the dinning room towards the front desk, and was upset. S1 stated R2 began to make a commotion and was pushing the monitors. S1 stated he/she attempted to de-escalate R2. S1 stated R1 then suddenly stood up and slapped R2. S1 stated after being slapped, R2 calmed down and S2 escorted R2 towards his/her bedroom. Staff S1 stated resident R1 and R2 did not have an argument or altercation earlier that day. Haven't seen any physical altercations between them in the past. Page 1 Out of 2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA interviewed ADM. ADM stated R1 and R2 do not have a history of fighting with each other. ADM stated R1 likes to sit in the front desk area, away from the other residents. ADM stated R1 does not enjoy R2's company due to being intrusive, such as trying to helpful. ADM stated she submitted updated care plans for both residents to CCL. Based on record review, Residents R1 and R2 have Neurocognitive disorder. LPA determined that the above incident does not require further investigation. This report was reviewed with Administrator Debbie Cota and a copy of the report was provided. Page 2 Out of 2. END OF REPORT.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Director of Community relations Diana (DCR) Jane Gutierrez. DCR informed that 50 residents and 29 staff in the facility. LPA reviewed 5 resident files and 5 staff files. LPA toured the facility with DCR. Lobby, common area, activity room, kitchen, dining room, laundry room, Salon room, break room, storage room, and restrooms were inspected. 28 shared resident bedrooms were inspected. 2 bedrooms shared with one restrooms and 1 single room with restroom, 3 common shower rooms and common restrooms were observed. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. The temperature of refrigerator was observed at 40 degree F and the temperature of the freezer was observed at -10 degree F. Medication room was observed locked. Cleaning product room was observed locked. Room temperature was at 70 degree F, and hot water temperature was at 106 degree F in facility. The emergency call in the resident room was tested and staff came within 1 minute. First aid boxes were observed in the facility. Fire extinguisher was found expired. The bought new Fire extinguishers and installed them before LPA finished the annual inspection. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors were tested and were observed working. The courtyard and backyard were toured. The last time the facility conducted the fire drill was on 6/18/2024. No citation were noted today. Exit interview was conducted with DCR. This report was provided to DCR for signature. A copy of the reports was provided to DCR.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Debbie Cota. Upon arrival, front desk staff took LPA body temperature, asked the infection control questionnaires, and checked LPA in the visitor log book. LPA toured the facility with ADM. COVID posters were observed at main entrance and the facility. Screening station with masks, hand sanitizer, thermometer and visitor log book was observed at the main entrance. Common area, activity room, kitchen, dining room and restrooms were inspected. All trash cans were observed with covers. Paper towel were observed with holder. 29 shared resident bedrooms were inspected. The beds in shared rooms were 6 feet apart. 2 bedrooms shared with one restrooms were observed. Some restrooms were observed without the posters of hand washing for 20 seconds. It was corrected before LPA finished the report. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. PPE supplies were observed sufficient. Medication room was observed locked. Cleaning product room was observed locked. Room temperature was at 73 degree F, and hot water temperature was at 110 degree F in facility. Fire extinguisher was serviced on 06/28/2022. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. ADM stated all the residents and staff are fully vaccinated and done with booster. ADM stated the Infection Control Plan was submitted to CCL office. No citation were noted today. Exit interview was conducted with ADM. This report was provided to ADM for signature.

Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced infection control site visit. LPA met with the Administrator Debbie Cota. One central entry point was designated for all staff, residents, and visitors. A temperature screening station, questionnaire, and sign in sheet were present at the entrance. LPA was temperature checked and screened before entering. LPA toured the facility. The facility was observed to be in sanitary condition. All staff members and visitors were observed to be wearing masks. There were COVID-19 signs and hand sanitizer at the entrance and throughout the facility. LPA inspected 2 restrooms. The restrooms were observed to be adequately stocked with paper towels, hand soap, and covered trash bins. Hand washing signs were present. Hand washing sign was also posted in the kitchen to remind the kitchen staff to wash their hands before handling food. There was an adequate supply of personal protective equipment in the storage areas. LPA discussed the infection control with Administrator. LPA reviewed the current Provider Information Notice PIN 21-40-ASC with Administrator. All residents and all staff were fully vaccinated and required so according to facility's policy. No deficiency cited during visit. This report was reviewed with Administrator. A copy of this report were provided.