Casa Alice Care Home

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Becky Bi. The purpose of the visit was to follow up on resident R1's Appraisal/Needs and Services Plan that was reviewed as part of the complaint investigation received on 01/11/2023. During the investigation, LPA Marrufo observed that R1's Appraisal/Needs and Services Plan had not been updated after R1 had undergone a surgery. LPA also observed that the Background Information section was left blank. An Advisory Note was issued. See LIC9102 form for more information. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Becky Bi and a copy of this report was provided.

During interview on 01/19/2023, R1 stated that S1 and S2 speak to R1 in an inappropriate manner by verbalizing disrespectful things to him/her such as saying R1 has “cow shit” or “pig shit” when they assist R1 with changing undergarments. R1 stated S1 and S2 say they don’t like R1 and say they will retire because of R1. During interview on 01/19/2023, S1 and S2 stated to have not spoken to R1 inappropriately. ADM stated during interview that staff do not speak to residents inappropriately. During interview on 09/24/2025, ADM stated that ADM and the staff knew that R1 had complained about R1’s previous care giver, so ADM and the staff did not want to risk talking to R1 inappropriately. On 01/19/2023, the Department obtained copies of R1’s Physician’s Report dated 07/27/2021 and R1’s Appraisal/Needs and Services Plan dated 10/20/2021. Allegation: Staff leaves resident soiled for extended periods of time. R1’s Physician’s Report states R1 had bowel impairment and bladder impairment, R1 was dependent on all his/her Activities of Daily Living (ADLs), and was unable to transfer independently to and from bed.R1’s Appraisal/Needs and Services Plan states two staff would provide lifting during transfers and staff would provide full services with R1’s shower and daily dressing. R1’s Appraisal/Needs and Services Plan states R1 was not able to go to the toilet and R1 wears incontinent supplies. The Physical/Health Method of Evaluating Progress section states, “remind [him/her] to relax [his/her] legs while we are changing [his/her] depends.” The Functioning Skills section states R1 has the following needs: “ambulation, showering, dressing, eating, toileting, [and] incontinence.” The Functioning Skills section includes the following objectives: “provide two people lifting with transfers, ensure [he/she] is safe, provide full services with [his/her] shower, provide full services with [his/her] daily dressing, assist with set up, independent with feeding, not able to go to toilet, [he/she] wears incontinent supplies, [he/she] is incontinent for both urine and bowel.” During interview on 01/19/2023, R1 stated staff S1 and S2 do not take R1 to the bathroom and only change R1’s diaper twice per day. R1 stated staff change R1 at 8:00 AM and 5:00 PM. R1 stated to have no way to notify staff if R1 needs help. R1 stated to not have a bell or the phone number of the staff. R1 stated that he/she text messages the “director of the program.” Page 2 of 5. 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 On 04/01/2025, the Department obtained screenshots of text messages from ADM that ADM stated were between ADM and R1. The text messages include a text from R1 requesting ADM to have staff provide R1 with a ride to the hospital on 10/02/2022. During interview on 01/19/2023, S1 stated staff changed R1’s diapers twice a day. S1 stated if R1’s diapers were wet at lunch time, R1 would verbally call to the staff for help. S1 stated R1 would call for help once per day. S1 stated staff would check on R1 in the afternoon. During interview on 01/19/2023, S2 stated staff check on bedridden residents every two hours. S2 stated if the bedridden residents are wet, the staff will change them. S2 stated staff would check on R1, but R1 does not like to be moved. S2 stated R1 will say he/she is not wet, but he/she would be wet. S2 stated that staff would tell R1 to call for staff to help when he/she is wet. During interview on 01/19/2023, ADM stated that if a resident is unable to go to the bathroom, staff will help residents with toileting at least three to four times a day or as needed. ADM stated at nighttime, staff will place a liner on the bed and there will be a nighttime change. ADM stated staff check on R1 after every meal. ADM stated that S2 asked ADM what to do if R1 refused a toileting needs check, and ADM told S2 to ask R1 again later. During interview on 09/24/2025, ADM stated nighttime staff would provide R1 with a diaper change as needed. ADM stated if R1 refused diaper changes, then ADM would try to convince R1 and talk to R1’s social worker. ADM stated if R1 continued to refuse diaper changes, then ADM and the staff would not force R1 to change diapers. ADM stated R1 would sometimes refuse diaper changes and always refused to be showered. ADM stated staff would need to sponge bathe R1 because R1 refused to shower. Allegation: Facility does not have proper equipment to assist resident in care. During interview on 01/19/2023, R1 stated that R1 needs a Hoyer lift. R1 stated R1’s Physical Therapist told R1 that he/she needs a Hoyer lift. Page 3 of 5. 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 During interview on 01/19/2023, S2 stated that R1’s Physical Therapist said R1 needs a Hoyer lift to transfer R1 to his/her wheelchair and give R1 a shower. S2 stated to not know what happened to the Physical Therapist’s request. During interview on 01/19/2023, ADM stated R1’s Physical Therapist never gave the facility any suggestion about transfer equipment. During interview on 09/24/2025, ADM stated R1 did not want to be transferred from bed. ADM stated R1’s physical therapist never gave ADM any documentation about a Hoyer lift for R1. ADM stated R1 would never give ADM any documentation from R1’s physical therapist or occupational therapist. ADM stated to not be able to remember if ADM had a conversation with R1’s physical therapist about getting a Hoyer lift for R1. Allegation: Staff do not properly store resident's food. When the department received the complaint, it was alleged that the facility staff do not put R1’s food that requires refrigeration in the facility refrigerator, causing the food to spoil. During interview on 01/19/2023, R1 stated R1 orders food from Walmart. R1 stated staff keep R1’s food that requires refrigeration in the refrigerator. During interview on 01/19/2023, S2 stated some of R1’s personal food is stored in R1’s room and some is stored in the facility refrigerator. S2 stated R1 currently does not have any of R1’s own food. S2 stated R1 already consumed R1’s own food. During interview on 09/24/2025, ADM stated R1’s food that needed refrigeration was kept in the facility refrigerator and the rest of the food was kept in R1’s room. Allegation: Staff does not treat resident with dignity or respect. Page 4 of 5. 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 When the department received the complaint, it was alleged that staff were not allowing R1 to put personal items on R1’s desk. During interview on 01/19/2023, R1 stated to have personal items such as a Bible, journal, and crossword puzzles. R1 stated the staff put R1’s items away in a box on the drawer by R1’s bed. R1 stated other objects are covering the box. R1 stated the box with R1’s personal items are out of reach to R1. During interview on 01/19/2023, S1 stated staff give R1 his/her crossword puzzles whenever R1 asks for them. S1 stated staff assist R1 with his/her personal belongings whenever he/she asks. During interview on 01/19/2023, S2 stated R1 has a laptop, an iPad, a Bible, and coloring books. S2 stated R1 does not use his/her belongings and watches television instead. S2 stated R1’s belongings began to pile up on R1’s table. S2 stated S2 put the belongings R1 was not using in a box. During interview on 01/19/2023, R1 stated staff “rip” R1’s legs open when changing R1. R1 stated the way staff change R1 is demeaning and condescending. During interviews on 09/24/2025, S1 and S2 stated to never open R1’s legs in a disrespectful way when cleaning R1 and changing R1’s diapers. During interview on 09/24/2025, ADM stated to not know where R1 is currently located. ADM stated R1 did not provide the contact information for R1’s physical therapist. ADM stated R1’s physical therapist would either call the house phone or speak with R1 directly. ADM stated R1’s physical therapist did not contact ADM on ADM’s cell phone. ADM stated that when R1 was a resident at the facility, the only staff were S1 and S2. Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Becky Bi and a copy of this report was provided. Page 5 of 5. END REPORT. 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 During interview 01/19/2023, ADM stated staff use a pot of warm water and a towel to clean up R1. ADM stated staff use non-rinse shampoo in R1’s hair. ADM stated when R1 had leg braces after surgery, staff could not shower R1. During interview on 09/24/2025, S1 stated to have never told R1 that it is not S1’s job to help R1 into the shower seat and shower. S1 stated to have never observed another staff say that helping R1 into the shower is not their job. S1 stated R1 did not like to be moved. S1 stated R1 would refuse to be changed if R1 was in pain. S1 stated if R1 were in pain but very wet, then R1 would not refuse to be changed. S1 stated if R1 refused to be changed, then S1 would return to R1 later to ask to change R1 again. During interview on 09/24/2025, S2 stated to have not stated that it was not S2’s job to help R1 into the shower seat and into the shower. S2 stated S1 would offer R1 a shower, but R1 would refuse. S2 stated to have never observed another staff tell R1 that it was not their job to help R1 into the shower seat and into the shower. S2 stated R1 would refuse to be changed if R1 was in pain. S2 stated staff would return later to ask R1 again to be changed if R1 previously refused to be changed.

On May 19, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Becky Bi, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had (6) residents in care and (2) staff members present at the time. At 11:04 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. LPA inspected the kitchen and found it clean, with lunch preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects, detergents, disinfectants, and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food items were noted. A locked box containing medications was observed. LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. One (1) resident was observed sitting in the dining area. LPA inspected the living room and observed it clean, with all furniture in good repair. There were a sofa sets, coffee table, piano and a television in the living room. LPA inspected the fire extinguisher mounted on the wall in the dining area hallway and found it fully charged, with the last service tag dated 01/21/2025. Continued on LIC809-C 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 The Administrator tested the smoke and carbon monoxide detector located in the living room in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. There were six (6) bedrooms and six (6) bathrooms designated for residents' use. All (6) resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. Storage closets with incontinence supplies were observed in every room. LPA inspected six (6) full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip flooring. The hot water temperature at the sink faucet measured 113.7°F and 115.1°F. The hallway closets were observed to contain clean linens and towels for residents’ use. LPA inspected the locked garage located behind the house in the backyard and observed a washer, a dryer, mattresses, suitcases, and furniture items. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The backyard has a set of a patio table, chairs, and shaded areas for resident use. No bodies of water were noted. LPA reviewed five (5) staff personnel records and (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 5 of 5 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet inside the dining area. Medications were organized in separate bins for each resident. All medication bottles were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 03/19/2025. Continued on LIC809-C 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 The following updated forms are requested to be submitted to CCLD by 05/26/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Administrator. A copy of this report was left with the Administrator, Becky Bi, whose signature on this form confirms receipt of the report.

LPA Kabariti interviewed 2 staff members. S1 states that R1 is always sitting in the chair and they cannot stop R1 from doing what he/she wants. They encourage R1 to elevate his/her leg while sitting on the chair throughout the day, but R1 does not listen, but R1 is good at elevating his/her leg while sleeping. The doctor knows about R1s foot and encourages R1 to elevate his/her legs but never does that. S2 is one of the main people who takes care of R1. S2 states that they encourage R1 to elevate his/her foot while sitting on the chair everyday and throughout the day but R1 doesn't listen. S2 encourages walks around the house but needs a 2-person assist because R1 is of risk of falling. R1 takes a really long time to take a few steps. From the living room to R1s room it can take 45 minutes but staff are always there to watch and assist. The doctor encourages to elevate R1s foot and do physical therapy. According to records review, part of the reappraisal of the resident dated before the complaint was filed, it is stated that R1s feet are more swollen and staff encourage R1 to keep feet up as much as possible. R1s ambulation will be addressed by providing two people lifting with transfers and ensure that R1 is safe due to fall risk being high. Based on visitation logs provided by the facility, there was a scheduled physical therapist doing visits to R1. Based on interviews & records review , although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited today. Report is reviewed and copy is provided. Page 2 of 2

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Annual Continuation visit and met with Administrator Becky Bi. During visit, LPA Marrufo toured the kitchen area and garage area. LPA Marrufo observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. The garage area was locked and contained cleaning supplies. LPA Marrufo observed the first aid kit and found it to be complete. LPA Marrufo toured the outside area and found the exits to be clear of obstructions. LPA Marrufo reviewed the Centrally Stored Medications and Destruction Records and Resident Records for 6 out of 6 residents and found them to be complete. LPA Marrufo reviewed 3 staff files and found them to be complete. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Becky Bi and a copy of this report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Becky Bi. During visit, LPA Marrufo conducted interviews with 2 staff and 2 residents. LPA Marrufo tested the detectors of smoke and carbon monoxide in each bedroom and hallway and each detector functioned properly when tested. LPA Marrufo toured 6 out of 6 resident bathrooms. Each bathroom had water temperatures between 105 F to 108 F. Each bathroom had available soap and paper towels. LPA toured 6 out of 6 resident bedrooms and each bedroom had working lights and available bedding and clothing storage areas. Due to time constraints, the annual inspection will need to be continued at a later time. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Becky Bi and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Becky Bi. During visit, LPA Marrufo toured the facility. LPA Marrufo observed a visitor screening area with a thermometer. LPA Marrufo observed the facility bathroom had hand washing posters and available soap and paper towels. LPA Marrufo observed there to be a PPE supply of at least 30 days. LPA observed a perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Becky Bi and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced COVID-19 Infection Control Required 1 Year visit and met with Becky Bi. During visit, LPA Marrufo toured six out of six resident bathrooms, hallways, dinning and common areas, outdoor visiting area, kitchen area, and resident bedrooms. Staff were observed wearing surgical masks. LPA Marrufo observed that 6 out of 6 bathrooms did not have trash cans with foot-operated lids. LPA observed the facility entrance way did not have a log to screen visitor symptoms. LPA Marrufo observed that the facility has not yet submitted an LIC808 Mitigation Plan. Becky Bi also stated that the facility does not document daily temperature and COVID-19 symptom checks amongst residents and staff. LPA Marrufo observed the facility has an adequate supply of PPEs. Advisory Notes were issues. See LIC9102s for more information. No Deficiencies were cited at this time as per California Code of Regulations, Title 22. This report was reviewed with Becky Bi and a copy of the report was provided.