Maureen House

On 9/10/2025 at 10:00 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with care staff Lea Robes and explained the purpose of the visit. Care staff Lea phoned the Licensee/ Administrator Alberto Bernardino and he arrived to the facility at 11:07 AM. The administrator currently holds a certificate (#7035909740) expires 10/26/2025. The facility’s fire clearance was approved for six (6) residents, five (5) may be non-ambulatory and one (1) may be bedridden. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of seven (7) bedrooms, with one (1) being occupied for a staff room and three (3) bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 73 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared restroom was measured at 107.4 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. Fire extinguisher was last purchased on 4/25/2025. First aid kit was observed to be complete. Continued on LIC809C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (Continued from LIC809...) Emergency Disaster Plan was last reviewed on 7/30/2025 and Emergency disaster drill (fire and earthquake) was last conducted on 7/4/2025. LPA reviewed six (6) staff and six (6) resident records. LPA reviewed a sample of medication. The following forms will be updated and submitted to CCLD by 9/17/2025: LIC500: (Personnel Record) Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 10/23/2024 at 10:05 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Lea Robes and explained the purpose of the visit. Lea phoned the Licensee/Administrator, Alberto Bernardino to inform. The facility’s fire clearance was approved for capacity of six (6) residents in which all may be non-ambulatory. One (1) resident may be bedridden. Hospice waiver approved for six (6) residents. Administrator certificate #7035909740 expires 10/26/2025. Licensee/Administrator, Alberto, arrived approximately an hour later. LPA toured facility with Lea including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms which six (6) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 105 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LIC809-C Continued... 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 LIC809-C Continued... Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last purchased on 03/21/2024. Emergency Disaster Plan was last posted on 10/23/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/03/2024. LPA reviewed five (5) residents records. LPA reviewed seven (7) staff records and 7 of 7 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/30/2024: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 500 Personnel Report - Reviewed LIC 610E Emergency Disaster Plan - Reviewed (last page) Liability Insurance - Reviewed Current Administrator’s Certificate - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 01/30/2024 at 12:30PM, Licensing Program Analyst L. Alexander arrived unannounced to conduct a case management visit to deliver amended report originally dated 01/24/2024. LPA met with Caregiver, Lea Robes and informed her the reason for visit. Lea phoned Licensee/Administrator, Alberto Bernardino to inform. Alberto arrived at the facility approx. 20 mins later. During visit, LPA obtained original report dated 01/24/2024 from Lea Robes. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

Allegation: Staff not allowing residents to leave the facility. Unsubstantiated. On 11/02/2023 LPA attempted to speak to RP and did not receive a return call. On 11/02/2023 LPA interviewed S1 who stated that all residents can leave the facility with their family, and on 11/02/2023 LPA interviewed R2 (found to be capable) who reported observing the residents leave the facility. Allegation: Facility not providing activities to residents. Unsubstantiated. On 11/02/2023 LPA attempted to speak to RP and did not receive a return call. On 11/02/2023 LPA interviewed R2 and R3 (found to be capable) who reported that they participate in music performances; and that the facility offers games, movie nights (residents can come out to the common area, or watch Netflix films in their own rooms), opportunities to go out into the community. R2 and R3 reported that several residents decline to participate. Allegation: Bedridden resident not repositioned. Unsubstantiated. On 11/02/2023 LPA attempted to speak with RP and did not receive a return call. On 01/24/2024 LPA reviewed R1s Physician's Report which does not indicate that R1 is bedridden. Further, on 11/02/2023 LPA observed R1 ambulating and moving about. Allegation: Facility retained resident who can not can not physically and mentally operate own oxygen. Unsubstantiated. On 11/02/2023 LPA attempted to speak with RP and did not receive a return call. 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 01/24/2024 LPA interviewed S1 and S2 who reported that R1 Requires oxygen 24/7, that Apria services the oxygen machine, and that R1s physician regularly checks on the oxygen readings. On 01/24/2024 LPA and LPM Jeremy Fong interviewed W1 (R1s conservator for health) who confirmed that R1 had home health monitoring the oxygen, that the Physician is regularly visiting R1 to confirm adequate oxygen administration, and that arrangements are being made for R1 to be admitted to hospice where an appropriately skilled professional will be handling R1 and ensure adequate oxygen administration. Allegation: Facility not allowing family member to visit resident. Unsubstantiated. On 11/02/2023 LPA attempted to speak with RP and did not receive a return call. On 01/24/2024 LPA interviewed S1 who stated that the subject family member (RP) has not been denied entry to visit R1, but that on 09/11/2023 the family member became belligerent and the police were called. When the PD responded, they asked the family member if she was the POA or conservator; when RP stated "no", the PD escorted RP out of the facility. On same date, LPA observed that RP signed in to visit on 09/11/2023. Allegation: Family member was not notified when resident was sent out to the hospital for procedure. On 11/02/2023 LPA attempted to speak with RP and did not receive a return call. On 01/24/2024 LPA interviewed S2 who stated that R1 has a conservator (W1) for health and that is the person they called. S2 stated that W1 would be the one to notify the family. LPA reviewed R1's file and observed that R1 does have a conservator that is not a family member. LPA and LPM spoke with W1 who further confirmed being the appointed conservator. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted and a copy of this report was provided.

Allegation: Staff are unable to effectively communicate with residents due to language barrier. Unsubstantiated. On 08/03/2023 LPA called and spoke with RP. It was alleged that staff are unable to communicate with residents. LPA interviewed S2 that stated that they are able to communicate with residents. LPA interviewed R5 that stated that the caregivers speak to each other in their own language. However, when they talk to the residents they speak in English and they can understand what their saying and have no problem with communicating. Allegation: Staff force residents to wear diapers. Unsubstantiated. On 08/03/2023 LPA called and spoke with RP. It was alleged that staff forces the residents to wear diapers. On 01/24/2024 LPA interviewed S2 that reported that all of the residents wear diapers because they are incontinent. LPA reviewed all of the residents (R1-R6) Physician's Reports and Appraisal/Needs and Services Plans which indicated incontinence. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted and a copy of this report was provided.

On 08/22/2023 at 11:15 AM Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla arrived unannounced to conduct a Case Management visit. LPAs met with Caregiver, Lea Robes. The Licensee/Administrator, Albert Bernardino, arrived approximately 1 hour later. While LPA L. Alexander was conducting file review related to complaint # 15-AS-20230801143742, LPA observed Resident 2 (R2) hospital discharge dated 5/26/2023 indicates R2 Pressure injury of right heel stage 3 ... During the visit, LPAs obtained the following records: Admission Agreement Resident Appraisal Appraisal/Needs and Services Plan Functional Capability Assessment Identification and Emergency Information Emergency Sheet Maureen House Durable Power of Attorney for Financial Release of Client/Resident Medical Information Continued 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 Continued from LIC809 Attested Discharge Summary (05/26/23) Hospital Discharge Summary - Contra Costa Health Services (05/26/23) After Visit Summary - Pittsburg Podiatry (06/08/23) After Visit Summary - Pittsburg Podiatry (07/20/23) Admission Notes (12/16/22) Financial Counseling Addendum (07/13/22) History & Physical (07/11/22) Faxed 19 pages Physician's Report for RCFE signed 12/01/22 Covid-19 Test Result (05/26/23) Power PICC SOLO Catheter Info. (05/18/23) Blood Pressure Chart, Progress Report notes Contra Costa Regional Medical Labs (05/17/23 thru 05/25/23) Client Weight Record Immunization Summary LPAs will review documents and issue citations at a later time, if needed. Exit interview conducted and a copy of this report provided.

On 08/22/2023 at 10:33 AM Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla conducted an unannounced Case Management visit to amend a Complaint Report from the previous visit on 08/03/2023. LPAs met with Caregiver, Lea Robes and explained the purpose of the visit. A copy of the amended report was provided to Albert Bernardino.

On 07/31/2023 at 10:15 AM Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla conducted an unannounced Case Management visit to amend a Complaint Report from the previous visit on 07/18/2023. LPAs met with Administrator, Albert Bernardino and explained the purpose of the visit. A copy of the amended report was provided to Albert Bernardino.