complaint·July 8, 2025

The investigation revealed the following: Regarding allegation: Facility is in disrepair. Interview with S1 revealed that resident bedroom #4 had a hole in the ceiling. S1 interview also revealed, that one of the walls in bathroom #1 was chipped at the bottom and bathroom vent was dirty. S1 interview further indicated, that the repairs and cleaning were completed prior to today’s visit. During visit, LPA observation indicated repairs had been completed for the hole in the ceiling and chipped wall in the bathroom and the vent in the bathroom was cleaned. Based on interview with S1 and LPA observation, the allegation is corroborated; therefore the allegation is SUBSTANTIATED . Regarding: Staff did not ensure medical services were provided. Interview with S1 revealed, an appointment for routine medical services for R1 had not been scheduled because family had not signed the declination/acceptance form which would grant or deny permission for R1 to attend the routine medical appointment. Record review conducted during visit revealed, medical appointment for R1 had not been scheduled; however, there was no documentation indicating family’s decline for a medical appointment until it was sent by family on 5/28/25 . Further record review conducted by LPA indicated, facility staff received the declination for the routine medical appointment from family last year on 12/5/24; however, the decline form for this year had not been requested from family by licensee until 5/28/25. Interview with S1 further revealed, R2’s file was missing Immunization record but review conducted by LPA at the time of visit indicated, R2’s immunization record was present in the file. Record review also showed no indication of R2 attending a dental appointment around the anniversary of last years appointment which took place on 6/24/24 or confirmation of an upcoming scheduled appointment. Licensee scheduled dental appointment for R2 at the time of visit via phone call to dental facility. Based on interview with S1 and LPA record review, the allegation is corroborated and therefore the allegation is SUBSTANTIATED. Continues on LIC 9099-C The investigation revealed the following: Regarding allegation: Staff does not ensure staff are adequately trained. Record review indicated that S1-S6 have the required job training received during initial hire and through continued education for various topics, including but not limited to Reporting and Documentation, Abuse and Neglect Reporting and Dementia Training. Records indicate staff have the initial (40) hours of training provided during orientation and are required by licensee to continue with training throughout the year. Record review further indicated, S1-S6 have certification through continued education for care and supervision for residents in their care. Record review does not corroborate the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Fidelito Ruiz, Administrator, and a copy of this report was provided during visit. Regarding allegation: Facility did not meet food service requirements. Record review and observation conducted by LPA revealed, facility's current menu plan for residents does not offer a variety of foods to meet personal preferences, special dietary needs, food habits and cultural background. Interview with S1 indicated, alternate menu had not been updated nor posted. Based on interview with S1 and LPA record review and observation, the allegation is corroborated and therefore the allegations is SUBSTANTIATED . Based on LPA’s observations, interviews and record review, the preponderance of evidence standard has been met; therefore, the allegations noted above are found to be SUBSTANTIATED. Deficiencies were observed and cited per California Code of Regulation Title 22 Division 6. Refer to LIC 9099-D. Exit interview held with Fidelito Ruiz, Administrator and copy of report and Appeal Rights provided during visit.