Abundant Peace

87464(d) Basic Services(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.This was not met as evidence by: Based on interviews with two facility staff who both stated that they were not aware of R1 who need supervision for safety in regard to repositing, transferring and toileting needs as well as wondering behavior. This posed a potential health and safety risk to residents.

7211(a)(1)(D) Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence:Based on file reviewed, CCLD electronic facility files and interviews, the Licensee did not ensure to submit R1’s incident reports to CCLD. This posed an immediate health and safety risk to R1.

87405(a) Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility… This was not met as evidence by:Based on interviews, observation and visits to the facility, the Administrator has not at facility. It was learned that administrator Barbara Williams has not been present at the facility since LPA Lee’s visit on 08/05/2025 and is not carrying out administrator duties. This posed a potential health and safety risk to residents.

Based on observations Medication storage was found to be unlocked and accessible to residents, which is not in compliance with regulations, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observed the facility is not in good repair due to broken tiles in the kitchen that posed a tripping hazard. which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation during the garage inspection, the door was found to be unlocked, and multiple toxic substances were accessible to residents. These included multipurpose cleaner, tire shine spray, five paint cans, two toilet bowl cleaners, a Comet deodorizing cleanser, and a super oxygen bathroom cleaner. which poses an immediate health, safety or personal rights risk to persons in care.

87355(e) Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to the Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:This requirement is not met as evidenced by: Based on interviews and records reviews, the licensee/administrator did not ensure that the administrator’s husband (DW) is associated with the facility prior to visiting the facility on multiple occasions.

87405(d)(2) Administrator - Qualifications and Duties(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.(2) Knowledge of and ability to conform to the applicable laws, rules and regulations.This requirement is not met as evidenced by: Based on interviews and records reviews the administrator did not conform to title 22 regulations when administrator left residents in care unsupervised, incidents reports are not reported to CCLD and responsible party, providing false statement and allowing an individual at the facility without being associated to the facility. This poses/posed a potential health and safety risks to residents in care.

87464(f)(1) Basic Services(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure care and supervision needs were provided on July 10, 2025, when the administrator left the facility resulted in absence of care and supervision for longer than 1 hour 10 minutes. This poses/posed an immediate health and safety risks to residents in care

87506(d) Resident Records(d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by:Based on interviews and records reviews, the licensee/administrator did not ensure that R1 has a complete file on site for LPA Lee and Ombudsman Toliver to review. This poses/posed a potential health and safety risks to residents in care.

87465(a)(1) Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by:Based on interviews conducted, Administrator Williams did not assist Resident 1 (R1) in a timely manner after R1 experienced a fall and was unable to get up.

87207 False ClaimsNo licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.This requirement is not met as evidenced by: Based on interviews, the administrator provided false statements to LPA Lee and Ombudsman Toliver. This poses/posed a potential health and safety risks to residents in care.

87211(a) Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified…(D) Any incident which threatens the welfare, safety or health of any resident… This requirement is not met as evidenced by:Based on interviews and records reviews, the licensee/administrator is not reporting incident reports to CCLD. This poses/posed a potential health and safety risks to residents in care.

87208 Plan of OperationThe licensee shall have and maintain a current, written definitive plan of operation for the facility…(7) Sketches, showing dimensions, of the following:(A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents… This requirement is not met as evidenced by:LPA Lee observed that one of the resident’s bedrooms was switched with the staff room based on observation and facility sketch that was submitted to the department. This posed a potential risk to residents in care.

87219(i) Planned Activities(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall includeThis requirement is not met as evidenced by: LPA Lee did not observe multiple activities, equipment and supplies for residents. LPA Lee only observed books and a guitar. This posed a potential risk to residents in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:LPA Lee observed exposed wires in the common area by the television. This posed a potential risk to residents in care.

87307(d)(4) Personal Accommodations and Services(d) The following space and safety provisions shall apply to all facilities:(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. This requirement is not met as evidenced by:PA Lee observed ramps that were put in place in the patio were not sturdy and a tripping hazards. This posed an immediate risk to residents in care.

87311 TelephonesAll facilities shall have telephone service on the premises. Facilities with a capacity of sixteen (16) or more persons shall be listed in the telephone directory under the name of the facility.This requirement is not met as evidenced by: LPA Lee observe telephone on the premises does not have services. This posed an immediate risk to residents in care.

87212(c) Emergency Disaster Plan(c) Emergency exiting plans and telephone numbers shall be posted.This requirement is not met as evidenced by: LPA Lee did not observe an emergency telephone number posted in the facility. This posed a potential risk to residents in care.