Follow-up·December 18, 2025

On 12/18/2025, Licensing Program Analysts (LPAs) Cynthia Tamayo and Avelina Martinez made an unannounced case management visit to this facility to conduct a case management visit. LPAs met with Susan McClure (S2), Dietary Manager and assistant administrator and explained the purpose of today's visit. Administrator, Sherry Richardson (S1), was not present during this visit. LPAs discussed the plan of correction deficiencies cited 11/14-19/25 and requested an update on the following : 1. Maintenance and Operation 87303 (a): The building roof and resident exterior patio were not in good repair. The exterior resident back courtyard patio is under construction and closed to residents in care. Residents use the covered side patio area at this time. Plan update: Code enforcement documentation shows that the facility was found to be in violation of code enforcement on 8/6/24, in which repairs were initiated by the facility. Code enforcement came back out to the facility on 10/15/24, in which they deemed the repair work was not done correctly by the contractor that was hired; the facility initiated a new contractor to complete the violation corrections and is in process to be completed this month. The construction crew received approval to pour the cement the week of 12/8/25 and it has been curing in the patio area. LPAs observed construction workers working on the patio area during this visit. Sacramento county inspector is coming out tomorrow, 12/18/25. S2 will send Sacramento County inspector’s contact information to LPAs. Sacramento code enforcement confirmed that the facility obtained a permit earlier this year. S2 stated code enforcement has not been back out in 2025 and the reason for delay is due to clarification and communication, as staff were not able to get a hold of permits and planning department. CONTINUED ON 809-C 2. On 11/19/25, LPA Martinez observed there was mold and leaks in two vacant resident bedrooms on the second floor. Remediation quotes from a third party company confirmed 6 out of 6 bedrooms tested positive for mold and asbestos. LPAs spoke with S2 via phone call during this visit in which they stated they will put a plan in place to test additional rooms throughout the facility for asbestos and mold as well. LPAs informed staff that the entire facility including all resident rooms, common areas, and exteriors and facility staff must be safe for residents and staff. Administrator will also ensure precautions will be put in place to ensure safe remediation is completed. Roof: Due to mold and asbestos needing to be addressed first in addition to rainy conditions, the roofing repairs are not able to start until Spring 2026. Documentation of quote from one roofing company states “this application can only be done between April and September with adequate outside temperatures per manufactures instructions”. During a facility tour with S2, LPAs observed there was water damage such as warping, bubbling, and discoloration on several hallway ceiling panels on the both floors of the facility. LPA also observed there was water leaking from a ceiling panel on the second floor near in room 219 and 220, in which trash bin was placed underneath the hole in the ceiling hole to collect the water dripping from the ceiling panel. 3. Fire Safety 87203: The facility's last fire alarm system inspection was completed on April 11, 2025. The last fire testing and maintenance inspection was on May 20, 2025. Sprinkler system and water gong were not in good repair which. S2 stated the facilities sprinkler system plan, and water gong repairs plan update: Fire Marshall, came to the facility on 11/18/25 and the documentation was received during this visit. Sprinklers were added, gongs were repaired, and fire alarms pull boxes were inspected. POC was cleared. 4. HSC 1569.695(c): quarterly fire drills were not being completed by facility staff POC cleared. LPA observed the light fixture in the fire exit stairwell was non- operational during this visit. S2 had maintenance replace the light bulb of the stairwell during this visit. 5. Incidental and Medical 87465(a)(6) (6) facility did not maintain an accurate record of dosages of medications. POC cleared and staff agrees to continue maintain accurate MAR. CONTINUED ON 809-C 6. General Food Service Requirements 87555(b)(17): Per food service consultation report, the last food service consultation was in December of 2019. Additionally, there is not a nutritionist, dietitian, or home economist available at the facility. Plan update: Qualified Nutritionist, Dietitian, or a Home Economist is scheduled to conduct audits in January 2025, and facility will submit findings to Licensing upon completion. 7. Incidental Medical and Dental Care: 87465(h)(4): Due to the alteration of a residents \ medication bottle label. Plan update: POC cleared, and facility agrees to not make any alteration of a residents medication bottle labels. 8. 87411(c)(1) Personnel Requirements – [ [2] out of [8] staff did not have a current first aid certificate Plan update: POC was cleared and facility staff will ensure staff have a current first aid certificate. 9.P&I financial ledgers. Current surety bond amount is $5,000 via CAN Surety. Business office manager, Rabinder Singh (S3) stated residents PNI is deposited into a facility bank account designated for residents' money and all payees have designated payees. S3 stated Facility will Bank information to LPA by 12/22/25. Facility staff will review 87217 Safeguards for Resident Cash, Personal Property, and Valuables. 10. Facility sketch that includes camera locations will be submitted by 12/22/2025 11. Administrator oversight: Per LIC 500, Administer Sherry Richardson is scheduled at this facility 4 days per week from 7:00-17:00 however their schedule is variable and the LIC 500 is not accurate at this time. S1 holds current certificate #7007545740 that is valid thru 01/25/2027. S2 hold administrator certificate #7007207740 which expires12/28/2026. S1 stated they are spending most of their time overseeing Country Place Assisted Living – 075601547 in Antioch and S2 is "like the main administrator" for the most part. S2 stated the licensee/owner of the building has been informed of the conditions of the building. S3 assists with administrator duties. Med techs act as leads in case of an emergency. An updated LIC 500 and LIC 308 will be submitted to LPA by 12/22/25. S1 stated maintenance workers are scheduled to be present at the facility next week. LPAs discussed the importance that a qualified administrator is present next week to ensure there is oversight over the roof leaking issues during the upcoming rainy days. 12. LPAs advised S2 on ensuring the elevator certificate is renewed expiration date: January 8th, 2026. CONTINUED on 809-C 13. Emergency Safety Plan: In the event residents need to be relocated, an updated safety plan shall be in place. Facility staff agree to submit written emergency/ safety plan update by 12/22/25. Licensee shall be included in the development of this plan. As a result of this visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with S2 and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.