Non-compliance follow-up·July 29, 2025

At approximately 9:45 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced for the purpose of conducting a Case Management-Legal/Non-compliance (NCC) Inspection and met with caregiver Martha Reyes who has Designation of Facility Responsibility (DFR). Administrator Madonna Martinez was called to advise of NCC inspection, but was not able to attend as she was at a sister facility. This facility was placed on a non-compliance (NCC) on 06/26/2024 for a two-year term by Community Care Licensing (CCL); Concerns addressed in NCC meeting on 06/26/2024 were: Administrator Duties and Qualifications Active Administrator in place for facility oversight per regulation Clearing Plans of Correction (POCs) Reporting Requirements Timely response to CCL when communication is engaged LPA was advised that there were five (5) residents in care, one (1) of which is on hospice. At approximately 10:05 AM LPA and caregiver/DFR conducted a wellness and safety walk-through of facility, finding it at a comfortable temperature, clean, odor free, exits free from obstructions and well organized. Residents were clean and dressed appropriately. There was an ample supply of hygiene products for residents' care. There was also an ample supply of healthy perishable and non-perishable food as required by Title 22. DFR was reminded of the mandate to label foods in airtight containers with the date they are removed from commercial packaging. A fire extinguisher in the kitchen was last serviced on 2/16/2024 and observed to be fully charged, DRF was advised to have the device re-inspected or have a new device purchased with the receipt taped to the new extinguisher. Smoke detectors/carbon monoxide detectors are centrally wired and tested to be functional. The front and back yards are well maintained and the back yard pool is fenced and secured as required by regulation. Continued on LIC809C Continued for LIC809 There is also a covered patio with seating for outdoor activities and visits. There are comfortable couches and chairs in the living room with television and simple games available. Soaps and toxins, as well as sharps were locked securely and inaccessible to residents. Medications were kept secured in a closet in hallway. At approximately 11:00 AM, five (5) staff files were reviewed and two (2) of five (5) were found incomplete with S1 having expired 1st aid (and CPR), S2 missing a MD health screening (LIC503) and S3 missing evidence of current 1st aid (and CPR) training. Type B violation issued with a plan of correction to attain missing documents by Friday 08/29/2025 Five (5) of 5 Resident files were reviewed and 5 of 5 were found to have all required documentation including recently attained Consents for Emergency Medical Treatment (LIC627C) DRF advised LPA that a non-hospice resident expired May 16, 2025 but Community Care Licensing (CCL) has no evidence of an incident report submitted to CCL for the hospital admission on May 14th, 2025 or for the death and death report. Licensee was advised via phone that these two documents should be submitted to CCL along with a death certificate once received. In addition, licensee was advised by phone that not a single incident report is documented at CCL for items like hospital admissions, notification of hospice services, non-payment of resident fees etc. Finally licensee was contacted by phone to make her aware that Triune, INC (4299104) not good standing with the Franchise Tax Board (FTB). Licensee indicated she had made efforts without success to reach out to FTB. Licensee was made aware that that CCL will need evidence of her efforts (email or letter or payment plan etc) of Triune, INC resuming good standing with FTB by Wednesday August 6th, 2025 by end of business day or face the potential of citation and financial penalties from CCL. In addition, licensee was notified that licensing fees of $742.00 are due and the PIN number was given to DRF/caregiver during today's inspection. In addition, FTB was provided Technical Support Program support brochure to share with licensee. Updated Liability insurance was obtained by LPA today. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Martha Reyes (DFR) in person and Licensee Madonna Martinez by phone and and Appeal rights were given.