Complaint·July 29, 2025

Continued from LIC9099, dated 7/29/2025.. Per interview with S3, they used to work at the facility assisting residents' with medications but left to start an agency for care staff. LPA requested a business card, but S3/ staff stated they didn't have one to provide the LPA. LPA requested Administrator to provide documents on file regarding S3 as a staff of the facility and/or documents as an agency registry staff in the facility providing services. Administrator stated they didn't have any agency staff documents on S3, but have repeatedly requested required documentation from S3, and S3 has never provided it to the facility. Administrator stated they would see what documents they have on former staff S3, and will request S3 to complete required documentation to them. Administrator stated they would provide records on S3's qualifications, and their agency/registry documentation to the LPA. Records were provided to the LPA. Per review of records, staff interviews, and obtained information, the investigation revealed, S3 last completed required medication training hours on 11/11/2023 and 11/12/2023. This is out of compliance with health & safety code requirements, there is initial medication training hours required, including medication shadowing hours, and medication training annually. This deficiency will be cited, HSC1569.69(a)(1)(b) Employees assisting residents with self-administration of medication; training requirements, see LIC9099D. Per review of Guardian, criminal record clearance database, S3 is not associated to the facility and was separated by Cogir of Rohnert Park on 12/5/2023. It was also identified that S3's fingerprint clearance was separated from North Bay Home Care agency on 10/9/2024, and separated from North Bay Home Care, INC. agency on 2/18/2025. This is out of compliance with title 22 regulation requirements, 87355(e)(2)(3) Criminal Record Clearance, it will be cited, see LIC9099D. There was sufficient information obtained to support that a violation occurred regarding the allegation. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator Kelly Ording. Appeal Rights Provided.