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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209026
Report Date: 05/09/2026
Date Signed: 05/15/2026 08:15:24 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2026 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20260501091427
FACILITY NAME:LLC RETIREMENT HOMES IIFACILITY NUMBER:
247209026
ADMINISTRATOR:BRYANT, PAULAFACILITY TYPE:
740
ADDRESS:1944 FAXON DRTELEPHONE:
(209) 761-2478
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:6CENSUS: 6DATE:
05/09/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Liensee, Lindsey LamersonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff mismanaged residents medication records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations lsited above. LPA met with Licensee, Lindsey Lamerson and explained the purpose of today's visit.

Regarding the allegation that staff mismanaged resident’s medication records, Licensing Program Analyst (LPA) Sarah Hurt conducted interviews and reviewed facility records including physician orders, over the counter PRN medication administration records, medication logs, and additional documentation maintained by facility staff regarding physician notification for over the counter PRN medication administration. LPA reviewed multiple over the counter PRN medication administration records maintained by the facility for the resident. Records reviewed documented over the counter PRN medications administered for symptoms including pain, anxiety, and other symptoms. LPA reviewed handwritten documentation maintained by the facility reflecting staff communication with the house manager and/or physician regarding over the counter PRN medication administration. Documentation reviewed reflected the facility maintained an internal process in which staff notified the house manager and/or physician when over the counter PRN medications were needed for the resident.. LPA identified documentation deficiencies within the PRN medication records. LPA observed several entries on the over the counter PRN medication administration records which contained incomplete documentation including missing times, incomplete results documentation, missing follow-up entries regarding effectiveness of medication administration, and inconsistent documentation regarding symptom resolution following administration of over the counter PRN medications. LPA did not observe evidence indicating the resident suffered harm related to the medication administration practices reviewed. However, the facility failed to ensure over the counter PRN medication records were consistently and accurately completed as required. . Based on interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficincies are being cited Per title 22 regulations.

Exit interview conducted with Licensee, Lindsey Lamerson and copy of report provided along with appeals rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2026 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20260501091427

FACILITY NAME:LLC RETIREMENT HOMES IIFACILITY NUMBER:
247209026
ADMINISTRATOR:BRYANT, PAULAFACILITY TYPE:
740
ADDRESS:1944 FAXON DRTELEPHONE:
(209) 761-2478
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY:6CENSUS: 6DATE:
05/09/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Liensee, Lindsey LamersonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure residents needs and services plan was maintained
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations lsited above. LPA met with Licensee, Lindsey Lamerson and explained the purpose of today's visit.

Regarding the allegation that staff did not ensure the resident’s needs and services plan was maintained, LPA reviewed the resident’s facility records including the resident’s Needs and Services Plan, PRN medication documentation, and internal facility procedures regarding PRN medication administration.
Records reviewed indicated the facility maintained an internal process requiring staff to notify the house manager and/or physician when PRN medications were needed for residents unable to independently communicate their symptoms or medication needs. Documentation reviewed reflected ongoing physician contact regarding PRN medication administration and symptom monitoring.Although RP expressed concerns that the resident’s Needs and Services Plan did not specifically outline all aspects of the PRN physician notification process, records and interviews conducted demonstrated the facility had an established procedure utilized by staff regarding PRN medication administration for the resident. LPA did not observe evidence establishing the resident’s Needs and Services Plan was not maintained or that the resident’s care needs were not being addressed by facility staff. Therefore, this allegation is UNSUBSTANTIATED. A finding that an allegation is unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted with Licensee, Lindsey Lamerson and copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20260501091427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: LLC RETIREMENT HOMES II
FACILITY NUMBER: 247209026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2026
Section Cited
CCR
87465(d)
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87465 Incidental Medical and Dental Care (d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met:

(1) Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication.

(2) The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record.

(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. The following requirement has not been met as evidenced by:
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Licensee agrees to complete the following:
Review and audit all resident PRN medication records to ensure documentation includes:date and time administered,medication administered,
reason for administration,staff initials/signature,resident response/results following administration, and follow-up documentation when required, and submit proof to LPA by POC date of 05/23/2026.
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Resident 1's PRN tracking log was not accurate and did not include all times PRN given, and results, which poses a potential, health, safety, or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3