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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435294258
Report Date: 10/09/2025
Date Signed: 10/09/2025 12:37:33 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250115102820
FACILITY NAME:BECK CARE HOMEFACILITY NUMBER:
435294258
ADMINISTRATOR:ZHANG, YU & LUO, XI-HUAFACILITY TYPE:
740
ADDRESS:1681 BECK DRIVETELEPHONE:
(408) 866-7858
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:6CENSUS: 6DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensees Xi-Hua 'Julia' LuoTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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9
Resident was overcharged for extra month of rent.
Resident's bedrail and wheels on hospital bed are not in good repair.
Facility staff are not trained to assist residents with transfers.
Resident's private caregiver sleeping on the couch in the living room
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marcella Tarin and Manuel Monter conducted an unannounced visit to deliver the complaint findings and met with administrator Licensee Julia Luo. LPA stated the purpose of the visit.

On 1/15/2025 the Department received a complaint alleging a resident was overcharged for extra month of rent. It has been alleged that R1 was overcharged for an extra month of rent for the month of January 2025.

On 1/15/2025 the Department interviewed Reporting Party (RP). RP stated he/she decided to take R1 out of the facility on 1/13/2025. RP stated he/she did not provide a 30 days’ notice for the facility.

On 7/17/2025, and 9/25/2025 LPA Tarin interviewed ADM. ADM stated RP did not provide a 30 days’ notice when RP moved R1 out of the facility on 1/12/2025.

Page 1 of 4
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250115102820

FACILITY NAME:BECK CARE HOMEFACILITY NUMBER:
435294258
ADMINISTRATOR:ZHANG, YU & LUO, XI-HUAFACILITY TYPE:
740
ADDRESS:1681 BECK DRIVETELEPHONE:
(408) 866-7858
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:6CENSUS: 6DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensees Xi-Hua 'Julia' LuoTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff not following infection control policy, resulting in COVID-19 and Norovirus outbreak.
Facility staff using residents room as hallway to get to the backyard.
INVESTIGATION FINDINGS:
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13
On 12/4/2025, LPA Marcella Tarin and David Marrufo arrived unannounced to deliver an amended report to change the findings from unsubstantiated to substantiated for the allegation facility staff using residents room as hallway to get to the backyard. See LIC9099 Substantiated report on 12/4/2025. Licensing Program Analyst (LPA) Marcella Tarin and Manuel Monter conducted an unannounced visit to deliver the complaint findings and met with administrator Licensee Julia Luo. LPA stated the purpose of the visit.

On 1/15/2025 the Department received a complaint alleging Facility staff not following infection control policy, resulting in COVID-19 and Norovirus outbreak.

On January 24 and August 4, 2025, the Department interviewed Reporting Party (RP). RP stated the staff are not keeping the facility in a sanitary condition, resulting in residents becoming sick. RP stated these outbreaks occurred in November 2024 and January 2024. RP states he/she cannot confirm if the stomach infection R1 had in November 2024 was norovirus.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/09/2025
NARRATIVE
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The Department requested documentation regarding R1 contracting norovirus, but RP did not provide the Department with said documentation.

On 1/24/2025 LPAs Christine Dolores and Santino Fortes conducted the initial complaint investigation visit. During the initial visit, LPAs observed PPE supplies to include gowns in the linen closet, gloves in a separate closet which contained toxins, and hand sanitizer at the front door.

On 1/24/2025 and 7/15/2025 the Department interviewed staff S1. S1 stated staff cares for residents with COVID-19 by using PPE supplies such as gloves and gowns. S1 states the facility notifies families of any illnesses or outbreaks. S1 stated the facility provides PPE, and staff care gloves.

On 7/15/2025 Licensing Program Analyst Marcella Tarin interviewed ADM. ADM states in the event of an outbreak the facility staff will follow the facility infection control policy. ADM stated staff wash hands multiple times daily and in between caring for residents. ADM states staff clean and disinfect the facility at least 2 times a day and are using sanitizing wipes daily as well. ADM stated there are currently no illness/COVID cases at the facility, but if there were, the staff would be using Personal Protection Equipment (PPE). ADM stated PPE equipment is available to staff, such as gloves, masks, face shields. ADM states staff always use gloves when caring for residents, and if a resident has a cold, masks are worn by both residents and staff.

On 9/25/2025 LPA Tarin interviewed Staff S2 and S3. S2 stated he/she is not aware of any outbreaks of COVID or Noro virus. S2 states the facility follow infection protocol by wearing gloves, masks and sanitizing, and letting the ADM know is residents are sick. S3 stated he/she facility follows infection control protocol, and staff wear gloves, masks, and clean/disinfect.

On 10/6/2025, LPA Tarin interviewed Witnesses (W1 to W5). 4 out of 5 Witnesses stated he/she has observed staff wearing gloves. W1 did not provide information regarding staff wearing gloves. 5 Out of 5 witnesses stated he/she observed the facility to be clean and sanitary when they have visited his/her loved one at the facility.

Page 2 of 3
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/09/2025
NARRATIVE
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On 9/25/2025, LPAs interviewed 3 Residents R2 to R4. 3 Out of 3 (R2-R4) residents did not provide answers to questions LPAs posed regarding this allegation. On 10/9/2025, LPA interviewed Resident R4. R4 state he/she has no issues.
Facility staff using resident's room as hallway to get to the backyard.
On 1/15/2025 the Department received a complaint alleging Facility staff using resident's room as hallway to get to the backyard

On 8/4/ 2025, LPA Tarin interviewed Reporting Party(RP). RP stated he/she has told staff S2 not to walk through R1’s room. RP stated he/she was visiting R1 in his/her bedroom, when S2 entered R1’s bedroom to access the backyard of the facility. RP stated the door was closed and S2 did not knock. RP did not provide additional information regarding this incident.

On 1/24/2025, the Department interviewed staff S1. S1 stated they sometimes they use the resident's room to go to the backyard because it has an exit door. S1 stated staff knows they should go around through the siding door of the living room or garage.

On 7/17/2025, LPA Tarin interviewed ADM. ADM states she has not observed staff using a residents room as a hallway to get to the backyard.

On 9/25/2025 LPAs interviewed S2 to S3. Staff S2 stated he/she has never used or observed a staff used a resident’s room to exit to the backyard. Staff S3 stated he/she has never seen staff use a resident’s room to exit to the backyard.

On 9/25/2025, LPAs interviewed 3 Residents R2 to R4. 3 Out of 3 (R2-R4) residents did not provide answers to questions LPAs posed regarding this allegation. On 10/9/2025, LPA interviewed Resident R4. R4 state he/she has no issues.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided.

Page 3 of 3

END OF REPORT

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/09/2025
NARRATIVE
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Review of documentation provided by RP, RP did not provide a 30 days notice to the facility regarding R1 moving out. Documentation states RP requested to pick up R1's belongings from the facility on 1/13/2025."

Based on review of R1’s Invoice dated for January 2025, dated 1/17/2025, the invoice states “Discharge notice on 1/12/2025 ahead 30 day requirement based on the admission agreement, start on 1/13/2025 until last room on board date 2/12/2025 at $210.00 per day.”

Review of R1’s Admission Agreement dated 4/19/2024 under Refund Policy, states “Residents moving out due to non-medical reasons requires 30 days advance notice…resident or the residents responsible person give a thirty-day (30 days) written notice to the licensee.” RP moved out R1 on 1/12/2025 without providing a 30 days notice to the facility.

Resident's bedrail and wheels on hospital bed are not in good repair.
On 1/15/2025 the Department received a complaint alleging Resident's bedrail and wheels on his/her hospital bed are not in good repair.

On January 15, 2025 and August 4, 2025, the Department interviewed Witness RP. RP stated the facility provided R1 with a hospital bed that was not in good repair. RP states the hospital bed was not stabilized but did not provide details about the hospital bed.

On January 24, 2025, the Department interviewed Staff S1. S1 stated R1’s hospital bed and half rails were not in disrepair. S1 showed LPA Dolores and Santino how they use the rails and LPAs observed it was in working condition.

On 9/25/2025, LPA Tarin interviewed 2 staff, S2 to S3. Both staff interviewed stated they have not observed a bed in the facility that was not in good repair

On 9/25/2025, LPAs interviewed 3 Residents R1 to R3. 3 Out of 3 residents did not provide answers to questions LPA’s posed.

Page 2 of 4
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/09/2025
NARRATIVE
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On 10/9/2025, LPAs interviewed 2 residents (R5 and R6). 2 Out of 2 residents stated he/she has no issues with his/her bed.

On 10/2/2025, LPA’s toured the facility and inspected all residents beds. LPA’s observed 6 out of 6 resident beds to be in good repair with no issues.

On 10/2/2025, LPA’s interviewed ADM. ADM stated R1's bed was not in disrepair. ADM stated the wheels on R1's bed would sometimes slide on on the hardwood floor when R1 was transferring out of the bed to a chair.

On 10/6/2025 LPA Tarin interviewed 5 Witnesses (W1 to W5). 4 out of 5 witnesses stated he/she has not observed a resident's bed in disrepair. W1 did not provide additional information.

Facility staff are not trained to assist residents with transfers.
On 1/15/2025 the Department received a complaint alleging Facility staff are not trained to assist residents with transfers.

On 1/24/2025, LPA Dolores interviewed Staff S1. S1 stated staff receives training quarterly. S1 stated staff received training on how to transfer residents.

On 1/17/2025, LPA Tarin interviewed ADM. ADM stated all staff have been trained to transfer residents. ADM stated the training was conducted by a third-party home health agency.

On September 25, 2025, LPA interviewed Staff S2 and S3. Both staff interviewed stated he/she has been trained in how to transfer residents.

On 9/25/2025, LPAs interviewed 3 Residents R1 to R3. 3 Out of 3 residents did not provide answers to questions LPA’s posed.


Page 3 of 4
SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2025 and conducted by Evaluator Marcella Tarin
COMPLAINT CONTROL NUMBER: 26-AS-20250115102820

FACILITY NAME:BECK CARE HOMEFACILITY NUMBER:
435294258
ADMINISTRATOR:ZHANG, YU & LUO, XI-HUAFACILITY TYPE:
740
ADDRESS:1681 BECK DRIVETELEPHONE:
(408) 866-7858
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:6CENSUS: 6DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensees Xi-Hua 'Julia' LuoTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Resident was charged for staff providing basic care and supervision at night.
INVESTIGATION FINDINGS:
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This report was inadvertently amended. Licensing Program Analyst (LPA) Marcella Tarin and Manuel Monter conducted an unannounced visit to deliver the complaint findings and met with administrator Licensee Julia Luo. LPA stated the purpose of the visit.

On 1/15/2025 the Department received a complaint alleging Resident was charged for staff providing basic care and supervision at night. It has been alleged that the ADM was charging for R1's care at night.

RP alleges the facility charged R1 for ‘night charges’, when R1 needed care at night.


Page 1 of 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 8 of 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/09/2025
NARRATIVE
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This page was inadvertently amended. On 9/30/2025 the Department interviewed ADM. ADM stated the facility does not provide care and services for residents from 10:00PM to 6:00AM. ADM states the ‘night charges’ are not listed in the admission agreement. ADM states ‘night charges’ are explained to resident’s responsible parties before being admitted into the facility.

Review of R1’s ‘Night Charges’ log, R1 was charged for ‘night services’ on the following dates: 7/25/2024, 8/5/2024, 9/7/2024, 9/10/2024, 10/3/2024, 10/5/2024, 10/07/2024, 11/6/2024, 11/08/2024, 11/12/2024, 12/31/2024, 1/4/2025. R1’s ‘night services’ are listed as “diaper change, ” “toileting.”

Review of R1’s Admission Agreement dated 4/19/2024, under 5.1 Basic Services, a. “Assistance with bathing, dress, grooming, toileting, eating, continence, transferring from bed or chair, and other personal needs.” Under 5.1 Basic Services, j. “continuous supervision and observations for changes in physical, mental, emotional, and social functions.”

Based on review of R1's physician report dated 12/16/2024, R1's has bladder and bowel impairments and requires assistance with toileting needs. Review of R1's care plan dated 4/20/2024 states staff will assist R1 with bladder and bowel incontinence.


Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.
SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2025
Section Cited
CCR
87625(b)(2
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87625 Managed incontinence (b)(2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.
This is not met as evidenced by:
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ADM stated she will develop an incontinence plan for all her residence who are incontinent. ADM stated this plan will ensure that all incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.
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Based on interview and document review, ADM stated she doesn't check the residents at night 10pm-6am. This poses an immediate health, safety, and personal rights risks to residents in care.
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ADM stated she will also send a letter of understanding regarding the regulation. ADM stated she will submit the plan of correction by POC due date, October 10, 2025.
Type B
10/16/2025
Section Cited
CCR
87507(g)(3)(B)(2)
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87507 Admission Agreements (g)(3)(B)(2) A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement.
This requirement was not met as evidenced by;
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ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will submit the plan of correction by POC due date, October 16, 2025
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Based on interview and records reviewed, the facility charged resident for care being provided from 10pm-6am. ADM stated the night charges are not reflected on the admission agreement. This poses an immediate health, safety, and personal rights risks 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: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 10 of 10
Control Number 26-AS-20250115102820
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: BECK CARE HOME
FACILITY NUMBER: 435294258
VISIT DATE: 10/09/2025
NARRATIVE
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On 10/9/2025 LPAs interviewed 2 residents (R5 and R6). 2 Out of 2 residents stated he/she has no issues when staff assist him/her with transferring.

Based on review of Staff Training and In-Service Record dated 12/27/2024, staff received training on ‘transfer skill training with PT/OT. LPA also reviewed the documentation Caregiver Training for R1 dated 1/8/2025 provided by a third-party home health agency. Documentation included staff signatures and topics such as transferring R1 from wheelchair to bed, bed to wheelchair.

Based on document review, the facility provided training every quarter from 1/26/2024 to 1/8/2025, which included transferring residents from wheelchair to bed, postural support, and assisting during transfers.
Resident's private caregiver sleeping on the couch in the living room

On 1/15/2025 the Department received a complaint alleging Resident's private caregiver sleeping on the couch in the living room.

On 7/16/2025, LPA interviewed ADM. ADM stated he/she has not observed a resident’s private caregiver sleeping on the facility couch.

On 7/16/2025 and 9/25/2025, LPAs interviewed 3 Staff. 3 Out of 3 staff stated they have not observed a resident’s private caregiver sleeping on the facility couch.

On 9/25/2025, LPAs interviewed 3 residents (R2 to R4). 3 Out of 3 residents did not respond to questions posed by LPAs.

On 10/9/2025, LPAs interviewed 2 residents (R5 and R6). R5 and R6 stated they have not seen staff or private care givers sleeping in the couch. R5 and R6 stated they have not seen this.

This agency has investigated the complaint alleging a resident was overcharged for extra month of rent, resident's bedrail and wheels on hospital bed are not in good repair, facility staff are not trained to assist residents with transfers, resident's private caregiver sleeping on the couch in the living room. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

SUPERVISORS NAME: Jin Jackie
LICENSING EVALUATOR NAME: Marcella Tarin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
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