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Allegation investigated: Personal Rights Facility is not kept clean, safe, and sanitary Illegal drugs present in facility Uncleared adults residing or working in the facility

On 05/13/2026, Licensing Program Analyst (LPA) Julie Florio, Licensing Program Manager (LPM) Bethany Moellers, LPM, Kimberly Mota, and Regional Manager (RM), Carla Nuti-Martinez arrived unannounced to deliver complaint # 21-AS-20260424101234 investigation findings and met with Arlene Wing, Licensee. The complainant alleges the following: personal rights violations; the facility is not kept clean, safe, and sanitary; there are illegal drugs present in facility; and there are uncleared adults residing or working in the facility. The Department conducted 10-day complaint investigation visit on 04/24/2026 and obtained documents, made observations, and conducted interviews with Individual 1 (I1), staff and clients which revealed sufficient evidence to support the allegation that the clients’ personal rights have been violated. Continued on LIC9099C... Substantiated Continued from LIC9099... I1 expressed frustration that the clients were allowed to “go wherever” they wanted in the common areas. I1 explained that clients should be in their rooms between 2100 hours to 0800 hours and I1 expressed being upset that the clients have access to the whole house. Staff and client interviews revealed that I1 “gets loud” with them, has had verbal altercations with them, screams and yells at them, acts erratic, makes them feel uncomfortable, and has reviewed unsecured client files without their consent. Both staff and client interviews revealed that there have been multiple instances where a pin was observed inserted in the sliding door that provides the female clients with access to the living room. The pin in the door prevented the door from opening. Interviews also revealed that I1 stated they had drilled the hole and placed the pin into the door to lock it. During facility inspection, the Department observed a hole in the door consistent with interviews conducted. Interviews with staff and clients revealed that I1 locked the refrigerator preventing the clients access to food on more than one occasion. Interviews with I1 and staff, along with a review of available information, revealed sufficient evidence to support the allegation that the facility is not kept clean, safe, and sanitary. It was revealed that I1 may possess or store firearms at the facility. I1 admitted possessing firearms but denied storing them at the facility; however, one staff witness observed I1 with a firearm on the premises in 2025. Staff also reported that I1 made verbal threats involving the use of a firearm against clients or other individuals in 2025 and 2026. I1 and Licensee denied access to I1’s room, preventing verification of whether firearms were present or stored inside. Additionally, I1 resides in a room where the entryway was observed obstructed. Licensee stated they did not have key or access to this room in the event of an emergency. As mentioned above, I1 locked clients in area of the facility which is not approved to be locked. During the 04/27/2026 facility visit, LPA and LPM smelled a urine odor in the facility, and observed unsecured medications, motor vehicle chemicals, pesticides, and manual and power tools accessible to clients in care. Interviews with staff and clients revealed that they have observed containers of human urine and feces around the facility. Interviews with I1, staff and clients revealed sufficient evidence to support the allegation that I1 may possess, store, or consume controlled substances at the facility. In April 2026, Client 1 (C1) directly observed I1 smoking a glass pipe used with methamphetamines on the premises and reported that I1 made comments regarding seeking money to buy and share drugs. I1 and Licensee denied access to I1’s room, preventing verification of whether controlled substances were present or stored inside. Continued on LIC9099C... Continued from LIC9099C... The Department issued a citation on 05/01/2025 for uncleared individuals being present at the facility. At that time, the Licensee stated they planned to make I1 a client of record. During the 04/27/2026 complaint investigation visit, the Licensee did not have the required documentation per regulation to verify that I1 was a client. I1 resides in a room that is not fire cleared for clients. Per interview with Licensee, it was revealed that I1 is more of a tenant than a client and that they have a verbal agreement allowing I1 to live there. I1 is not fingerprint cleared as required per regulation for all non-clients residing in the facility. Based on interviews conducted, observations made, and records reviewed, the allegations listed above are SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited from Title 22 Regulations, Division 6. Exit interview conducted. Copy of report discussed and provided to Licensee, whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, May 13, 2026 · control 21-AS-20260424101234

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: May 14, 2026

Fire Clearance 87202(a): (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.[...] This requirement is not met as evidenced by: Based on observations made, photos obtained, and interviews conducted, the Department confirmed that clients were restricted to one area in the facility, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: May 14, 2026

Maintenance and Operation 87303(a) : The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on interviews conducted, the Department confirmed that I1 made verbal threats involving the use of a firearm against clients and other individuals, LPA observed unsecured chemicals, tools, medications, and smelled a urine odor, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 14, 2026

87468.1 Personal Rights of Residents in All Facilities: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews conducted, the Department confirmed that I1 was observed using a glass pipe used in methamphetamines at the facility, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87355(e) · Plan of correction due date: May 14, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Based on observations made, records obtained, and interviews conducted, the Department confirmed that I1 is an uncleared adult on the facility grounds, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee was served a Temporary Suspension Order on May 13, 2026. The facility license has been suspended as of May 13, 2026 at 10:45 AM.

Type of visit: Case Management - Other

At approximately 10:45 AM, Licensing Program Analyst (LPA) Julie Florio, Licensing Program Manager (LPM), Bethany Moellers, LPM, Kimberly Mota, Regional Manager (RM), Carla Nuti-Martinez, Local Sheriff, Lake County Behavioral Health, Lake County Public Guardian, Adult Protective Services, Local Long Term Ombudsman, and potential placement professionals for residents in care arrived unannounced to deliver a temporary suspension order (TSO) and met with Licensee, Arlene Wing. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) clients in care. Facility is approved for 6 non-ambulatory residents and has a Hospice waiver for 2. RM reviewed TSO packet with Licensee who conveyed understanding, Licensee was informed of APS contact information and services. Immediate exclusion for Individual 1 (I1) was provided to Licensee. LPA delivered complaint investigation #21-AS-20260424101234 substantiated findings on all four allegations. License obtained. All clients in care were relocated at the time TSO was issued, relocation sites provided. Exit interview conducted with Arlene Wing.the state’s words, verbatim · CDSS document, May 13, 2026

Type of visit: Office

An office meeting was conducted today, 04/22/2026, in the Santa Rosa Regional Office. The following individuals were present in the meeting: Licensing Program Manager, Bethany Moellers, Licensing Program Analyst, Julie Florio, Licensee, Arlene Wing. The purpose of the informal office meeting was to discuss the current operation of the facility and uncleared adults on the facility grounds. On 05/01/2025, the Department received a complaint regarding uncleared adults on the facility grounds which was substantiated on 05/06/2025, when LPAs observed multiple uncleared individuals residing in the facility. An immediate civil penalty in the amount of $1,100 was issued during that visit and Licensee agreed to have the individuals fingerprinted and background cleared. Following this visit, Individual 1 (I1) did not pass their background screening and Licensee agreed that I1 would not stay on the property to ensure compliance with regulation. Subsequently, on or about 04/23/2026, the Department received information that I1 is residing on the property again. On or about, 04/08/2026, LPA Florio spoke with Licensee via telephone where the conversation revealed that I1 has been staying on the property in their car. During today's office meeting, Licensee was informed that I1 shall not reside on the property unless an exemption is obtained. The process for attempting to obtain a background clearance exemption was explained to Licensee. No deficiencies were cited during today's office meeting. Exit interview conducted with Licensee whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Required - 1 Year

At approximately 1:45 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Licensee, Arlene Wing, was contacted via telephone and arrived at approximately 2:45 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with 4 residents in care. Facility is approved for 6 non-ambulatory residents and has a Hospice waiver for 2. At approximately 1:45 AM, LPA initiated a tour of the facility with staff and observed the following: Facility is a one story building, was a comfortable temperature, and passageways were free from obstructions. Facility has agreed to post warning signs at all faucets and showers that test above the allowable water temperature range of 105 to 120 degrees F per Title 22 regulations in order to bring the facility into compliance. LPA observed a supply of hygiene products, clean linens, paper products, and incontinent care briefs available for residents. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were observed centrally stored and locked. There is a covered seating area in the backyard with outdoor space for activities. Facility has internet available to residents in care and the phone was tested an operational. Facility agrees to purchase an internet access device and have it available to residents in care. Facility's fire extinguishers were observed charged and were last serviced 05/2025. Facility Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on LIC809-C... Continued from LIC809... Facility conducts quarterly disaster drills with the most recent drill conducted 05/2025. LPA observed facility's infection control plan and emergency disaster plan which was last updated 08/2022. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights for emergency preparedness. Facility has a generator. Licensee agrees to submit a copy of the facility's current liability insurance to the Department. At approximately 2:30 PM, LPA reviewed three (3) staff files and four (4) resident files. Three (3) of three (3) staff files reviewed have all of the required paperwork and proof of current CPR and First Aid training. Staff 2 (S2) and Staff (3) were missing proof of the required annual and medication training hours, (see LIC809D). Four (4) of four (4) resident files reviewed have all the required paperwork. Licensee agrees to ensure all residents' needs and services care plans are complete and current in order to bring the facility back into compliance. Licensee and facility staff coordinate residents' medical and dental visits and transportation to and from their appointments. At approximately 4:00 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation. Facility does not manage P&I for residents. The following updated documents shall be submitted to CCL within 30 days of this inspection: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate (when receive) Copy of Certificate of Liability Insurance 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, or repeat violations within a 12 month period, may result in a civil penalty assessment. Exit interview conducted with Licensee whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, Aug 6, 2025

Allegation investigated: Uncleared adults on the facility grounds

On 05/06/2025, Licensing Program Analysts (LPAs) Julie Florio and Christopher Arnhold arrived unannounced to initiate a 10-day complaint investigation and deliver complaint findings regarding LIC802 - Complaint Report #21-AS-20250501100125, which was received by Community Care Licensing (CCL) on 05/01/2025. LPAs met with Arlene Wing, Licensee. The complainant alleges that there are uncleared adults on the facility grounds. During inspection, LPAs made observations, reviewed records, and conducted interviews. Based on observations made and interviews conducted, LPAs confirmed that there are three uncleared adults on the facility grounds (see LIC9099D and LIC421BG). A civil penalty in the amount of $1,100 if being issued during today's visit. Continued on LIC9099C... Substantiated Continued from LIC9099... Based on interviews conducted, observations made, and record review, the allegation listed above is SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency is cited from Title 22 Regulations, Division 6. Exit interview conducted. Copy of report discussed and provided to Licensee, whose signature on form confirms receipt of documents. Appeal rights provided.the state’s words, verbatim · CDSS document, May 6, 2025 · control 21-AS-20250501100125

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: May 16, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Based on observations made and interviews conducted, LPAs confirmed that there are three uncleared adults on the facility grounds, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 6, 2025

Plan of correction: Licensee to self certify that the three adults observed in the facility during today's inspection will get fingerprint cleared by 05/07/2025. Licensee to submit proof that this process has been intiated to CCL by POC due date 05/16/2025.

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required – 1 yr. inspection of this RCFE and was greeted by staff Sarah Steptoe. LPA met with licensee/Administrator, Arlene Wing. There is a total of 5 residents none are diagnosed with dementia. There are no residents currently on Hospice. At 9:00 AM LPA toured facility with staff & Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the facility laundry room and locked hallway closet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Fire Extinguisher was found to be last charged on 2/1/2024 at the time of the visit. Smoke Detectors and carbon monoxide detectors were found to be operational at the time of visit. Residents bathroom faucet water tested 119 & 131.7 degrees F. at time of visit, falling out of Title 22 Regulation range of 105 degrees F. and 120 degrees F , Facility to put a sign up for individual bathroom that temp exceeds 125 (see LIC 9102). There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A review of five resident & two staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 9:45 AM and learned that 5 of 5 residents have an updated re-appraisals/needs & care plans and physician’s assessments (LIC 602A). Continue on LIC 809-C LPA reviewed a sample of staff records at 10:45 AM and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements are current. LPA was presented with proof CPR & 1st Aid certification for staff of files reviewed are current. Arlene Wing Administrator Certificate # 6045408740 expired on 8/22/2023. Administrator informed they have completed most of the required training hours and will submit. LPA is citing facility for no current Administrator Certificate 87405(a) (see LIC809-D). Medications were centrally stored in locked cabinet in facility office area. The Medications of 2 out of 5 residents were found to be given according to physicians’ directions on 8/27/2024 at 11:55 AM. Centrally Stored Medication Record (CSMR) of 2 out of 5 residents were found to be complete and accurate. Disaster Drills are conducted quarterly with the last one being conducted on 7/25/2024. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 9/17/2024: LIC 308 Designated (if changes) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate (when receive) Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Aug 27, 2024