St John of God Residence

Allegation investigated: Due to lack of supervision, residents physically assault other residents Staff threatened authorized representative of eviction Staff did not do a proper reassessment of resident

On 7/9/2026 at 2:35 PM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the above allegations. LPA identified herself and met with Administrator Mary Aguirre, who was informed of the purpose of the visit. On June 11, 2026, at 3:55 PM, the Department requested the staff and client roster for the Assisted Living buildings dated June 10, 2026. Ms. Aguirre was informed that, due to time constraints, the Department would need to return to complete additional interviews and review supplemental records. The investigation consisted of the following: Allegation 1: Due to a lack of supervision, residents physically assault other residents. Allegation 2: Staff threatened an authorized representative with eviction. Allegation 3: Staff did not complete a proper reassessment of a resident. Unfounded The investigation revealed the following: As part of the investigation, on June 12, 2026, at 11:00 AM, the Department contacted Maryy Aguirre and requested the client roster for the Retirement & Care Center–SNF. Upon review of both the Assisted Living roster dated June 10, 2026, and the Retirement & Care Center–SNF roster, the Department determined that R1 is not, and was not, a resident of the Assisted Living Community. Mary Aguirre was also interviewed and she stated R1 is not a resident of the Assisted Living Community. The SNF roster confirmed that R1 is a resident of the Retirement & Care Center–SNF, which is not licensed by the CCLD Adult and Senior Care Division. Because R1 is not a resident of the Assisted Living facility where the allegations were reported to have occurred, the alleged incidents could not have taken place at this location. Based on the evidence reviewed and interviews conducted, the above allegations are determined to be Unfounded, meaning the allegations are false, could not have happened, and/or are without a reasonable basis. The complaint is therefore dismissed. An exit interview was conducted with Administrator Mary Aguirre and a copy of this report, along with appeal rights, was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 9, 2026 · control 11-AS-20260608104233

Type of visit: Required - 1 Year

On 04/24/2026 at approximately 08:14AM, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Assistant Administrator Paula Dela Rosa. LPA explained the purpose of today’s visit. The facility is a two-story RCFE residence, licensed for (35) non-ambulatory and (3) Hospice Residents ages 60 and up. The facility consists of (33) resident bedrooms, (2) visitor bathrooms, (1) living room, (1) activity room, (1) dining room, (1) kitchen, (1) laundry room, and (1) shaded patio area. On 04/24/2026 the Department toured the physical plant with the Assistant Administrator Paula Dela Rosa. There were no bodies of water or obstructions on the premises. A total of (10) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents, personal belongings were observed. The Bathrooms were found to be within Title 22 regulations and were completely operational with grab bars in the shower and grab bars by the toilet. The department inspected () the smoke alarms / carbon monoxide detectors. And they were in operable condition. The water temperature measured between: (113.7°F – 116 °F) in the Kitchen and (110. °F -115.7°F) in the Bathrooms. CONTINUED ON LIC809-C Evaluation Report Continues LIC 809-C The Department observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene products were observed. Sharps objects and cleaning agents were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available on the property premises. All (9) fire extinguishers were inspected, charged and operable. The facility currently has 32 residents, and 3 resident files were reviewed and complete. The facility currently has 8 staffed employees, and 3 files were reviewed. The facility has 2 locked medicine carts stored for residents’ medication. The first AID kit was checked and contained a certified manual and it contained tweezers, thermometer, tape, gauze and scissors. The department observed the facility's Infection Control Practices, Plan of Operations, Emergency Disaster Plan and See Something Say Something Poster, posted in the facilities hallway. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Administrator Arjene Aguirre.the state’s words, verbatim · CDSS document, Apr 24, 2026

Type of visit: Required - 1 Year

On 01/27/2025, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced subsequent annual visit using the CARE Inspection Tool. LPA met with the Patient Care Coordinator Ophelia Cruz. LPA Watson toured the physical plant with the supervisor. There were no bodies of water or obstructions on the premises. A total of(8) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected the smoke/carbon monoxide detectors combo and found that they were recently inspected and in operable condition. The water temperature properly measured between: 111.8 °F and 114°F, between the bathrooms and in the kitchen. Evaluation Report Continues LIC 809-C LPA Troy Watson observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Sharps objects in the facility kitchen and cleaning agents were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available at the property. All fire extinguishers were charged and were operable.The personnel files, resident files and MARs were reviewed. The first AID kits was checked and contained the correct manual, tweezers, scissors, tape, and gauze. LPA observed the facility's infection control practices. All required postings were displayed and present at the facility. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Ophelia Cruz.the state’s words, verbatim · CDSS document, Jan 27, 2025

Type of visit: Required - 1 Year

On 01/13/24, LPA conducted an annual inspection. LPA met with the Administrator Arjene Aguirre and the purpose of today’s visit was explained. The annual visit consisted of the following: The department requested and obtained copies of the staff roster, resident roster, face sheet, physicians report, preplacement appraisal information, needs and service plan, personal rights. Due to insufficient time, the annual inspection will have to continue at a later time. An exit interview was conducted with Administrator Arjene Aguirre and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 13, 2025

Type of visit: Required - 1 Year

On 2/1/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced Annual required visit using the CARE tool. LPA was met by Assistant Administrator Arjene Aguirre and the purpose of today’s visit was explained. LPA was granted access into this facility. The facility is licensed to serve 40 non-ambulatory residents ages 60 and above. St. Benidict Menni is the buildings name. Delayed egress approved-dementia special program. Hospice waiver approved for three (3) residents. There are currently twenty-three (23) residents in placement. The facility is a two-story structure located in a residential neighborhood. It consists of thirty-three (33) resident bedrooms with private bathrooms, dining room, kitchen, living room, shaded area, indoor and outdoor activity area, laundry room and media room. LPA and Assistant Administrator toured the physical plant inside and out. Bedrooms 225, 230, 216 and 207 were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings were observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be complying within Title 22 regulations and were clean and operational. The water temperature measured between 105.0 F and 120.0 F. In bathroom 225 water temperature measured at 112.8, in bathroom 230 water temperature measured at 112.3, in bathroom 216 water temperature measured at 113.1, and in bathroom 207 water temperature measured at 113.2. A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was checked and observed to be within Title 22 regulations. Sharps, toxins, cleaning solutions, hazardous items, and medications were secured and inaccessible to residents. Medications were centrally stored and properly locked. Continued on LIC 809-C Smoke detectors and carbon monoxide detectors were operational and working properly. Fire extinguishers were fully charged. LPA observed a stocked First Aid kit along with manual locked and inaccessible to residents. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. There are sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings and all mandated inspection control postings throughout the facility. The facility has an approved CCLD Mitigation Plan. During this inspection LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Report and Appeal Rights was provided to Assistant Administrator Arjene Aguirre.the state’s words, verbatim · CDSS document, Feb 1, 2024