Golden Hills Retirement Ctr

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan met with Assistant Administrator Adriana Cisneros for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. This facility is fire cleared for sixty (60) non-ambulatory residents, ten (10) of which may be bedridden. Hospice waiver for six (6) residents. A tour of the physical plant was conducted at 9:12 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. The facility had submitted and approved Mitigation and Infection plan. The facility have designated visitors' area at the front yard. The facility has sufficient stock of PPE in the office upstairs. The facility is a two (2) storey building with shared and private bedrooms and bathrooms. Second floor is used only as an office/storage for staff use only. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and tested regularly every month. Fire inspection was last done on 06/30/26 and valid until 03/31/28. The facility is also equipped with sprinkler system which was last tested on June 2026 and valid for five (5) years. Fire extinguishers are located all throughout the facility and were last serviced on 10/13/25. Fire Drill was last conducted on 07/03/26. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. (continued to LIC 809-C) (continued from LIC 9099) Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 108.6°F to 119.2°F and observed to be within the required range. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications were observed to be stored in designated Medication room. The Medication room was observed to be locked at the time of visit. There is a complete set of first aid kit in the Medication room. Resident/Staff File Review: LPA reviewed records of five (5) random residents and five (5) staff. Residents and staff records appeared to be complete and updated. Laundry room located in the underground level of the facility and observed to be locked during visit. There is no immediate health and safety hazard during this visit. Exit interview conducted. Copy of this report issued,the state’s words, verbatim · CDSS document, Aug 22, 2026

Allegation investigated: Staff left resident soiled for an extended period of time Staff did not respond to residents call for help Staff did not ensure documents are not accessible to residents

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Itzel Guevarra and explained the reason for the visit. LPA conducted physical plant tour at 9:20 AM, requested copies of facility documents at 9:49 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:15 PM. Regarding the allegation that Staff left resident soiled for an extended period of time, it was alleged that Resident #1 (R1) was found covered in own urine when the Agency Staff arrived on shift. LPA's record review today between 10:00 AM to 11:00 AM revealed that on 04/28/26 the facility staff changed R1's diaper to 1:20 AM, 3:00 AM, 5:40 AM, 7:00 AM and 9:05 AM., or immediately after the arrival of Agency Staff at 9:00 AM. LPA's interview with four (4) other incontinent residents today between 11:00 AM to 2:30 PM revealed that four (4) out of four (4) residents interviewed stated that they are being changed regularly by staff all the time including nights. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099-C) Regarding the allegation that Staff did not respond to residents call for help, it was alleged that R1 called for help and needed assistance to change but help did not arrive. LPA's interview with R1 today at 11:29 AM revealed that whenever R1 needed help staff always come. LPA's interview with Staff #1 (S1) today at 12:45 PM revealed that S1 regularly checked on R1 during shift and did not get any call from R1 at any time during S1's shift. LPA's interview with four (4) other incontinent residents today between 11:00 AM to 2:30 PM revealed that four (4) out of four (4) residents interviewed stated that staff always come to help whenever they call at any time. Regarding the allegation that Staff did not ensure documents are not accessible to residents, it was alleged that the facility did not present any logs of the rounds they do every two hours during the night, rather they said a resident goes into the office and takes their documents to draw on. LPA's observation during today's visit revealed that the Incontinent log was always kept in the office to be accessible to all caregivers to sign on every after routine checks to all residents but this particular resident (R2) always picks up any paper near or by the office and write/draw on them. LPA's interview with staff and Administrator revealed that the Incontinent log was located at the table in the office and R2 reached out from the window to open the office and took the Incontinent log and drew on them. The log did not have any information aside from the name of the resident and the time and staff initials when they did the routine check on the resident. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 13, 2026 · control 31-AS-20260507112329

Type of visit: Case Management - Other

LPA conducted an unannounced case management visit at this facility to conduct health and safety check and operational well being of the facility. LPA conducted physical plant tour at 11:23 AM, LPA observed that the facility has enough supplies of food both perishable and non-perishable. LPA also observed that they have sufficient stock cleaning supplies and toiletries in their storage. The facility is fully staffed during visit. LPA also conducted interview with staff and administrator. Staff interview revealed that they did not experience any financial distress at this facility pay and operation wise. There is no health and safety issue during this visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 8, 2026

Allegation investigated: Staff speaks inappropriately to resident Staff do not ensure resident has privacy in their bedroom

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Itzel Guevarra and explained the reason for the visit. LPA conducted a physical plant tour at 9:23 AM, requested copy of facility documents relevant to the investigation at 10:02 AM, reviewed records from 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM and 1:00 PM. Regarding the allegation that Staff speaks inappropriately to resident, it was alleged that staff told Resident #1 (R1) "a drunk and every bad thing a person can call a person". LPA’s record review today between 10:15 AM to 11:15 AM revealed that R1 made similar allegations on 05/16/24 under complaint control number 31-AS-20240516145438 and then again on 11/04/24 under complaint control number 31-AS-20241104113106 and again on 07/31/ 25 under complaint control number 31-AS-20250731111405. All were unsubstantiated (please see reports on the same date). (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA’s interview with R1 today at 11:19 AM revealed that R1 did not directly hear any staff talking to or about R1 but heard it over the speaker on the wall and the Television on R1's room. LPA did not observe any speaker on the wall nor a hidden camera nor a bug in R1's room. LPA's interview with the Assistant Administrator today at 1:12 PM revealed that this is an ongoing thing with R1 that whenever R1 goes to the hospital or anywhere else outside of the facility such as mental health clinics or the like. Regarding the allegation that Staff do not ensure resident has privacy in their bedroom, it was alleged that staff put a “bug by the end table and can tell what R1 was reading and they have a microphone and cameras in R1's room. LPA's observation today revealed that there was no speaker on the wall, no microphone or any camera's installed in R1's room. LPA's interview with the Administrator today confirmed that the facility doesn’t install any microphone, "a bug" and/or camera in R1's room. LPA's record review today also revealed that R1 had a mental health condition that causes paranoia. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 9, 2025 · control 31-AS-20251204081145

Allegation investigated: Staff administering unprescribed medication to resident.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. LPA conducted a physical plant tour at 9:30 AM, requested copies of facility documents relevant to the investigation at 9:58 AM, reviewed records between 10:05 AM to 11:15 AM and interviewed residents and staff between 11:15 AM to 1:00 PM. Regarding the allegation that Staff administering unprescribed medication to resident, it was alleged that staff are crushing up a medication called Taminal and put it into Resident #1 (R1)'s food. LPA's interview with R1 today at 12:18 PM, revealed that the staff did not give R1 unprescribed medication, R1 was given a medication that is called Klonopin (Clonazepam) that is blue in color but now the staff are giving R1 a green colored pill which they say is the same medication. LPA's record review today at 10:05 AM, revealed that Klonopin is a Pro Re Nata (PRN) medication or only given as needed for R1 and the pill color is green. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's observation during inspection of R1's medication confirmed that all Klonopin (1 mg) pills are green in color compared to other residents' medication of the same name. LPA's interview with staff today between 11:15 AM to 1:00 PM revealed that the same medication used to be color blue but the pharmacy is sending them the green ones, both two (2) medication staff interviewed denied crushing any pill for R1 as they have no doctor's order for it. LPA's record review confirmed that there was no order for R1 to be given a crushed pill. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 28, 2025 · control 31-AS-20251020105302

Allegation investigated: Staff hit resident

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint to further investigate the above allegations. LPA initially met with staff Emily Shah who called the Administrator and explained the reason for the visit. LPA conducted physical plant tour at 12:30 PM, requested copy of facility documents relevant to the investigation at 12:50 PM and interviewed staff and resident between 12:50 PM to 1:30 PM. Regarding the allegation that Staff hit resident, it was alleged that Staff #1 (S1) and Staff #2 (S2) were "whacking" and "smashing" Resident #1 (R1)'s hands repeatedly. LPA's interview with S1 on 09/25/25 revealed that S1 did not touch R1 unless doing S1's regular duty such as changing R1's diapers and/or dressing R1. S1 denied smashing or whacking R1's hand at any time S1 was working with R1. LPA's interview with S2 today revealed that S2 also denied hurting R1's arm in any way. LPA's interview with R1 today revealed that it was the nurse at the hospital who smashed R1's hand over and over again and denied any staff at the facility hurting R1. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 27, 2025 · control 31-AS-20250923134116

Allegation investigated: Staff left resident soaked in urine Staff does not ensure resident has wheelchair access to the bathroom

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint to further investigate the above allegations. LPA initially met with staff Emily Shah who called the Administrator and explained the reason for the visit. Assistant Administrator arrived 30 minutes later. LPA conducted physical plant tour at 8:30 AM, requested copy of facility documents relevant to the investigation at 9:02 AM and interviewed staff and residents between 9:30 AM to 12:00 PM. Regarding the allegation that Staff left resident soaked in urine, it was alleged that R1 was soaked in urine during Reporting Party’s (RP)’s visit. LPA's interview with R1 today at 10:02 AM, revealed that there was no time that R1 was left soaked or soiled for a long time and staff are regularly changing R1 at all times. LPA's interview with four (4) incontinent residents today revealed that four (4) out of four (4) residents interviewed stated that staff change them regularly and check on them regularly all the time. (continuef on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with two (2) staff today confirmed that they changed incontinent residents regularly four (4) to five (5) times a day during their shift and check on them every one and a half (1 1/2) hours to two (2) hours. Regarding the allegation that Staff does not ensure resident has wheelchair access to the bathroom, it was alleged that R1 is unable to get into the available bathrooms. LPA's observation during physical plant tour revealed that the bathroom nearest R1's room is wheelchair accessible and about fifteen (15) feet away. Further, LPA observed that R1 was able to wheel self around the facility going to the dining room, TV room and office which is farther than R1's room. LPA's interview with the staff revealed that R1 would rather have the staff change R1's diapers rather than going to the bathroom. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 27, 2025 · control 31-AS-20250611093220

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan met with Administrator Itzel Guevarra for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. This facility is fire cleared for sixty (60) non-ambulatory residents, ten (10) of which may be bedridden. Hospice waiver for six (6) residents. A tour of the physical plant was conducted at 9:14 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. There are required poster posted at the main door. Screening area is located immediately upon entrance. There is also a sign in sheet, hand sanitizer, gloves and masks available. The facility had submitted and approved Mitigation and Infection plan. The facility have designated visitors' area at the front yard. The facility has sufficient stock of PPE in the office upstairs. The facility is a two (2) storey building with shared and private bedrooms and bathrooms. Second floor is used only as an office/storage for staff use only. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and tested regularly every month. Fire inspection was last done on 08/04/23 and valid until 05/31/26. The facility is also equipped with sprinkler system which was last tested on April 2023 and valid for five (5) years. Fire extinguishers are located all throughout the facility and were last serviced on 10/09/24. Fire Drill was last conducted on 07/10/25. (continued to LIC 809-C) (continued from LIC 9099) Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 117.3°F to 118.6°F and observed to be within the required range. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications were observed to be stored in designated Medication room. The Medication room was observed to be locked at the time of visit. There is a complete set of first aid kit in the Medication room. Resident/Staff File Review: LPA reviewed records of five (5) random residents and five (5) staff. Residents and staff records appeared to be complete and updated. Laundry room located in the underground level of the facility and observed to be locked during visit. There is no immediate health and safety hazard during this visit. Exit interview conducted. Copy of this report issued,the state’s words, verbatim · CDSS document, Sep 11, 2025

Allegation investigated: Staff does not ensure resident's medical needs are being met Staff does not provide resident toiletries.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with the Assistant Administrator and explained the reason for the visit. LPA conducted a physical plant tour at 9:28 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegations that Staff does not provide resident toiletries, it was alleged that there are no paper towels or towels in Resident #1 (R1)'s bathroom to dry hands after washing. LPA's observation on 06/03/25 and today during physical plant tour revealed that of the nine (9) rooms visited including that or R1's, all nine (9) rooms have towels and toiletries in their room. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with five (5) residents or more than 10% of current census revealed that five (5) out of five (5) residents interviewed were provided with towels and toiletries everyday by the staff and if they need more, they always ask the office and they are provided with toiletries including but not limited to soap, shampoo & deodorant. Regarding the allegation that Staff does not ensure resident's medical needs are being met, it was alleged that R1 was supposed to be given the opportunity to go to the hospital lab to get stool samples so that R1 can be further tested with regards to R1's chronic medical condition. To date this still hasn't happened and it can't be left for R1 to figure out. LPA's interview with R1 on 06/23/25 at around 11:00 AM revealed that R1 was the one who supposed to make the appointment to the medical test but hasn't done so yet. LPA's interview with R1's Social worker from non-governmental agency that helps R1 for all medical appointments and transport revealed that they were the ones responsible to make an appointment and bring R1 to any medical or diagnostic appointments and not the facility. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 20, 2025 · control 31-AS-20250529123348

Allegation investigated: Staff made an inappropriate comment towards a resident in care

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. LPA conducted a physical plant tour at 9:28 AM, requested copies of facility documents relevant to the investigation at 9:59 AM and interviewed residents and staff between 11:10 AM to 1:00 PM. Regarding the allegation that Staff made an inappropriate comment towards a resident in care, it was alleged that Staff #1 (S1) was going to take Resident #1 (R1)’s “(marijuana) pipe” even if she has to drag R1 out of R1’s room. LPA’s record review today between 10:00 AM to 11:00 AM revealed that R1 made similar allegations on 05/16/24 under complaint control number 31-AS-20240516145438 and then again on 11/04/24 under complaint control number 31-AS-20241104113106 and both were unsubstantiated (please see report on the same date.) LPA’s interview with R1 today at 11:15 AM revealed that S1 did not directly tell R1 but heard S1 over the speaker on the wall of R1's room. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099-C) LPA’s observation during physical plant tour revealed that there is no speaker on R1's room wall or any resident's room anywhere. LPA's interview with Resident #2 (R2) or R1's roommate today at 11:59 AM today revealed that R2 did not experience nor witness S1 saying inappropriate comments at anyone. LPA’s interview with a total of four (4) residents or 10% of current census revealed that four (4) out of four (4) residents interviewed did not experience or witness S1 saying inappropriate comments to anyone at the facility. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 1, 2025 · control 31-AS-20250731111405

Allegation investigated: Staff is overcharging resident Staff is not addressing facility plumbing issues Staff does not ensure resident's restroom is kept sanitary

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. LPA conducted physical plant tour at 9:31 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed residents and staff between 10:15 AM to 1:00 PM. Regarding the allegation that Staff is overcharging resident, it was alleged that Resident #1 (R1) was told that there is a $300 fine if R1 soils bedding and the facility has to provide new. LPA's record review today at 1:00 PM revealed that R1 is a client of Los Angeles County Department of Mental Health (LA DMH) and does not have a Share of Cost (SOC) or simply, R1 is not paying the facility out of pocket. LPA's interview with R1 today at 10:18 AM, revealed that it was a misrepresentation of R1's statement, R1 denied saying there was a fine at the facility. LPA's interview with the Assistant Administrator (AA) today at 11:04 AM revealed that AA is not aware of any fine at the facility nor they impose any fine at any resident at any time. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff is not addressing facility plumbing issues, it was alleged that R1 was informed that the facility has very bad plumbing. LPA's observation during physical plant tour at around 9:31 AM, revealed that there was no issue on R1's room plumbing, LPA tested that toilet multiple times and the bathroom sink and shower too and did not observe anything wrong or there is any plumbing issue at R1's bathroom. LPA's interview with R1 today with revealed that there is no plumbing issue at R1's room and was only told by the staff of the probable issue with plumbing. LPA's interview with R2 or R1's roommate confirmed that there was no plumbing issue in their bathroom Regarding the allegation that Staff does not ensure resident's restroom is kept sanitary, it was alleged that R1 has been using Depends (Pull up Diaper), that R1 will wear the same item for weeks on end for fear that there is nowhere or no process to dispose of it. LPA's record review today revealed that R1 has no bladder and/or bowel impairment, ambulatory and has the capacity for self-care including but not limited to bathing, dressing, grooming and toileting. LPA's interview with R1 today revealed that R1 used Depends sparingly at R1's own volition only. R1 stated that R1 goes to the bathroom on R1's own and able to take care of own toileting needs and denied being incontinent. LPA's observation during physical plant tour revealed that there is a trash can with lid at R1's bathroom. Based on the information gathered during this visit, these allegations are unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 3, 2025 · control 31-AS-20250529123348

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff did not prevent resident from being sexually abused

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. On 09/26/24, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted as an assignment by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Olivia Spindola to interview Resident #1 (R1). On 09/27/2024 at 9:16 AM, LPA initiated the complaint visit. LPA interviewed the assistant administrator, staff and residents and obtained copies of the facility records relevant to the investigation. (continued to LIC 9099) Unsubstantiated (continued from LIC 9099) During the course of the investigation, LPA Tan interviewed the assistant administrator, staff, and resident on 09/27/24 between 10:30 AM PM to 1:15 PM. Investigator Spindola interviewed R1 on 10/23/24 at approximately 12:30 PM. Regarding the allegation that Staff did not prevent resident from being sexually abused, it was alleged that R1 was sexually abused by Resident #2 (R2). Investigator Spindola’s interview with R1 revealed that no other resident bothered R1. Further, R1 denied being raped or sexually abused by R2 at any time. LPA’s record review on 03/29/25 at 9:44 AM revealed that R1 has a history of false accusation against staff and resident prior to this complaint, please see report dated 09/15/22 (complaint control no.: 31-AS-20220321155906) and 03/28/24 (complaint control no.: 31-AS-20240320145828) LPA’s interview with Assistant administrator also confirmed that R1 had accused R2 before and other staff of abusing R1 physically and sexually but it never really happened as R1’s room is located just in front of the front office which is manned by a staff 24/7. Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 6, 2025 · control 31-AS-20240926144530

Allegation investigated: Staff failed to ensure medication were assisted with as prescribed.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a initial complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Itzel Guevara and advised them about the visit. At 10:45 AM LPA conducted a physical plant tour to ensure the health and safety of the clients in care. An entrance interview was conducted. Allegation #1: Staff failed to ensure medication were assisted with as prescribed. It was alleged that Resident #1(R1) was not given medication (PRN) when needed as prescirbed by physician. LPA did a record review on 1.2.2025 between 11:15 AM to 12:30 PM revealed that R1 has been getting their medication on-time as precribed by the physician. Continue to LIC 9099-C Unsubstantiated At 11:30 AM LPA interview with three (3) staff on 1.2.2025 confirmed that R1 called 911 on 11.29.2024 by themselves and was brought to the hospital for breathing issues. Upon discharged R1 was adamant about getting Clonazepam for a refill, that was just prescribed for only 14 days. Refill request was denied by prescribing physician and/ or primary care physician (PCP); which made R1 was very upset with the facility. LPA interview seven (7) out of thirty-five (35) residents who were at the facility and it was revealed that medication were given on-time to all the residents with the right dosage. A review of R1’s Medication Administration Record (MAR) supported the information received from staff. Therefore, residents interview revealed that staff do administer medications as prescribed and on time. Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 2, 2025 · control 31-AS-20241227105933

Allegation investigated: Resident is being verbally abused while in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. LPA conducted physical plant tour at 9:23 AM, requested copy of facility documents relevant to the investigation at 9:55 AM, reviewed records from 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. It was alleged that Resident #1 (R1) is experiencing verbal abuse and name calling to where R1 lives. LPA's record review between 10:00 AM to 11:00 AM today revealed that R1 made the same allegation on 05/16/24 under complaint control number 31-AS-20240516145438 and was unsubstantiated. LPA's interview with R1 today at 11:37 AM revealed that R1 did not personally see or heard any of the staff verbally abusing or calling R1 names but only overheard it through the wall of R1's room. Further interview with R1 also revealed that R1 narrated the same things that R1 told the LPA during the interview on the prior complaint stated above. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with three (3) staff today between 11:00 AM to 1:00 PM revealed that no one among the three (3) staff witnessed anyone calling R1 names or yelling or verbally abusing R1. Further, all the staff interviewed denied calling R1 names, yelled or verbally abused R1. LPA's interview with four (4) residents today between 11:00 AM to 1:00 PM revealed that all of them did not experience being called names, yelled at, or verbally abused by any staff nor witnessed any staff calling names, verbally abusing, or yelling at any resident. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 31-AS-20241104113106

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Gary Tan and Michael Cava met with Administrator Itzel Guevarra and Office Manager Adriana Cisneros for a One (1) Year Required visit for this facility. LPAs explained the reason for the visit. This facility is fire cleared for sixty (60) non-ambulatory residents, ten (10) of which may be bedridden. Hospice waiver for six (6) residents. A tour of the physical plant was conducted at 11:15 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. There are required poster posted at the main door. Screening area is located immediately upon entrance. There is also a sign in sheet, hand sanitizer, gloves and masks available. The facility had submitted and approved Mitigation and Infection plan. There are hand sanitizing stations all over the facility. There are signs for Covid 19 prevention protocol were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in common bathrooms and all over the common areas of the facility. The facility have designated visitors' area at the front yard. The facility has sufficient stock of PPE in the office upstairs. The facility is a two (2) storey building with shared and private bedrooms and bathrooms. Second floor is used only as an office/storage for staff use only. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and tested regularly every month. Fire inspection was last done on 08/14/23 and valid until 05/31/26. The facility is also equipped with sprinkler system which was last tested on April 2023 and valid for five (5) years. Fire extinguishers are located all throughout the facility and were last serviced on 10/12/23. Fire Drill was last conducted on 07/08/24. (continued to LIC 809-C) (continued from LIC 9099) Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPAs observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPAs observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPAs observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 114.4°F to 118.9°F and observed to be within the required range. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications were observed to be stored in designated Medication room. The Medication room was observed to be locked at the time of visit. There is a complete set of first aid kit in the Medication room. Resident/Staff File Review: LPAs reviewed records of four (4) random residents and five (5) staff. Resident and staff records appeared to be complete and updated. Laundry room located in the underground level of the facility and observed to be locked during visit. There is no immediate health and safety hazard during this visit. Exit interview conducted. Copy of this report issued,the state’s words, verbatim · CDSS document, Aug 21, 2024

Allegation investigated: Staff stole resident's credit card Staff did not safeguard resident's funds.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. LPA conducted physical plant tour at 9:05 AM, requested copies of facility documents relevant to the investigation at 9:43 AM and interviewed staff and residents between 10:00 AM to 12:00 PM. LPA also conducted record review between 12:15 PM to 1:00 PM. Regarding the allegation that staff stole resident's credit card, it was alleged that staff is taking Resident #1 (R1)'s credit cards. LPA's interview with R1 on 01/25/24 at around 12:30 PM revealed that no staff took R1's credit card and R1 kept all of R1's bank cards and denied any usage from any staff. LPA's observation also revealed that R1 had own one on one caregiver from Lanterman Regional Center five (5) days a week during daytime. LPA's interview with the R1's caregiver confirmed that R1 did not lose any bank card or not that the caregiver was aware of since started working with R1. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not safeguard resident's funds, it was alleged that R1 had a $6000 check that was missing. LPA's interview with R1 on 01/25/24 at around 12:30 PM revealed the supposed missing check was from a settlement money from when R1 had a car accident about eight (8) or more years ago. Further interview also revealed that it supposed to have come from R1's lawyer that R1 could not remember. LPA's interview with the Administrator today at 11:10 AM revealed that R1 did not disclose anything financial to the facility since admission and the administrator was not aware of any accident happened to R1 while living at the facility nor the facility received any letter from any lawyer other than the regular lawyer of R1 who pays R1's rent. LPA's record review today between 12:15 PM to 1:00 PM revealed that R1 was able to manage own cash resources and LPA's interview with the administrator today at 11:10 AM confirmed that R1 had been managing own cash resource from the time R1 was initially admitted at this facility in 2013, so any mail or money goes directly to R1 and never passed on to or through the facility. Based on the information gathered during this and prior visits, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 7, 2024 · control 31-AS-20240123093103

Allegation investigated: Staff did not ensure that resident's needs were met

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Assistant Administrator Adriana Cisneros and explained the reason for the visit. LPA conducted physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 9:54 AM, reviewed records from 10:00 AM to 11:15 AM and interviewed staff, residents, and witness between 11:30 AM to 1:10 PM. It was alleged that Staff doesn't come when needed and R1's wheelchair is broken and not being replaced. LPA's record review today revealed that R1 is a client of Frank D Lanterman Regional Center (FDLRC) since 2012. Further review also revealed that R1 is being provided a 1:1 care staff by the Regional Center for five (5) hours every day five (5) days a week. LPA's interview with R1 today at 11:30 AM revealed that R1 was aware that it was the responsibility of and following up with FLDRC for the replacement of R1's wheelchair. LPA's interview with FDLRC's staff confirmed that R1's wheelchair is FLDRC's responsibility and has been working for the replacement since it was broken. Unsubstantiated (continued from LIC 9099) LPA's interview with the Assistant Administrator today at 12:13 PM revealed that the facility has a spare wheelchair in stock and willing to give it to R1 if R1 agreed. R1 agreed to have the replacement today offered by the Assistant Administrator. Further interview with R1 also revealed that staff always come when needed as it has been for long time. LPA's interview with additional four (4) residents or more than 10% of the current census also revealed that four (4) out of four (4) residents interviewed stated that staff always come when needed within reasonable time (5-15 minutes). Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 16, 2024 · control 31-AS-20240712160413

Allegation investigated: Resident was physically abused while in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with Administrator Itzel Guevarra and explained the reason for the visit. LPA conducted physical plant tour at 9:22 AM, requested copy of facility documents relevant to the investigation at 9:53 AM, reviewed records between 10:00 AM to 11:30 AM and interviewed staff and residents between 11:35 AM to 1:00 PM. It was alleged that Resident#1 (R1) was slapped by a caregiver's husband and threw coffee at R1. No other information was provided for this allegation. LPA made a reasonable attempt to contact the reporting party to get more details of the allegation but to no avail. LPA's record review revealed that R1 was admitted at the facility on 07/20/23 and went to the hospital due to a medical condition on 11/27/23 and discharged to a Skilled Nursing Facility (SNF) on 12/01/23. LPA's interview with the assistant administrator today at 12:06 PM revealed that R1's sister took R1's belongings at the facility on 12/08/23 and told the facility that R1 was not coming back. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with Resident #2 (R2) and former roommate of R1 while still at the facility revealed that R2 did not remember R1 but did not witness any roommate being slapped or physically/verbally abused or being thrown coffee by any staff or anyone in their room. LPA's interview with the administrator today at 12:54 PM also revealed that she did not receive any complaint from R1 of being physically or verbally abused by anyone while still living at the facility. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 2, 2024 · control 31-AS-20240628155539

Allegation investigated: Staff threatened resident Staff do not treat resident with dignity and respect

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with Administrator Itzel Guevarra and explained the reason for the visit. LPA conducted physical plant tour at 9:18 AM, requested copies of facility documents relevant to the investigation at 10:24 AM and interviewed staff and residents between 11:00 AM and 1:00 PM, It was alleged that Resident #1 (R1) was threatened by a staff to throw R1 in the stairs in R1's wheelchair. LPA's interview with R1 today at 11:12 AM revealed that it wasn't a staff who threatened R1 but another resident of the facility. LPA's interview with Resident #2 (R2) who allegedly threatened R1 revealed that R2 did not know R1 and did not threaten anyone. Further interview with R1 also revealed that R1 was not threatened directly by R2 but only overheard it and did not remember when and where R1 overheard it. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099-C) Regarding the allegation that Staff do not treat resident with dignity and respect, it was alleged that staff are calling R1 names. LPA's interview with five (5) residents or more than 10% of the current census today between 11:00 AM to 1:00 PM revealed that five (5) of five (5) residents believe that the staff are respectful and did not experience nor witness being called names by any staff of the facility. LPA's interview with Resident #3 (R3), R1's roommate for one and a half year (1 1/2) years revealed that R3 did not witness any staff calling R1 name when they were together in their room. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 22, 2024 · control 31-AS-20240516145438

Allegation investigated: . Staff took resident's personal items received by mail 2. Staff do not ensure that resident's dietary needs are met

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit to deliver the final finding of the allegations mentioned above. LPA met with Adriana Cisneros and Administrator Itzel Guevara and informed the reason of the visit. Allegation # 1: It was alleged staff took resident’s personal items received by mail. On 02/09/2023, former LPA Shira Stamps, conducted the initial visit and interviewed staff and residents. During today’s visit, from 12pm to 2pm, LPA conducted additional interviews and obtained resident records. Through interviews, it was reported that residents receive their packages and mail, and never have had any issues. Residents also stated that they were not 100% sure staff opened or took their mail. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Allegation # 2: It was alleged staff do not ensure that resident’s dietary needs are met. On 02/09/2023, former LPA Shira Stamps, conducted the initial visit and interviewed staff and residents. During today’s visit, Unsubstantiated LPA conducted additional interviews from staff and residents, and obtained and reviewed records pertaining to the complaint. From the information obtained, it was revealed, R1 has had no dietary restriction on record for the last four (4) years. LPAs' interview with R1 also revealed that R1 was aware that R1 had no dietary order from a physician. Therefore, based on documentation and interviews, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, May 16, 2024 · control 31-AS-20230131105058

Allegation investigated: Resident sustained fracture while in care

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit to to deliver the final finding of the allegation mentioned above. LPA met with Adriana Ciscernos and Administrator Itzel Guevarra and informed the reason of the visit. It was alleged resident sustained fracture while in care. On 02/09/2023, former LPA Shira Stamps, conducted the initial visit, and interviewed staff and residents. During today’s visit, from 930am to 12pm, LPA conducted additional interviews and obtained resident records. From all the information obtained, it was revealed, resident # 1 (R1) complained to the in-house physician about pain in the shoulder. R1 did not inform staff that R1 was in any pain or injured. R1 was sent to the hospital by the orders of the doctor. It was later reported to the Administrator that R1 needed a higher level of care and would not be returning to the facility and would be admitted to a skilled nursing facility (SNF). It was also revealed to LPA, that staff visited R1 while in the SNF, and R1 never mentioned falling at the facility, and interviews revealed no-one witnessed R1 falling. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 16, 2024 · control 31-AS-20230130162534

Allegation investigated: Staff spat in a residents drink.

Licensing Program Analysts (LPAs) Gary Tan and Ray Comer conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPAs met with administrator Itzel Guevarra and explained the reason for the visit. LPAs conducted a physical tour at 9:09 AM, requested copies of facility documents relevant to the investigation at 9:33 AM and interviewed staff and residents between 10:00 AM to 12:30 AM. Regarding the allegation that Staff spat in a resident’s drink, it was alleged that Resident #1 (R1) watched the staff members spit in R1's drink. LPAs' interview with Resident #1 (R1) today at 10:00 AM revealed that R1 did not witness any staff mentioned on the report spitting on R1's drink and R1 just "tasted" the saliva on the drink. LPAs' record review today revealed that all the staff mentioned are kitchen staff and four (4) out of four (4) staff has current State Food Handling certificate on file. LPAs' interview with the four (4) kitchen staff also revealed that none of them spat on any residents' food and/or drink nor witness any other staff spat on any resident's food and/or drink. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPAs' interview with four (4) random residents today between 10:00 AM to 1:00 PM revealed that four (4) out of four (4) residents did not witness any staff spitting on any resident's food and/or drink at any time. Based on the information gathered during this visit. The allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 31-AS-20240320145828

Allegation investigated: Staff does not ensure facility is free of pest.

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced visit to investigate the above allegation. LPA was greeted by the facility manager Adriana Cisneros. LPA explained the reason for the visit. At 9:45 AM LPA met with facility administrator Itzel Guevara. Entrance interview conducted. LPA conducted a physical plant tour at 9:31 AM, requested facility documents relevant to the investigation which include but not limited to maintenance records and contracts for the pest control company. LPA reviewed records between 9:52 AM and 11:18 AM. LPA interviewed 5 staff and 13 residents between 11:20 AM and 1:08 PM. Conitnue to LIC 9099-C Unsubstantiated The complainant’s concern is that the facility staff does not ensure the facility is pest free. LPA conducted a physical plant tour and interviewed residents. At the time of inspection, LPA did not observe any pests in the facility. Twelve(12) out of thirty-eight (38) residents state that there were no pests observed in their rooms. LPA toured the room of the one resident who may have had an issue with pests, however, did not observe and active infestation. Interviews with five (5) out of fourteen (14) staff) revealed that there are no pests observed in the facility. LPA reviewed the pest control company’s invoice. The facility maintains a contract with the pest control company to come out a couple time a month to ensure the facility is free of pests which include roaches. Therefore, based on inspection, observation and interviews, there is an insufficient information to support the allegation. The allegation is deemed Unsubstantiated at this time. Exit interview.the state’s words, verbatim · CDSS document, Feb 16, 2024 · control 31-AS-20240207092211

Allegation investigated: Staff are not following resident's dietary plan

Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPAs met with administrator Itzel Guevarra and explained the reason for the visit. LPAs conducted physical plant tour at 11:35 AM, requested copies of facility documents relevant to the investigation at 12:02 PM and interviewed staff and resident between 12:20 PM to 1:45 PM. Regarding the allegation that Staff are not following resident's dietary plan, it was alleged that staff are ignoring Resident #1 (R1)'s dietary restriction is being ignored by the staff. LPAs' record review at 12:15 PM revealed R1 had no dietary restriction on record for the last four (4) years. LPAs' interview with R1 also revealed that R1 was aware that R1 had no dietary order from a physician. Based on the information gathered during this visit. The allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 25, 2024 · control 31-AS-20240123093103

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.