Sterling Senior Living 3

Type of visit: Required - 1 Year

On October 28, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrators Sheryl Tongol and Kian Pascual and explained the purpose of today’s visit. The facility is licensed to operate for (6) elderly residents. (2) ambulatory, (3) non-ambulatory and (1) bedridden. The facility is approved for (4) hospice residents. Currently, there are no hospice resident in care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (6) resident bedrooms (2) common bathrooms, an activity room, a dining area, a kitchen, a patio, and a garage. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.2 degree F. A comfortable temperature of 77 degrees was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. The facility has conducted a fire drill on 10/01/25. A landline telephone was in working condition. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted including Schedule Menu and Plan Activities. LPA observed First Aid Kit was maintained. The facility has current liability insurance policy #00136973 on file effective 11/04/24 through 11/04/25. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#4 (R1-R4) service files and staff #1-#6 (S1-S6) personnel files revealed to be complete. The facility has the current administrator's certification on file for Arnold Mendoza #606813740 - Expiration 12/06/25. No deficiencies during this inspection visit. An exit interview was conducted with Sheryl Tongol and a copy of the report was providedthe state’s words, verbatim · CDSS document, Oct 28, 2025

Type of visit: Required - 1 Year

On 09/26/2024 Licensing Program Analyst (LPA) Hollie Enriquez conducted an unannounced random visit to the above facility. LPA met with Caregiver Crystal Sanchez and the purpose of the visit was explained. The facility is licensed to serve residents ages 60 years and over and is approved for 2 ambulatory, 3 non-ambulatory , and 1 bedridden resident and has a hospice waiver approved for 4 residents on file. Currently there are 5 residents in care. The facility is a one story home located in a residential neighborhood. It consists of the following: (6) six resident bedrooms, 2 resident bathrooms, 1 staff room, a guest/staff bathroom, living room, dining area, kitchen and detached garage. The backyard has a covered seating area with dining table and chairs. LPA toured the Resident bedrooms and observed the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Kitchen was checked and observed to be within Title 22 regulations. LPA observed 2 days perishable and 1 week non-perishable food supply. Toxins, cleaning supplies and medications were securely locked and inaccessible to residents. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA observed 3 fire extinguishers fully charged and last serviced on 04/16/2024. Due to time constraints, LPA was unable to complete the visit and will return at another unannounced time. No citations have been issued during this visit. An exit interview has been conducted and a copy of this report has been provided to Caregiver Crystal Sanchez.the state’s words, verbatim · CDSS document, Sep 26, 2024

Allegation investigated: Resident sustained multiple unexplained injuries while in care.

On 07/25/24, at 09:30am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Arnold Mendoza, Administrator, and Alberto Pimentel Narez, Licensee. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegations mentioned above. The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S4), witness (W1), and residents (R1-R4) R1 could not be interviewed due to R1’s health condition R1 is unable to participate in the interview process. Resident Roster (Dated: 07/10/2024), Staff Roster (Dated: 02/02/2024), Unusual Incident Report (Dated: 07/15/2024) ID/Emergency Information (No Date), Physicians Report (Dated: 03/05/2024), Preplacement Appraisal Information (No Date) Appraisal/Needs and Services Plan (Dated: 04/03/2024) and Healthy Lifestyle Hospice Care Notes (Dated: 02/23/2024, 07/17/2024, 07/18/2024, 07/19/2024, & 07/20/2024) for R1 were obtained from the facility. Report continued on LIC 9099-C Unsubstantiated The investigation revealed the following: Allegation #1- Resident sustained multiple unexplained injuries while in care. The details of the complaint alleged that the resident was observed with contusions all over the body including private area while at the facility. On 07/25/24, from 9:30am- 1:30pm, LPA reviewed facility files, interviewed staff (S1-S4), witness (W1) and residents (R1-R4) regarding the allegation. 4 of 4 staff denied the allegation that the Resident sustained multiple unexplained injuries while in care. Staff stated that R1 did not have any discoloration on R1’s body the night before (07/14/2024). The staff were alerted on the morning of 07/15/2024 that R1 had bruising on R1’s thigh, buttocks, legs, and pelvic area. S1-S4 stated that they did not know how the bruises were sustained. S2 stated that interviews of the residents and staff were conducted, and no one confirmed that they saw or heard anything out of the ordinary during this period. LPA reviewed Healthy Lifestyle Hospice Care Notes (Dated: 07/17/2024) that stated that R1 has unexplained scattered ecchymosis (bruising), bluish in color that look a few days old, and extend to R1’s private area. LPA also reviewed Healthy Lifestyle Hospice Care Notes (Dated: 07/20/2024) that stated that R1 had new ecchymosis (bruising) that were not present on last visit. Ecchymosis on vagina, left thigh, and anus were noted. R1 had 5”x 6” bruise which was blueish and purple in color, as described in the hospice notes. LPA reviewed R1’s medication and noted that the resident is taking Keppra (500mg), Atorvastatin (10mg), and Baclofen (20mg) which has side effects that causes itching, rashes, and swelling; according to webmd.com. LPA observed that the facility has cameras but S1 stated that the cameras were not working. LPA interviewed R1-R4 about the allegation and 3 of 4 residents that were interviewed denied the allegation that Resident sustained multiple unexplained injuries while in care. Residents that were interviewed stated that they have not experienced any unexplained bruising on their body and have not witnessed abuse or heard of any abuse of another resident while in care. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Resident sustained multiple unexplained injuries while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted with Arnold Mendoza, Administrator, and a hard copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 7, 2024 · control 11-AS-20240719140342

Type of visit: Case Management - Deficiencies

On 08/07/24, Licensing Program Analyst (LPA) Perry Scott conducted a case management inspection visit at this facility. LPA met with Arnold Mendoza, Administrator and explained the purpose of the visit is in association with a complaint investigation conducted on 07/25/24 for complaint# 11-AS-20240719140342. During the investigation visit on 07/25/24, LPA Perry Scott audited the residents file identified in the complaint and found an SIR for the complaint but could not verify that the SIR was sent to Community Care Licensing. The licensee is being cited with Title 22 Reporting Requirements 87211(a)(B)(D). Based on interviews, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 8 by not reporting the incident to Community Care Licensing. A deficiency was issued. An exit interview was conducted with Arnold Mendoza, Administrator; and copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 7, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(B)(D) · Plan of correction due date: Aug 14, 2024

87211(a)(B)(D) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (B) Any serious injury... occurring while the resident is under facility supervision. (D) Any incident which threatens the welfare, safety, or health of any resident... This requirement is not met as evidenced by: Based on records and interviews, the facility failed to submit a written report to Licensing for resident R1 who sustained multiple unexplained injuries while in care. This violation poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section 87211 “Reporting Requirements” and send a written statement to CCLD that you have read and understand this section and report all resident's incidents in the future. Written statement must be submitted to LPA Perry Scott at email perry.scott@dss.ca.gov by POC due date 08/14/2024.

Allegation investigated: Facility staff failed to properly administer resident’s medications. Facility failed to maintain complete and accurate staff records.

On 12/12/23 Licensing Program Analyst (LPA) Mario Leon arrived at the above-mentioned facility at 8:09AM and conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by Bennie Ballon, Caregiver (S3), and later by Arnold Mendoza, Administrator (S2), and Albert Pimental Narez, Licensee (S1). Both S3 and LPA toured the facility. The investigation consisted of the following: On 12/12/23 LPA requested and reviewed facility documents and toured the facility. LPA interviewed two (2) out of three (3) residents and two (2) out of seven (7) staff. The investigation revealed the following: Regarding the allegation: "Facility staff failed to properly administer resident’s medications.". LPA interviewed two (2) staff (S1,S3). All staff have denied the allegation. LPA interviewed two (2) residents (R1-R2). One (1) out of two (2) residents have agreed with the allegation. Report Continues, see LIC9099C Substantiated Record reviews revealed, through the Medication Admission Record, that on 12/04/23 and 12/06/23 all residents were not provided any of their medications. Furthermore, there were no other marking in the Vital Signs - 2023 book marking any record of dosages of medications, which are centrally stored, maintained by the facility. Based on record reviews and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6) is being cited on the attached LIC 9099D. Regarding the allegation: "Facility failed to maintain complete and accurate staff records.". LPA interviewed two (2) staff (S1, S3). One staff member was unaware of the allegation while one disagreed with the allegation. Record reviews revealed that one (1) staff member's CPR certificate was not present, nor on file, at the above-mentioned facility. The CPR certificate was later provided, renewed on 12/12/2023. Based on record reviews and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6) is being cited on the attached LIC 9099D. There have been two (2) citations provided, please see LIC9099D. An exit interview was held with S3, Bennie Ballon, and a copy of this report and appeal rights have been provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation: "Facility is not adequately staffed.". LPA interviewed two (2) staff (S1, S3). All staff have denied the allegation. LPA interviewed two (2) residents (R1-R2). Two (2) out of two (2) have denied the allegation. Record reviews revealed that staff roster (LIC500) was later provided, as requested, dated 11/10/2023. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation: "Facility failed to maintain a complete and accurate resident’s records.". LPA interviewed two (2) staff (S1, S3). All staff have denied the allegation. LPA interviewed two (2) residents (R1-R2). Two (2) out of two (2) residents have denied the allegation. Record reviews revealed that all three (3) residents had appropriate resident records on file. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been no deficiencies cited. An exit interview was held with S3, Bennie Ballon, and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 11-AS-20231211140912

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5) · Plan of correction due date: Dec 12, 2023

87465 Incidental Medical..Care (a) A plan for incidental medical..care shall be..by each facility. The plan shall encourage routine medical..care and provide for assistance in obtaining such care, by compliance with the following: (6) When requested by..the Department, a record of dosages which are centrally stored shall be maintained by the facility. This has not been met as evidenced by: LPA observed 12/04/23 and 12/06/23 without medications prescribed by physician's order recorded as written above.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: LPA and Licensee have agreed that the E-Mar will also be printed in the MAR book. This way, for those staff who have not yet been trained at how to record medications electronically, staff will still be able to record the medication provided and number of dosages for residents at the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Dec 12, 2023

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information. This has not been met as evidenced by: Based on LPA's observations, the Licensee's current CPR certificate expired 12/02/23. Licensee later provided CPR certificate, updated 12/12/23.the state’s words, verbatim · CDSS document, Dec 12, 2023

Plan of correction: LPA and Licensee have agreed that Licensee will stay aware of all required certification(s) for staff to stay in compliance. Licensee will review staff folders to make sure all staff will stay in complaince for future State Licensing visits and to avoid future citations.

Allegation investigated: Staff gave resident medication not prescribed.

On 12/09/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent complaint visit at this facility. LPA was greeted by caregiver Ben Ballon, Ballon contacted administrators Arnold Mendoza and Albert Pimentel who later arrived at the facility. LPA explained the purpose of the visit was to deliver findings for the allegation mentioned above. The investigation consisted of the following: Interviews with residents #1-#5, witnesses #1-#5, and staff #1-#4. A review of resident #1 (R1's) service records and other pertinent documents associated with this complaint. A physical tour of the facility was conducted. A collateral visit was conducted at Golden Eden II. (Evaluation Report continues LIC 9099-C) (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff gave resident medication not prescribed. The details of the complaint alleged staff chemically restrained resident #1 (R1) by administering a non-prescribed medication. The complainant reported sometime in October 15 through 30, 2023 a staff gave Lorazepam to (R1) during the early morning hours of 12 am – 6 am when (R1) experienced restlessness and agitation. The complainant did not observe the staff administering the Lorazepam to (R1) and that it was only information provided by another individual. Resident #1 (R1) was admitted to this facility on 09/29/22 according to the facilities’ Identification and Emergency Information LIC 601 dated: 09/28/22. (R1) voluntarily terminated residency on 11/3/23. A review of (R1’s) Medication Administration Record (MAR) (dated: 10/01/23 – 10/31/23) of (R1’s) medications has remained consistent. The (MAR) for (R1) noted medications were taken daily, and no medications were missed or refused. There were no non-prescribed medications listed by staff identified as Lorazepam or Ativan noted on the Centrally Stored Medication and Destruction Record LIC 622 (dated: 11/08/23). There were (7) of (11) medications prescribed by (R1’s) medical physicians such as Risperidone, Sertraline, Melatonin, Trazodone, Buspirone, and Memantine all have side effects that may result in a state of being relaxed, sleepy or calmness according to the National Institute of Health (ref.NIH.gov). On 11/15/23 between 10:01 am and 10:29 am, the Department interviewed the family representative of (R1) witness #1 (W1) who confirmed that (R1) was prescribed Lorazepam but became suspicious when (W1) was informed by a former staff that had issued Lorazepam to sedate (R1). (W1) was unable to determine the date of the alleged incident and stated that (W1) did not witness this activity only through information provided by the former staff. On 11/15/23 between 10:30 am – 12:00 pm, the Department interviewed (3) out of (3) staff #2-#4 (S2-S4) claimed to not know any staff providing non-prescribed medications to any of the residents. (S2-S4) claimed only what is listed on the (MAR) or (LIC 622) is administered to residents. (Evaluation Report continues LIC 9099-C) On 11/15/23 between 12:00 pm – 12:22 pm, the Department interviewed the former staff witness #2 (W2) the informant to (W1) with this information. (W2) claimed to have been informed by staff #1(S1) that Lorazepam was issued to (R1) when (R1) was agitated and restless during early morning hours. (W2) stated no other witnesses overheard this conversation and were unable to verify the date or time when given the information from (S1). (W2) confirms that information was only given to (W1) and no other individuals were made aware of the matter. On 11/15/23 between 1:02 pm and 1:23 pm, the Department interviewed staff #1 (S1) who denied this alleged act and claimed this accusation was false. (S1) stated no nonprescribed medications such as Lorazepam or Ativan were ever given to (R1). (S1) denied ever informing any individuals of this matter. (S1) claimed that only residents in hospice care are prescribed such medication. (S1) claimed to be fully trained in administering or delivering prescription medications and follows what is on the listed on (LIC 622). On 11/15/23 between 2:00 pm – 2:47 pm, the Department interviewed (2) out of (4) residents #2-#3 (R2-R3) who reported needing assistance with medication management and have not encountered issues nor have been provided medications that are not prescribed by their medical physician. (R4-R5) were interviewed but were unable to fully participate in conversation due to their health conditions. On 11/15/23 between 3:02 pm – 4:15 pm, the Department interviewed family representatives witnesses #3-#4 (W3-W4) for residents #4-#5 (R4-R5) were complimentary of the staff and reported to have no concerns for the care and supervision of residents at this facility. (W3-W4) claimed there have been no medication errors that have been witnessed or reported by any facility staff. On 11/15/23 between 8:44 am – 9:02 am the Department interviewed facility administrator witness #5 (W5) who verified (R1) was admitted on 11/09/23 with no Lorazepam or Ativan was listed on the medication list and no refills included such medication. On 11/15/23 between 9:03 am – 9:24 am the Department interviewed resident #1 (R1) who had no comments. (R1) was unable to fully participate in a conversation due to (R1’s) health condition. (Evaluation Report continues LIC 9099-C) The Department reviewed personnel records for staff #1 (S1) and verified that medication training was completed by staff. Biological Laboratory urine drug screening test results for (R1) conducted 10/23/23 revealed negative for Lorazepam or Ativan. Based on the information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Arnold Mendoza, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Dec 9, 2023 · control 11-AS-20231109114136

Type of visit: POC

On 11/15/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a Plan of Correction (POC) and was met by assistant administrator Kian Pascual. The purpose of the visit is to follow-up on the POC that was due on 10/26/23. The facility requested for an extension and was granted with a new POC date of 11/05/23. On 10/05/23, an annual visit was conducted and facility was cited for: DEFICIENCIES: 87608(5)(B) Postural Support: non-authorized full bed rails for resident #3 – Type B (corrected 11/15/23) 87309(a)(1) Disinfectants/Toxic Cleaning Solutions: unsecured/unlocked bathroom #2 cabinet – Type A (corrected) 87303(a) Room #3 window blinds: Broken shades – Type B (corrected) 87303(a) Room #4 End Table missing drawer – Type B (corrected) Administrators Certificate: Expired for Staff #1 – Type B (not cleared) 87411(c)(1) No current CPR/First Aid certificates - staff #1 and #5 - Type B (corrected) 87705(5)) Resident 4: No current medical and appraisal assessment for resident with Dementia – Type (not cleared) 87309(b) Medicines required refrigeration not stored properly - Type A (corrected) 87415(a) No night supervision - No night shift staff after 8pm - Type B (corrected 11/15/23) 1569.695(c) No quarterly emergency drills conducted/documented - Type B (not cleared) 87465(d) No documentation/record keeping of PRN for resident #4 - Type B (corrected 11/15/23) 87465(d)(3) Prescribed medications and PRN not included in (MAR) - Type B (corrected 11/15/23) 87405(b)(2) Administrator's Qualification: Failed to conform to applicable rules and regulations, which resulted to multiple citations. - Type B (not cleared) The licensee is being cited civil penalties for violations that have not been cleared as of 11/15/23. An exit interview conducted with Kian Pascual and a copy of the report is provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, Nov 15, 2023