Alabaster Elderly Care

Allegation investigated: Staff do not safeguard resident's personal belongings. Staff did not administer medication as prescribed.

On July 30, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted a follow-up complaint visit to the facility above. During the visit, LPA Richard met Administrator (A1) Delores Davis, who was informed about the purpose of the visit. The investigation included a request for several documents, such as the staff roster, resident roster, documents related to Resident 1 (R-1), the admission agreement, physician report, Medication Administration Records (MAR), the California General Durable Power of Attorney, Revocation of Power of Attorney, Advance Health Care Directive Form, records of resident personal property and valuables, daily adjournment sheets, and Serious Incident Reports (SIR). LPA Richard interviewed five residents (R2-R6), three staff members (S1-S3), the Administrator (A1), and the Power of Attorney (POA). Resident (R1) moved out of the facility on July 23, 2026. Report continued on LIC9099C. Unsubstantiated Allegation: #1: Staff do not safeguard resident’s personal belongings. The complaint alleged that the Power of Attorney (POA) and another individual took the resident’s ID and bank cards under the pretense of preventing theft. On July 28, 2026, the Licensing Program Analyst (LPA) Richard interviewed the Administrator (A1), who denied the allegations. A1 stated that when the resident was admitted to the facility, no bank cards were recorded as personal belongings. During the same investigation, the department interviewed three staff members (S1-S3), all of whom also denied the allegations, claiming they were unaware of any resident's bank cards. Additionally, the LPA spoke with five residents (R2-R6); three out of 5 expressed that they enjoyed living at the facility. The LPA interviewed the Power of Attorney (POA), who denied the allegations and stated that the resident (R1) has access to R1's bank card. The LPA also reviewed records of the resident's personal property and valuables dated July 3, 2026, at the time of R1's admission to the facility. The records did not list any bank cards. On July 23, 2026, during R1's move-out, personal property and valuables were taken; no bank card was listed. The LPA also reviewed the facility's unusual incident report to the Community Care Licensing Department regarding R1's move-out with a family member. However, on July 28, 2026, the LPA was unable to interview resident R1 because R1 had moved out of the facility on July 23, 2026, and their current whereabouts are unknown. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation is unsubstantiated. Allegation #2: Staff did not administer medication as prescribed. The complaint alleged that staff provided inadequate daily assistance and routinely failed to administer R1's prescribed blood pressure medication. On July 28, 2026, LPA Richard interviewed the Administrator (A1), who denied the allegations. The Administrator stated that staff measured blood pressure twice daily and assisted R1 with blood pressure medication. The Administrator also noted that R1 was aware of all medications and knew when to take them. On July 28, 2026, the LPA interviewed three staff members (S1-S3), all of whom also denied the allegations. They confirmed that they took the resident's blood pressure twice a day and ensured it remained at safe levels. The LPA also interviewed five residents (R2-R6) on the same day, and three of five reported that staff helped them. Furthermore, the Power of Attorney (POA) for resident R1 denied the allegations, stating that facility staff took good care of R1 and that the POA had no concerns about the quality of care R1 received while living in the facility. During the investigation, the LPA reviewed the Medication Administration Record (MAR), which showed that staff documented the administration of R1's blood pressure medication each time it was given. The LPA also examined the facility's daily adjournment sheet, which indicated that R1's vital signs were taken twice daily from July 4, 2026, to July 22, 2026. Unfortunately, when R1 moved out of the facility, R1 took all medications with them. The LPA was unable to compare the actual blood pressure medication with the MAR. Report continued on LIC9099C. Upon reviewing the facility records, on July 28,2026, the LPA found no discrepancies in the MAR regarding blood pressure medication. However, on July 28, 2026, the LPA was unable to interview resident R1 because R1 had moved out of the facility on July 23, 2026, and their current whereabouts are unknown. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to Administrator Delores Davis.the state’s words, verbatim · CDSS document, Jul 30, 2026 · control 11-AS-20260722135317

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced case management visit. LPA Bunker met with staff member Mollie Davis and explained the purpose of today's visit. LPA was granted entry into the facility. The facility’s buildings and grounds were toured to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit. During the visit, LPA Bunker spoke with Licensee Delores Davis by telephone. Ms. Davis stated that she fulfilled the payment plans with both families in accordance with the agreed-upon terms. She submitted proof of the final payment, along with an Incident Report, to the California Department of Social Services. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 2, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced case management visit. LPA Bunker met with staff member Kari Barton and explained the purpose of today's visit. LPA was granted entry into the facility. The facility’s buildings and grounds were toured to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit. During the visit, LPA Bunker spoke with Licensee Delores Davis by telephone. Ms. Davis stated that she paid one family’s refund in full on February 1, 2026, and sent them a thank-you note. She also confirmed that she fulfilled the second agreement and paid the remaining balance in full on April 6, 2026, in accordance with the terms. Proof of the final payment and an Incident Report were submitted to the State of California Department of Social Services. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 10, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced case management visit. LPA Bunker met with staff member Kari Barton and explained the purpose of today's visit. LPA was granted entry into the facility. The facility’s buildings and grounds were toured to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit. During the visit, LPA Bunker spoke with Licensee Delores Davis via telephone. Ms. Davis stated that she paid one family’s refunds in full as of February 1, 2026, and sent a thank-you note. She further confirmed that one remaining refund will be paid in full by April 1, 2026, in accordance with the agreement, and proof of the final payment will be emailed to the Department. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced annual required 1-year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the evaluation, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms, and temperature was checked. LPA Bunker met Licensee Delores Davis and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There are currently six (6) residents in placement. The facility's annual fees are current. The following 12 Domains will be observed and reviewed: Infection Control, Physical Plant & Environmental Safety, Operational Requirements, Staffing, Personnel Records-Training, Client Rights-Information, Client Records-Incident Reports, Food Service, Health-Related Services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." The facility is a single-story family home located in a residential neighborhood. It features a living room, dining room, kitchen, 3 bedrooms, 1.5 bathrooms, an office area, a laundry room, an indoor/outdoor activity area, and a shaded area with outdoor patio furniture, tables, and chairs. Bedrooms #1-3 are designated as the resident's bedrooms. See continued LIC809-C page 2 Continued LIC809-C – Page 2 During the tour, LPA Bunker observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. Documents are posted as mandated on the wall near the entryway’s sign-in sheet. The following Title 22-regulated areas were audited and found to be in compliance: • Telephones: Facility telephones are operational. • Bedrooms: All bedrooms meet the required standards for furniture, safety, privacy, and comfort. The facility maintains an adequate supply of linens. • Bathrooms: Bathrooms are clean and operational, providing necessary personal accommodations. Non-skid surface mats are in place to ensure safety and privacy. • Kitchen and Food Service: The kitchen is adequately equipped for food preparation and service. A review of the food supply confirmed an ample stock of perishable and nonperishable items, all stored appropriately. • Medication Storage and Management: Medications are centrally stored in a locked cabinet in the kitchen. Records are up to date, ensuring proper storage and documentation. • Common Areas: The living room, dining room, and other shared spaces are well-maintained, free of hazards, and meet cleanliness standards necessary for resident safety and well-being. • Safety Equipment and Measures: The facility is equipped with a fully stocked first aid kit and manual, functional smoke and carbon monoxide detectors, and properly charged fire extinguishers. Hot water temperature was measured at 120°F and remains within the standard range of 105–120°F. • Emergency Preparedness: All exit doors are in compliance. Client bedroom windows are equipped with sliding locks without thumbscrews. A fire drill was conducted on April 17, 2025. • Environmental Safety: The yard is free of debris and hazards. Trash cans are covered, and no firearms or bodies of water are present on the premises. Hazardous items are kept inaccessible to clients. • Staff Training: Staff members have received training on dependent adult and elder abuse reporting. • Administrative Compliance: The Administrator’s Certificate is current, with an expiration date of June 16, 2027. Compliance with HIV/TB requirements has been verified. There were no deficiencies were cited. LPA Bunker provided Licensee Delores Davis with a copy of the facility evaluation report. An exit interview was conducted.the state’s words, verbatim · CDSS document, Nov 6, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced case management visit. LPA Bunker met with staff member Melissa Cortez and explained the purpose of today's visit. LPA was granted entry into the facility. The facility’s buildings and grounds were toured to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit. During the visit, LPA Bunker spoke with Licensee Delores Davis via telephone. Ms. Davis stated that she is still making monthly payments and is sending documents to the Department by October 31, 2025. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 23, 2025

Allegation investigated: Staff did not provide a refund upon resident’s death

*** The purpose of the visit is to add additional information not included in the report dated 07/18/2025; findings remain the same.*** On 09/18/2025, at 8:18 a.m., the California Department of Social Services Community Care Licensing Division (CDSS/CCLD) Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced subsequent visit to gather information regarding the above allegations. LPA Bunker met with Delores Davis, Licensee, and explained the purpose of the visit. LPA was granted entry into the facility. The investigation consisted of the following: On 07/18/2025 at 12:30 p.m., LPA Bunker reviewed and obtained copies of resident 1's records, Resident Roster (Dated 07/01/2025), Admission Agreement (Dated 11/06/2024), Identification and Emergency Information (Dated 11/06/2024), Physician’s Report (Dated 11/06/2024), Appraisal & Needs and Services Plan (Dated 11/06/2024), See continued LIC9099-C Page #2 Substantiated Continued LIC9099-C page #2 Functional Capability Assessment (Dated 11/06/2024), Preplacement Appraisal Information (Dated 11/06/2024), Consent Form (Dated 11/06/2024), Personal Rights (Dated 11/06/2024), Safeguards for Cash Resources (Dated 11/06/2024), Safeguards for Property/Valuables (Dated 11/06/2024), Death Report (Dated 12/17/2024). The Department conducted interviews with the Staff Member #1 (S1) and Witnesses #1 and #2 (W1-W2). Investigation Reveals the following: Allegation: Staff did not provide a refund upon the resident’s death. It was alleged that Resident 1 (R1)'s room and board were paid for the entire month of December 2024, and staff did not issue a refund upon the resident’s death. At 2:00 p.m., Staff Member #1 (S1) was interviewed and reported that R1 moved into the facility on November 06, 2024, and passed away on December 12, 2024. On December 17, 2025, S1 submitted a copy of the death report to Community Care Licensing regarding R1's passing. R1's Admission Agreement on Refund Conditions/Resident Death, dated November 06, 2024, was reviewed. It states that the facility will refund any fees paid in advance covering the time after the resident's personal property has been removed from the facility within 15 days. One out of one staff member agreed that R1 was owed $3,065.00, which has not been refunded after R1's death and the removal of their belongings. S1 confirmed that, as of today, no payment has been made. On 07/18/2025, the Department interviewed Witnesses #1 and #2 (W1-W2), who stated that Resident #1 (R1) lived at the facility and passed away on 12/12/2024. W1 and W2 reported that they paid for the entire month of December 2024 and have both spoken to Staff Member 1 (S1) regarding the refund they are owed. W1 and W2 stated that S1 requested that payment arrangements could be made in monthly installments; however, no payments have been made. See continued LIC9099-C page 3 Continued LIC9099-C page 3 Based on LPA’s observations, interviews that were conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. Appeal rights were discussed, and copies of the Complaint Investigation Report LIC 9099 and LIC9099-C were provided to Licensee Delores Davis. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 18, 2025 · control 11-AS-20250708131300

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Oct 5, 2025

Health and Safety Code section 1569.652 (c): A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by: The licensee failed to refund fees paid in advance. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: The licensee agrees to a payment plan and will refund the $3,065.00 in fees by the POC due date of 10/05/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Case Management. LPA Bunker met with staff member Melissa Cortez and explained the purpose of today's visit. LPA was granted entry into the facility. We toured the facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. During the visit, LPA Bunker spoke to Licensee Delores Davis via telephone. The Licensee, Ms. Davis, stated that she was not available to meet today and requested that LPA Bunker return at a later date to discuss the complaint allegation. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Sep 11, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Case Management. LPA Bunker met with staff member Kari Barton and explained the purpose of today's visit. LPA was granted entry into the facility. We toured the facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. During the visit, LPA Bunker spoke to Licensee Delores Davis via telephone. The Licensee, Ms. Davis, stated that she was not available to meet today and requested that LPA Bunker return at a later date to discuss the complaint allegation. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 29, 2025

Allegation investigated: Staff did not provide a refund upon resident’s death

On 07/18/2025, at 11:50 a.m., the California Department of Social Services Community Care Licensing Division (CDSS/CCLD) Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced initial visit to gather information regarding the above allegations. LPA Bunker met with Delores Davis, Licensee, and explained the purpose of the visit. LPA was granted entry into the facility. The investigation consisted of the following: On 07/18/2025 at 12:30 p.m., LPA Bunker reviewed and obtained copies of resident 1's records, Resident Roster (Dated 07/01/2025), Admission Agreement (Dated 11/06/2024) Identification and Emergency Information (Dated 11/06/2024), Physician’s Report (Dated 11/06/2024), Appraisal & Needs and Services Plan (Dated 11/06/2024), Functional Capability Assessment (Dated 11/06/2024), Preplacement Appraisal Information (Dated 11/06/2024), Consent Form (Dated 11/06/2024), Personal Rights (Dated 11/06/2024), Safeguards for Cash Resources (Dated 11/06/2024), Safeguards for Property/Valuables (Dated 11/06/2024), Death Report (Dated 12/17/2024) and interview were conducted with staff member (S1). See continued LIC9099-C Page #2 Substantiated Continued LIC9099-C page #2 Investigation Reveals the following: Allegation: Staff did not provide a refund upon the resident’s death. It was alleged that Resident 1 (R1)'s room and board were paid for the entire month of December 2024, and staff did not issue a refund upon the resident’s death. At 2:00 p.m., Staff Member #1 (S1) was interviewed and reported that R1 moved into the facility on November 06, 2024, and passed away on December 12, 2024. On December 17, 2025, S1 submitted a copy of the death report to Community Care Licensing regarding R1's passing. R1's Admission Agreement on Refund Conditions/Resident Death, dated November 06, 2024, was reviewed. It states that the facility will refund any fees paid in advance covering the time after the resident's personal property has been removed from the facility within 15 days. One out of one staff member agreed that R1 was owed $3,065.00, which has not been refunded after R1's death and the removal of their belongings. S1 confirmed that, as of today, no payment has been made. Based on LPA’s observations, interviews that were conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. Appeal rights were discussed, and copies of the Complaint Investigation Report LIC 9099 and LIC9099-C were provided to Licensee Delores Davis. Exit interview conducted.the state’s words, verbatim · CDSS document, Jul 18, 2025 · control 11-AS-20250708131300

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Aug 5, 2025

Health and Safety Code section 1569.652 (c): A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by: The licensee failed to refund fees paid in advance. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Jul 18, 2025

Plan of correction: The licensee agrees to a payment plan and will refund the $3,065.00 in fees by the POC due date of 08/05/2025.

Type of visit: Office

On 2/20/2025 at 11:17am an Informal Conference meeting was held at the El Segundo Adult and Senior Care Regional Office. Present during this meeting were Regional Manager (RM) Benita Yates, Licensing Program Manager (LPM) Stephanie Cifuentes, Licensing Program Analyst (LPA) Zina Brown and from Alabaster Elderly Care, Licensee Delores Davis. On 1/14/2021 the department sent a letter to the facility, making them aware we had been contacted by the California Department of Industrial Relations of an outstanding final judgement against them for Labor Code violations and asking them to contact the Division of Labor Standards Enforcement – Department of Industrial Relations (Labor Commissioners Office) to remain in compliance and avoid any further action. The department was recently made aware of issues in the payment of the final judgement and met with licensee to discuss importance of compliance with state laws and regulations. Licensee stated she will be working with the Division of Labor Standards Enforcement on a payment plan on 02.22.2025 by 5pm. Also the department will update the facility phone number today. An exit interview was conducted with Licensee and a copy of this licensing report was provided.the state’s words, verbatim · CDSS document, Feb 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met House Manager Andrea Whitehead and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan report. There are currently four (4) residents in placement. The facility's annual fees are current. There are 12 Domains in the Infection Control Practices that will be observed and reviewed. "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." The facility is a single-story family home located in a residential-commercial neighborhood with, a living room, dining room, kitchen, 3 bedrooms, 1 1/2 bathrooms, office area, laundry room, an indoor/outdoor activity area, and a shaded area with outdoor patio furniture, tables, and chairs. Bedrooms #1-3 are designated as the resident's bedrooms. During the tour, LPA Bunker observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. LPA observed staff and residents wearing face coverings and social distancing. See continued LIC809-C page 2 Continued LIC809-C page 2 Documents have been diligently posted as mandated on the wall in the kitchen and breakfast area. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture, and bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, and comfort, including the provision of non-skid surface mats. The kitchen was observed for its ability to prepare and serve food. The food service was reviewed for appropriate quantity and proper storage; there was an ample supply of perishable and nonperishable food. The resident’s medications were reviewed for proper storage, documentation, and system implementation. Medications are securely locked, and records are current and up to date. Common areas observed for the ability to safely serve the needs of the residents, including cleanliness, and clear of any potential hazards to the residents. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance, the hot water temperature was measured within normal limits at 120 degrees Fahrenheit (within the range of 105-120 degrees Fahrenheit). The fire extinguisher is fully charged, adequate linen supply, and the facility's telephones are tested and found to be in working order, The client's bedroom windows have no sliding window lock with thumbscrews, all exit doors were found to be in compliance, the yard was free of debris hazards, and trash cans were covered. Staff members have undergone training on reporting dependent adult and elder abuse. The facility conducted a fire drill on June 26, 2024. Due to time constraints, LPA Bunker will return at a later date to conclude the visit. There were no deficiencies cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Nov 18, 2024