Rossmoor Sunshine Villa-Wembley

Type of visit: Required - 1 Year

On May 20, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee (LI) Ricardo Banos was notified via telephone and later arrived to assist with the inspection. LPA observed that Ricardo Banos has a valid Administrator certificate which expires on January 11, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for four. The facility is a single story home which consist of five resident bedrooms, one of which is shared, one staff bedroom, two shared resident bathrooms, a living room, a dining room, a kitchen, a family room, and a detached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed three residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five resident bedrooms and observed them to be clear of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in hallway cabinets. LPA inspected the two resident bathrooms and observed them to be clean. Resident bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 114.9 and 115.5 degrees Fahrenheit. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand in the kitchen. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C LPA observed fire extinguishers to be mounted on the wall in the kitchen and in the resident hallway. Fire extinguishers were observed to be charged and services as of February 27, 2026. LPA tested the wired smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their most recent emergency disaster drill on May 2, 2026. LPA observed the centrally stored medication to be kept in a locked closet. LPA observed there is also a first aid kit stored in the locked closet and it has all the required components. LPA, accompanied by the LI, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be clear of any obstructions or hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA observed the door leading to the detached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA observed chemicals and toxins to be stored in the garage. LPA observed the facility also has a three day emergency food and water supply stored in the garage. LPA reviewed all three resident files. All the required documentation was present and current in the resident files reviewed. LPA reviewed the residents' medication and medication administration records. LPA reviewed five staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Ricardo Banos and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, May 20, 2026

Allegation investigated: facility did not properly handle resident to avoid skin issues facility staff did not notify resident’s responsible party of changes in residents condition, facility staff did not follow resident’s doctor’s orders, facility staff abandoned resident in the hospital emergency room facility did not operate within the terms of their license

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received the complaint on 04/21/2023 and LPA Mendivil conducted the initial visit on 04/28/2023. During the visit LPA Mendivil obtained copies of resident records including physician report and appraisals. LPA Mendivil interviewed staff and attempted to interview residents. Regarding the allegations facility did not properly handle resident to avoid skin issues, facility staff did not notify resident’s responsible party of changes in residents condition, facility staff did not follow resident’s doctor’s orders, facility staff abandoned resident in the hospital emergency room and facility did not operate within the terms of their license the investigation revealed the following: Resident 1 (R1) was admitted to the facility on March 22nd 2023 following a hospital stay due to left leg wound. Per Administrator (AD) Flormine Resurreccion, AD went to the hospital on March 19th 2023 to assess R1, per AD R1’s leg was wrapped and the wound was not visible during assessment. Per AD home health was arranged for wound care through Care Plus Home Health. Unsubstantiated Per AD it was only discovered at a later date that R1’s leg was recommended to be amputated which was also listed on LIC 602 Physician’s Report dated 03/20/2023. Per LIC 602 Physician's Report R1 has a history of skin breakdown “extensively on bilateral upper and lower extremities”. Per LIC 624 Unusual Incident/Injury Report received on 04/04/2023 for an incident that occurred on 04/02/2023 it was noted that skin tears were observed by staff for R1/ Per LIC 624 AD notified R1’s responsible party and contacted Home Health for a nurse’s assessment. Per report nurse assessed resident and first aid was applied. Based on interviews with 3 out of 3 staff, staff stated they did not mishandle resident causing skin issues. Residents present during LPA Mendivil’s visit on April 28rd, 2023 were not interviewed as they were either asleep or not oriented to time and space. Per review of LIC 624 submitted to the Department on 04/13/2023 for an incident that occurred on 04/11/2023. Per incident report R1 was sent to UCI hospital due to an unstageable wound and family was contacted after resident was transported using a non-emergent transport. It was alleged that facility staff did not follow R1’s doctor’s orders. Based on interviews with AD there were contradictory orders from R1's physician and Home Health's physician. Based on interviews with staff, staff stated they follow all physician’s orders and interviews. It was alleged that the facility abandoned resident in the hospital, Per interview with AD, AD stated she stayed with R1 while in the hospital on 04/11/2023 and was in contact with R1’s family. It was alleged that the facility did not operate within the terms of their license regarding bedridden residents. Per review of residents’ LIC 602 physician reports, only R1 was listed as bedridden and all other residents were listed as non-ambulatory. Per review of license the facility does have a fire clearance for 1 bedridden resident. Therefore based on the preponderance of evidence through records reviewed and interviews the allegations facility did not properly handle resident to avoid skin issues, facility staff did not notify resident’s responsible party of changes in residents condition, facility staff did not follow resident’s doctor’s orders, facility staff abandoned resident in the hospital emergency room and facility did not operate within the terms of their license are determined to be unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. No deficiencies cited. An exit interview was conducted and a copy of this report was provided. Per AD it was only discovered at a later date that R1’s leg was recommended to be amputated which was also listed on LIC 602 Physician’s Report dated 03/20/2023. Per LIC 602 Physician's Report R1 has a history of skin breakdown “extensively on bilateral upper and lower extremities”. AD stated she visits the resident where they are and conducts an assessment. During interview with AD, AD stated R1's leg wound was wrapped and she did not view the wound until the resident was in the facility. Per AD's interview and a summation of the events AD stated that R1 needed a higher level of care. Therefore based on the preponderance of evidence through records reviewed the allegation Facility staff did not properly assess resident before acceptance into the facility is determined to be SUBSTANTIATED, meaning the alleged violation occurred. The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted and a copy of this report with appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 24, 2026 · control 22-AS-20230421093912

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87456(a)(3) · Plan of correction due date: May 6, 2026

(a)Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8:(3) Obtain and evaluate a recent medical assessment. This requirement was not met as evidence by R1's physician report provided information that the faciltiy used to determine R1 needed a higher level of care. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 24, 2026

Plan of correction: Administrator stated has implimented a checklist for assesments and has family or responsible party's signature for verification. Administrator stated will create a body check assessment and provide proof to LPA by POC due date.

Type of visit: Required - 1 Year

On May 19, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Assistant Administrator (AD) Maria Tavarez was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents, One (1) may be bedridden, with approved hospice waiver for four (4) residents. Currently, there is three (3) Hospice residents present during today’s visit. This is a single story home with detached garage facility. The facility has five(5) resident bedrooms (four private, one shared) and one (1) staff room with two bathrooms. At around 12:45 PM, LPA conducted a tour of the physical plant accompanied by Assistant Administrator Maria Tavarez, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 105.4 to 108.8 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning products and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed two fire extinguishers which was fully charged and mounted. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on May 1, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 8/1/2024 – 8/1/2025. A review of five residents (R1-R5) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Robert Dale Kalagayan # 6067291740 - Expiration 08/07/2025. No deficiencies during this inspection visit. An exit interview was conducted with Assistant Administrator Maria Tavarez, and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 19, 2025

Allegation investigated: Staff yells at or belittles resident Facility did not arrange for medical care appropriate to resident needs

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Jesus Gueco. LPA explained the reason for the visit. This agency has investigated the complaint alleging that staff yells at or belittles resident and facility did not arrange for medical care appropriate to resident needs. Regarding the allegations, the following was revealed: Two of two individuals interviewed denied the allegations. LPA reviewed documents including the Report of Suspected Dependent Adult/Elder Abuse (SOC341) dated August 28, 2024 for Resident 1 (R1). Per Report of Suspected Dependent Adult/Elder Abuse R1 lives at Rossmoor Sunshine Villa located at 11322 Wembley Road Los Alamitos, CA 90720. CONTINUED ON LIC9099-C... Unfounded During the initial visit on September 05, 2024 LPA reviewed documents including the Register of Facility Clients/Residents dated September 05, 2024. Per Register of Facility Clients/Residents R1 is not a resident at Rossmoor Sunshine Villa-Wembley. During the course of the interviews with staff, Staff 1 (S1) reported that R1 has never been a resident at this facility. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis. LPA Ramirez conducted an exit interview with caregiver Gueco, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 5, 2024 · control 22-AS-20240829103548

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA’s) Bernadette Allen made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPA met with Maria Tavarez support staff who granted entry into the facility. LPA observed 3 staff and 5 residents during the inspection.The facility is licensed for 6 non-ambulatory,of which 1 may be bedridden. Hospice waiver for 4.The facility is operating in the capacity and conditions approved by CCL. Physical Plant: LPA observed there are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected clients bedrooms: they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. The hot water temperature tested within regulation at 104 degrees F. The facility is equipped with operating smoke detectors, carbon monoxide alarms and fully charge fire extinguishers. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. All sharps are locked in a cabinet over the kitchen sink. There was a designated place for client/staff files locked in closet, Overall, the facility appeared to be clean, in good repair, and operating in safe conditions. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed two (2) client files for admission agreements, updated physician reports, and Medication Administration Records (MAR’s) which appeared to be administered as prescribed by their physicians. LPA also reviewed two (2) staff files for First Aid/CPR certification, training's, and health screenings and appeared to be current. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Maria Tavarez support staff at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 19, 2024