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Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: -Staff do not ensure that facility is clean and sanitary

On this day Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to the facility for the purpose of delivering the findings of the above-mentioned allegation. LPA was greeted and granted entry into the facility by caregiving staff after introducing himself and stating the purpose for the visit. LPA began to explain the detailed information of the findings. LPA Vanegas explained the following. LPA conducted the initial 10-day visit on March 30, 2026. LPA conducted a tour of the interior and exterior of the facility and gathered photo evidence in relation to the above-mentioned allegation. Additionally, LPA interviewed two of two staff and interviewed the complainant in regard to the above-mentioned allegation. In regard to the allegation stating Staff do not ensure that the facility is clean and sanitary the following has been concluded: LPA conducted two staff interviews. No resident interviews were conducted due to all residents being asleep at the time of unannouthe state’s words, verbatim · CDSS document, Apr 23, 2026 · control 22-AS-20260320114355

Allegation investigated: -Staff financially abused resident

On this day Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to the facility for the purpose of delivering the findings of the above-mentioned allegation. LPA was greeted and granted entry into the facility by caregiving staff after introducing himself and stating the purpose for the visit. LPA began to explain the detailed information of the findings. LPA Vanegas explained the following. Regarding the allegation that Staff Financially Abused Resident The following has been concluded: Based on the evidence gathered and interviews conducted R1 invested a total of $72,500 at their own discretion. Based on Interview with R1 they stated that they invested money at their own discretion however they feel that they were talked into investing. Based on interview with Potential Witness 1 (PW1) They advised R1 not to invest their money as this was the only type of income they have at the moment. PW1 states that they were not the designated P.O.A at the time of the investthe state’s words, verbatim · CDSS document, Apr 23, 2026 · control 22-AS-20260210150244

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff did not follow a resident's dietary needs

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility to deliver findings on the complaint allegation listed above. LPA was greeted and granted entry by staff after introducing himself and stating the purpose of the visit. The complaint investigation consisted of interviews with facility staff, a witnesses, a resident family member, and document review. During interviews, 5 of 5 individuals were not able to provide any corroborating evidence or information to support the complaint allegation. According to Staff 1 (S1), Resident 1 (R1) passed away at UCI Medical Center. S1 explained, R1 was sent to the hospital due to a cough and after consulting with the residents family. R1 passed away at the hospital about a week later. S1 talked a little about R1’s diagnoses and explained that everyone including the nurses at CalOptima knew R1 was in poor health. Continued on LIC9099C Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 23, 2025 · control 22-AS-20211129125638

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff do not ensure resident's special diet is followed

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced visit to the facility to continue the investigation and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Ngoc "Nick" Mai. It was alleged that staff do not ensure resident's special diet is followed. 2 out of 2 resident interviews and 1 out of 1 staff interview did not corroborate with the allegation. Per resident 1 's (R1) physician report, R1 is to be on a puree diet. R1 is the only resident at the facility who has a special diet, while the remaining 4 residents do not require special dietary orders. Upon entrance of the facility, LPA observed staff preparing R1's breakfast by pureéing it with a blender. During the tour of the facility, LPA observed that the facility is equipped with multiple blenders and supplies to ensure that R1's special dietary needs are followed. Continued on LIC9099-C... Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 24, 2025 · control 22-AS-20220620170336

Allegation investigated: Staff are not addressing a resident's hygiene needs while in care

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced visit to the facility to continue the investigation and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Ngoc "Nick" Mai. It was alleged that staff are not addressing a resident's hygiene needs while in care. 2 out of 2 resident interviews and 1 out of 1 staff interview did not corroborate with the allegation by verifying that staff assist with tolieting and showering needs. Per resident 1 's (R1) physician report, R1 requires assistance with showering. Per interviews, showering schedule for each resident ranges between 2 to 4 times a week. During the tour of the facility, LPA observed that all residents are clean, and that the facility is equipped with multiple supplies to ensure resident hygiene needs are met (such as pads, diapers, tolieting supples, shampoo and soap). Continued on LIC9099-C... Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 24, 2025 · control 22-AS-20220831160613

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Facility staff did not adequately supervise resident in care.

Licensing Program Analyst (LPA) Michael Tea made an unannounced complaint visit on this day to deliver findings for the allegations mentioned above. LPA met with Caregiver (CG) staff Quy "Anna" Mai while administrator was not present. It was alleged that facility staff did not adequately supervise resident while in care. During the investigation LPA interviewed staff and attempted to interview resident; obtained staff and resident roster, checked resident file, admission agreement, level of care assessment, discharge paperwork. The investigation determined the following: During investigation, LPA obtain and reviewed Resident 1’s (R1) physician’s report dated 02/17/2023 showing that R1’s primary diagnosis is dementia. In section 14, “Mental Condition,” sub-section k “able to leave facility unassisted” the doctor marked “NO.” R1 is unable to leave the facility without a staff assisting them. On the evening of 2/01/23, R1 left the facility unassisted and was missing until the following mothe state’s words, verbatim · CDSS document, Sep 26, 2024 · control 22-AS-20230203140953

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Resident left in soiled diapers on multiple occassions. Resident left in soiled diaper for an extended period of time.

Licensing Program Analyst (LPA) Jessica Cho made an unannounced subsequent visit for the purpose of delivering the findings into the above allegations. LPA met with Licensee/Administrator Ngoc Mai and was advised of the visit and the allegations. On September 1, 2020, the Department received the complaint. The complaint investigation was initiated by LPA Ruth Martinez on September 9, 2020, via a tele-visit due to Coronavirus 2019 precautionary measures. During the tele-visit, LPA Martinez conducted an interview with staff and obtained pertinent records via email. On April 24, 2024, LPA Cho made an unannounced subsequent visit to continue the investigation from 9:20am-11:10am. LPA Cho conducted interviews with the staff and residents; however, interviews were terminated prematurely for three out of the three residents due to language barriers and/or their refusal to participate. Additional interviews were conducted via telephone with the exception of Resident #1 (R1). The following wasthe state’s words, verbatim · CDSS document, Apr 29, 2024 · control 22-AS-20200901153600

Allegation investigated: Facility failed to pay electricity bill timely

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA Mendivil was greeted and granted entry into the facility by Licensee/Administrator Ngoc Mai and explained the reason for the visit. The department received a complaint on 03/08/2024, and LPA Mendivil conducted initial 10 day visit same day. LPA Mendivil interviewed Licensee/Administrator Ngoc Mai and obtained copies of electronic payment receipt. Regarding the allegation facility failed to pay electricity bill timely, the investigation revealed the following: Per interview with Licensee/Administrator Mai the electricity was on auto pay and the card linked to the account had expired in October 2023. Licensee Mai stated that he was not aware as he does not often check his emails linked to the electricity account and did not receive anything in the mail or calls regarding the late payments. On 03/01/2024 a door tag was left on the front door of the facility indithe state’s words, verbatim · CDSS document, Mar 8, 2024 · control 22-AS-20240308085205

Allegation investigated: Staff hit resident in care

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed staff, witness and residents as well as reviewed and obtained pertinent documentation such as staff schedule and physician report. Regarding the allegation that staff hit resident in care, the investigation revealed the following: LPA interviewed staff, residents and witnesses during the course of the investigation. Three out of three residents deny any verbal or physical abuse at the facility. All three residents verbalized satisfaction and safety at the facility. Residents all appeared clean, well taken care of and happy. On both visits, LPA observed residents engaged in activities and enjoying themselves. Two out of two staff and witness deny any verbal or physical abuse occurring in ththe state’s words, verbatim · CDSS document, Sep 26, 2023 · control 22-AS-20230811164351