Rossmoor Sunshine Villa-Oak Way

Type of visit: Required - 1 Year

On March 17, 2026, 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. Licensee Flormine Resurreccion was available to assist with the facility inspection. Licensee Ricardo Banos arrived at later time to also assist with inspection. The facility is licensed to operate for six (6) non-ambulatory residents, of which two (2) may be bedridden, and has a hospice waiver for five (5) residents. The facility is a single-story structure with attached garage located in a residential neighborhood. The facility has six bedrooms and seven restrooms. Currently, there are three (3) Hospice residents present during today’s visit. LPA conducted a tour of the physical plant accompanied by Licensee, 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 109.4 to 114.6 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 cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has supply of emergency food and water. Facility has one fire extinguisher which was mounted and charged. 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 land line phone was operational. The last fire drill was conducted on 3/14/2026. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 6/22/25- 6/22/26. A review of six residents (R1-R6) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Maria Jesusa Gonzales # 6075311740 - Expiration 02/13/2027. No deficiencies during this inspection visit. An exit interview was conducted with Licensee Ricardo Banos, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 17, 2026

Allegation investigated: Due to lack of care and supervision resulted in resident eloping

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to initiate complaint investigation. LPA Tirre was greeted and granted entry into the facility by staff and explained reason for visit. During the course of investigation, LPA reviewed records, conducted interviews, toured facility and made visual observations. Department requested pertinent documentation such as Physician’s Report, Resident Apprasial,Incident Report, Personnel report and Resident Roster. The investigation conducted revealed the following: On December 23, 2025 the department received a complaint alleging due to lack of care and supervision resulted in resident eloping. Record review revealed that Resident 1 (R1) has a Dementia diagnosis listed on Physician’s report dated 10/19/2025. R1’s Physician’s report also notates under capacity for self care, R1 is not able to leave the facility unsupervised. Under Behavioral Expressions section of Physician’s report R1 is noted to have disorientation, Lack of hazard awareness, unsafe wandering and elopement as behaviors CONTINUED ON 9099C Substantiated Residents appraisal dated 10/26/2025 notes under Services needed, R1 needs special observation and night supervision due to confusion, forgetfulness & wandering. Record Review revealed Department received Unusual Incident Report from facility on 12/23/2025, notifying Department of R1’s exiting the facility without staff’s awareness. Incident report indicates that staff 1 & 2 were present in the facility and both helping assist another resident (R2) during the time incident occurred. Incident report stated that R1 had a history of sundowning and no previous incidents of exiting facility without supervision. Interviews with staff stated that staff searched facility and surrounding neighborhood for R1. Staff interviews stated that Licensee’s who were out of town during the time of incident and were contacted regarding R1. Staff Interviews stated that incident occurred around 4:30PM. Staff interviews revealed that Staff contacted family and local police regarding R1. Staff interviews also revealed that R1 had a 1:1 care plan for R1 between the hours of 5:00-10:00pm due to R1’s sundowning behavior. Five of Five staff stated R1 had no previous incidents of eloping from facility. Interviews with 3 of 5 staff state R1 was located by Police and taken to Local Hospital around 9:00PM. Interview with witness states R1 was missing approximately for four hours. Witness interview stated that Staff left R1 unsupervised knowing Their condition. Witness interview stated Facility had alarm for front door upon opening. During Department visit, LPA observed that each exits in and surrounding facility had audible alarms that chime each time someone exits the doors. Interview with staff 1 and staff 2 stated they did not hear alarm go off while they assisted R2 due to R2 was verbally loud during transfer to bed. LPA observed cameras in common areas and perimeter of home which Staff stated Licensee has access to. Per information gathered from Investigation, the preponderance of evidence has been met, deeming the allegation “Due to lack of care and supervision resulted in resident eloping” to be Substantiated. The facility is being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with Representative and copy of report was discussed, provided along with appeal rights.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 22-AS-20251223142340

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(e)(5) · Plan of correction due date: Feb 23, 2026

Care Of Persons With Dementia 87705(e)(5) Facility staff shall ensure the continued safety of residents if they wander away from the facility... This requirement is not met as evidence by: Resident 1 left the facility unattended on December 21, 2025 for approximately four hours which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee agrees to train all staff on elopement prevention training and to provide proof of training to LPA by the POC due date 2/23/2026

Type of visit: Case Management - Annual Continuation

On March 11, 2025, at 10:20 AM, Licensing Program Analyst (LPA) Edward Kim conducted a continuation visit for a required 1-year annual visit that was started on March 4, 2025. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Eloisa Reyes. Licensee Flormine Resurreccion arrived to the facility around 10:30 AM. LPA Kim conducted an audit review of resident records (R1-R5) and Staff records (S1-S7). LPA conducted one staff interview. First aid kit contains all necessary elements. The facility has operable smoke detectors and carbon monoxide detectors. The facility has a video teleconferencing device dedicated to the residents that remains available No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was provided to Licensee Flormine Resurreccion.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

On March 4, 2025, at 1:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Eloisa Reyes. Assistant Administrator (AA) Maria Tavarez arrived at the facility around 1:40 PM and LPA explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents, of which two (2) may be bedridden, and has a hospice waiver for five (5) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, seven (7) bathrooms, living area, dining area, kitchen, an outdoor patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with AA Tavarez. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, and Resident Room 6. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 111.5 degrees F to 113.5 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility. LPA Kim observed the facility to be 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 a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A working telephone (562-357-4717) remains available. Last emergency drill was conducted on February 19, 2025. Two fire extinguishers are charged and mounted in the kitchen and in the entrance hallway. Emergency food, emergency water, and emergency supplies are stored in the garage. Facility has evidence of liability of insurance effective June 22, 2024, and expires June 22, 2025. LPA Kim conducted an audit of medication and medication administration record that was in order and complete. Due to time constraints a continuation inspection will be on a later date. LPA Kim will conduct an audit review of staff records, resident records, staff/resident interviews, an audit of first aid kit, and make sure the smoke detectors and carbon monoxide detectors are operational. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). Prior to construction or alterations, facility built an enclosed storage room in the garage with an additional two built walls. An exit interview was conducted, and a copy of this report and appeal rights were provided to Assistant Administrator Maria Tavarez.the state’s words, verbatim · CDSS document, Mar 4, 2025