Belmont Village Aliso Viejo

Allegation investigated: Staff excluded resident's authorized person from making decisions regarding resident's care Staff retained resident at the facility without consent or court order

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. 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 and interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as court documents. Regarding the allegations that Staff retained resident at the facility without consent or court order and Staff excluded resident's authorized person from making decisions regarding resident's care, the investigation revealed the following: R1 has Durable Power of Attorney (DPOA) paperwork dated July 6, 2021, designating three family members as agents of healthcare and financial decisions. The Department reviewed a Probate Settlement Agreement dated 06/10/2025 through the Superior Court of Orange County. Agreement indicates if R1 is unable to be safely maintained in the home, the residthe state’s words, verbatim · CDSS document, May 26, 2026 · control 22-AS-20260107132248

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.

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 are not trained properly on how to deal with dementia residents

Licensing Program Analysts (LPAs) Kimberly Lyman and Fred Arias conducted an unannounced complaint visit to deliver findings on the above allegation. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff. Regarding the allegation that staff are not trained properly on how to deal with dementia residents, the investigation revealed the following: On 02/12/2024, Staff 1 (S1) had an altercation with a memory care resident. Resident 1 (R1) grabbed a duster from S1's cart and attempted to push the cart. Per interviews conducted, S1 reacted inappropriately and was subsequently terminated. LPA reviewed training record for S1 and the staff received Dementia training in 05/23/2023 and 12/14/2023 even though she was employed as a housekeeper and not a caregiver. Based on interviews conducted and record review, the allegation is deemed UNFOUNDED, meaning the allegation isthe state’s words, verbatim · CDSS document, Feb 4, 2025 · control 22-AS-20240212153740

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 provide an appropriate sleeping arrangement for a resident Staff do not provide adequate care and supervision to a resident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as home health documentation. Regarding the allegations that staff do not provide adequate care and supervision to a resident and staff did not provide an appropriate sleeping arrangement for a resident, the investigation revealed the following: Resident 1 (R1) was seen by home health for dermatitis for approximately two months and was discharged from home health on 01/24/2024. Resident has a primary care physician in the San Diego area and stated requesting a physician visit from the Wellness Center in an attempt to find a physician nearby. Resident stated having some swelling on the legs as the resident is prone to Dthe state’s words, verbatim · CDSS document, May 6, 2024 · control 22-AS-20240501161913

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 failed to provide care and supervision which resulted in resident sustaining injuries during elopement

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility and explained the reason for the visit. During course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation including Physician Report, Resident Service Plan, Orange County Sheriff’s Report, Orange County Death Certificate and Mission Hospital Medical Records. The purpose of today’s visit is to follow up on an investigation conducted by the Department regarding the above allegation. The investigation conducted revealed the following: Resident 1 (R1) was admitted to the facility on April 30, 2023. Physician report dated April 25, 2023, notes that R1 had a diagnosis of Dementia. On July 09, 2023, R1 sustained a fall from their bedroom window located on the second floor of the facility. Surveillance video obtained from Alithe state’s words, verbatim · CDSS document, Mar 20, 2024 · control 22-AS-20230711102555

Allegation investigated: -Facility failed to provide resident's records to authorized representative

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the investigation, LPA interviewed Executive Director as well as reviewed and obtained documentation such as request letter for documents. Regarding the allegation that facility failed to provide resident's records to authorized representative, the investigation revealed the following: Facility received a request for Resident 1's (R1) records dated 11/16/2023 and received via Federal Express 11/17/2023. Facility indicated working on submitting records as of today, 11/29/2023 but that the records had not been submitted to date. Based on records reviewed 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 22, Division 6, Chathe state’s words, verbatim · CDSS document, Nov 29, 2023 · control 22-AS-20231121140704

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 give medications timely Oxygen was not kept on resident according to physicians orders

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. 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 and witnesses as well as reviewed and obtained pertinent documentation such as physician report and hospice notes. Regarding the allegations that oxygen was not kept on resident according to physicians orders and staff did not give medications timely, the investigation revealed the following: Resident 1 (R1) admitted into hospice care on 12/02/2021. Hospice orders dated 12/02/2021 indicated an order for oxygen, 2 liters, given continuously and 2-5 liters for shortness of breath. Two out of two staff stated that the resident was agitated and would pull the canula out. However, hospice notes dated 01/14/2022 and 01/19/2022 indicated the oxygen tank was turned off when hospice nurse arthe state’s words, verbatim · CDSS document, Nov 7, 2023 · control 22-AS-20220223091921

Allegation investigated: Staff did not provide adequate food service

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 09/05/23. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Rosa Ayala. LPA explained the reason for the visit. This agency has investigated the complaint alleging that staff did not provide adequate food service. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Three of ten individuals interviewed corroborated the allegation. During the investigation LPA reviewed documents including the Belmont Village Aliso Viejo Weekly Menu dated 09/07/23 through 09/20/23. Per Belmont Village Aliso Viejo Weekly Menu residents have multiple options to choose from for breakfast, lunch and dinner. During the interviews with residents it was reported that staff do not bring the correct food order. Per Resident 1 (R1) thethe state’s words, verbatim · CDSS document, Oct 11, 2023 · control 22-AS-20230905151814