Carver Senior Homes 1

Allegation investigated: Staff physically abused resident

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez for the purpose of delivering findings. LPA met with Administrator (AD) Van Pao and explained the purpose of the inspection. It is alleged Staff 1 (S1) and Staff 2 (S2) physically abused Resident 1 (R1). Interviews were conducted with five facility residents, including R1, and S1 and S2. During their interview, R1 stated only S1, and not S2 had been physically abusive towards them, however, stated the abuse had occurred in the past. On February 22, 2023, the Department received complaint #22-AS-20230222151633 alleging facility staff sexually abused R1 and on May 16, 2025, the complaint was determined to be unsubstantiated. During their interview, Resident 2 (R2) denied staff being physically abusive to either them or R1 and stated, staff loves R1 and "they love me too!" (Cont. LIC9099-C) Unsubstantiated During their interview, Resident 3 (R3) was unable to confirm or deny allegation. During their interview, Resident 4 (R4) denied the allegation and stated R1 has a "filthy mouth" and often uses profanity, especially towards staff. R4 denied staff being retaliatory toward R1 either verbally or physically. During their interview, Resident 5 (R5) denied the allegation and stated it is R1 who is physically and verbally abusive towards staff and has attempted to hit staff with their wheelchair on multiple occasions. During their interview, S1 stated R1 often makes comments sexual in nature towards them, however, denied being personally abusive towards R1 and denied having any knowledge of any staff being physically abusive towards R1. During their interview, S2 stated R1 tends to be verbally abusive towards staff, however, denied being personally abusive towards R1 and denied having any knowledge of any staff being physically abusive towards R1, including S1. Due to allegation being uncorroborated during interviews conducted, the Department is unable to determine if Staff physically abused resident. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jan 23, 2026 · control 22-AS-20251223121237

Allegation investigated: Facility staff handled resident roughly

On January 21, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Van Pao was notified via telephone and later arrived to assist with the inspection. During the course of the investigation, the Department interviewed residents, interviewed staff, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, facility staff handled resident roughly, the following has been concluded: It was alleged that facility staff handled Resident # 1 (R1) roughly. LPA attempted to speak with R1 regarding this allegation, however, R1 refused to be interviewed. LPA conducted five staff interviews. Five out of the five staff interviewed denied the allegation and stated that staff have never handled R1 in a rough manner. Staff interviewed also stated that R1 has made similar allegations in the past, all of which have been false. LPA conducted four resident interviews. CONTINUED ON LIC9099-C Unfounded Four out of the four residents interviewed denied the allegation and stated that they have never been treated roughly by staff. Residents interviewed also stated that they have never seen staff treat any other resident in a rough manner. Additionally, two out of the four residents interviewed stated that R1 has made similar allegations about the staff in the past, all of which have been false. Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegations is false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator Van Pao and a copy of the report was provided. Staff interviewed stated that R1 has refused to participate in meetings about his care, R1 has refused to take his medication at times, R1 has refused to be bathed by staff at times, R1 has refused to follow the diet recommended to him by his primary care physician, and R1 has refused for staff to help him with his hygiene needs at times. Staff interviewed stated that R1 has been allowed to refuse care, so that staff do not violate his personal rights. Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Van Pao and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 22-AS-20230424101734

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Froilan Sy. LPA met with Staff Ransey Laxamana and explained the purpose of the inspection. Administrator (AD) Van Pao arrived at approximately 12:00 p.m. to assist with the inspection. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, two bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area, as well as a detached storage building. Per AD, the storage building is used as a staff break room, however, LPA observed a bed made with linen and blankets and staff’s personal items, including clothing and hygiene items; a Deficiency was cited on today’s date. LPA observed residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 111.0 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated October 23, 2025. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Medication was observed to be centrally stored and locked. LPA reviewed five resident files and two staff files. Two of five resident medical assessments did not include results of examination for TB; a Deficiency was cited on today’s date. LPA interviewed three residents and three staff. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Dec 26, 2025

Allegation investigated: Staff are not meeting resident's dietary needs. Staff are not providing adequate food service to resident in care. Staff physically abused residents in care. Staff verbally abuse residents in care.

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez. LPA met with Licensee Carmen Nicolas and explained the purpose of the inspection. Regarding the allegations, Staff are not meeting resident's dietary needs and Staff are not providing adequate food service to resident in care, the following was revealed: It is alleged Staff 1 (S1) is controlling Resident 1’s (R1’s) food intake at R1’s responsible party, Witness 1’s (W1’s) request. During the course of the investigation, interviews were conducted with R1, S1, W1, four additional facility residents, and two additional staff. During their interview, R1 stated their dietary needs are not being met, as they are hungry all the time. Per R1, they are not served with sufficient food at mealtimes and cannot snack in between meals because W1 is "cuckoo" and tells the staff not to give them any food. During their interview, W1 stated that due to R1’s medical diagnosis, R1 is unable to recall when they last ate, even if they have just eaten, therefore, R1 is often heard saying they are hungry. (Cont. LIC9099-C) Unsubstantiated Per W1, R1 receives more than enough food and has actually gained weight. W1 stated they would like R1’s diet to be more restricted so R1 may lose weight and maintain their mobility. During their interview, S1 stated R1’s diet consists of a lot of veggies and protein, per W1’s request, however, R1 is served with three meals a day plus snacks. S1 denied R1’s food intake being restricted and stated R1 can have a snack or additional food servings upon request. One of four residents interviewed was unable to confirm or deny the allegations, due their medical diagnosis. Three of four additional residents interviewed stated their dietary needs are being met and they receive sufficient food in quantity. Two of two additional staff interviewed stated residents’ dietary needs are being met and they are provided sufficient food in quantity. Regarding the allegation, Staff physically abused residents in care, the following was revealed: It is alleged S1 slapped R1 due to R1’s constant cursing. During their interview, R1 denied ever being physically abused by facility staff, including S1. R1 also denied S1 ever slapped them. During their interview, S1 denied personally slapping R1 or any other resident and denied having any knowledge of any facility staff physically abusing any resident. One of four residents interviewed was unable to confirm or deny the allegation, due their medical diagnosis. Three of four additional residents interviewed denied having any knowledge of S1 slapping R1 and denied personally having been physically abused by S1 or any other staff. Two of two additional staff interviewed denied having any knowledge of S1 slapping R1 and denied personally abusing any resident or having any knowledge of any other facility staff physically abusing residents. Regarding the allegation, Staff verbally abuse residents in care, the following was revealed: It is alleged S2 cursed at R2. During their interview, R2 denied having been verbally abused by facility staff, including S2. During their interview, S2 denied ever cursing at R2 or any other resident. S2 also denied having any knowledge of any facility staff verbally abusing any resident. One of four residents interviewed was unable to confirm or deny the allegation, due their medical diagnosis. Two of four additional residents interviewed stated R1 and R2 are constantly cursing at facility staff, however, denied staff cursing back. During their interview, R1 denied being verbally abused by staff and denied having any knowledge of staff verbally abusing any resident, including R2. Two of two additional staff interviewed denied having any knowledge of S2 cursing at R2 and denied having any knowledge of any other facility staff verbally abusing residents. (Cont. LIC9099-C) Due to allegations being uncorroborated during interviews conducted, the Department is unable to determine if Staff are not meeting resident's dietary needs, if Staff are not providing adequate food service to resident in care, or if Staff physically or verbally abused residents in care. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 22-AS-20251105113209

Allegation investigated: Facility did not accord resident privacy. Resident was admitted without required admission documentation.

Licensing Program Analysts (LPA) Kerry Hiratsuka and Cheyenne Ratajczak, conducted this unannounced complaint visit to deliver the results of the allegations above. The Department conducted an investigation into allegations above. The allegation was made in January 2023. A review of the resident's file today showed the file is complete and all required paperwork upon admission were signed prior to the resident moving in. Interviews conducted showed one resident had a camera with the responsible party's consent and the responsible party was the only one who had access to the camera feed. Otherwise, no one else has cameras in their rooms. A tour of the rooms showed no cameras in resident rooms. Based on information above, the department concluded that the allegations are Unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. nothe state’s words, verbatim · CDSS document, Jul 12, 2025 · control 22-AS-20230109131855

Allegation investigated: Staff sexually abused a resident.

On 05/16/25, Donna Gurriere, Licensing Program Analyst (LPA) contacted the facility to advise of the final findings regarding a complaint that was received on 02/22/23. LPA Gurriere spoke with Carmen Nicolas, Licensee and explained the purpose of the contact. Staff sexually abused a resident. During the interview process, a staff person and the resident (Resident 1) were interviewed. In addition, documents were reviewed and obtained to include the Physicians Report, Emergency Information, Appraisal, Medication Administration Records (MARs) and the Resident Facility Roster. continued Unsubstantiated During the investigation, of a complaint received on 02/22/23, the resident (Resident 1) alleged that two persons from the facility sexually abused him. Staff were interviewed and denied the allegation. The resident was interviewed; however, made inconsistent statements and questionable credibility of the allegation. No actionable evidence was gathered during the investigation. Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated. Licensee/administrator was advised a copy of this report will be sent via certified mail. Two copies of the report will be sent. The Licensee is to sign and return one copy to the Orange County Regional Office.the state’s words, verbatim · CDSS document, May 16, 2025 · control 22-AS-20230222151633

Type of visit: POC

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced Plan of Correction (POC) inspection. LPA was greeted and granted entry by Licensee Carmen Nicholas and the purpose of the inspection was discussed. LPA is following-up on deficiencies cited on February 19, 2025, during annual inspection. Deficiency 1569.625(b)(2) was cited as annual staff training records for three staff did not include eight hours of dementia care training, and four hours specific to postural supports, restricted health conditions, and hospice care. During today’s visit, LPA reviewed staff training records for three of three staff and observed staff files to include required annual staff training. Deficiency 1569.69(a)(2) was cited as staff file for employee of the facility who assists residents with the self-administration did not contain any documentation for hands-on shadowing medication training. During today’s visit, LPA reviewed staff training records for one of one staff and observed staff file to include hands-on shadowing medication training. Both POCs have been met and deficiencies previously cited will be cleared. Based on today’s observations, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Katherine Espina and the purpose of the inspection was discussed. During the inspection, LPA and Staff Espina conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, two bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 117.1 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA reviewed four resident files and three staff files. Staff files did not contain any documentation for for hands-on shadowing medication training and annual training completed did not include eight hours of dementia care training, and four hours specific to postural supports, restricted health conditions, and hospice care; a Deficiency was cited on today’s date. LPA interviewed three residents and three staff. Based on the observations made during today’s inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Licensee Carmen Nicholas and explained the purpose of the inspection. During the inspection LPA and Licensee conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, two bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings, however, in bedroom of Resident 1 (R1), LPA observed and obtained a picture of a 32 ounce plastic urinal container containing R1’s urine, being stored without a lid in R1's room; a Deficiency was cited on today’s date. LPA observed all resident beds had linens and blankets. The back yard has a shaded sitting area. LPA observed residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 114.8 degrees Fahrenheit. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. Sharps were observed locked in a kitchen drawer. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication cabinet was observed to be locked. Administrator (AD) Isaiah Tashiro arrived at 11:00 a.m. to assist with the inspection. LPA reviewed five resident files and three staff files. Three out of five resident files did not have a completed appraisal dated in the last twelve months; a Deficiency was cited on today’s date. (Cont. LIC809-C) Staff files did not contain any documentation for initial 6 hours of hands-on required medication shadowing training. AD stated training was conducted upon hire but was not originally documented. Staff file review indicated 20 hours of annual training has been completed, however, did not contain eight hours of dementia care training, and four hours of which shall be specific to postural supports, restricted health, and hospice; two additional Deficiencies were cited on today’s date. LPA interviewed three residents and two staff. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 29, 2024