Cozy Home Senior Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced site visit to the facility for the purpose of amending Complaint Control Number 22-AS-20230831105029. Upon arrival, LPA met with Administrator (AD) Paris Dumaliang, explained the reason for the visit. LPA toured the intrior and extrioe of the facility and conducted a health and safety check. During the visit, LPA provided AD with a copy of the amended report. An exit interview was conducted, and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 8, 2026

Allegation investigated: Facility is a hostile environment for residents. Facility has no proper ventialtion resulting in residents rooms being hot. Resident was able to leave facility unassisted. Resident are left unasssited.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to deliver findings regarding the above-mentioned allegations. LPA was granted entry by Administrator (AD) Paris Dumaliang and explained the purpose of the visit. At the time of the visit, there were three staff members working and four residents in care. During the course of the investigation, LPA interviewed staff, reviewed facility records, conducted a health and safety walk-through of the facility, and attempted to interview current residents. LPA also attempted to contact the reporting party by telephone on three separate dates; however, LPA was unable to obtain additional information from the reporting party. It was alleged that “Facility is a hostile environment for residents,” “Residents are left unassisted,” “Resident was able to leave facility unassisted,” and “Facility has no proper ventilation resulting in residents’ rooms being hot.” {***CONTINUE9099C***} {***THIS IS AN AMENDED REPORT***} Unsubstantiated LPA conducted interviews with three staff members. All three staff members denied the allegations. Staff denied that the facility is a hostile environment and stated that residents are treated respectfully. Staff also denied that residents are left unassisted and stated that staff are available to assist residents as needed. Staff further denied that any resident, including Resident 1 (R1), left or attempted to leave the facility unassisted. LPA attempted to interview residents; however, due to residents’ cognitive limitations, LPA was unable to obtain reliable statements from residents to support or refute the allegations. During staff interviews, staff stated that R1 could not have left the facility unassisted because R1 required assistance with ambulation and used a walker. LPA reviewed R1’s admission agreement and physician’s report. The records reviewed indicated that R1 was not receiving hospice services, had mild cognitive dementia, was non-ambulatory, and used a walker. Staff also denied any known elopement incidents involving R1 or any other resident. LPA observed exit alarms and door chimes in the facility. LPA also reviewed the Department’s system and facility records and did not observe any incident reports or records showing a known elopement incident. LPA conducted a health and safety walk-through of the interior and exterior areas of the facility. During the walk-through, LPA did not observe the facility to be a hostile environment for residents. Residents observed during the visit appeared calm and were not observed to be in distress. LPA observed staff present and available to assist residents as needed. LPA did not observe residents being left unassisted, and LPA did not observe any resident exiting or attempting to leave the facility unassisted. Regarding the allegation that the facility had no proper ventilation, LPA observed the facility to have adequate ventilation during the visit. Resident rooms inspected by LPA did not appear excessively hot or uncomfortable. LPA observed that windows were operable, the HVAC/air conditioning system was functioning, fans were present, and the thermostat was working properly. Based on the information gathered during the investigation, including staff interviews, records reviewed, and LPA’s observations, the Department is unable to determine that the allegations occurred as reported. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed Unsubstantiated. An exit interview was conducted, and a copy of this report was provided to AD Paris Dumaliang. {***THIS IS AN AMENDED REPORT***}the state’s words, verbatim · CDSS document, Apr 23, 2026 · control 22-AS-20230831105029

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez conducted this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and were greeted and granted entry by caregiver and LPA explained the nature of the visit. There are six residents at the facility and there is one resident receiving hospice services currently. Serparis Dumaliang, Administrator arrived to the facility and met with LPA. LPA began the tour of the inside and outside of the facility. LPA observed resident in the living room watching TV. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in storage a cabinet and refrigerator located in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA observed a small refrigerator with resident medication located in the dining room which contains a lock. LPA observed a first aid kit located with medication. LPA inspected the bathroom and LPA measured the hot water temperature which measured 116.9 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Facility lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants were stored locked in hallway storage Continued on LIC809-C closet. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which had sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of November 8, 2025, in kitchen. LPA verified fire drills are conducted. LPA began review of records. LPA reviewed four resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. LPA as a reminder provided annual fee dues information. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Ruth Martinez and Nancy Guillen are conducting this unannounced visit for the purpose of completing an annual required inspection. LPAs arrived at the facility and were greeted and granted entry by caregiver and LPAs explained the nature of the visit. There are six residents at the facility and there is one resident receiving hospice services currently. LPAs began the tour of the inside and outside of the facility. LPAs observed resident in the living room watching TV. LPAs observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in storage a cabinet and refrigerator located in the garage. The facility is maintained at a comfortable temperature. LPAs inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPAs reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPAs observed a lock box in the refrigerator with resident medication. LPAs observed a first aid kit located with medication. LPAs inspected the bathroom and LPAs measured the hot water temperature which measured 115.5 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Facility lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs observed that toxic chemicals, cleaning solutions and disinfectants were stored locked underneath kitchen sink and locked in hallways storage closet. The facility has an available clean supply of linens. LPAs inspected residents’ bedrooms which had sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPAs toured the outside of the facility and observed outdoor passageways are free of obstructions. LPAs observed there are shaded seating areas for residents’ Continued on LIC809-C enjoyment. LPAs observed a fire extinguisher with service date of November 2023, in kitchen. LPAs verified fire drills are conducted. LPAs began review of records. LPAs reviewed six resident records. All the required documentation was present and current in the residents’ files reviewed. LPAs reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPAs observed records reviewed have a current First Aid certificate. LPA as a reminder provided annual fee dues information. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 7, 2024

Allegation investigated: • Facility staff caused injury to resident. • Facility staff handled resident in a rough manner. • Facility staff did not seek medical attention in a timely manner.

Licensing program analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrive at facility was greeted at the door by staff and granted entry. LPA spoke with Paris Dumaliang, Administrator and explained the purpose of the visit. Findings are based upon this investigation which included file review, hospice records review, interviews conducted with staff and residents. It is alleged that the facility staff caused injury to resident. Interviews, conducted with 2 of 2 facility residents indicate that there have never been signs of bad treatment from staff to residents. Residents indicate that they are treated good, and they get the care that is needed. Interview with residents reported there are no Continued on LIC9099-C Unsubstantiated concerns with staff at facility or any other residents and never observed any abusive behavior by the staff against any resident. Interview with witness revealed that they are not concerned with the care of the residents at the facility or of R1. They indicate that the care that R1 receives is good and that it brings them comfort to know that R1 is getting good care. They have no concerns that injuries are being cause by a staff member, they indicate that R1 has picking habit. R1 likes to pick and take off bandages when they have skin tears. Witness indicates that they don’t feel that the skin tears are done on purpose and knows that it happens because R1 has sensitive skin. Witness indicates that if they felt that R1 was not cared for appropriately they would have moved R1 out of the facility. It is alleged that the facility staff handled residents in a rough manner. On May 14, 2021, assessment narrative – medical socials worker spoke with patients’ friend/power of attorney, that he reports to visiting patient regularly. He is pleased with the care that facility and hospice provide. He joked that it was suggested to him “you should get a room here." This comforting, knowing the patient feels well cared for. Describe patient's cognitive function: alert to self and immediate situation and can recall that I was there 10 minutes after I leave and come back, she is able to answer simple questions, she is forgetful and confused at times describe effects of anxiety on patient yells out with care being done, occasionally pushes away from caregiver refuses care. Indicate functional assessment staging fast score: ability to speak limited to approximately a half dozen different words or fewer, over an average day or in the course of an intensive interview. It is alleged that facility staff did not seek medical attention in a timely manner. Interview with staff indicated that staff noticed a new skin tear and reported it to administrator. To which administrator indicated that a call was made to hospice to report new skin tear on or about May 16, 2021. The administrator received a call from the hospice on May 17, 2021, indicating that hospice was coming to see R1. Review of hospice records revealed the following: On May 10, 2021, interventions for safety concerns were in place and no concerns were identified. Records indicate other actual potential abuse/neglect risk factor: PT has a new skin tear in web of right hand between thumb and index, the staff reports from a cotton hand guard and the PT pulling it. This skin tear is in several months. May 20, 2021, document all autonomy concerns/ risk factors identified in focal assessment: no concerns/ risk factors identified this visit. Describe patient's cognitive function: patient is alert to self and current situation, easily confused and she answers questions inappropriately at times because patient cannot hear you and or you need to re state what you want. Indicate functional assessment Continued on LIC9099-C staging fast score: ability to speak limited to approximately a half dozen different words or fewer, over an average day or in the course of an intensive interview. On May 24, 2021, palm right skin tear inactivated onset date May 16, 2021, wound assessed inactivated wound completely. Based on the information gathered during the investigation, interviews and review of all documents obtained, the Department is unable to ascertain if the allegation 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, this allegation is deemed Unsubstantiated. This report was reviewed with Administrator and a copy was furnished to the facility.the state’s words, verbatim · CDSS document, Dec 27, 2023 · control 22-AS-20210518155603