Golden Age Senior Homes 2

Allegation investigated: Resident developed pressure injuries due to staff neglect. Staff did not ensure resident's diapering needs were being met resulting in resident developing multiple UTI's. Staff mismanaged resident's medications. Staff does not provide adequate supervision to residents. Staff smokes marijuana during shift Staff did not ensure resident's nutrition needs were being met. Staff did not provide a comfortable environment for resident. Staff is operating beyond the scope of license.

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Administrator Virgilio Delantar and explained the reason for the visit. During the course of the investigation, Department staff inspected the facility, interviewed the staff and witnesses and reviewed documents including, resident roster, staff roster, facility fire clearance, staff schedule, Resident 1's (R1) physician’s report, R1's resident appraisal, R1's medication list, R1's care plan, R1's hospice records and R1's Admission Agreement. The investigation into the allegation, Resident developed pressure injuries due to staff neglect, revealed the following. Unsubstantiated It was reported that R1 developed pressures injures (stage unknown) on their back and buttocks during their stay at the facility. No dates were provided as to when the pressure injuries were developed or discovered and the number of pressure injures was not provided. R1 moved into the facility on May 8, 2025 and moved out of the facility on May 29, 2026. R1 moved into a new facility on May 29, 2026 and passed away at that facility due to Non-Hodgkin's Lymphoma on June 19, 2026. Staff 1 and Staff 2 reported that R1 never went to the hospital or had home health visits during their stay at the facility. A review of R1's hospice records does not show any reports of any pressure injuries. R1's physician reports dated November 7, 2025 and the physician report dated June 4, 2026, do not list any pressure injuries. R1's preplacement appraisal dated May 7, 2025 does not list any pressure injuries. LPA interviewed the Administrator from the facility R1 moved into on May 29, 2025, the Administrator reported they do not remember R1 having any pressure injuries. LPA attempted to contact Witness 1 (W1) who was reported to have knowledge of the incident, but they did not respond to requests for an interview. LPA attempted to contact Hospice Nurse 1 but did not receive a response. There is no record of R1 ever having a pressure injury while they resided at the facility. There is no record of R1 having a pressure injury at the new facility they moved to on May 29, 2026. Based on the evidence gathered the allegation is deemed unsubstantiated, meaning although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff did not ensure resident's diapering needs were being met resulting in resident developing multiple UTI's, revealed the following. R1 moved into the facility on May 8, 2025 and moved out of the facility on May 29, 2026. R1 was on hospice. Staff 1 and Staff 2 reported that during their stay at the facility R1 never had home health visits and never went to the hospital. A review of facility records and hospice records shows there is no mention of any Urinary Tract Infections (UTI) for R1. LPA attempted to contact Hospice Nurse 1 but did not receive a response. Staff 1 and Staff 2 reported that R1 never had a UTI. LPA attempted to contact Witness 1 (W1) who was reported to have knowledge of the incident, but they did not respond to requests for an interview. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff mismanaged resident's medications, revealed the following. It was reported that staff mismanaged R1’s medication and when R1 moved to a new facility their medications were mixed together in different bottles, and they could not determine what each medication was for. Staff 1 and Staff 2 denied the allegation and reported that each medication was provided to R1’s responsible party in it’s original container. LPA interviewed Staff 3 who works at the facility R1 moved to on May 29, 2026. Staff 3 stated they don’t remember any issues with R1’s medication and as far as they remember the medication was fine. R1 passed away on June 19, 2026, and was not interviewed. R1’s responsible party did not respond to requests for an interview. A review of records shows there was no transfer sheet showing R1’s responsible party signed for the medication when R1 moved out of the facility. A medication list was provided at the time of move out which matches the medication list at the new facility. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff does not provide adequate supervision to residents, revealed the following. It was reported that Staff 1 and Staff 2 leave the facility for extended periods of time and leave the residents unsupervised or have their minor child watch residents. No dates or times were provided as to when this happened. Staff 1 and Staff 2 denied the allegation. 2 out of 4 residents reported they have never been left unattended. 2 out of 4 residents could not be interviewed and did not respond to the LPA’s questions. LPA attempted to contact 2 responsible parties of residents 1 and 2 but never received a response. During the initial visit and the visit on September 15, 2026, LPA did not observe anyone at the facility except the residents and Staff 1 and Staff 2. None of the evidence gathered supports the allegation. Based on the evidence gathered, the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff smokes marijuana during shift, revealed the following. It was reported that Staff 1 told Witness 1 that they smoke marijuana at night and offered marijuana to Witness 1. LPA interviewed Staff 2 who reported they have never seen anyone smoke anything at the facility. Staff 1 denied the allegation. LPA interviewed 2 out of 4 residents who reported that they have never seen anyone smoke and have never smelled marijuana or cigarette smoke at the facility. Witness 1 did not respond to requests for an interview. LPA attempted to contact 2 responsible parties of residents 1 and 2 but never received a response. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff did not ensure resident's nutrition needs were being met, revealed the following. It was reported that during Resident 1’s (R1) last few days at the facility they were not provided with their pureed meals. Staff 1 and Staff 2 denied the report and stated that R1 was always provided with their pureed meals but R1 did not always finish their meals because their appetite had declined. LPA attempted to contact Witness 1 (W1) who was reported to have knowledge of the incident, but they did not respond to requests for an interview. R1 passed away on June 19, 2026, and was not interviewed. LPA interviewed 2 out of 4 residents who reported they were unaware if R1 ate pureed meals or not. LPA attempted to contact Hospice Nurse 1 but never received a response. Based on the evidence gathered, the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff did not provide a comfortable environment for resident, revealed the following. It was reported that facility staff did not provide a comfortable environment because facility staff made inappropriate comments to residents and their visitors which resulted in visitors and residents feeling uncomfortable. No specific details were provided as to what was said by facility staff. LPA interviewed 2 out of 4 residents who reported they had no issues with facility staff and felt comfortable living at the facility. 2 out of 2 facility staff denied the allegation and reported they never did anything inappropriate at the facility. LPA attempted to contact 2 responsible parties of residents 1 and 2 but never received a response. LPA attempted to contact Witness 1 (W1) who was reported to have knowledge of the incident but they did not respond to requests for an interview. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff is operating beyond the scope of license, revealed the following, it was reported that staff at the facility had converted the garage into 3 bedrooms and the new bedrooms were intended for resident use. LPA toured the facility on June 3, 2026, and on September 15, 2026. The garage has not been converted into 3 bedrooms. The Administrator had put up a room divider to partition part of the room to store old furniture and other items that were not needed. LPA did not observe any personal items or beds in the garage. The garage has not been altered in any and no permanent changes to the structure have been made. LPA reviewed the facility sketch, no changes have been made to the facility. Facility has 4 residents at this time and no one is on hospice. At the time of the original 10-day visit, June 3, 2026, the census was 4 residents with no one on hospice. Staff 1 and Staff 2 reported no one is sleeping in the garage. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, meaning that, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Sep 15, 2026 · control 22-AS-20260601173403

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by caregiver and explained the nature of the visit. There are four residents at the facility and there is four residents receiving hospice services currently. LPA began the tour of the inside and outside of the facility. 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 a freezer 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 closet located in the hallway leading to resident bedrooms. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 112.6 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. 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 are stored locked underneath kitchen sink and locked storage cabinet in the garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has 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 Continued on LIC809-C 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 mounted in the wall of the kitchen mounted and charged dated February 1, 2026. Fire drills are conducted every three months and LPA verified facility is conducting drills. LPA began review of records. LPA reviewed two resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two 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. 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 facility representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by caregiver and LPA explained the nature of the visit. Rico Mico, Administrator arrived shortly after and met with LPA. There are three residents at the facility and there is two residents receiving hospice services currently. LPA accompanied began the tour of the inside and outside of the facility. 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 freezer and refrigerator in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage closet located in the hallway leading to resident bedrooms. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 111.9 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. 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 are stored locked underneath kitchen sink and locked storage cabinet in the garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has 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 mounted in the wall of the Continued on LIC809-C kitchen mounted and charged. Fire drills are conducted every three months and LPA verified facility is conducting drills. LPA began review of records. LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two 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. 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, Feb 24, 2025