Irvine Cottage #1

Allegation investigated: Lack of supervision resulting in residents sustaining injuries. Facility did not provide planned activities. Residents were not accorded a safe environment. Resident's representative was not provided access to the resident's record. Resident's representative was not informed about the resident's care. Facility statff made a misleading statement regarding resident's care. Staff did not ensure residents were fed resulting in weight loss

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received a complaint on March 20, 2026. The Department obtained copies of pertinent documents such as resident's physician report, admission agreement, and apprasials. LPA interviewed staff and residents. Regarding the allegations Lack of supervision resulting in residents sustaining injuries. Facility did not provide planned activities, Residents were not accorded a safe environment, Resident's representative was not provided access to the resident's record, Resident's representative was not informed about the resident's care, Facility staff made a misleading statement regarding resident's care, Staff did not ensure residents were fed resulting in weight loss, the investigation revealed the following : Unsubstantiated It was reported to the Department that Resident 1 (R1) was injured by Resident 2 (R2) during the night/early morning hours of February 1, 2026. It was reported that staff informed Administrator Kimberly Arnett that R1 had a swollen right hand on February 1, 2026 around 9AM. Administrator stated they called R1’s responsible party to notify them of the issue. R1’s responsible party took R1 to the emergency room, during the ER visit R1’s responsible party called Administrator R1’s responsible party advised the Administrator R1 disclosed a female nurse came into their room and twisted their hand back and the female nurse then placed her hand over R1’s mouth. Administrator Kimberly reported that they reviewed internal camera footage and it showed staff placing R1 in their room around 11:03 pm. During review of the footage Administrator stated the video showed R2 going into R1’s room around 3:40am and leaving approximately 2 minutes later. Administrator Kimberly stated they called OC Sheriff’s non emergent line but was told to call back when R1 returned to the facility. R1 returned on the same day of February 1, 2026 with a splint for immobilization. It was stated then staff called OC Sheriff’s non emergent line but was transferred to Irvine Police Department. Officer M. Krouse (Badge # 655) arrived at the facility. It was reported by staff R1 and R2 were interviewed by Officer M. Krouse and staff was informed no other follow up needed for the incident. It was reported that R2 stated they were sleep walking. LPA could not confirm the events with R1 as they were not oriented to time and space during the interview process. LPA could not confirm the events with R2 as they were not available for interview. It was alleged lack of care and supervision resulted in residents sustaining injuries. Per review of R1 and R2’s physician reports neither resident had wandering issues or required awake staff. Per interviews with 2 out of 2 staff indicated no other resident required awake night staff. Interviews with 2 out of 2 staff stated this was R2’s first incident of sleep walking or issues with aggressive behaviors. It was alleged that residents were not accorded a safe environment. Per review of both R1 and R2’s pre-placement appraisals neither needed awake staff at night for wandering behaviors. Per review of incident reports submitted by the facility this is R2’s first incident of any behaviors with other residents. After the incident on February 1, 2026, R2 was re-evaluated and moved to a new facility. Interviews with 3 out of 6 residents reported they do not have concerns about their safety at the facility. It was alleged that resident's representative was not provided access to the resident's record. Administrator Kimberly reported that R1’s medical records are stored by their own health insurance and R1’s family would have to supply those reports to the facility such as after summary visits, medication list, and physician’s reports. Administrator stated there is no form that the family does not have access to unless it is an internal document meant for staff only. It was alleged that residents representative was not informed about the resident’s care. Per interviews with facility, 2 out of 2 staff deny that R1’s responsible party was not informed of R1’s care as R1’s responsible party came to the facility as a result of the facility’s reporting. It was alleged that staff made a misleading statement regarding resident’s care. Per interviews R1’s responsible party was notified that R1 had a swollen hand, no reason for the injury was provided until R1’s responsible party advised Administrator Kimberly about the “female nurse” that was later determined to be R2. It was alleged that staff did not ensure residents were fed resulting in weight loss. Per review of facility meal photos sent in November and December 2025, the facility documented R1’s meal consumption. Per review of R1’s physician’s report R1 is able to feed themselves. During today’s visit LPA observed residents eating a meal of chicken, mashed potatoes, green salad, and chopped fruit. It was alleged that the facility does not provide planned activities. Interviews with 3 out of 6 residents interviewed stated they do not wish to participate in activities. The remaining 3 residents were not oriented to time or space or were not available for interviews. Administrator Kimberly stated activities are offered such as working out, walks outside to the park, coloring and arts/crafts. Therefore based on the preponderance of evidence through records reviewed ,interviews and observations the allegations Lack of supervision resulting in residents sustaining injuries, Facility did not provide planned activities, Residents were not accorded a safe environment, Resident's representative was not provided access to the resident's record, Resident's representative was not informed about the resident's care, Facility staff made a misleading statement regarding resident's care, Staff did not ensure residents were fed resulting in weight loss meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. No deficiencies cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2026 · control 22-AS-20260320171458

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents and has 6 residents during today's visit. During today’s visit, LPA along with Compliance Manager Michelle Nesbitt toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in bathrooms. The hot water temperature measured between 112.2 and 112,8 degrees Fahrenheit and all smoke detectors were operational. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed emergency food in locked garage. Facility conducted last fire and earthquake drill 03/01/2026. LPA observed resident's medication securely stored in kitchen cabinet. LPA reviewed medications and all appear to be given as prescribed. LPA observed an empty pre rolled marijuana cigarette container on patio chair. LPA observed locked staff room to have discarded food and cigarette butts on the floor and an odor was present when door was opened. LPA reviewed two out of two staff training and fingerprint records. LPA conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on 07/21/2026. Therefore no deficiencies are being cited during today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 21, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff are not meeting the needs and services of a resident Staff are not allowing a resident to communicate Staff do not have planned activities for a resident Staff are unable to communicate effectively Staff are not providing water to a resident Staff are overmedicating a resident Resident sustained multiple bruises due to staff neglect or physical abuse Staff do not ensure a resident is being provided appropriate therapy

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facilty and explained the reason for the visit. The Department received a complaint on 12/02/2025 and the initial complaint visit was conducted on 12/04/2025. LPA Mendivil interviewed staff and residents as well as obtained copies of resident records including physician report, hospital paperwork. Regarding the allegations Staff are not meeting the needs and services of a resident, Staff are not allowing a resident to communicate , Staff do not have planned activities for a resident, Staff are unable to communicate effectively , Staff are not providing water to a resident , Staff are overmedicating a resident, Resident sustained multiple bruises due to staff neglect or physical abuse, Staff do not ensure a resident is being provided appropriate therapy the investigation revealed the following: Unsubstantiated Regarding the allegation that staff are not meeting residents’ needs. Per interviews with 7 out of 7 staff stated they are able to meet residents needs. Per Kimberly all residents are assessed prior to moving into the facility to ensure they are appropriately fit. Interviews with 2 out of 5 residents interviewed on 12/04/2025 stated facility offers different activities. 3 of the residents were unavailable to be interviewed or not oriented to space and time. Regarding the allegation that staff are not allowing residents to communicate, Per interviews with 7 out of 7 staff they are not restricting any residents from communicating with anyone. During interviews staff expressed understanding for resident’s personal rights including residents having communication. Regarding the allegation staff do not have planned activities. Per interviews with 7 out 7 staff stated they offer different activities including walks out of the facility. Per staff they utilize Youtube for chair workouts. Interviews with 2 out of 5 residents interviewed stated facility offers different activities. Regarding the allegation staff are unable to communicate effectively. Per interviews with 7 out of 7 staff indicate they are able to communicate effectively with residents and their families. LPA Mendivil was able to individually interview caregiving staff and they were able to communicate with LPA Mendivil. Regarding the allegation staff are not providing water to a resident Interviews with 7 out of 7 staff stated residents are provided with water and juice throughout the day. LPA Mendivil observed on 12/04/2025 and again on 03/27/2026 all residents have their own cups with water or juice. Interviews with 2 out of 5 residents stated they have water or juice available at all times. Regarding the allegation Staff are overmedicating a resident. Per interviews with 7 out of 7 staff stated they are not overmedicating residents. Staff stated they give medications are prescribed and would not give more than prescribed. Interviews with 2 out of 5 residents indicated they are not being overmedicated. Regarding the allegation resident sustained multiple bruises due to staff neglect or physical abuse. Per interviews with 7 out of 7 staff indicate staff are not neglectful or abusive towards residents in care. 2 out of 5 residents denied that staff is abusive or neglectful. Regarding the allegation staff do not provide the appropriate therapy per interviews with 7 out of 7 staff stated they will follow physician's orders for any therapy needed for the residents. Therefore based on the preponderance of evidence through records reviewed and interviews the allegations are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. No deficiencies cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2026 · control 22-AS-20251202134153

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to the facility today to conduct an Annual Required inspection. LPA was greeted and granted entry by staff and explained the reason for the visit. The facility is a one story building with an approved fire clearance for six non-ambulatory residents of which six may be on hospice. The facility currently has a census of two residents. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in three bathrooms. The hot water temperature measured between 105 and 109 degrees Fahrenheit and all smoke detectors were operational. The facility’s last fire drill was conducted on March 01, 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review completed medication appear to be being given as prescribed. LPA reviewed four out of four staff training and fingerprint records. LPA conducted a complete review of resident records. LPA confirmed that administrator has a current administrator certificate which expires on July 21, 2026 Based on the observations made during today’s visit no deficiencies cited on this date. An exit interview was conducted with Administrator Kimberly Arnett, Compliance Manager Michelle Nesbitt and Executive Administrator Jozef Springer and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Case Management - Other

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a case management. LPA was greeted and granted entry into the facility and explained the reason for the visit. The facility had remolded the home and had a completed and approved fire clearance inspection on 03/4/2025. The facility is licensed for 6 non-ambulatory residents. The facility currently has zero residents. LPA Mendivil toured the facility and reviewed current floor plan. Facility is a single story home with 6 resident bedrooms , 1 staff room and 3 bathrooms. Based on today's observations no deficiencies noted. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea and Licensing Program Analyst Manager (LPM) Sheila Santos conducted an unannounced annual inspection. Upon arrival no one was home, LPA contacted Administrator Kimberly Arnett and was informed that facilities not operating at this time. There were no clients observed and construction and remodeling was notice inside the facility. Spoke to Admin. Arnett that the facility is going under remodeling and per administrator that an email was sent to licensing to notify about the on-going construction. This report was reviewed with the Administrator and a copy of this report was provided to the facility at the time of exit interview for the annual inspection for Irvine Cottage #2 facility.the state’s words, verbatim · CDSS document, May 8, 2024