The Hills of Santa Teresa

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Annual/Random

On September 9, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit. Upon arrival at the facility, LPA Bentley introduced self and was granted entry into the facility by staff, after stating the purpose of the visit. Licensee Allen Medina was contacted by telephone and Licensee Maricel Nepomuceno arrived a short time later to assist with the annual inspection. During the visit, LPA toured the inside and outside of the physical plant with Licensee Nepomuceno and observed the following: All rooms were inspected, beds and bedding supplies were in good condition, and storage for each resident’s personal belongings was observed. In 3 out of 4 bathrooms (Bathrooms 2, 3, and 4) used by residents in care, light bulbs were not working and needed to be replaced. In Bathroom #1, pipes are absent in the bathtub and the shower is inoperable. Bathroom #2/Large bathroom was observed with mold between the wall/grout and ceiling corner and rust around the bottom of the toilet. The shower tile in Bathroom #4 is in need of cleaning and repair to a large crack on the floor. There are two overgrown trees impeding on neighbor's fence and the roof of the facility in the backyard. The large, exterior garage door is inoperable as the motor door sounds but door does not open. Interviews conducted revealed licensee has not paid August and September rent, late fees, and remaining $8,000 of lump sum judgement due to landlord. Wages were due to two employees on September 7, 2026. Licensee admitted that one employee did not receive back pay for July and August and another employee did not receive back pay for July 2026. Due to insufficient time available, a continuation visit is needed and Licensee was informed that deficiencies may be cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Licensee Maricel Nepomuceno, and a copy of this report provide at the end of the visit.the state’s words, verbatim · CDSS document, Sep 9, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of assessing a civil penalty in connection to Complaint Investigation Control Number: 22-AS-20260819141836. LPA was greeted and granted entry by Caregiver Rian De Leon after stating the reason for the visit. Chief Executive Officer Allen Medina was advised of the visit by telephone at 4:41pm. Civil penalty is being assessed for a repeat violation in the amount of $1,000.00. An exit interview was conducted with Caregivers Kristilyn Opinion and Rian De Leon, and a copy of this report including the civil penalty assessment (LIC421IM) were provided at exit.the state’s words, verbatim · CDSS document, Sep 3, 2026

Allegation investigated: Facility is in financial distress.

On August 21, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted and granted entry by Caregiver Rian De Leon followed by Caregiver Kristilyn Opinion after stating the reason for the visit. LPA attempted to contact Chief Executive Officer Allen Medina by telephone at 8:30AM and Chief Officer of Operations/Co-Founder Maricel Nepomuceno at 8:31AM; however calls went unanswered, and voice messages were left requesting a call back. LPA observed six residents in care and two staff on duty during today's visit. During the course of the investigation, LPA conducted a tour of the physical plant, interviewed two staff, five of six residents, and obtained the following documentation for review: Resident Roster, Personnel Report Summary, Face Sheets, Physician's Reports, Admission Agreements, and payroll records. Substantiated The investigation is as follows: Regarding the allegation, Facility is in financial distress, it is alleged the licensee owes the landlord $40,000.00 in outstanding rent and other payments related to damages, and drain pipes being unnecessarily removed by a plumber hired by the licensee. Additionally, it has been reported that the staff had not received wages owed to them. LPA toured the physical plant and observed the utilities were operating, indoor temperature was within range, sufficient supply of food was maintained, and the facility land line remains available. LPA observed two meal services approximately 8AM and 12PM and observed residents having cereal with toast, banana, and apple juice for breakfast and rice, burger patty, steamed mixed vegetables, and sliced watermelon for lunch. LPA observed the indoor temperature was at a comfortable range of 74.8 degrees Fahrenheit, and the hot water temperature in the three resident bathrooms measured at 114.2, 115.3, and 112.4 degrees Fahrenheit. LPA observed the presence of mold in the grout and ceiling of the large shower room, shower head needs to be reattached in Bedroom #4, and the toilet water is leaking in Bedroom #4. Based on interviews, five of six residents and two of two staff reported three meals were served daily, no interruptions with electricity and water, and no issues with the residents' care. However, five of six residents and two of two staff confirmed that the staff had not been paid since July 16, 2026. LPA was unable to qualify the statement of one resident due to their medical condition. Based on the review of the lease agreement signed by both licensee and landlord on June 1, 2023, licensee owes $4,525 per month. The summary of amounts claimed by the landlord, documents that the licensee owes $23,302 of which $13,877 is attributed to unpaid rent, late fees from March 2026 to July 15, 2026, and an outstanding judgement balance that is still owed. Text messages between staff and licensee on August 17, 2026 at 12PM and August 20, 2026 at 5:53PM confirms the licensee owing staff. Evidence corroborates financial distress. Therefore, based on interviews and record review, the preponderance of evidence standard has been met, and the allegation of Facility is in financial distress, is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D. As of this exit interview, Chief Executive Officer Allen Medina and Chief Officer of Operations/Co-Founder Maricel Nepomuceno did not appear and did not return the telephone call despite the attempted contact. An exit interview was conducted with Caregivers Rian De Leon and Kristilyn Opinion, and a copy of this report including the appeal rights were discussed and provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 21, 2026 · control 22-AS-20260819141836

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Aug 22, 2026

87213 Finances "The licensee shall have a financial plan...that assures sufficient resources to meeting operating costs of residents." This requirement was not met as evidenced by: Based on interivews and record review, licensee had been unable to cover operating costs related to the delinquency of rental dues, late fees, outstanding judgement balance, damage and repair claims, and staff wages which poses an immediate Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: Licensee to take immediate action in resolving the outstanding financial obligation owed to the landlord, totaling approximately $23,302 as of July 15, 2026 as well as $10,230 for both staff from July 16 to August 15, 2026. The licensee will submit a payment plan also agreed by the landlord or provide proof of lump sum payment owed to landlord and staff to LPA Cho via email by POC due date. Please copy Eboni Bentley on the email.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of issuing a deficiency after an observed violation in connection to complaint investigation control number: 22-AS-20260327115632. LPA met with Caregivers Kristilyn Opinion and Rian De Leon and explained the reason for the visit. During the visit mentioned above, LPA conducted a tour of the physical plant and observed the following: presence of mold between the grout and ceiling corner in the large bathroom water leaking behind the toilet after flushing in the bathroom of Bedroom #4 shower head detached in the bathroom of Bedroom #4 Based on today's observations, a deficiency is being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Caregivers Kristilyn Opinion and Rian De Leon, and a copy of this report and the appeals rights were provide at the end of the visit.the state’s words, verbatim · CDSS document, Aug 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Aug 22, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on observation, there is a presence of mold in the large shower, the shower head was detached in the bathroom of Bedroom #4, and the toilet is leaking after flushing in the bathroom of Bedroom #4.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: Licensee to ensure staff deep cleans the large shower removing mold, plumber reattaches the shower head and repairs the toilet. Evidence of repair will be submitted to LPA via email by POC due date.

Type of visit: Case Management - Health Checks

On July 21, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was contacted via telephone and designated Rian De Leon to sign the report. During today’s visit, LPA conducted a tour of the physical plant with staff and observed the following: There are currently six residents present and two staff on duty. Residents were observed in clean clothes, watching television, and some sleeping, with no concerns. Water, electricity, gas, and cable are all operational. Bathroom faucets are verified to dispense hot water between 112.1 and 114.8 degrees F. The kitchen was observed clean with all appliances operational. The facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Proof of Liability Insurance was provided and is effective from March 3, 2026, through March 3, 2027. Interviews were conducted with residents and staff. Residents stated there have been no interruption in utilities and staff are always present to assist. LPA observed the tub in Bathroom #1 in need of repair as overflow and drain covers were not present and there is rust throughout the bottom of the tub. The landlord and facility staff reported pipes were removed from the tub in Bathroom #1 in June 2026. Records were requested. LPA also observed two overgrown trees in the backyard. The landlord reported that July 2026 rent has not been paid as of July 21, 2026. Based on today's observations, two deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Caregiver Rian De Leon, and a copy of this report, LIC809-D, and appeals rights were provide at the end of the visit.the state’s words, verbatim · CDSS document, Jul 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Jul 22, 2026

87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement is not evidenced by: Based on interviews and record review, the facility paid July 2026 rent late, which poses an immediate health and safety risk to persons in care. Landlord stated July rent of $4525 was due on by 7/5/2026 and late fee of $250 was applied due to non payment. Record review revealed July rent was paid on 7/20/2026.the state’s words, verbatim · CDSS document, Jul 21, 2026

Plan of correction: Licensee will submit a financial plan to ensure that staff receive their pay timely for next pay period and ongoing. Administrator/Licensee will submit proof to CCLD via email or fax by POC date. CIVIL PENALTY ASSESSED

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(a) · Plan of correction due date: Jul 22, 2026

87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview, the facility failed to comply with the section cited, which poses an immediate risk to persons in care. LPA observed the tub in Bathroom #1 in need of repair and two overgrown trees in the backyard.the state’s words, verbatim · CDSS document, Jul 21, 2026

Plan of correction: Licensee will have plumber repair pipes and replace overflow & drain cover in Bathroom #1 and submit proof to LPA by POC due date. Licensee will trim/cut overgrown trees in the backyard for safety and will provide proof of maintenance to CCLD by POC due date. CIVIL PENALTY ASSESSED

Type of visit: Case Management - Health Checks

On June 30, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by staff. Licensee (LI) Allen Medina was contacted via telephone and designated Rian De Leon to sign the report. During today’s visit, LPA conducted a tour of the physical plant with staff and observed the following: There are currently six residents present and two staff on duty. Residents were observed in clean clothes, watching television, and some sleeping, with no concerns. Water, electricity, gas, and cable are all operational. Bathroom faucets are verified to dispense hot water between 112 and 113.2 degrees F. The kitchen was observed clean with all appliances operational. The facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Proof of Liability Insurance was provided and is effective from March 3, 2026, through March 3, 2027. No additional health or safety concerns were observed during the visit. Interviews were conducted with residents and staff. All residents stated there have been no interruption in utilities and staff are always present to assist. Based on today's observations, no deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Caregiver Rian De Leon, and a copy of this report provide at the end of the visit.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Case Management - Health Checks

On May 26 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was contacted via telephone and arrived shortly to assist with the visit. During today’s visit, LPA conducted a tour of the physical plant with staff and observed the following: There are currently five residents present and two staff on duty. Residents were observed in clean clothes, watching television, and some sleeping, with no concerns. Water, electricity, gas, and cable are all operational. Bathroom faucets are verified to dispense hot water between 113.0 and 114.7 degrees F. The kitchen was observed clean with all appliances operational. The facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Proof of Liability Insurance was provided and is effective from March 3, 2026, through March 3, 2027. No additional health or safety concerns were observed during the visit. Interviews were conducted with residents and staff. All residents stated there have been no interruption in utilities and staff are always present to assist. The Department began proceedings to revoke the license for the facility effective May 7, 2026. The facility is required to notify all residents and responsible parties in writing within 10 days regarding the commencement of revocation of the license. CONTINUE TO LIC809-C...... LPA spoke to five out of five responsible parties over the phone. The five responsible parties have not been notified of the commencement of revocation of the license. There is no notification of the proceedings to revoke the license posted at the facility for review. Based on today's observations, deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with staff, and a copy of this report provided at the end of the visit.the state’s words, verbatim · CDSS document, May 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: May 27, 2026

1569.38(b)(1) Posting of licensing reports A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days from the occurrence of either of the following...: The department commences proceedings to... revoke the license of the facility... The requirement is not met as evidenced by: Five responsible parties have not been notified of the proceedings which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: AD stated all responsible parties and ombudsman will be notified by certified mail regarding the commencement of revocation. AD to submit proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(e) · Plan of correction due date: May 27, 2026

1569.38(e) Posting of licensing reports Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include posted... any other easily accessible location in the facility. The posting shall include all of the following information: The requirement is not met as evidenced by: LPA did not observe any posting regarding the revocation at the facility. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: AD stated the legal accusation document will be posted at the facility. AD to send photo of posting to LPA by POC due date.

Type of visit: Case Management - Health Checks

On May 15, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was contacted via telephone and was unable to be present during the visit. During today’s visit, LPA conducted a tour of the physical plant with staff and observed the following: There are currently five residents on census and present and two staff present. Residents were observed in clean clothes, watching television, and some sleeping, with no concerns. Water, electricity, gas, and cable are all operational. Bathroom faucets are verified to dispense hot water between 112.3 and 116 degrees F. The kitchen was observed clean with all appliances found operational. The facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Proof of Liability Insurance was provided and is effective from March 3, 2026, through March 3, 2027. No additional health or safety concerns were observed during the visit. Interviews were conducted with residents and staff. All residents stated there have been no interruption in utilities and staff are always present to assist. Staff stated they were notified on May 11, 2026 that they are no longer being paid weekly effective May 22, 2026. Based on today's observations, no deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with staff, and a copy of this report provided at the end of the visit.the state’s words, verbatim · CDSS document, May 15, 2026

Allegation investigated: Resident has lack of care and supervision/ neglect. There is no staff present.

On April 28, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of concluding the complaint investigation and delivering findings for the above allegations. Administrator (AD) Rosendo Carla Miranda was contacted via telephone, unable to be present during the visit, and designated Caregiver Rian De Leon to sign the facility report. On July 7, 2025, the Department received a complaint alleging neglect/lack of care and supervision of residents and the investigation was initiated on July 10, 2025 with a subsequent investigation visit was conducted on July 21, 2025. During the course of the investigation, the LPA interviewed five residents, six staff, two witnesses, and obtained the following documentation: Resident/Staff Rosters, Staff Contacts, Staff Schedules for July 2025, S1-S5 Time Sheets, and Staff Statements. Records were also obtained for five residents, which include: Face Sheet, Physician's Report, Admission Agreement, and Appraisals. CONTINUE TO LIC9099-C......... Unsubstantiated Regarding the allegation, Resident has lack of care and supervision/ neglect, it is alleged that staff are not providing care and supervision to residents in care. During visits to the facility, LPA did not observe any lack of care and supervision/neglect. All residents were clean, well groomed, provided continent care, served meals, and actively engaged with staff. LPA observed all residents well groomed, with neatly combed hair. There were no residents screaming during the visit and LPA observed residents drinking fluids for hydration. Interviews were conducted and two out of three residents denied there being a lack of care and supervision/neglect, stating staff assist them throughout every day, often without being called to do so. One resident stated staff assist them with showers and grooming daily and additionally, as needed. Another resident stated they had to wait for care on one or two occasions but also stated “maybe they didn’t hear me calling them.” Five out of six staff denied the allegation, stating all staff are attentive and assist residents regularly and promptly. One staff stated, R1 is under hospice and requires assistance with their G-Tube and a Hoyer Lift. One staff stated during the tour, that hospice only comes once to twice a week and that the staff was trained by LVN from hospice to handle the G-Tube. Two out of two witnesses were not available for interview. Records reviewed for five out of five residents did not indicate any lack of care. Regarding the allegation, There is no staff present, it is alleged that on July 9, 2025, there was no staff present at the facility for a period of 30 minutes (from 6:22 AM to 6:54 AM) as the night staff left their shift early without ensuring the morning staff arrived to take over care for residents. During the investigation, five out of six staff denied the allegation, stating there has never been a time when staff were not present to assist residents in care. Two out of three residents stated staff are always present and they are not aware of a time where they were not. Resident 1 (R1) stated they called out for staff between 6:22 AM to 6:54 AM on July 9, 2026 and no one responded. The resident stated they do not recall what they needed at the time but they called for staff twice and no one answered or came to the room. Two out of two witnesses were not available for interview. A record review revealed, R1 has a G-Tube and continent needs, R2 has a colostomy bag and needs assistance with care, R3 needs total supervision per Physician’s report and wakes up at night per appraisal. Based on the observations made, interviews which were conducted and the records that were reviewed, although the 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 the aforementioned allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Caregiver Rian De Leon, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 22-AS-20250707162910

Type of visit: Case Management - Health Checks

On April 28, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was contacted via telephone, unable to be present during the visit, and designated Caregiver Rian De Leon to sign the facility report. LPA conducted a tour of the physical plant with staff and observed the following: There are currently six residents in care with three staff present. Residents were observed watching television, eating lunch, and socializing with no concerns. Water, electricity, gas, and cable are all operational. Bathroom faucets are verified to dispense hot water between 117.1 and 118.4 degrees F. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The indoor temperature measured at 72 degrees F. The kitchen was observed clean and operational. The facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Liability Insurance is effective from March 3, 2026, through March 3, 2027. Interviews were conducted with six residents and three staff. All staff stated they are being paid on a weekly basis, were last paid on April 22, 2026, with no outstanding wages. Staff stated food gets delivered one time per week. Residents stated there have been no interruption in utilities and staff are always present to assist. Based on today's observations, no deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Caregiver Rian De Leo, and a copy of this report provide at the end of the visit.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Health Checks

On April 14, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit. LPA introduced self, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was contacted via telephone, unable to be present during the visit, and designated Caregiver Rian De Leon to sign the facility report. During today’s visit, LPA conducted a tour of the physical plant with staff and observed the following: There are currently four residents in care with three staff present. Residents were observed watching television, some sleeping, with no concerns. Water, electricity, gas, and cable are all operational. Bathroom faucets are verified to dispense hot water between 115.3 and 117.2 degrees F. The kitchen was observed clean and the facility has a two day supply of perishable and seven day supply of nonperishable food items available. Emergency food and water supplies were available in the garage. Liability Insurance is effective from March 3, 2026, through March 3, 2027. Interviews were conducted with four residents and two staff. All staff stated they are being paid on a weekly basis, were last paid on April 8, 2026, and there are no outstanding wages. Residents stated there have been no interruption in utilities and staff are always present to assist. Based on today's observations, no deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with staff, and a copy of this report provide at the end of the visit.the state’s words, verbatim · CDSS document, Apr 14, 2026

Allegation investigated: Facility is in financial distress.

On April 3, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting an initial complaint investigation visit into the above allegation and delivering findings. Administrator (AD) Rosendo Carla Miranda was contacted via telephone, unable to be present during the visit, and designated Caregiver Nadia Morales to sign the facility report. During the course of the investigation, LPA conducted a tour of the facility with staff and reviewed documentation which consists of the Resident/Staff Rosters, Staff Contacts, Rent payments, and payroll records. Interviews were conducted with four residents and four staff. The following was determined during the investigation: Regarding the allegation, Facility is in financial distress, it is alleged that the facility experiencing financial problems, resulting in staff not being paid on time. CONTINUE TO LIC9099-C.... Substantiated During the course of the investigation, interviews were conducted with four residents and four staff. Four out of four staff confirmed the allegation, stating they received paychecks late that were due on March 13 and March 27, 2026. One staff stated they resigned after receiving late paychecks and another staff reported taking a leave of absence for the same reason. Two staff reported receiving paychecks that bounced when first deposited into their bank accounts and stated the checks cleared, after being told by facility staff to deposit the payroll check a second time and on a later date. Two out of four residents stated they are aware that staff have received paychecks late on multiple occasions, one staff resigned, and another staff has taken a leave of absence due to late payroll payments and bounced checks. One resident stated the facility is using different caregivers to cover shifts for staff that are no longer working at the facility and they are frustrated that previous caregivers are no longer working there. A record review revealed that March and April rent payments were returned by the bank and not paid. The licensee confirmed the transactions were returned multiple times but did not clear and rent was not paid. Based on observations made, interviews that were conducted, and record reviewed, the preponderance of evidence standard has been met, therefore the allegation, Facility is in financial distress is deemed SUBSTANTIATED. See the attached LIC9099-D. An exit interview was conducted with staff, and a copy of this report, LIC9099-D, and appeals rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Apr 3, 2026 · control 22-AS-20260327115632

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Apr 4, 2026

87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on observations, interviews, and record review, the paychecks due to staff were paid late, two staff paychecks bounces, and March and April rent payments were returned. This poses a immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2026

Plan of correction: Licensee will pay staff in a timely manner, ensure checks are paid in full, and cleared. Licensee stated they will resubmit rent payments for March and April and provide proof via email to eboni.bentley@dss.ca.gov by POC due date.

Type of visit: Case Management - Health Checks

On April 3, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was contacted via telephone, unable to be present during the visit, and designated Caregiver Nadia Morales to sign the facility report. During today’s visit, LPA conducted a tour of the physical plant with staff and observed the following: There are currently four residents in care with one staff present. Residents were observed dressed, watching Television, and socializing with one another. Water, electricity, gas, and air conditioning are all operational. Bathroom faucets are verified to dispense hot water between 111.4 and 116.3 degrees F. Kitchen appliances are operational and the facility has a two day supply of perishable and seven day supply of nonperishable food items were available. LPA observed the front yard and backyard landscape are well maintained with no obstructions. Interviews were conducted with four residents and one staff. All residents stated utilities have been in working order with no interruption in services. Staff stated they were paid on April 2, 2026. Liability Insurance is effective from March 3, 2026, through March 3, 2027. Based on today's observations, no deficiencies are being cited. An exit interview was conducted with staff, and a copy of this report provide at the end of the visit.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Case Management - Health Checks

On March 25, 2026, at 2:15 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a Health and Safety check. LPA Kim spoke with Administrator (ADMIN) Rosendo Carla Ward over the phone and explained the purpose of the visit. ADMIN Ward stated she could not attend today’s visit and stated that Caregiver (CG) Rian De Leon could sign on behalf of the facility. LPA Kim conducted a health and safety check. During the visit, LPA toured the facility and observed the following: LPA observed two staff on duty providing care to three residents. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Staff stated food gets delivered one time per week. Resident hygiene supplies are stored in their bathrooms and extra supplies in the garage. The indoor temperature measured at 72 degrees F. All smoke detectors and carbon monoxide detectors were operational. All emergency disaster supplies were prepared and available in the garage. Facility land line (714)951-9188 was tested and remains available. No obstacles observed in the backyard. All staff on LIC 500 are cleared and associated to the facility. Residents interviewed stated satisfaction with facility services and denied any issues with food supply or utilities. LPA conducted interviews with three residents, three staff, and one witness. The Evidence of Liability Insurance is effective from March 3, 2026, and expires March 3, 2027. Staff stated they were not paid on a timely manner for last week’s salary. Evaluation Report Continues on LIC 809-C A deficiency was cited during the visit per Title 22 Division 6 Chapter 8 of the California Code of Regulations. Facility has not paid staff in a timely manner for March 18, 2026, salary. A Civil Penalty is being assessed for Repeat Violations for not paying staff in a timely manner The total amount of Civil Penalties assessed today are $250. An exit interview was conducted, and a copy of this report, LIC809D, appeals rights, and LIC 421FC were provided to Caregiver Rian De Leonthe state’s words, verbatim · CDSS document, Mar 25, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 26, 2026

87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement was not met evidenced by: Based on observation, interviews, and record review, staff did not receive paycheck timely, which poses an immediate health and safety risk to persons in care. Staff stated they were due pay on 3/18/2026 and did not receive a paycheck as of 3/25/2026.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: Licensee will submit a financial plan to ensure that staff receive their pay timely for next pay period and ongoing. Administrator/Licensee will submit proof to CCLD via email or fax by POC date. A deficiency was previously cited on 12/31/2025 and 3/9/2026 for failure to comply with CCR 87213. CIVIL PENALTY ASSESSED.

Type of visit: Case Management - Health Checks

On March 16, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda was present to assist with the visit during the beginning of the visit, however, AD needed to run errands for the facility and designated Caregiver Nadia Morales to sign the report. During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three residents in care with three staff present. Residents were observed dressed, watching Television, with no concerns. Water, electricity, gas, and air conditioning are all operational. Bathroom faucets are verified to dispense hot water between 112.4 and 113 degrees F. Kitchen appliances are operational and the facility has a two day supply of perishable and seven day supply of nonperishable food items were available. LPA observed the front yard and backyard landscape are well maintained and sliding door screen has been repaired. Interviews were conducted with three residents and three staff. Three out of three residents stated utilities have been in working order with no interruption and there have been no shortage of staff providing care. Three out of three staff confirmed there have been no interruptions in utilities and no staff shortages. All three staff reported that they were paid in full through February 18, 2026 and expect to receive their next paycheck on March 22, 2026 for days worked from February 19, 2026 through March 15, 2026. All staff stated they were fine with that date as the pay schedule had recently changed. Based on today's observations, no deficiencies are being cited. An exit interview was conducted with staff, and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Case Management - Health Checks

On March 9, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda arrived a short time later to assist with the visit. During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three residents in care with three staff present. Residents were observed dressed and groomed with no concerns. Water, electricity, gas, and air conditioning are all operational. Bathroom faucets are verified to dispense hot water between 110.3 and 112 degrees F. Kitchen appliances are operational and the facility has a two day supply of perishable and seven day supply of nonperishable food items were available. LPA observed overgrown grass and weeds in the front yard and backyard, as well as a sliding door screen with two 1 inch holes in it. Interviews were conducted with residents and three staff. Staff interviewed reported that they were not paid on March 5, 2026 for days worked in February 2026 and were informed that the next pay disbursement date would be March 22, 2026 for all wages due. The facility does not currently have Liability Insurance. Two staff present and providing care were background cleared but not associated to the facility. Based on today's observations, deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations and Health and Safety Code. CIVIL PENALTIES ASSESSED. An exit interview was conducted with Administrator Rosendo Carla Miranda, and a copy of this report, LIC809-Ds, LIC421s, and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Mar 9, 2026

87355 (e)(3) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance... This requirement is not met as evidenced by Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA reviewed S1’s & S2's record and found that they are not associated with the facility. This poses an immediate health, and safety, risk to persons in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: The Administrator stated they will associate S1 & S2 to the facility and submit a written statement of acknowledgement and understanding to CCLD via email by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(a) · Plan of correction due date: Mar 10, 2026

87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the facility failed to comply with the section cited above in two out of two yards and one screen, which poses an immediate risk to persons in care. LPA observed overgrown grass and weeds in the front and back yards, as well as a sliding door screen with two 1 inch holes.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: Licensee will submit a plan is to have both the front and backyards maintained and will provide proof of maintenance to CCLD by POC due date. A deficiency was previously cited on 3/3/2026 for failure to comply with CCR 87303(a) CIVIL PENALTY ASSESSED.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 10, 2026

87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement is not evidenced by: Based on observation, interviews, and record review, staff did not receive paychecks timely, which poses an immediate health and safety risk to persons in care. Staff stated they were due pay on 3/5/2026 and did not receive a paycheck as of 3/9/2026.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: Licensee will submit a financial plan to ensure that staff receive their pay timely for next pay period and ongoing. Administrator/Licensee will submit proof to CCLD via email or fax by POC date. A deficiency was previously cited on 12/31/2025 for failure to comply with CCR 87213. CIVIL PENALTY ASSESSED.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Mar 10, 2026

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests...This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses an immediate health, safety, and personal rights risk to persons in care. Administrator stated the facility does not have current liability insurance.the state’s words, verbatim · CDSS document, Mar 9, 2026

Plan of correction: Administrator/Licensee will submit proof of bonded liability insurance for the facility to CCLD via email or fax by POC date.

Type of visit: Case Management - Health Checks

On March 3, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo Carla Miranda arrived a short time later to assist with the visit. During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three residents in care with three staff present. Residents were observed dressed and groomed with not concerns. Water, electricity, gas, and air conditioning are all operational. Bathroom faucets are verified to dispense hot water between 108.2 and 110 degrees F. Kitchen appliances are operational and the facility has a two day supply of perishable and seven day supply of nonperishable food items available. LPA observed overgrown grass and weeds in the front yard and backyard, as well as a sliding door screen with two 1 inch holes in it. Interviews were conducted with residents and three staff. Three out of the three staff interviewed reported that they were expected pay on February 27, 2026, for the hours they worked from February 4, 2026 through February 22, 2026 and have not received pay as of March 3, 2026. The facility does not currently have Liability Insurance. Based on today's observations, deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations and Health and Safety Code. CIVIL PENALTIES ASSESSED. An exit interview was conducted with Administrator Rosendo Carla Miranda, and a copy of this report, LIC809-Ds, LIC421FCs, and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Mar 4, 2026

13 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement is not evidenced by: Based on interviews and record review, staff did not receive paychecks timely, which poses an immediate health and safety risk to persons in care. Staff stated they were due pay on 2/27/2026 and have not received a paycheck as of 3/3/2026.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: Licensee will submit a financial plan to ensure that staff receive their pay timely for next pay period and ongoing. Administrator/Licensee will submit proof to CCLD via email or fax by POC date. A deficiency was previously cited on 12/31/2025 and 2/25/2026 for failure to comply with CCR 87213. CIVIL PENALTY ASSESSED.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Mar 4, 2026

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests...This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above, which poses an immediate health, safety, and personal rights risk to persons in care. The facility does not have current liability insurance.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: Licensee will submit proof of liability insurance for the facility to CCLD via email or fax by POC date. A deficiency was previously cited on 2/19/2026 for failure to comply with HSC 1569.605 CIVIL PENALTY ASSESSED.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Mar 4, 2026

87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the facility failed to comply with the section cited above in two out of two yards and one screen, which poses an immediate risk to persons in care. LPA observed overgrown grass and weeds in the front and back yards, as well as a sliding door screen with two 1 inch holes.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: Licensee will submit a plan is to have both the front and backyards maintained and will provide proof of maintenance to CCLD by POC due date. A deficiency was previously cited on 7/10/2025 for failure to comply with CCR 87303(a) CIVIL PENALTY ASSESSED.

Type of visit: Case Management - Health Checks

On February 25, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced case management visit for a Health & Safety check. LPA was greeted and granted entry to the facility by staff after explaining the purpose for the visit. Administrator (AD) Carla Miranda was notified via telephone and later arrived to assist with the inspection. On today's visit, LPA observed three residents in care and two staff present. LPA observed residents watching television in their room, eating in the dining room, and taking a walk. LPA observed residents to be in clean clothes. LPA, accompanied by the caregiver, conducted a tour of the physical plant. LPA inspected the four resident bedrooms (2 private and 2 shared), and observed them to be free of hazards. LPA observed residents' bedrooms to have the required furnishings of a bed, a chair, a dresser, and a lamp. LPA observed the lights in each of the resident bedrooms to be operational. The water and toilets in each of the resident bathrooms were operational. The hot water temperature measured between 106.8 to 107.2 degrees Fahrenheit. LPA observed the facility has two day perishable and seven day nonperishable food supplies on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner electric stove to be operational. LPA observed the facility has three day emergency food and water supplies stored in the garage. No health or safety concerns were observed. LPA additionally conducted interviews with two staff and three residents. Per staff interview, there were no issues with food supplies or utilities. However, two out of two staff reported late payments. Continued on LIC 809-C. Two out of two staff were supposed to be paid on February 13, 2026, but were paid on February 19, 2026 instead. One out of two staff reported not being paid in full. Liability insurance is not binded yet as of today (quote received on January 20, 2026) and licensee did not provide copies of financial records, utility bills, or payroll records. Based on the observations made during today's visit, deficiencies are being cited per Title 22 of California Code of Regulations. An exit interview was conducted with Administrator Carla Miranda and a copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 26, 2026

7213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement is not evidenced by: Based on observation, interviews, and record review, staff did not receive paychecks in full, which poses an immediate health and safety risk to persons in care. Staff stated they were not paid in full on 2/19/2026.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: Licensee will submit a financial plan to ensure that staff receive their pay in full. Administrator/Licensee will submit proof to CCLD via email or fax by POC date.

Type of visit: Case Management - Health Checks

On February 19, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a Case Management - Health Checks visit and to request documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo "Carla" Miranda spoke with LPA via telephone and arrived shortly to assist with the visit. During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three (3) residents in care with three (3) staff present. Resident were observed dressed and groomed with not concerns. Water, electricity, gas, and air conditioning are all operational. Bathroom faucets are verified to dispense hot water between 106.8 and 114 degrees F. Kitchen appliances were operational and there is an adequate supply of perishable and non-perishable food items. LPA conducted interviews with three (3) residents and three (3) staff. The following documentation was requested from the facility Administrator: - Payroll records for February 2026 - Grocery receipts for February 2026 - Utility bills (water, gas, cable, and electricity) for February 2026 - Proof of rent payment for February 2026 - Proof of Liability Insurance The facility does not have current Liability Insurance. Deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations and Health and Safety Code. CIVIL PENALTY ASSESSED. An exit interview was conducted with Administrator Rosendo "Carla" Miranda, and a copy of this report, LIC809-D, LIC421FC, and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Feb 19, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 20, 2026

7213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required .. licensing agency. This requirement is not evidenced by: Based on observation, interviews, and record review, staff did not receive paychecks timely, which poses an immediate health and safety risk to persons in care. Staff stated they were due pay on 2/13/2026 and did not receive a paycheck until 2/19/2026.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: Licensee will submit a financial plan to ensure that staff receive their pay timely for next pay period and ongoing. Administrator/Licensee will submit proof to CCLD via email or fax by POC date. A deficiency was previously cited on 12/31/2025 for failure to comply with CCR 87213. CIVIL PENALTY ASSESSED.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 20, 2026

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests...This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses an immediate health, safety, and personal rights risk to persons in care. Administrator stated the facility does not have current liability insurance.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: Administrator/Licensee will submit proof of liability insurance for the facility to CCLD via email or fax by POC date.

Type of visit: Case Management - Other

On February 5, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a case management visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility by staff. Administrator (AD) Rosendo "Carla" Miranda spoke with LPA via telephone and arrived shortly to assist with the visit. During today’s visit, LPA and AD conducted a tour of the physical plant and observed the following: There are currently three (3) residents in care with three (3) staff present. Water, electricity, gas, and air conditioning are in operation. Bathroom faucets are verified to dispense hot water between 114.8-116 degrees F. Emergency food and water supplies are available and adequately stocked. LPA conducted interviews with three (3) residents and three (3) staff. Perishable food supply observed adequately stocked, however, there is a limited supply of non-perishable food items in the kitchen. A deficiency is being cited. The following documentation was requested from facility staff: - Payroll records for December 2025, January & February 2026 - Grocery receipts for December 2025, January & February 2026 - Utility bills (water, gas and electricity) for December 2025, January & February 2026 - Proof of rent payments for December 2025, January & February 2026 - Proof of Liability Insurance - Resident Records: Emergency Face Sheets, Admissions Agreements, Physician's Reports, Appraisals, and Hospice Records An exit interview was conducted and a copy of this report, LIC809-D, and appeal rights were provided to Administrator Rosendo "Carla" Miranda at exit.the state’s words, verbatim · CDSS document, Feb 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(26) · Plan of correction due date: Feb 6, 2026

(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition (b) The following food service requirements shall apply:(26)Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, which poses a potential health and safety risk to persons in care. LPA observed a limited supply of canned goods, cereal, and pasta in kitchen cabinets.the state’s words, verbatim · CDSS document, Feb 5, 2026

Plan of correction: Licensee will check perishable food supplies and provide a receipt and picture of additional items delivered by POC due date by 2/6/2026

Allegation investigated: Staff sleeping while on duty.

On January 20, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a subsequent complaint investigation visit into the above allegation. LPA introduced self, stated the purpose of the visit to staff, and was granted entry into the facility. LPA spoke with Administrator (AD) Rosendo “Carla” Miranda and Licensee Allen Medina via telephone, explained the reason for the visit and was notified that Caregiver Rian DeLeon was granted permission to sign the report for today. On August 28, 2025, LPA initiated the complaint investigation. During the visit, LPA toured the facility accompanied by AD Miranda and obtained the following documentation: Resident/Staff Rosters, Personnel Record (LIC500), Staff Schedules, Face Sheets, Physician’s Reports, and Needs & Services appraisals. Report continued on LIC 9099-C….. Substantiated Regarding the allegation, Staff sleeping while on duty, it was reported that staff are not awake during the night shift. During initial visit, LPA conducted three staff interviews, five resident interviews, and reviewed records. While conducting interviews, S1 stated staff are sleeping at night when residents require care. S2 they sleep in living room and wake up to assist R1 when the bed alarm goes off. A record review revealed, R1 needs total supervision per Physician’s report and wakes up at night per appraisal. R2 has a G-Tube and continence needs, and R3 has a colostomy bag and needs assistance with care. Based on the records reviewed, staff are needed and required to remain awake during nighttime hours. During complaint intake, it was reported by Reporting Party (RP) that day shift, Staff #1 (S1) disclosed to RP that night shift staff sleeps while on duty. Based on the interview on September 3, 2025, RP stated S1 was the person who disclosed that other staff are sleeping at night but did not disclose any names. RP also stated that they do not know who works there and could not provide any additional details regarding the allegation. The investigation revealed that staff are sleeping while on duty when residents in care require total supervision. Based on interviews which were conducted and the records that were reviewed, 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 and Chapter 8 are being cited on the attached LIC9099D. An exit interview was conducted with Caregiver Rian DeLeon, LIC809-D, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jan 20, 2026 · control 22-AS-20250822085244

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jan 27, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not ensure staff are providing care and supervision to prevent and address R1, R2, and R3’s care needs during night supervision, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 20, 2026

Plan of correction: The licensee will retain staff on night supervision requirements to address care needs of residents. Licensee will submit proof of training to CCLD by POC due date.

Type of visit: Case Management - Other

On today’s date, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a case management visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility. Administrator (AD) Rosendo "Carla" Miranda spoke with LPA via telephone and granted permission for Caregiver Cecille Peterson to sign the report at exit. During the visit, LPA requested the following documentation from facility staff by phone and via email: - Proof of rent payments for October, November, December 2025 - Payroll records for October, November, December 2025 - Grocery receipts for October, November, December 2025 - Utility bills (water, gas and electricity) for October, November, December 2025 LPA toured the facility with staff and observed no health and safety issues. Property utilities are working, including electricity, gas, and water. Perishable and non-perishable food supply was observed adequately stocked at time of visit. It was reported that staff were not paid in a timely manner. Interviews were conducted during today’s visit and six out of six staff confirmed staff were not paid on time. All staff stated paychecks were scheduled to be paid on the 7th day of the month and staff did not receive payment as of today's date. S5 & S6 stated all facility staff were not paid on 1/7/26 and will receive the remaining half of their paycheck for 12/22/25, as well as their full paycheck for 1/7/25 on 1/9/26. Based on the observations, interviews, and records reviewed during the present visit, the deficiency cited on 12/31/25 remains uncorrected as the facility did not complete the plan of correction by the due date. CIVIL PENALTY ASSESSED for failure to correct. An exit interview was conducted and a copy of this report, LIC809-D, LIC421FC, and appeal rights were provided to a facility staff.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Case Management - Other

On today’s date, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a case management visit and requesting documentation. LPA introduced self to staff, explained the reason for the visit, and was granted entry into the facility. Administrator (AD) Rosendo "Carla" Miranda arrived shortly after and assisted with requests for documentation. During the visit, LPA requested the following documentation from facility staff and Licensee via email: - Proof of rent payments for October, November, December 2025 - Payroll records for October, November, December 2025 - Grocery receipts for October, November, December 2025 - Utility bills (water, gas and electricity) for October, November, December 2025 LPA toured the facility with AD and observed no health and safety issues. Property utilities are working, including electricity, gas, and water. Perishable and non-perishable food supply was observed adequately stocked at time of visit. It was reported that staff were not paid in a timely manner and received no response to requests for pay. Interviews were conducted and LPA received a telephone call and statement from Licensee during today’s visit. Five out of five staff and Licensee confirmed staff were not paid on time. All stated paychecks were scheduled to be paid on the 22nd day of the month and staff did not receive payment on that date. One staff stated all facility staff were paid late and received half of their pay on 12/30/25. A record review revealed four out of four staff did not receive a paycheck on 12/22/25. Two staff were paid late and two other staff had not received a paycheck by 12/31/25. Based on the observations, interviews, and records reviewed during the present visit, one Type B deficiency is being cited and CIVIL PENALTY ASSESSED. An exit interview was conducted and a copy of this report, LIC809-D, LIC421, and appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Dec 31, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Jan 7, 2026

87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on observations, interviews, and record review, the paychecks due to staff were paid late and some not issued at all as today's visit. This poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 31, 2025

Plan of correction: Licensee states they will pay staff in a timely manner and ensure checks are paid in full. They will send a Statement of Understanding of the CCR 87213 and state they understand, read, and provide a signature and send proof via email to eboni.bentley@dss.ca.gov by 1/7/2026.

Type of visit: Case Management - Health Checks

On October 30, 2025, Licensing Program Analyst (LPA) Eboni Bentley conducted a case management visit for the purpose of conducting a health and safety check and requesting documentation. LPA was greeted by facility staff, explained the reason for the visit, and granted entry into the facility. Director of Operations (DO) Joanna Gomez called LPA to discuss the reason for the visit and stated an email would be sent to LPA today, with the requested documentation. During the inspection, LPA toured the facility with staff and observed no health and safety issues. The facility is in good repair. Property utilities are working, including electricity, gas, and water. Perishable and non-perishable food supply was observed adequately stocked at time of visit. Based on the observations made during today’s inspection, no deficiencies are being cited at this time. An exit interview was conducted with staff, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Oct 30, 2025

Allegation investigated: Facility is in disrepair.

On October 23, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a subsequent complaint investigation visit into the above allegation. LPA announced self and stated the purpose of the visit to Administrator Rosendo Carlo Miranda/Carla. During the course of the investigation, LPA inspected the backyard and obtained documentation which consists of the Resident/Staff Rosters, Staff Contacts, Personnel Report, Lease Agreement, and Administrator Email/Statement. The following was determined during the investigation: Regarding the allegation, Facility is in disrepair, it was reported that there is an overgrown, big banana tree on the grounds that may cause damage to the fence and possibly encroach the neighboring property, as well as a Cherimoya tree that could damage the roof. Substantiated It was reported that attempts to contact the facility regarding tree maintenance were made by the landlord but no response was received. During the tour of the exterior of the facility with Administrator Miranda, LPA observed an overgrown banana tree that was growing over the fence and into the neighboring property, as well as a large banana tree with over a dozen leaves that have fallen, covering a six foot area of the ground. There is also a cherimoya tree growing within one foot of the roof, evidenced by photos attached. A record review of the lease agreement dated May 31, 2023, states in 11. Maintenance Use and Reportingthat it is the tenants/facility’s responsibility to maintain the landscape of the property, specifically the garden, bushes, and shrubs. Email correspondence dated October 23, 2025 at 3:04pm stated the facility’s plans to schedule tree trimming and notify the department when complete. The investigation revealed the facility failed to maintain the landscape in the backyard which includes the trimming of the banana and cherimoya trees. Based on observations made and record review, the preponderance of evidence standard has been met, therefore the allegation, The Facility is in disrepair is deemed SUBSTANTIATED. See the attached LIC9099-D. An exit interview was conducted with Administrator Rosendo Carlo Miranda/Carla, and a copy of this report, LIC9099-D, and appeals rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 22-AS-20251014152840

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 30, 2025

87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and record review, the facility failed to comply with the section cited above by failing to trim two overgrown trees in the backyard, which poses a potential risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: The administer stated the plan is to have all over grown trees trimmed and will provide proof to CCLD by POC due date.

Allegation investigated: - Facility is in financial distress

On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Administrator (AD) Carla Miranda and Director of Operations (DO) Joanna Gomez arrived shortly to assist with the visit. The Department received a complaint on April 8, 2025, and LPA Tea conducted the initial 10-day visit on April 11, 2025. LPA Tea spoke to facility staff and residents and reviewed and collected pertinent documents and information. It was alleged the facility is in financial distress. The investigation determined the following: During the initial visit LPA observed the facility to be operating normally, with no health and safety concerns. However, LPA gathered information that the facility was behind on rent for the property and payments were missed as (Complaint Investigation report continued on LIC9099-C) Substantiated promised by the licensee. Per interviews with the staff, initially they were paid on time and later around April and May, staff were not getting paid. The facility owed back pay to the staff and employee checks bounced. At one point, staff had a hard time purchasing groceries for the facility due to insufficient funds for the card used to purchase groceries. LPA also received information that the previous administrator for the facility quit due to non-payment of salary. One resident interviewed admitted there was a lack of staffing during a brief period, staff would quit and leave because they did not get paid. LPA received court documents regarding a stipulated judgement and settlement agreement between the Plaintiff being the property owner and the Defendant, the Licensee, The Hills of Santa Teresa, asserting breach of contract due to unpaid rent, late fees and legal expenses related to the property. The judgement and settlement were in favor of the plaintiff, the property owner, in which the back pay amount of total fees was due along with the ongoing monthly rent. Per interview with one of the licensees of The Hills of Santa Teresa, Maricel Nepomuceno, she admitted the company was going through financial hardship and trying to maintain operations. She admitted that they had hit a wall with legal troubles and were trying to seek other investors. Their business decisions had created a financial snowball effect in which the property owners of their facilities received the brunt end. During a meeting at the Regional Office on May 22, 2025 , Licensee Allen Medina admitted to financial struggles as a result of legal fees and loans and the rent and bills begin backing up. Therefore, based on LPA Tea's observations, review of records and interviews conducted, the allegation that facility is in financial distress has been determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred. The following deficiency is being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted with Administrator Carla Miranda and Director of Operations Joanna Gomez and a copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Oct 16, 2025 · control 22-AS-20250408152753

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Oct 17, 2025

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents. This requirement is not met as evidenced by: Based on LPA's observation, records obtained and interviews conducted, facility was unable to cover operating costs due to deliquency in rental property payments and staff salary as a result of legal and financial troubles. This poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Facility has already made arrangements for backpay through legal settlement. Facility stated they will submit a written detailed plan of action to LPA via email by POC due date, that ensures solutions and transparency to meet resources and operating costs for care of the residents.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Tea conducted a case management visit for the purpose of conducting a health and safety check. LPA was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrator (AD) Rosendo “Carla” Miranda and Director of Operations (DO) Joanna Gomez arrived shortly to assist with the visit. During the inspection, LPA toured and inspected the facility and observed no health and safety issues. The facility was in good repair. Property utilities were working, such as electricity, gas and water. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA conducted health and safety checks on residents and observed no health or safety concerns. LPA spoke to residents regarding the quality of care received and staff regarding the care provided and payroll. At the time of the visit LPA Tea requested six months’ proof of paid facility utilities and employee payroll within the last two months, which was received via email. Prior to the visit, LPA requested proof of payment for property by the Licensee, which was received via email. Based on the observations made during today’s inspection, no deficiencies are being cited at this time. An exit interview was conducted with Administrator Carla Miranda and Director of Operations Joanna Gomez and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Oct 16, 2025

Allegation investigated: Facility is in financial distress.

On September 30, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Director of Operations (DOP) Joanna Gomez and explained the purpose of today’s visit. The investigation consisted of the following: LPA Kim conducted an initial visit on June 30, 2025, and subsequent visit on July 21, 2025. LPA Kim obtained and reviewed copies of the resident and staff rosters, resident records which include the Physician’s Reports, Appraisal/Needs and Services Plans, and other pertinent records for five staff. Allegation: Facility is in financial distress Substantiated It is alleged that staff were not paid in a timely manner and had no response from the Licensee. LPA conducted six staff Interviews who all confirmed the allegation. However, five out of six staff refused to provide evidence of their claims. All staff stated that the payment schedule is on 7th and the 22nd day of the month. All staff stated they submit their timesheets on the 3rd and the 18th of the month. All staff reported experiencing at least one instance where their paycheck was delayed by one day to a week beyond the scheduled pay date. Based on record reviews, LPA observed one staff member received three letters from their bank of non-sufficient payments from the Licensee. The checks deposited on April 30, 2025, in the amount of $176.46, June 11, 2025, in the amount of $1333.52, and June 27, 2025, in the amount of $1178.09 have been returned unpaid due to non-sufficient funds. Licensee replaced the bounced checks at a later date without responding to staff’s inquiries about insufficient funds. Therefore, based on LPA's observations, interviews, and records reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility is in financial distress is deemed SUBSTANTIATED as per the California Code of Regulations, Title 22, Division 6, Chapter 8. A deficiency is being cited on the attached LIC9099D. Exit interview was conducted, and a copy of the report, LIC9099D,and the appeal rights were provided to Director of Operations Joanna Gomez.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 22-AS-20250625152918

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: Oct 14, 2025

87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents... This requirement is not met as evidenced by: Based on observations, record review, and interviews, the paychecks issued to staff were returned due to insufficient funds. This poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 30, 2025

Plan of correction: Licensee states they will pay staff in a timely manner and ensure checks do not get returned. They will send a Statement of Understanding of the CCR 87213 and state they understand, read, and provide a signature and send proof via email to edward.kim@dss.ca.gov by 10/14/2025

Type of visit: Required - 1 Year

On September 30, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Director of Operations (DOP) Joanna Gomez and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, a staff break room, four (4) bathrooms, two living areas, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with DOP Gomez. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 117.3 degrees F to 118.4 degrees F. A comfortable temperature of 77 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714)951-9188 and a dedicated tablet with videoconferencing technology both remain available. First Aid kit had all the necessary elements. The facility has one (1) fire extinguisher that was charged, mounted next to the exit door near the kitchen that was serviced on April 9, 2025. Emergency drills are conducted quarterly and were last conducted on August 4, 2025. Evidence of liability insurance was effective from December 1, 2024, to December 1, 2025. LPA Kim conducted an audit of resident files (R1-R5), staff files (S1-S5), and a medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with two (2) staff and three (3) residents. No deficiencies were cited during the inspection visit. An exit interview was conducted, and a copy of this report was provided to Director of Operations Joanna Gomez.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Case Management - Other

On July 21, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a case management deficiency visit unrelated to allegations of complaint #22-AS-20250625152918. Per record review, S1 is not associated with the facility. Per interview with Director of Operations, S1 worked on July 20, 2025 and July 21, 2025. S1 admitted working part time and a reliever at the facility for about a year now and S1 last worked two months ago, on July 20, 2025, and on July 21, 2025. A deficiency was cited by Title 22 Division 8 Chapter 6. An exit interview was conducted, and a copy of this report and appeal rights were provided to Director of Operations Joanna Gomezthe state’s words, verbatim · CDSS document, Jul 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jul 22, 2025

87355 (e)(3) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA reviewed S1’s record that they are not associated with the facility. This poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 21, 2025

Plan of correction: Licensee processed the asssociation of S1 during the visit. This has been corrected.

Type of visit: Case Management - Other

On this day, Licensing Program Analyst (LPA) Edward Kim conducted a case management visit to document a deficiency observed during the investigation of complaint 22-AS-20250707162910 but unrelated to the allegations investigated. During a tour of the physical plant, LPA observed in Resident Room #1 the ceiling fan was not operating, bathroom near Resident Room #1 faucet was dripping water even though it was turned off, and the backyard swinging bench seated area had a hole that was 13" x 3". A deficiency was cited by Title 22 Division 8 Chapter 6. The facility did not maintain a ceiling fan, bathroom faucet, and swinging bench that was safe and in good repair. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Joanna Gomez.the state’s words, verbatim · CDSS document, Jul 10, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 24, 2025

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance ...for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. LPA observed that the ceiling fan was not operating in room #1, leaky faucet in bathroom, and the swinging bench has a hole in the seated area. This poses a potential health or safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee states they will fix the ceiling fan in Room #1, leaky faucet in the bathroom, and swinging bench, and provide evidence of fix items to CCLD via email to edward.kim@dss.ca.gov by POC due date July 24, 2025.

Type of visit: Case Management - Health Checks

On June 16, 2025, at 10:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced case management visit for a health and safety check. LPA Kim met with Administrator (ADMIN) Mar Jason Dasco and LPA Kim explained the purpose of the visit. LPA Kim conducted a health and safety check with ADMIN Dasco. Facility maintained ample 2-day perishables and 7-day non-perishables in the kitchen. Resident hygiene supplies are stored in a locked closet next to resident room 2 and resident room 3. LPA Kim observed one meal service at 12:00 PM. Residents were served marinated chicken, rice, and mixed vegetables. The hot water temperature measured between 113.7 degrees F and 119.3 degrees F. The room temperature was at 78 degrees F. All dual functioning smoke/carbon monoxide detectors were operational. All emergency disaster supplies were prepared and available. Facility land line, (714) 951-9188, was tested and remains available. LPA observed two staff on duty providing care to six residents. LPA Kim reviewed and received copies of the facility staff roster and resident roster. LPA Kim reviewed and received through email the previous six months of the facility's electricity bills/payments and facility gas bills/payments. Facility will send the previous six months bills and payments of the water and the trash to LPA Kim before the close of business 5:00 PM June 16, 2025. LPA conducted three staff interviews. No deficiencies were cited during the visit. An exit interview was conducted and a copy of this report was provided to Administrator Mar Jason Dasco.the state’s words, verbatim · CDSS document, Jun 16, 2025

Type of visit: Office

On today's date, Licensing Program Managers (LPM) Alisa Ortiz and Licensing Program Analysts (LPAs) Michael Tea and Brandon Lopez met with Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy on this day for the purpose of discussing financial operations and distress and reporting requirements. The following was discussed: o Licensee's responsibilities of facility oversight o Licensee's requirement to maintain control of facility and property o Licensee’s responsibility to maintain financially solvent o Licensee’s responsibility to communicate with the Department o Report of suspected dissolution of partnership The following was agreed upon during today's meeting: · Licensees has clarified the dissolution of partnership is not related to license but rather a separate business deal. The dissolution of partnership will not impact Licensees facilities. · The Licensees has reported they are in communication with landlords for property’s leased and will maintain a valid lease and control of property. · The Licensees will maintain payment of all facility bills and ensure sufficient staffing to meet resident’s needs. The Licensee will communicate any health and safety concerns related to the residents in care to the Department immediately. The following items are to be provided to the Department: · Updated LIC 500 Personnel Report identifying all current working staff and their agreed upon schedules by close of business May 29, 2025. · Current lease agreements with letters from landlords voiding any outstanding evictions or unlaw detainers by close of business May 23, 2025. · A copy of loan contract to support financial solvency by close of business May 29, 2025. · LIC 308 Designation of Facility Responsibility documenting the new facility administrator An exit interview was conducted Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy. A copy of this report, LIC 809, was provided to Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy.the state’s words, verbatim · CDSS document, May 22, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Change of Ownership Pre-Licensing evaluation. During visit LPA observed five residents in care. Facility is a single story residential home. LPA along with Licensee Maricel Neponuceno, Administrators Diane Mahinay and Jeff Bencito toured facility at 10:05AM and observed the following: Fire clearance approval was received on 06/24/24. Structure: Facility is a one story, 4 bedroom (two private bedrooms and two shared bedrooms) and four bathrooms house with attached garage and a beige exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface mats in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens, blankets and towels. Facility has hygiene products for each resident. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has adequate supply of 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as ample emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has one fire extinguisher. Fire extinguisher is mounted and fully charged. Facility has audible alarms on all sliding/exit doors. Appliances: Facility has operating gas stove, refrigerator, microwave,washer and dryer. Toxins: LPA observed toxins secured in laundry storage area and Sharps secured in locked drawer. Water Temperature: Tested and recorded between 114.6 to 116.4 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility does exercises, music therapy, puzzles, games, books and coloring books. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility with proper components. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating. CONTINUED ON 809C Administrator's Certificate observed on wall expiring May, 15, 2026. Component III Orientation was waived during this pre licensing visit due to Licensee presently operating several facilities throughout Orange county. No deficiencies noted during todays visit. The pre-licensing visit has been completed. This location is ready for licensure. An exit interview was conducted with Licensee and Administrators and a copy of report was left at facility.the state’s words, verbatim · CDSS document, Aug 19, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census : 5 Method: Telephone call with CAB COMP II Participants: Maricel Nepomuceno (Licensee/Administrator), & Tammy Edwards, (Analyst). Licensee/administrator participated in COMP II via Telephone call with CAB Analyst. Identification of licensee/ administrator was verified by confirming driver’s license number. During COMP II, licensee/administrator confirmed the understanding of Title 22. Component II was successfully completed. Licensee/administrator was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed licensee/administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 18, 2024