Revival Senior Living

Allegation investigated: medication mismanagement facility not following admission agreement facility not providing proper notice for care increase facility not providing proper notice for rent increase facility not notifying POA of emergency events Facility not following reporting requirements facility not allowing resident to return to the facility

An office meeting was held on Monday June 29, 2026, to deliver findings for a complaint which was received by the Department on 1/9/2026. Present was Regional Manager Harpreet Humpal, Licensing Program Manager Laura Munoz, Licensing Program Analyst Melissa Parks, and Licensee Jonathan Gallegos. Over the course of the investigation, LPA interviewed the licensee, residents, and other related parties. LPA reviewed admission agreements, invoices, and emails related to R1 and R2’s care. LPA learned the following: Medication Mismanagement Based on records reviewed, R1 and R2 moved out of the facility on January 23, 2026. On their move-out day, their responsible party obtained all their medications which were available from Revival. The medications were provided to their new RCFE however it was found that two medications were missing. R1 was missing Levothyroxine and R2 was missing Diltiazem. Additionally, according to R1’s MAR for Substantiated January 2026, the facility did not administer Levothyroxine on the following dates in January: 9, 10, 13, 14, and 16. R2’s January 2026 MAR states that the Diltiazem was not in a bubble pack nor was there a bottle in stock at the facility yet documentation showed an active order and should have been administered routinely. Based on documentation, the facility did not administer prescribed medications to R1 and R2 as directed by physician. Not following admission agreement: Facility not providing proper notice for care increase According to the signed admission agreement for R1 provided by the licensee, it states ‘Modification of agreement: any changes or modifications to this admission agreement (including changes in service, fees, or policies) must be made in writing and signed by both the resident/representative and the facility”. During the course of the investigation, Documentation reviewed showed Revival uses a tier system for charging care costs for each resident. On 12/12/2025, Revival increased tier costs without providing 90-day notice to each resident as required by statute. According to documentation that was provided, the tier pricing increased in December 2025, however the licensee did not provide the Department with any notices which were given (and signed) to residents/authorized representatives. The Department obtained an email which was sent to R1’s payee notifying that R1 and R2’s tier cost increase would be effective on 01/01/2026, The email was sent on 12/12/2025 providing a 20-day notice of increase. Facility not providing proper notice for rent increase R1 and R2 moved into the facility in September 2025. The licensee billed R1 and R2 for a prorated amount for rent and care at time of move in. Based on the admission agreement, the monthly rate for R1 was $6300 and $1,200 for R2 totaling $7500 for both R1 and R2. In November 2025, the licensee billed R1 and R2 $8,000. The $500 increase in rent was not provided to R1, R2 or their responsible party as required by statute. Furthermore, January invoices dated 12/30/25 show R1 was billed for $5,750 and R2 was billed $6,300 for rent. The licensee did not follow the agreed upon admission agreement and increased monthly charges without required notification time frame. Facility not notifying POA of emergency events Facility not following reporting requirements R2 was transported to the hospital for a fall on 11/25/2025. R2’s responsible party was not notified by the facility, rather the hospital notified the responsible party when R2 was ready for discharge. R2 was returned back to the facility. On 11/26/2025, R1 and R2 both sustained falls resulting medical intervention and were taken to the hospital. As a result of R1’s fall, R1 sustained six broken ribs. The facility did not notify R1 and R2’s responsible party when R1 and R2 were sent to the hospital on 11/26/2025. Based on interviews and documentation, R1 and R2’s responsible party was notified by the hospital and not by the licensee that R1 and R2 were sent out. R1 and R2’s responsible party was emailed a detailed incident report regarding the 11/25 and 11/26 falls on December 15, 2025 by the licensee. Additionally, the licensee provided an incident report to the Department regarding the falls via email on December 16, 2025, which falls outside of the 7-day time requirement for notifying licensing. The licensee did not notify R1 and R2’s responsible party or the Department of incidents within the required time frame as documented in statute. Facility not allowing resident to return to the facility R1 was admitted to a skilled nursing facility after a hospitalization for a fall resulting in injury in November 2025. Documentation reviewed shows the skilled nursing facility attempted to discharge R1 back to Revival on 12/19/2026 and the licensee refused to take R1 back. According to a fax sent to R1’s primary physician from Licensee, ‘Manzanita Healthcare Center has attempted to discharge R1 for the last 8 days.’ Mr. Gallegos refused R1 to return to the facility citing incomplete paperwork from the SNF. The licensee did not accept R1 back to the facility upon discharge from the SNF. Based on the information detailed above, LPA finds the allegations to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on 9099-D. Exit interview. Copy of report and appeal rights provided. the Department was unable to determine if the licensee physically assaulted and/or spoke inappropriately with residents in care. Based on information obtained during the investigation, LPA finds the allegations to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred Exit interview conducted. A copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 29, 2026 · control 59-AS-20260109150649

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 30, 2026

1. 87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care . . . The plan shall encourage routine medical and dental care . ., by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by R1 and R2 not having requirement medication. This poses a direct threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: The licensee has agreed to submit a plan to include the following: regarding staff training and MAR documentation and procedures for obtaining medication when there are pharmacy obstacles.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Jul 13, 2026

2. 87507 Admission Agreements (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by R1 and R2 not being provided written and signed agreement for any changes. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: The licensee has agreed to review the admission agreement requirements and will ensure the facility's admission agreement terms are met. The licensee will send an acknowledgement to the Department once he has reviewed the regulations.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.655(a) · Plan of correction due date: Jul 13, 2026

§1569.655 Increase in fee rates for elderly residents; 90 days’ written notice . . . (a) . . . increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This requirement was not met as evidenced by the facility changing care tier costs and rent without proper notice. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: The licensee will send an acknowledgement to the Department once he has reviewed the regulations.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Jul 13, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly . . . (8) To have their representatives regularly informed by the licensee of activities . . . This requirement was not met as evidenced by R1 and R2 being sent to the hospital and the facility did not notify the responsible party. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: The licensee will submit a statement of understanding regarding reporting requirements.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jul 13, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency . . . (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events . . . This requirement was not met as evidenced by the Department did not receive incident reports regarding R1 and R2's hospitalization within the required time frame. This poses an indirect threat to the health and safety of residents in carethe state’s words, verbatim · CDSS document, Jun 29, 2026

Plan of correction: The licensee will submit a statement of understanding regarding the requlation for notifying the Department of unsual incidents. The licensee agrees to submit a statement of understanding regarding the regulations for accepting a resident back after a SNF or hospital discharge.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(20) · Plan of correction due date: Jul 13, 2026

Additional Personal Rights of Residents in Privately Operated Facilities (20) To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations . . . This requirement was not met as evidenced R1 not being allowed back to the facility once ready for SNF discharge. This poses an direct threat to the heatlh and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 29, 2026

Allegation investigated: Residents personal items were not safeguarded

An office meeting was held on Monday June 29, 2026 to deliver findings for a complaint which was received by the Department on 1/23/2026. Present was Regional Manager Harpreet Humpal, Licensing Program Manager Laura Munoz, Licensing Program Analyst Melissa Parks, and Licensee Jonathan Gallegos. Throughout the course of the investigation, LPA interviewed the management, staff, and residents regarding the allegations. LPA learned the following: Residents personal items were not safeguarded R1 and R2 moved out of the facility in January 2026. R1 and R2’s responsible party noticed that several personal items were missing. R2 was missing several personal items including a watch, ring, and cell phone. R1 was also missing a cell phone. S1 stated during an interview that facility staff confiscated the cell phones because R2 was consistently calling 911. S1 stated that the phones were secured at the facility and were not given back when R1 and R2 vacated the facility. Licensee Gallegos emailed LPA Parks on 1/30/2026 stated that he mailed the phones to R1 and R2’s responsible party. Substantiated Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 22, 2026 · control 59-AS-20260123132315

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(27) · Plan of correction due date: Jul 13, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, (27) To keep, have access to, and use their own personal possessions, including toilet articles, and to keep and be allowed to spend their own money, unless limited by statute or regulation. This requirement was not met as evidencd by R1 and R2's cell phones were confiscated and secured by the facility. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 22, 2026

Plan of correction: The licensee agrees to submit a statement of understanding regarding resident rights.

Allegation investigated: Facility staff left resident unattended Staff not answering facility phone

Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday March 18, 2026 to conduct a complaint investigation regarding the above allegations. LPA met with staff Neha Sharma and explained the purpose of the visit. Staff called the licensee, Jonathan Gallegos who indicated he was unable to come to the facility during today's visit. LPA interviewed S1 regarding the allegations. LPA learned the following: On Monday March 16, 2026, S1 was the only staff on duty at the facility. S1 needed to complete an appointment outside of the facility. At this time, R1 was being visited by a private duty caregiver. S1 let R1's private caregiver know they were leaving the facility. According to S1, they were absent from the facility for approximately 2 hours. When S1 returned, R1's family and private duty caregiver were at the facility. Additionally, since there were no staff at the facility, there was no one present to answer the facility phone. Although the family had a private caregiver on site with R1, it is the responsiblity of the licensee to ensure facility staff are present in the facility 24 hours a day to provide care and supervision to resident's in care. CONT on LIC9099C Substantiated Due to absence of staffing, an immediate civil penalty of $500 was issued during todays visit. Based on the information detailed above, LPA finds the allegations to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Appeal rights were given. A copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026 · control 59-AS-20260317095423

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Mar 19, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities . . . (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by absence of staff on 3/18/2026. This poses a direct threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: Licensee was not present to assist with developing a plan of correction. The licensee shall submit an LIC500 of a current staffing schedule as well as a statement of understanding of the regulation cited. POC shall be submitted by 03/19/2026.

Type of visit: Required - 1 Year

Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday March 18, 2026, to conduct the unannounced annual inspection. LPA met with staff Neha Sharma and explained the purpose of the visit. Staff called the licensee, Jonathan Gallegos who indicated he was unable to come to the facility during today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA and LPM reviewed resident (1) and staff (2) files. The resident file was missing a reappraisal. LPA only observed the initial appraisal which was completed upon move-in. During the staff file review, LPA observed S1 missing current CPR certification. S2 missing current first aid certification and physical. During a medication audit, LPA and LPM observed the following: medications which were prescribed for residents who moved out in January were still at the facility. On R1's MAR, potassium chloride was crossed out to indicate it was discontinued, however there was not a discontinued order on file. LPA and LPM observed two medications which were in R1's room, not locked up and accessible to the resident. See 809-D for citations issued during todays visit. Exit interview conducted. A copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Mar 18, 2026

Allegation investigated: Staff not meeting resident's needs Staff not meeting resident's prescribed dietary needs.

Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 02/13/2026 to complete and deliver findings to a complaint received on 06/13/2025. LPA met with Licensee, Jonathan Gallegos and explained the purpose of the visit. Throughout the course of the investigation, the department conducted interviews and record reviews. Please continue to LIC9099C.. Substantiated Staff Not Meeting Resident’s Medical Needs Based on interviews with staff and review of facility records, it was determined that the facility did not have a documented diabetes care plan for Resident 1 (R1). Records indicate R1 has multiple medical diagnoses of diabetes. The Admission Agreement signed on 04/25/2025 listed a monthly charge for “diabetic management.” However, when requested, facility staff were unable to produce a diabetes care plan outlining how R1’s diabetic needs were monitored or managed. Staff member S3 stated that R1’s blood sugar is checked daily; however, no blood glucose monitoring logs or documentation were available for review to support this statement. The LPA observed that R1’s diabetes was not addressed in the Appraisal/Needs and Services Plan on file. Additionally, the Physician’s Report (LIC 602) dated 04/18/2025 indicated that R1 requires a specialized diet. When requested, the facility was unable to provide a diabetic or specialized menu specific to R1. Staff Not Meeting Resident’s Prescribed Dietary Needs Based on record review and staff interviews, it was determined that the facility did not ensure R1’s prescribed dietary needs were met. The Physician’s Report (LIC 602) dated 04/18/2025 documented that R1 is diagnosed diabetes required a specialized diet and assistance with medical needs. The Admission Agreement signed on 04/25/2025 identified Diabetic Management under other personal care needs. Despite this, when the LPA requested documentation of a diabetic diet or diabetes care plan, staff member S1 stated that no such plan existed. Staff member S3 reported that blood glucose monitoring was conducted using a glucose monitor; however, no logs or records were available to verify ongoing monitoring. Additionally, the facility was unable to provide a sample menu or documentation demonstrating that R1 was receiving meals consistent with a prescribed diabetic or modified diet. Deficiencies cited on LIC9099-D Exit interview conducted. Copy of report was provided to licensee.the state’s words, verbatim · CDSS document, Feb 13, 2026 · control 59-AS-20250613085822

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c)(2) · Plan of correction due date: Mar 13, 2026

87457(c)(2) If an initial appraisal or any reappraisal identifies an individual resident service need which is not being met by the general program of facility services, advice shall then be obtained from a physician, social worker, or other appropriate consultant to determine if the needs can be met by the facility.This requirement was not met as evidence by: Based on interview and record review, the facility did not develop and maintain a documented plan of care addressing R1’s diabetes management and related medical needs, despite identifying diabetic management as a service provided which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: Licensee will submit a statement of understanding for section 87457(c)(2) by email to LPA by 03/13/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(7) · Plan of correction due date: Mar 13, 2026

87555 General Food Service Requirements (b)The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidenced by: Based on LPA interviews and records review it was determined that The facility failed to provide and document a physician-prescribed modified diet and failed to maintain records demonstrating monitoring of R1’s diabetic condition which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: Licensee will submit a statement of understanding for section 87555(b)(7) by email to LPA by 03/13/2026.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday December 9, 2025 for an unannounced post licensing inspection. LPA met with owner Jon and explained the purpose of visit. LPA reviewed 4 resident and 1 staff files. All resident and staff files contained the required documents. LPA and Jon toured the facility together to ensure the health and safety of residents in care. The areas toured include: resident rooms, bathrooms, kitchen, garage, and backyard. In the areas toured, there were no health or safety violations observed. The following topics were discussed: resident records, staff documents, and disaster drills. Exit interview conducted. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Dec 9, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Graham Gunby arrived on Thursday March 6, 2025 to conduct an announced pre-licensing visit. The Compliance and Regulatory Enforcement Tool was used during today's inspection. All files contained the required paperwork. This facility has a fire clearance for 6 (six) nonambulatory, of which 2 (two) can be on hospice. Facility has all required postings in the entry. LPAs toured the facility with the licensee and administrator. The following areas were inspected for compliance: kitchen, backyard, resident bedrooms, bathrooms, and common areas. Facility has current fire extinguisher and a full first aid kit. Medications will be kept locked in a cabinet. Cleaning chemicals and knives/sharps are kept locked and inaccessible to residents. Component III has been completed at this time. The facility appears to be in substantial compliance and ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with licensee and a copy of this report will be left at the facility.the state’s words, verbatim · CDSS document, Mar 6, 2025