Angelica's Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Angelica Oosting. LPA began inspection with introduction, visit purpose and provided the facility with LPA identification and business card. Resident record review began- Six (6) records were reviewed. LPA reviewed for admission agreement-1 amended, medical assessment and TB test results, consent forms-missing, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records-6 missing, safeguard for personal property/valuables, and personal rights notification. This facility is not meeting documentation requirements. TSP will be requested and mandated for the facility. Employee records review began- Four (4) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance-1 does not have, 1 is not associated, personnel/job application, health screening-2 missing and TB test results, criminal record statement, training verification-(4) requested and was not able to be viewed for 2026, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current 03/12/2027. Corporation or LLC is active and in good standing. TSP will be requested and mandatory for the facility. (Continued on LIC809, Page 2) (Continued from LIC809, Page 1) Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside-1 white metal door guard observed in Resident room #1 that prevents exiting the room. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 112.9 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction except a Master lock was observed on the hook of the perimeter fence gate and was unable to be unlocked due to key not being available to unlock. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA made observations throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations in which it is not at this time. The facility has exceeded its capacity limitation, and the structure has changed according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher was not able to be verified as there was no tag or receipts when it was last tested or replaced. The facility is conducting emergency disaster drills. Corporation is active and in good standing. Based on the information received during this visit today, there are four (4) deficiencies that are being cited with Civil Penalties for a total of $2000 per Title 22, Division 6 of The California Code of Regulations. This report, LIC 809D, LIC421BG, LIC421M, Appeal Rights was reviewed with Angelica Oosting and copies provided at the time of the exit interview. *LPA was away from the facility from 12:00 PM-1:00 PMthe state’s words, verbatim · CDSS document, Jul 8, 2026

Allegation investigated: Due to lack of supervision, a resident was sexually assaulted

On 03/30/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to investigate the allegation listed above. LPA met with Chief Executive Officer Kenneth Oosting, Administrator Angelica Oosting and Administrative Assistant Adrian "AJ" Ooosting who were informed of the purpose of the visit. During today's visit, LPA observed six (6) residents and two (2) care staff present along with the administrator. LPA toured the facility with administrator, conducted interviews, and obtained copies of pertinent documentation. Regarding the allegation, “Due to lack of supervision, a resident was sexually assaulted” it was alleged that facility staff have been required to pull an unclothed resident off an unwilling resident more than once. The incident dates/times and identities of the involved residents were unknown. Unsubstantiated Administrator Oosting was interviewed and reported the following information. In December of 2023, Resident 1 (R1) resided in the facility and experienced behavioral challenges due to the progression of their dementia diagnosis. On two occasions, R1 was provided with dress assistance and later removed their own clothing. R1 then attempted to walk towards the beds of Resident 2 (R2) and Resident 3 (R3) while unclothed. However, Administrator Oosting and another caregiver were present during both incidents and successfully redirected R1 back to their room to put on clothing. Staff gently and physically redirected R1 by their arms guiding them towards their bedroom. R1 was never “pulled off” any resident in the facility and never made physical contact with the residents or their beds. Administrator Oosting later learned R1 enjoyed walking around their personal home unclothed and believes the incidents were a result of R1’s increased confusion. R1 was subsequently relocated to a different facility and their contact information is unknown. LPA conducted a collateral visit and interviewed R2. R2 reported that on one occasion, a disoriented resident walked into their room thinking it was their own room and were immediately redirected by staff. However, R2 was unable to identify the resident or recall whether they were clothed. LPA was informed R3 moved out of the facility years ago and has since passed away. CEO Oosting was interviewed and reported in December of 2023, the administrator was unaware the above incidents were required to be reported to Community Care Licensing. On 03/27/2026, the facility was cited for not meeting the reporting requirements regarding R1 and a plan of correction was put in place. Therefore, an additional case management deficiency is not warranted during today's visit. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report and Confidential Names list (LIC 811) was reviewed and provided to Administrator Oosting.the state’s words, verbatim · CDSS document, Mar 30, 2026 · control 18-AS-20260327125652

Allegation investigated: Staff did not refund authorized representative the proper amount after resident moved out.

Licensing Program Analyst (LPA), Robert Campbell made an unannounced visit to the facility to deliver findings regarding the allegation listed above. LPA met with Angelica Oosting/Administrator and explained the purpose of the visit and the elements of the allegation. LPA conducted an investigation, which consisted of interviews and record review. The department was unable to obtain any additional information from Resident #1 due to their condition. On January 11, 2024, Community Care Licensing (CCL) received a complaint that alleged staff did not refund authorized representative the proper amount after resident moved out. It was reported that Resident #1 was removed from the home on December 15, 2023 due to an incident. It was reported that Resident’s Responsible Party was refunded $163.50. Resident #1 was placed in the facility in September 2023 and agreed to pay $7,075 monthly, which included the basic rate and memory care services. LPA conducted an interview with Administrator and was advised that Resident’s Responsible Party was refunded the correct amount due to additional charges. (Continue on 9099C) Substantiated It was reported that Resident was charged fees pertaining to cleaning and repair services and hardware installation. LPA conducted a review of Resident #1’s monthly billing invoices, Admission Agreement dated 9/07/2023, Pre-appraisal documents, and the facility’s Program Statement/Plan of Operation. The review of documentation did not detail or inform resident’s or their responsible parties regarding refunds pertaining to partial placement or additional charges for damages, additional cleaning services, or reimbursement for additional staffing. The facility failed to notify Resident #1 or Responsible Party of any additional fees prior to the request for the refund. This is in violation of Title 22 regulations, which is a potential risk to residents in care. Based on interviews and documentation reviewed, the allegation that staff did not refund authorized representative the proper amount after resident moved out is substantiated. A substantiated finding means that the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. The facility will be cited. An exit interview was conducted. A copy of the report, along with the LIC 9099-D and appeal rights were provided to **************.the state’s words, verbatim · CDSS document, Mar 27, 2026 · control 18-AS-20240111145220

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87101 · Plan of correction due date: Apr 17, 2026

This 9099 D page was made in error. This page was intentionally left blankthe state’s words, verbatim · CDSS document, Mar 27, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(B)(2) · Plan of correction due date: Apr 10, 2026

T2287507(g)(B)(2) Admission agreements shall specify the following: Rate for additional items and services, including: A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement. Evidenced by the following: LPA reviewed documentation and interviewed Licensee to come to the deficiency.the state’s words, verbatim · CDSS document, Mar 27, 2026

Plan of correction: Licensee will refund R1 to the POA $522.00, 857.00, & 1745.00 fro a total $3,124.00. Licensee will submit refund receipt to the LPA by POC date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Robert Campbell conducted a case management visit to the facility for the purpose of issuing deficiencies related to complaint investigation 18-AS-20240111145220. LPA Robert met with Angelica Oosting/Administrator, and explained the purpose of the visit and assisted LPA. During the investigation, information obtained revealed that Resident 1 (R1) had multiple times where R1 eloped from the facility, also reported by Ken Oosting/Licensee R1 came to the facility high on medication violating other resident personal rights. LPA conducted a review of Special Incident Reports submitted by facility staff and did not find any documentation referencing incidents listed above. Interview with Administrator, Ken Oosting acknowledged the incidents with R1 occurred and could not provide Special Incident Reports submitted to Community Care Licensing Division upon request. As a result, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report, 809-D and Appeal Rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Mar 27, 2026

From the deficiency page — Deficiency type: Type B · Section cited: ILS 81061(b)(2) · Plan of correction due date: Apr 24, 2026

T22-81061(b)(2) Upon the occurrence, during the operation of the facility, of any events specified, a report shall be made to licensing agency within the agency's next working day during normal business hours. In addition, a written report....submitted within 7 days. Evidenced by the following... The licensee stated in interviews, and documentation review special incidents that were not reported in files.the state’s words, verbatim · CDSS document, Mar 27, 2026

Plan of correction: Licensee will train all staff on reporting special/unusual incidents with documentation, sign in sheet, date and time. LPA will receive all training information and documentation by the POC date.

Type of visit: Required - 1 Year

On May 30, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator, Angelica Oosting. The facility file review was conducted in the Regional Office and additional forms were reviewed and requested on site. The facility is licensed six Senior Adults and is providing care to five senior Adults currently. LPA Mixson toured the facility along with the Administrator and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways currently. The facility is a single-story home located at 31916 Corte Posita, Temecula Ca. 92592. Physical Plant: The facility phone number is (951) 240-7280 and it is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications: Were locked and inaccessible to residents in care, and there were a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility cooling and heating system and other appliances were operable currently at the time of this visit, and there were safety lights for night. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharps are locked. Care & Supervision: Facility has sufficient staff, two staff on site at the time of this visit and the Administrator arrived later. Records Review: The LPA reviewed resident and staff files, conducted staff and resident interviews, and previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Administrator, Angelica Oosting.the state’s words, verbatim · CDSS document, May 30, 2024

Allegation investigated: Facility staff are not assisting resident with bathing Facility staff are not assisting resident with personal care

Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to deliver findings regarding the allegations listed above. LPA met with Licensee/Administrator, Angelica Oosting and explained the purpose of the visit and the elements of the allegation. LPA Banrasavong conducted the investigation which consisted of observations, interviews with staff members and residents, and record review. On 01/03/2020, Community Care Licensing (CCL) received a complaint that alleged staff are not assisting resident with personal care and staff are not assisting resident with bathing. In regards to the allegation of facility staff not assisting resident with personal care, information obtained from an interview with Resident 1 (R1) stated they inquired about applying for In Home Supportive Services and the Assisted Living Waiver Program. R1 stated R1 is currently residing at the facility but stated that the facility may be relocating and wanted to see what other programs can assist with R1's needs. Unfounded R1 stated that there are no issues with staff assisting resident with personal care. R1 stated that all their needs are met at the facility such as assistance with medication, grooming, prepping food, laundry, cleaning, and specifically bathing. LPA interviewed the staff members at the facility, who indicted that there were no issues with assisting the residents with personal care. In regards to facility staff bathing residents, staff members indicated that do assist residents with bathing and they chart when residents refuse showers. LPA was able to verify and randomly pull dates from the time period of R1's residency at the facility to confirm this information. LPA reviewed the months of October, December of 2023 and January of 2024. The information obtained from additional interviews with residents corroborated the information. Based on LPA's observation, interview conducted, and record reviews, the preponderance of evidence shows that the allegations that facility staff are not assisting resident with personal care and bathing services are unfounded. The Department has found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report was provided to the Licensee, Angelica Oosting.the state’s words, verbatim · CDSS document, Feb 28, 2024 · control 18-AS-20240103104304