Integrated Care Communities - A1

Type of visit: Required - 1 Year

On November 05, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with the Licensee, Emely Rodriguez. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for 22 Elderly Adults, and is currently operating at a capacity of 20 Elderly Adults (740). LPA Mixson toured the facility and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The facility is a single-story cottage facility, located at 14265 Nason Street Moreno Valley, CA. 92555. Physical Plant: The facility phone number is (951) 601-9100 and it is operable. LPA Mixson observed the residents’ living units, and each was furnished with required fixtures as per Title 22. LPA Mixson inspected the 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. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the LTCO poster. The cleaning supplies and sharp items were locked and inaccessible to the residents in care at the present. There were designated storage spaces for the residents’ and staff’s files, and it was locked and inaccessible to residents in care at present. Care, Supervision & Administration: There were adequate staff present for the supervision of resident in care at the time of this annual visit. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Emely Rodriguez, possesses a current administrator’s certificate with an expiration date of 06/13/2026. Medications: The medications were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. There were no documented errors observed on the centrally stored medication forms, and medications were stored in their original containers during this visit. The facility has five caregivers present and a housekeeping staff arrived shortly after the LPA. Disaster preparedness: LPA Mixson reviewed the facility's emergency & disaster plan as well as the training binder. LPA observed the last fire drill met the Department standards and was logged, as required per Regulations. Records Reviewed & Resident/Staff Files: The LPA reviewed staff files and reviewed the facility's staff schedule. The staff files reviewed have criminal clearance, updated training, along with current First Aid certification. Resident files reviewed possessed the required paperwork as per Regulations at the present. Food Service& furniture: The non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents at this time. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The overall facility is clean; the furniture is in good condition and arranged in a manner which provides space for residents to move safely. The facility cooling system and other appliances were operable at present. Licensee informed LPA there were safety lights for night throughout the facility. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found required infection control measures met the Department requirements. An exit interview was conducted, and a copy of this report was reviewed and given to Licensee, Emely Rodriguezthe state’s words, verbatim · CDSS document, Nov 5, 2025

Allegation investigated: Staff does not treat resident with respect

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with Jonathan Fuentes and explained the reason for the visit. The investigation consisted of the following: On 12/7/22 LPA Torres conducted an initial complaint investigation visit. On 10/13/25 LPA Flores contacted administrator and requested copies of resident #1(R1)’s admission agreement, physician’s report, needs and care appraisal, identification and emergency information sheet, power of attorney (POA) signed 5/20/22, incident reports, and death report. On 10/14/25 LPA Flores conducted interviews with 5 staff over the phone and R1’s power of attorney (POA). On 12/15/25 LPA Flores conducted interviews with 6 residents and delivered findings. (CONTINUED ON LIC 9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff does not treat resident with respect. It is alleged that staff are treating R1 inappropriately and in a rough manner. Interviews with residents revealed staff are respectful and gentle when assisting with care. Interviews with staff revealed they have not observed residents treated in a rough or disrespectful manner. It has not been reported to any staff of residents being mistreated either by staff or residents and staff treat the residents with respect. Per staff they are provided training on resident’s personal rights yearly. Interview with POA revealed they were satisfied with the care and there were no concerns regarding the staff. Documents reviewed revealed R1 was admitted on 5/9/22. R1 is no longer residing at the facility therefore an interview was not conducted. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Jonathan Fuentes and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 18-AS-20221130131306

Type of visit: Case Management - Other

On January 10, 2025, Licensing Program Analysts (LPAs), Abdoulaye Zerbo and Seo Jeon did an unannounced visit to conduct a case management, and met with the Administrator Emely Rodriguez. LPAs introduced themselves and stated the purpose of the visit. LPAs toured the facility, along with the Administrator Emely Rodriguez and made observations. The facility have three(3) staff per shift attending the residents' needs and conducting rounds every hour or more frequently if needed. The administrator stated that they are doing constant fire check to make sure all residents stay within the premises. There were no imminent health and/or safety concerns observed at the time of visit. LPAs did not observe any obstructions or debris inside or outside of the facility at the time of this visit. LPAs observed the facility is using a generator as a source of power due to the outage. LPAs assessed the available food and observed sufficient food to be available for the residents in care. The food supply meets the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care. The facility is clean, and meets all the requirements for the residents in care. Based on the information obtained during today's visit, there were no immediate health and safety issues of the residents in care. An exit interview was conducted, and a copy of this report was provided to the Administrator, Emely Rodriguez.the state’s words, verbatim · CDSS document, Jan 10, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to continue the annual inspection that was started on 11/22/2024. The LPA met with Administrator, Emely Rodriguez, and informed her of the purpose for the visit. Physical Plant: The facility consists of Twelve (12) resident bedrooms, thirteen (13) bathrooms, one (1) laundry room, a kitchen and dinning area, a living room area, a medication room and office, a staff work station and a yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to Administrator Rodriguez, no weapons are stored at the facility. The facility is being maintained at a comfortable temperature. All indoor passageways were kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet and shower used by residents. Resident showers have non-skid mats present. The hot water temperature was tested and observed to be within regulatory requirements. One carbon monoxide device was tested by staff and was observed to be in operating condition. The facility's smoke alarm panel was observed to show the system was in normal operation. The facility was kept clean, organized and free of any odors. The LPA observed a chain and lock on the only emergency exit in the back yard area of the facility. An interview with the local fire department revealed the chain and lock should not have been placed on the exit gate. A citation and civil penalty will be issued. Record Review: All staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Staff responsible for direct care and supervision have current first aid and CPR training. Dementia care and medication training was observed on file. No postural support training or restricted health training was observed on file for Staff One (S1) or Two (S2). Insufficient hours for hospice training were observed on file for S1 and S2. A citation will be issued. Resident files had admission agreements, medical assessments, appraisal/needs and services plans, and other required records on file. The facility was not operating beyond the conditions specified on the license. The facility currently has an approved Hospice Waiver for ten (10) residents and there are currently five (5) residents in care receiving hospice services. There is a disaster and mass casualty plan in place. Proof of emergency drills was observed on file. According to Administrator Rodriguez, the corporation is currently active. The LPA observed current liability insurance on file. Medication Review: The LPA inspected resident medications. Medications were observed to be well organize and inaccessible to unauthorized individuals. Centrally stored medication destruction records were observed on file. Administrator Rodrgiuez reported an updated admission agreement was established by the licensee and she agreed to provide the LPA with a copy for department review. She also agreed to provide the LPA with a copy of the current liability insurance, staff schedule, and resident roster. An exit interview was conducted with Administrator Rodriguez, in which this report was reviewed and a copy was provided, along with supportive documents. Administrator reported she had no questions regarding the report.the state’s words, verbatim · CDSS document, Dec 3, 2024

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs),Abdoulaye Zerbo and Armando Perez conducted an unannounced visit to the facility for a case management. The LPAs met with Facility Assistant manager Kristin Hernandez, and informed her of the purpose for the visit and were granted access. The facility is a single story building and consists of Twelve (12) resident rooms, and thirteen (13) bathrooms. The LPAs obtained copies of relevant documentation such as the LIC 500 Personnel Report and client roster. LPAs observed current personnel to be fingerprint cleared and listed on the facility's personnel report. There are currently nineteen (19) residents in care. LPAs' case management included interview with management, obtaining pertinent documentation and conducting a tour of the facility for a health and safety check. No health and safety concern were observed during today's visit. According to the Care consultant Luz Rodriguez, an internal investigation was conducted. . The information received from the in house investigation indicated the SA did hug resident in Care. The internal investigation revealed that SA hugged the resident because she was crying and was emotional from moving that same day from Integrated B1 to Integrated A1. The Care consultant also stated the resident was upset at SA because she felt SA moved the wrong TV to her previous room to her new room. Further review is needed at this time. Possible visits and phone interviews will be conducted before a decision is rendered. An exit interview was conducted, and a copy of this report was provided to Care consultant Luz Rodriguez.the state’s words, verbatim · CDSS document, Nov 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the facility. The LPA was allowed entrance into the facility and met with Assistant Manager, Kristin Hernandez. The LPA informed Hernandez of the purpose for the visit. The inspection included the following: Food Service: The LPA inspected the facility's kitchen areas and food supply. The LPA observed all food to be of good quality. All readily perishable foods and beverages capable of supporting rapid and progressive growth of micro-organisms were stored in covered containers at appropriate temperatures. Soaps, detergents, cleaning compounds and similar substances were stored in areas separate from food supplies. All kitchen areas were kept clean and free of litter, rodents, vermin, and insects. According to Assistant Manager Hernandez, modified diets are being provided to residents in care. An interview was conducted with the staff member on shift who is engaged in food preparation and services. The staff member reported personal hygiene and food services sanitation practices are being observed. Due to insufficient time, another visit will be completed to continue the annual inspection. This report was reviewed and Assistant Manager Hernandez and a copy was provided. NOTE: Administrator, Emely Rodriguez, was not available during the LPA's visit.the state’s words, verbatim · CDSS document, Nov 22, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to follow up on an incident reported by the facility regarding an alleged sexual assault involving a resident in care. The LPA met with Facility Manager, Amanda Redell, and informed her of the purpose for the visit. The Unusual Incident Report (UIR), received on 10/21/2024, revealed that on 10/20/2024 Resident One (R1) called 911 and reported a staff member touched a private area of their body on two separate occasions. The LPA's investigation included staff, resident and third party interviews, records review, and records collection. One third party interview revealed the suspected individual was Staff One (S1). The third party and staff interviews revealed no one works for the facility by S1's name. R1 was interviewed and reported the incidences did take place several months ago. R1 provided a name of the alleged suspect, identified as Staff Two (S2). S2 was interviewed and denied the allegation. Three (3) resident interviews revealed no knowledge of any inappropriate behavior between staff and residents. Additional time is required, prior to the conclusion of the investigation, in order to obtain further information. This report was reviewed and a copy was provided. (NOTE: Administrator, Emely Rodriguez, was not available for the LPA's visit).the state’s words, verbatim · CDSS document, Nov 5, 2024

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Emely Rodriguez, and informed her of the purpose for the visit. A report was obtained by the Department alleging a resident in care was illegally evicted from the facility on or around 10/01/2024. The investigation included staff and resident interviews, records review, and collection of relevant documentation. A review of the facility's resident roster revealed no individual in care by the alleged resident's name. Two (2) of two (2) resident interviews reported no knowledge of the resident in question being in care. Neither resident had knowledge of a resident who was evicted from the facility. Three (3) of three (3) staff interviews reported no resident was in care by the alleged resident's name. Two (2) of two (2) staff members reported no resident has been evicted from the facility in the last several months. Administrator Rodriguez was interviewed and reported no individual has been evicted from the facility in the last few months. Therefore, based on interviews and records review, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Administrator Rodriguez; this report was reviewed, and a copy was provided. Unfoundedthe state’s words, verbatim · CDSS document, Oct 7, 2024 · control 18-AS-20241001141358

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs), Stephanie Martinez and Seo Jeon, conducted an unannounced visit to the home to follow up on an Unusual Incident/Injury Report (UIR) received from the facility on 06/24/2024. The LPA met with Amanda Redell, Facility Manager, and informed her of the purpose for the visit. Administrator, Emily Rodriguez, was notified of the visit via telephone. A UIR was received by the Department from the facility reporting an alleged incident of abuse between a staff member and resident in care. According to the report, Resident One (R1) reported that on 06/19/2024 Staff One (S1) placed their hands around their neck and threw R1 to the ground. It was also reported R1 called emergency services (911); however, S1 would not allow the personnel inside the home. During the visit the LPA conducted staff and resident interviews, reviewed records, and obtained copies of relevant documentation. No immediate health and safety concerns were observed at time of visit. No one by the name of S1 was listed on the facility's staff schedule. Additional time is required, in order to obtain further information, prior to the conclusion of this investigation. This report was reviewed with Facility Manager Redell and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 8, 2024

Type of visit: Required - 1 Year

On 11/16/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA met with Administrator, Emely Rodriguez and Facility Manager, Amanda Redell who were informed of the purpose of visit. LPA toured the facility with Amanda Redell. The following was observed, reviewed, and inspected: The physical plant, in general, was in good repair. The facility is operating in the capacity approved by Community Care Licensing (CCL). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. LPA inspected a sample of resident bedrooms and bathrooms. Resident bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. Room temperatures were comfortable for residents in care. LPA inspected a sample of resident bathrooms; LPA observed bathrooms to be clean and sanitary. There is also a good number of personal toiletries available for the residents in care. LPA measured the hot water temperature in the sampled bathrooms, in which all bathroom sinks measured within regulation. Sampled bathrooms were equipped with non-skid surfaces and grab bars. Bedrooms were equipped with a pull cord system to notify staff of any emergencies. LPA toured the kitchen and dining area. The facility was stocked with a 2-day supply of perishable and 7-day supply of non-perishable food items that were labeled appropriately. The facility had a menu posted and available for review. Dishes, glasses, and utensils were in good condition and stored in a healthful manner. LPA inspected the common areas. Smoke detectors were last tested on 7/24/2023 by Costco. LPA observed several carbon monoxide alarms throughout the facility. Continue on LIC809-C Continued from LIC809 There was a locked and centralized storage area for medications, including refrigerated medications. Medications appeared to be dispensed and documented appropriately. The facility had a designated area for resident files and staff files. All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Random staff and residents' records were reviewed. All required postings were posted near the entryway and throughout the facility. There was adequate seating in the common areas and several activity rooms. LPA observed several activity posters. The facility was also equipped with a complete first aid kit as well as the first aid manual. LPA inspected the outdoor area of the facility. There was shaded area with seating. Overall, the facility was clean, in good repair, and operating in safe conditions for residents in care. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Emely Rodriguez.the state’s words, verbatim · CDSS document, Nov 16, 2023