Carmie Cares Home for the Elderly 1

Allegation investigated: Staff are not meeting residents toileting Staff leave resident in soiled clothing for an extended period of time Staff are not maintaining resident’s hygiene

Licensing Program Analyst (LPA) Seo Jeon mailed this report to the ex-licensee’s last known mailing address via USPS certified mail, to communicate the findings related to the above-mentioned allegations. The facility has been closed since 09-11-2025. On July 14, 2025, the Department received a complaint report with the following allegations. It was alleged that staff are not meeting residents toileting. According to the information received, Resident #1 (R1) was observed severely soiled at 10:45 AM on July 10, 2025. LPA’s record review revealed that R1 required incontinence care and had a cognitive condition that impacted their ability to communicate or care for themselves. LPA conducted an interview with a relevant party (RP), who stated that R1’s clothing, bedding and incontinence brief were severely soiled at the time of their visit. Continued on LIC9099-C.... Substantiated RP stated R1 had not been changed since the day before and noted that this was not an isolated incident. RP stated they previously advised Staff #1 and #2 (S1 and S2) to ensure R1 was kept clean and dry. However, RP stated that both S1 and S2 continued to rely on outside care teams to manage R1’s toileting needs. LPA’s record review confirmed R1’s soiled clothing, bedding, and incontinence brief. Based on interviews conducted and record review, the Department’s investigation provided enough information to corroborate the allegation that staff are not meeting residents toileting. This allegation is substantiated. It was alleged that staff leave resident in soiled clothing for an extended period of time. According to the information received, R1’s clothes were severely soiled, and R1 was found to have 2 incontinence briefs on at one time. LPA conducted an interview with a relevant party (RP), who stated that R1 had not been changed since the day before when they visited on July 10, 2025. RP stated that R1’s clothes, bedding and incontinence brief were severely soiled at the time of their visit. LPA’s record review confirmed R1’s soiled clothing, bedding, and incontinence brief. Based on interviews conducted and record review, the Department’s investigation provided enough information to corroborate the allegation that staff leave resident in soiled clothing for an extended period of time. This allegation is substantiated. It was alleged that staff are not maintaining resident’s hygiene. LPA conducted an interview with a relevant party (RP) who stated that R1’s clothes were completely saturated with urine and feces. The feces were in the R1’s hair, face, hands and mouth. LPA’s record review confirmed R1’s soiled clothing, bedding, incontinence brief, and the feces on R1’s hand and face. Based on interview conducted and records review, the Department’s investigation provided enough information to corroborate the allegation that staff are not maintaining resident’s hygiene. This allegation is substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was not conducted as the facility has been closed since 09-11-2025. A copy of this report was sent to the ex-licensee’s last known address via USPS certified mail due to the facility closure. LPA’s records review revealed that R1 had history of skin condition or breakdown. LPA was unable to conduct interviews with R1 due to R1’s cognitive condition. Based on records review and interviews conducted, the Department’s investigation did not provide enough information to corroborate the allegation that staff are not properly supervising a resident who is a fall risk. This allegation is unsubstantiated. It was alleged that staff left resident in soiled in feces and urine resulting in rashes. LPA conducted an interview with reporting party (RP) who stated R1 developed rashes due to being soiled in urine and feces. LPA conducted records review but was unable to observe any evidence of R1 having rashes. LPA’s attempt to interview R1 was unsuccessful due to R1’s cognitive condition. The Department’s investigation did not provide enough information to corroborate the allegation that staff left resident in soiled in feces and urine resulting in rashes. This allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was not conducted as the facility has been closed since 09-11-2025. A copy of this report was sent to the ex-licensee’s last known address via USPS certified mail, due to the facility closure.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 18-AS-20250714084243

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Apr 15, 2026

Additional Personal Rights of Residents in Privately Operated Facilities, (a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents ..., (4)To care, supervision, and services that meet their individual needs... This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not provide care and supervision to R1. This posed immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: This facility has been closed since 09/11/2025. There are no residents in care.

Allegation investigated: Licensee did not issue a timely refund to resident Licensee did not ensure facility had a working telephone

Licensing Program Analyst (LPA) Seo Jeon mailed this report to the ex-licensee’s last known mailing address via USPS certified mail, to communicate the findings related to the above-mentioned allegations. The facility has been closed since September 11, 2025 . On 09-03-2025, the Department received a complaint report with the following allegations. It was alleged that licensee did not issue a timely refund to resident. According to the information received, Resident #1 (R1) moved out of the facility on 08-04-2025, and R1’s rent was paid until 08-15-2025. LPA conducted an interview with R1’s relevant party (RP), who stated that the licensee owed 10 days of rent paid in advance. RP stated that no refund had been received as of 09-12- 2025. On 10-23-2025, LPA conducted another interview with RP, who stated that the licensee still has not sent the refund. Continued on LIC9099-C Substantiated LPA’s interview with the Administrator on 10-23-2025, confirmed that the refund has not been made. Based on interviews conducted, LPA determined that the Licensee did not issue a refund within 15 days after R1’s move out date. Therefore, the allegation that licensee did not issue a timely refund to resident is substantiated. It was alleged that licensee did not ensure facility had a working telephone. Information received indicated that the facility phone number was out of service, making the facility unreachable. On 09-11-2025, LPA’s file review revealed there were two (2) telephone numbers associated with the facility. LPA confirmed that those two (2) telephone numbers associated with the facility were out of service. LPA’s further file review revealed that the Licensee did not notify the Department of any change of facility contact information. LPA determined that the facility did not have working telephone, making the facility unreachable. Based on file review and observation, the allegation that licensee did not ensure facility had a working telephone is substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was not conducted as the facility has been closed since 09-11-2025. A copy of this report, LIC9099-D, and Appeal Rights were sent to the ex-licensee’s last known mailing address via USPS certified mail, due to the facility closure.the state’s words, verbatim · CDSS document, Mar 30, 2026 · control 18-AS-20250903135038

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Apr 30, 2026

87507 Admission Agreements, (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement... This requirement was not met as evidenced by: Based on interviews and records review, the Licensee did not issue refund in timely manner. This posed potential personal rights violations to resident in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: The ex-Licensee will issue refund and send proof of payment to LPA via email by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87311 · Plan of correction due date: Mar 30, 2026

87311 Telephones , All facilities shall have telephone service on the premises... This requirement was not met as evidenced by: Based on facility visits and verification of the facility phone numbers, the facility did not have working telephone services. This posed potential personal rights and/or health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: Licensee closed the facility. There are no residents in care.

Type of visit: Case Management - Other

Licensing Program Analyst (LPAs) Seo Jeon and Abdoulaye Zerbo conducted an unannounced visit to complete closure of the facility. The Department became aware of the facility's closure when LPA Seo Jeon visited the facility on September 11, 2025 to investigate a complaint report control #18-AS-20250903135038. LPAs observed the interior of the facility through glass on the front entry door. The facility is vacant with no visible furniture inside. LPAs did not observe any residents or sign of any person residing in the facility. LPAs observed "For Sale" sign in the front yard.LPAs did not observe any health and safety concern. The Administrator, Jay Sese, emailed LPA Seo Jeon on September 12, 2025 that they no longer intend to operate the facility. The Administrator stated they would mail the original license to the Riverside Regional Office. The Administrator was advised that the license is no long valid. No facility staff were available at the facility. LPAs were unable to obtain any signatures from the facility staff. An exit interview was not conducted as the facility has been closed since the end of August 2025. A copy of this report was sent to the Administrator via email, USPS mail, and certified USPS mail to the last known address due to the facility closure.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Seo Jeon arrived unannounced to the facility to conduct a case management visit to check on the health, safety, and welfare of residents in care. Upon arrival at the facility, LPA observed a "For Sale" sign in the front yard. LPA knocked on the door, but no one answered. LPA observed the facility to be vacant with no furniture inside. LPA attempted to reach out to the licensee/administrator, however all phone numbers listed were disconnected. LPA sent an email to the licensee but has not received any reply. LPA called the listing agent on the for-sale sign for more information. According to the listing agent, the home was listed for sale 10 days ago. The listing agent did not have any knowledge of the occupants but confirmed the occupants were renters of the home. The listing agent declined to share the current property owner's contact information. LPA was unable to enter the facility to conduct an interior tour of the home. LPA was unable to conduct interviews, and file reviews. LPA was unable to obtain any signatures. Based on LPA’s observation and interviews conducted, the Licensee did not notify their facility closure and relocation of the residents to the Department. A citation was issued. – 87211(a)(1)(D) Based on LPA’s observation of the facility being vacant and attempted unsuccessful phone calls to the Licensee, the Licensee abandoned the facility. A citation was issued. – 87112(f)the state’s words, verbatim · CDSS document, Sep 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Sep 12, 2025

Reporting Requirements. (a)Each licensee shall furnish to the licensing agency... (1)A written report shall be submitted... (D)Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by: Based on observation and interviews, LPA verified the Licensee did not notify the Department of vacating the location of the licensed facility. This posed a potential health, safety or personal rights to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR87112(f) · Plan of correction due date: Sep 12, 2025

Conditions for Forfeiture of a License. (f)The licensee abandons the facility. This requirement was met as evidenced by: Based on LPA's observation and telephone calls, LPA verified the Licensee did not comply with the conditions for forfeiture resulting in facility abandonment. This posed a potential health, safety or personal rights to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to deliver an amended report. Upon entry, LPA was greeted by Carmie Sese, Caregiver, and informed them of the purpose of the visit. An exit interview was conducted, during which this report was reviewed and provided along with the amended report.the state’s words, verbatim · CDSS document, May 15, 2025

Allegation investigated: Staff did not refund authorized representative after resident's death

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced complaint visit to the facility to investigate the above allegation and met with Jay Sese, Licensee, informing them of the purpose of the visit. During this investigation, LPA conducted interview with staff and obtained supportive documentation to assist in determining the findings of the noted allegation. On March 10, 2025, Community Care Licensing (CCLD) received a complaint report alleging that staff did not refund authorized representative after resident's death. LPA's investigation involved a comprehensive review of Resident #1's (R1) records and interviews with staff. The records review included R1’s physician’s report, admission agreement, and Licensee's record of refund checks issued. Continued on LIC9099-C.... Substantiated LPA's record review revealed R1 passed away on 11-28-2024. R1's responsible person paid December 2024 rent on 11-25-2024. R1's responsible person vacated the room on 12-3-2024 by removing all personal properties. Licensee owes December rent to R1's responsible person. LPA's review of payment record revealed the Licensee issued 2 checks in equal amounts payable to R1's responsible person on 3-16-2025. Each check shows 50% of refund due. Total amount of the 2 checks equal to full refund due the R1's responsible person. Based on interviews and records review, staff did not refund authorized representative after resident's death is substantiated. The preponderance of the evidence standard has been met; therefore, the above allegation is found to be substantiated. An exit interview was conducted, and a copy of this report was provided along with copies of LIC9099-D and appeal rights.the state’s words, verbatim · CDSS document, Mar 17, 2025 · control 18-AS-20250310145715

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Mar 28, 2025

Termination of admission agreement upon death of resident (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed ..... to the resident’s estate, within 15 days after the personal property is removed. Based on interviews and records review, the facility did not issue a full refund to the R1's responsible party within the required time frame. This poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 17, 2025

Plan of correction: Licensee provided 2 check stubs showing full refund amount of $2900 payble to R1's responsible party. The checks were mailed on 3-16-2025. Licensee will forward receipt of refund from R1's responsible party by 3-28-2025.

Allegation investigated: Staff are not providing adequate care and supervision for a resident

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver an amended report to clarify the findings for the above-mentioned allegation. LPA met with Jay Sese, Licensee, and explained the purpose of the visit. On July 22, 2024, Community Care Licensing received a complaint alleging that staff are not providing adequate care and supervision for a resident. LPA's investigation involved a comprehensive review of Resident #1’s (R1) records and interviews with other residents. The records review included R1’s physician’s report, admission agreement, hospital discharge report, doctor’s order, and medication review report. During an interview with R1, LPA observed R1 to be slightly confused. R1 was able to demonstrate to LPA how to independently get out of a geriatric chair. Information obtained from R1’s interview revealed R1 never Continues on LIC9099-C.... Unsubstantiated felt they were being confined or isolated. R1 acknowledged the geriatric chair could prevent them from falling. LPA conducted interview with a witness, and they had no health and safety concerns for R1 living at this facility. Based on observation, interviews and records review, staff did not provide adequate care and supervision for a resident is Unsubstantiated. A finding of Unsubstantiated means that the allegation may have happened or is valid, but there is no preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided to Jay Sese.the state’s words, verbatim · CDSS document, Mar 17, 2025 · control 18-AS-20240722120359

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Carmelita Sese, caregiver, and informed her of the purpose of the visit. At the time of the visit, there were (2) staff members and (6) residents present. Facility Overview: The facility is a one-story home with (5) bedrooms and (3) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 120°F. Food Service: The facility’s kitchen counter top was cluttered with many items that were not related to food preparation. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator's certificate has been expired as of 8-6-2024. Citation is issued. Continued on LIC809-C..... Record Review and Resident/Staff Files: LPA reviewed files for one (1) staff member, confirming criminal clearances, updated training, and CPR/First Aid certification. Four resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. One (1) deficiency was cited during the visit. An exit interview was conducted, during which this report was reviewed and provided along with LIC809-D and appeals rights.the state’s words, verbatim · CDSS document, Sep 19, 2024