An Angel Garden

Allegation investigated: Staff are not administering residents medication as prescribed Staff did not notice residents change in condition resulting in hospitaliization Staff did not ensure resident was eating meals in quantity resulting in 20lb weight loss

On 08/18/26, Licensing Program Analyst (LPA) Melina Oropeza made an unannounced visit to this facility to continue a complaint investigation for the above allegations. LPA identified themselves upon arrival, stated the purpose of their vist to staff. Administrator, Youngsuk Cho was called and joined 10 minutes later and LPA stated the purpose of the visit. Staff are not administering resident’s medication as prescribed based on the Department reviewed records and R1’s medical records. The records reviewed did not support that medication mismanagement resulted in R1’s hospitalization or bodily harm. Therefore, the allegation is UNSUBSTANTIATED. Staff did not notice resident’s change in condition resulting in hospitalization based on the Department reviewed records and R1’s medical records. Records indicated facility staff observed a change in R1’s condition and sent R1 for medical evaluation. Therefore, the allegation is UNSUBSTANTIATED. Staff did not ensure resident was eating meals in quantity resulting in 20-lb weight lose based on the Department reviewed records and R1’s medical records. The records reviewed did not support that R1 experienced the alleged significant weight loss. Therefore, the allegation is UNSUBSTANTIATED. Unsubstantiated A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of the report was given the acting administrator, Youngsuk Cho. No citations were not issued per Title 22 regulations.the state’s words, verbatim · CDSS document, Aug 18, 2026 · control 27-AS-20260518111947

Allegation investigated: Staff are not ensuring residents meal times are appropriately spaced to meet the needs of resident Staff did not allow authorized representative to bring outside food to resident Staff do not allow residents to drink after 3 PM Staff make residents stay in their room

On 08/04/26, Licensing Program Analyst (LPA) Melina Oropeza made an unannounced visit to this facility to continue a complaint investigation for the above allegations. LPA identified themselves upon arrival, stated the purpose of their vist to staff. Administrator, Youngsuk Cho was called and joined 10 minutes later and LPA stated the purpose of the visit. During the visit LPA requested and reviewed the follwoing documention: most recent LIC 500, LIC 9020 and Sample menu. Staff are not ensuring residents meal times are appropriately spaced to meet the needs of resident, based on observations, interviews, and records reviewed, the facility meal schedule was reviewed and meals were observed being provided. Unsubstantiated Based on interviews, records reviewed and observations, it was determined that residents were not routinely provided snacks as stated in the sample menu. Therefore, the above allegation is found to be Substantiated. Based on interviews, record review and observations, the allegations are substantiated. The preponderance of evidence standard has been met, therefore, the allegation is SUBSTANTIATED. Exit interview was conducted and a copy of the report was given the acting administrator, Youngsuk Cho. No citations were issued per Title 22 regulations. Staff did not allow authorized representative to bring outside food to resident, based on interviews conducted, the facility permits family members to bring outside food for residents. Staff do not allow residents to drink after 3 PM, interviews, and records reviewed, staff reported that water is offered with meals and between meals as needed. During the visit, LPA did not observe residents being denied fluids. Staff make residents stay in their room based on LPA observations and interviews conducted resident (R1) were observed in the common areas of the facility. LPA did not observe staff restricting residents to their rooms or preventing residents from leaving their rooms. Based on interviews, record review and observations, the allegations are unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations occurred, therefore, the allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of the report was given the acting administrator, Youngsuk ChoNo citations were issued per Title 22 regulations.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 27-AS-20260518111947

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with facility staff, and explained the purpose of the visit. LPA was later met by Administrator Youngsuk Cho. LPA Valerio toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed resident rooms to be fully furnished, clean, and free from odors. Resident bathrooms were clean and sanitary. The hot water was measured within the regulatory range of 105 to 120 degrees F. LPA observed the common areas (kitchen, dinning room, living room, and hallways) to be free from obstructions with hazardous items locked away and inaccessible to residents in care. The facility temperature was set to a comfortable temperature. The facility was observed to have an adequate amount of food, of which was in good quality. LPA Valerio observed residents listening to music, taking a nap, and being assisted with visits. The exterior area was observed to have an area for sitting. No emergency exit were obstructed. LPA Valerio observed the fire extinguisher to be fully charged. The facility last emergency drill was on 02/02/2026. LPA Valerio reviewed facility files; one staff file and one resident file. All files were observed to be up to date. Administrator Youngsuk Cho stated she sent the annual documentation to Regional Office email. Per California Code of Regulations (CCR) - Title 22 - no deficiencies were observed. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 6, 2026

Allegation investigated: Staff did not dispense medication to resident as prescribed Staff did not prevent resident from becoming malnourished while in care Staff are not meeting resident's needs

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to deliver findings of the complaint investigation on 2/20/25 at 8:30am. LPA met with Administrator Youngsuk Cho and stated the purpose of the visit. Regarding allegation, “Staff did not dispense medication to resident as prescribed” LPA observed that the local fire department was called by home health at the request of a visiting nurse. LPA observed a Physician order that discontinued Coumadin 3.5mg and to start 3mg both were 1 tablet at bedtime beginning 8/28/24 and to be rechecked on 9/4/24. LPA interviewed R1 resonsible party on 2/20/25 who stated the facility staff did not make mistakes with medications for R1.Administrator stated that doctor orders are always followed. Unsubstantiated Regarding allegation, “Staff did not prevent resident from becoming malnourished while in care” LPA interviewed R1 responsible party on 2/20/25 who stated R1 was not malnourished while living in the facility and that R1 looked and was doing great. The Administrator stated we feed the residents healthy food, they don't lose weight because of the food. Regarding allegation, “Staff are not meeting resident's needs” LPA interviewed R1 responsible party on 2/20/25 who stated R1 was well cared for while living at the facility. RP stated visits were frequent and all residents there were getting the proper care they needed. The Administrator stated we do everything the residents need all the time. The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 27-AS-20240910103111

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Administrator Youngsuk Cho, and explained the purpose of the visit. LPA Valerio and Administrator Youngsuk toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed resident bedrooms to be clean and fully furnished. Resident bathrooms were observed to be sanitary. Hot water faucets delivered water within the regulatory range of 105.0 - 120.0 degrees F. Common areas, including the kitchen, dinning area, living room area, and hallways were observed to be fully furnished, free from debris, and clear of obstructions for emergency exits. LPA observed the fire extinguisher to be within compliance. Heating/Air conditioning, carbon monoxide detectors, and alarms were observed to be in working condition. The facility was observed to have an adequate food supply that was in good quality. Medications, sharps, and toxins were observed to be locked and inaccessible to residents in care. No health or safety concerns were observed. LPA observed residents being assisted with physical therapy visit, eating breakfast, listening to music, and doing morning ADLs. Staff were observed to be conducting daily household chores, assisting residents with ADLs, preparing meals/snacks, and checking on residents. LPA Valerio went over the new dementia care regulations for Title 22, reviewed staff files, and reviewed resident files. Files were observed to be up to date with required annual documentation. LPA Valerio requested the following annual documents be sent via fax: LIC 500, LIC 308, LIC 610E, Proof of Control of Property, and any updates to their program services/procedures Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was held with Administrator Youngusk Cho, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2025

Allegation investigated: Staff neglect resulted in a resident to sustain multiple pressure injuries Staff interfered with a resident's visitations Staff did not seek timely medical attention for a resident Staff unable to properly assist a resident while in care Resident sustained an unexplained injuries while in care Staff did not properly report incidents involving a resident Staff unlawfully evicted a resident

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to deliver the findings of the investigation on 10/25/24 at 2:00pm. LPA met with Administrator Youngsuk Cho and stated the purpose of the visit. Regarding allegation, “Staff neglect resulted in a resident to sustain multiple pressure injuries”, LPA observed a text between Responsible party and Administrator dated 5/20/24, Administrator informed responsible party R1 was scratching buttock and back at which time Administrator stated, “So I have been doing wound treatment every day and dressing”. On 5/30/24, the responsible party stated that a nurse will come out on 5/31/24 to assess R1 which was coordinated with the doctor. A review of the Preplacement Appraisal Information dated 6/30/22 indicates incontinence care every 2hrs applying bowel and bladder program to prevent UTI and any other skin breakdown. Appraisal/Needs and Services Plan dated 7/1/22 indicates under background information skin break down; under Physical/Health Incontinent B/B with high risk for UTI, skin breakdown objective/plan no skin irritation, no UTI/No skin issues (next eval June 23), assessment 8/29/23 indicates total incontinent of B/B (bowel and bladder) will be clean and dry, no skin issue (next eval July 24). Substantiated A review of the Home Health dated 6/3/24 notes revealed a pressure injury at stage 2 (Left Thigh) which is allowed in residential facilities. However, it also revealed that R1 had a pressure injury at stage 3 (Right ankle) and a pressure injury at stage 4 (Coccyx) and (Lower Back), and a pressure injury which was unstageable (Right Thigh). A review of the hospital medical records dated 6/4/24, revealed R1 as non-verbal, Mid-back, stage 3, Sacrum, stage 4, Right hip, unstageable, Left hip, unstageable. LPA observed that R1 was not receiving hospice care services while residing in the facility. During an interview on 9/18/24 the Administrator stated the wound got worse within 2 weeks. Based on the Administrator being aware of the 5 pressure injuries 4 of which are deemed prohibited, this allegation is deemed substantiated. Regarding allegation, “Staff interfered with a resident's visitations”, A review of the Admission Agreement signed and dated 6/18/22 regarding visitation, LPA observed the visiting hours to be 9a – 7p requesting that all visitors sign in and be respectful to other residents and staff. After 8p or before 8a visits, they are requested to ring the doorbell. Administrator also asked if they could call as a courtesy so staff can expect them. Interviews revealed that R1 had visitors and was never refused. S1 stated that there was a visitor who wanted to see R1’s body and the visitor was told not to violate the residents’ personal rights. A review of documented “Texts” revealed that RP usually informs Administrator when visits will be conducted and who will arrive. Administrator was aware that a nurse was coming to assess R1. LPA observed an email from Administrator to responsible party indicating time to visit is 9a-1p and that after 4p is the staff’s busiest time. If there are special circumstances requiring visits during this time visits may occur after contacting staff in advance. On 5/20/24 at 9:20am the responsible party attempted to arrange a 6:30p visit via text and Administrator responded could it be before 3-4p because at 6:30p is too late for other residents and R1 goes to bed at 5p. The Administrator discovered it wasn’t family but other facilities looking to assess and was not aware the family was looking at other placement options and they were looking to no longer having resident at the facility. Based on visiting policy in the admission agreement which indicates the hours of 9-7p and Administrator admittance in stating no is evident that the administrator did not uphold the admission agreement visiting policy. Regarding allegation, “Staff did not seek timely medical attention for a resident”, LPA observed that on 5/30/24 a text revealed that Responsible Party mentioned a nurse would come to assess R1 and the physician will be contacted. On 5/31/24 the nurse was requested. On 6/1/24 Responsible Party stated in text a friend of family (nurse) will arrive on 6/2/24. On 6/2/24, the nurse and doctor indicated R1 may have pressure injuries and to repositioned. On 6/3/24 nurse and Responsible Party arrived at which time, the nurse staged the pressure injuries to be stage 4 and for R1 to be non-emergency transported to ER. Administrator suggested calling 911 rather than wait to transport for an hour. Based on information received from documentation and interviews, the following deems this allegation to be SUBSTANTIATED: -A review of text message on 5/20/24, the Administrator notified the responsible party regarding a wound on R1 -A review of the preplacement Appraisal dated 6/30/22 which indicated R1 is a risk of skin breakdown -Administrator was trying to manage the wounds instead of sending R1 to see a skilled medical professional. -R1 did not receive medical attention for the wound(s) until 14 days later. The investigation revealed that Administrator did not activate 911 until the visiting nurse mentioned a non-emergency transport was called. Regarding allegation, “Staff did not properly report incidents involving a resident”, LPA received information through interviews that R1 had a head injury on or about 3/27/23 where the responsible party was not notified in a timely manner and there was a R2 who fell on or about 9/28/22 where R1’s responsible party was asked to assist in lifting the resident. R2 is no longer living in the facility. Upon a research of files, LPA did not observe an LIC624 for either incident. Allegation is deemed SUBSTANTIATED Regarding allegation, “Resident sustained an unexplained injury while in care” LPA received information through interviews that R1 sustained bruises to the head and mouth between the dates of May 4th through May 20, 2024 from a fall. These bruises were brought to the attention of the responsible party by photos sent by staff who were not sure on how the bruises happened. Allegation is deemed SUBSTANTIATED Regarding allegation, “Staff unable to properly assist a resident while in care”, LPA obtained information that the Administrator was providing wound care at the facility. LPA observed a text message from Administrator to the family stating she was providing the wound treatment every day and dressing with calmoseptine. Due to this information from interviews and medical records review, Community Care Licensing (CCL) finds this allegation(s) to be SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. You are hereby notified that a civil penalty of $500.00 is assessed for a violation that resulted in serious bodily injury/serious injury of a client, or that constitutes physical abuse of a client. The licensee was informed that a civil penalty assessment based on Health and Safety Code 1569.49 is currently under review (pending determination) and may be assessed on a later date, as a result of R1’s sustaining pressure injuries (serious bodily injury) while in care of the facility. Once civil penalty assessment has been determined, CCL will return on a future date to assess the civil penalty. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Licensee representative was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted with Licensee representative and a copy of this report was provided. LPA observed that on 5/21/24 a text from responsible party that indicated supplies will be delivered to the facility. LPA did not observe any written agreement stating the responsible party will or not provide supplies. Based on interviews, the verbal agreement was continued from June 2022 until R1 left the facility. Regarding allegation, “Staff intimidated a resident while in care” LPA received information through interviews that Administrator was observed to have a bad “tone” when speaking with R1. LPA obtained information through interviews that a visitor observed Administrator raise a hand at another resident on or about August or September 2023 and when questioned, the Administrator stated they were joking around. However, the resident is no longer residing in the facility. Regarding allegation, “Staff allowed a resident to be soiled while in care” LPA received information that although R1 did not have a foul body odor, upon arrival of visitation, R1’s clothing and gauze was soiled in the area of the wounds. During interviews, LPA obtained information that R1 did not have a body odor and the home was clean. LPA was unable to obtain a preponderance of evidence to substantiate the allegation. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted with Licensee representative and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 25, 2024 · control 27-AS-20240606204602

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Oct 26, 2024

Prohibited Health Conditions. (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3, (1) stage 4 and (2) unstageable pressure injuries. This regulation was not met as evidence by: The licensee did not ensure that persons having prohibited health conditions were not retained in the facility. Based on documentation, R1 had 3 unstageable pressure injuries. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Administrator shall provide confirmation of understanding of this regulation. POC will be faxed by POC due date You are hereby assessed a Civil penalty in the amount of $500. You are hereby assessed a Civil penalty in the amount of $500.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87507(f) · Plan of correction due date: Oct 26, 2024

Admission Agreements The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This regulation was not met as evidence by: Based on Licensee did not ensure visitation rights as stated in the admission agreement. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Administrator shall provide confirmation of understanding of this regulation. POC will be faxed by POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Oct 26, 2024

Incidental Medical and Dental Care The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This regulation was not met as evidence by: Based on Licensee did not ensure R1 was seen by a licensed skilled professional timely. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Administrator shall provide confirmation of understanding of this regulation. POC will be faxed by POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1) · Plan of correction due date: Oct 26, 2024

Reporting Requirements Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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 specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This regulation was not met as evidence by: Based on Licensee did not report in writing to CCL about resident falls in the facility. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Licensee shall submit a letter stating that incidents that occur with residents shall be reported to CCL in accordance to the regulations. POC will be faxed by POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Oct 26, 2024

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This regulation was not met as evidence by: Based on Licensee did not report to the responsible party timely regarding 2 falls for R1. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Licensee shall submit in writing that Responsible parties will be kept informed regarding the care of residents. POC will be faxed by POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Oct 26, 2024

Prohibited Health Conditions Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Stage 3 and 4 pressure injuries. This regulation was not met as evidence by: Based on Licensee did not ensure R1 was seen by a physician for wounds and provided wound care at the facility. This poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2024

Plan of correction: Licensee shall submit a letter stating that all wounds shall be diagnosed by a physician, medications to be prescribed and wound care conducted by licensed skileed professional. POC will be faxed by POC due date

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 2/1/24 at 9:00am. LPA met with Youngsuk Cho, Administrator and stated the purpose of the visit. Caregiver present are fingerprint cleared and associated to the facility. The facility is licensed for a capacity of 6 Non-ambulatory residents of which 2 may receive hospice care services. There is 0 residents receiving hospice care services at this time. Administrator Certificate expires 7/23/25. The license fees are current. LPA observed an LIC308 Designation of Responsibility form. LPA observed a copy if the Infection Control Plan during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 72 *F which is within the required range of 68-85*F. The hot water temperature was measured at 112.7*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. The most recent emergency drill was conducted on 1/8/24. LPA reviewed 2 resident and 2 staff files and conducted interviews during this visit. LPA reviewed 2 staff and 2 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Liability Insurance-Submit Designation of Administrative Responsibility LIC308-Submit Administrative Organization LIC309-Current Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Personnel Report LIC500-Submit Emergency Disaster Plan (LIC610E)-Submit Criminal Record Clearances LIS536-Current Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-Current Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-Current Partnership Agreement-NA Control of Property-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-NA First aid/CPR certificates-Current -Any updates to Infection Control Plan Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.the state’s words, verbatim · CDSS document, Feb 1, 2024