All Seasons

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced on 9/22/26 to conduct the annual inspection. LPA met with staff, Alma Peregrino who assisted LPA during today's inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed residents (2) and staff files (2). All residents files contained the required paperwork. Staff file contained the required paperwork. Staff have current first aid and CPR training. Facility was clean. All required postings were observed. Staff training contained the required initial and annual training. LPA and Alma toured the facility together to ensure the health and safety of residents in care. The areas toured included but not limited to residents rooms, bathrooms, kitchen, common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. All exits were unobstructed. There is a gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use . Water temperature is within compliance (106 degree F) .Inside temperature was observed to be 73-74 degree F. In the areas toured, there were no health or safety violations observed. No deficiencies were observed or cited during today's visit per Title 22 Regulations. Exit interview conducted. A copy of this report was printed and left at the facility.the state’s words, verbatim · CDSS document, Sep 22, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 7/13/26 to do case management visit . LPA met with Staff, Alma Peregrino and explained the purpose of the visit. Department followed up on Incident Report (IR), LIC624 sent by facility on 7/1/26 stating that on 06/28/26, resident R1 had a fall incident during family outing with family member present. It was learnt that R1s family called emergency services, 9-1-1 immediately after the fall incident and R1 got the required medical care at local hospital. Record review indicated that R1 got injuries to their neck and spine due to the fall incident. R1 was discharged back to facility on 06/29/26 with discharge diagnosis of open fracture of nasal bone. Facility notified R1s physician, Long Term Care Ombudsman and other required agencies regarding this incident. It was learnt from today's visit that R1 was doing fine at the facility for now. During today’s visit, the Department conducted interviews with residents, R1 and staff ,S1 regarding this incident. At this time, this case in under review and department will do follow up as warranted. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Jul 13, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 6/1/26 to do case management visit . LPA met with Staff, Alma Peregrino and explained the purpose of the visit. Department followed up on SOC 341 sent by facility on 5/26/26 stating that resident, R1 reported that staff yelled at R1 and R1 got unexplained bruises from staff during care and transfers. Facility notified R1s family/responsible party, Long Term Care Ombudsman and other required agencies regarding this incident . Per facility’s records, R1 was doing fine. During today’s visit, the Department conducted interviews with residents, R1, R2 and staff ,S1,S2 regarding this incident. At this time, this case in under review and department will do follow up as warranted. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Jun 1, 2026

Allegation investigated: Staff did not ensure they were not over capacity. Staff are operating outside the scope of their license.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 4/15/26 to deliver complaint findings for above allegations. LPA met with Staff, Alma Peregrino and explained the purpose of the visit. The department conducted records review ,facility observations and interviews to investigate the complaint. Residents interviews indicated that their care needs were met and there were no complaints. Staff interviews reflected that facility was Not over capacity and operating within their scope of practice and there were no wrongdoings in this context. During department's visits on 4/2/26 and 4/15/26 , department observed no concerns in this area. From the gathered information, It was evaluated that facility was operating within their scope of practice with directed guidelines and following Title 22 regulations with facility's operations and there were no issues to address. Based on gathered information, these allegations were UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents. Unfoundedthe state’s words, verbatim · CDSS document, Apr 15, 2026 · control 59-AS-20260330120415

Allegation investigated: Licensee allows uncleared staff to work in the facility. Licensee does not ensure staff have the required training.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 01/07/26 to deliver complaint findings for above allegations. LPA met with Staff, Cynthia Davies and explained the purpose of the visit. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated **Report continued from 9099.... Allegation: Licensee allows uncleared staff to work in the facility. UNSUBSTANTIATED LPA reviewed staff roster on file at the facility and observed that all staff listed received a criminal background clearance from the Department. Staff Interviews indicated that facility do not let staff work without obtaining a criminal background clearance. Interviews with residents and staff indicated that they have not observed any unfamiliar people at the facility and have no concerns regarding staff not obtaining a criminal background clearance prior to employment. Allegation: Licensee does not ensure staff have the required training. UNSUBSTANTIATED During investigation, LPA obtained and reviewed staff records for staff members S1, S2, S3. LPA also reviewed the facility's Plan of Operation in regard to staff training. LPA observed that S1, S2, S3 received training in accordance with Title 22, the Health and Safety Code, and the facility's Plan of Operation. Staff Interviews indicated that staff are trained in accordance with Title 22, the Health and Safety Code, and the facility's Plan of Operation. Residents Interviews indicated that they feel that staff are adequately trained at the facility and they have no concerns regarding staff training. Based on interviews conducted and records reviewed, the preponderance of evidence standards has not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jan 7, 2026 · control 59-AS-20251201114654

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced on 10/28/25 to conduct the annual inspection. LPA met with staff, Cynthia Davies who assisted LPA during today's inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed two residents (2) and two staff files (2). All residents files contained the required paperwork. Staff file contained the required paperwork. Staff have current first aid and CPR training. Facility was clean and organized . All required postings were observed. Staff training contained the required initial and annual training. LPA and staff toured the facility together to ensure the health and safety of residents in care. The areas toured included but not limited to residents rooms, bathrooms, kitchen, common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. All exits were unobstructed. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use . Water temperature is within compliance (106 degree F) .Inside temperature was observed to be 74 degree F. In the areas toured, there were no health or safety violations were observed. LPA requested a copy of the LIC500, LIC610E and current liability insurance to be sent to the Department by 11/10/25. No deficiencies were observed or cited during today's visit per Title 22 Regulations. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 28, 2025

Allegation investigated: Staff did not provide a safe environment for residents in care. Staff did not prevent a resident from exposing himself to other residents in care.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 10/16/24 to deliver complaint findings for above allegations. LPA met with Resident Care Manager , Alma Caniedo and explained the purpose of the visit. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated ***Report continued from 9099........ Allegation- Staff did not provide a safe environment for residents in care. Staff did not prevent a resident from exposing himself to other residents in care. Unsubstantiated. The Department conducted records review, interviews with staff and residents to investigate these allegations. Six (6) residents interviews conducted on 09/25/24 indicated that residents care needs were met per their needs and service plans and there were no concerns. Residents interviews reflected that resident, R1 has dementia with behaviors and R1 can be challenging sometimes with other individuals but staff able to redirect them in safe and professional manner. Residents interviews indicated that residents felt safe at facility and were receiving good care from staff. Four (4) staff interviews conducted on 09/25/24, reflected that there were no concerns from any resident or family with residents care. Staff were well aware about resident, R1 who got admitted to facility on 08/12/24 from other facility where they were residing at memory care unit. Staff verbalized that R1 has diagnosis of dementia and R1 can be challenging sometimes with staff. There were few incidents where R1 was non-co-operative with staff and resistive to their care due to their medical issues. Staff and residents indicated that R1 has been seen not properly dressed in common areas as R1 has poor awareness of their surroundings due to their dementia diagnosis. Per record review , there were no indication of R1 having any behaviors related to their dementia as noted in R1s pre-appraisal done by facility prior to R1s admission, however R1 started exhibiting challenging behaviors within few days when they got admitted to facility. Record review reflected that facility was continually working with R1s physicians and family to manage R1s behaviors with adjustments in their medications and other possible ways. Additionally, facility was providing required training's to staff regarding working with dementia residents on on-going basis and providing the adequate staffing to take care of R1 and other residents. Based on this information, these allegations were found to be Unsubstantiated means Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation(s) occurred. Exit interview conducted. Copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 16, 2024 · control 59-AS-20240924122440

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 10/16/24 to conduct the annual inspection. LPA met with Resident Care Manager , Alma Caniedo (S1) and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed medications of two (2) residents comparing with physician orders and find no errors. LPA reviewed two (2) residents and two (2) staff files and found all required documents. LPA and S1 toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher was last serviced on 11/16/23 and was ready for emergency use. Hot water temperature was observed to be 106 degrees F, which is within the regulation range of 105-120 degree. Inside temperature was 74 degree F. Facility was clean and well organized. All required postings were observed. Facility is conducting quarterly fire and disaster drill as required. No deficiencies were observed or cited per Title 22, CCR Regulations during this visit. Exit interview conducted and copy of this report was provided to S1.the state’s words, verbatim · CDSS document, Oct 16, 2024

Type of visit: Case Management - Other

On 04/17/24, Licensing Program Manager (LPM), Laura Munoz and Licensing Program Analysts (LPAs) Talwinder Bains and Cheyenne Ratajczak conducted an unannounced case management visit on 04/17/24. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES. LPAs and LPM met with Operations Director, Galina Chikivchuk and stated the purpose of visit. Facility understands this is an Immediate Exclusion effective 04/17/2024 and S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.the state’s words, verbatim · CDSS document, Apr 17, 2024

Type of visit: Case Management - Incident

On 04/17/24, Licensing Program Manager (LPM), Laura Munoz and Licensing Program Analysts (LPAs) Talwinder Bains and Cheyenne Ratajczak arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 04/05/24. LPAs and LPM met with Operations Director, Galina Chikivchuk and explained reason for visit. The facility submitted an incident report (LIC624) and SOC341 to the Department on 04/08/24. Incident report indicated a staff at the facility slapped a resident while in care on 04/05/24. Department conducted record review , interviewed staff and residents regarding this incident. Based on this information,Department has concluded that facility was failed to provide safe environment to resident , R1 and violated R1s personal rights. Citation has been issued per CCR, Title 22 Regulations, Appeal Rights and copy of the report has been provided after exit meeting.the state’s words, verbatim · CDSS document, Apr 17, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Apr 18, 2024

87468.1- Personal Rights of Residents in All Facilities ..(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons....this requirement is not met as evidence by; Record review and interviews indicated that Facility staff ,S1 slapped resident, R1 while in care on 04/05/24 which is violation of this regulation and poses immediate health and safety risks for residents in care.the state’s words, verbatim · CDSS document, Apr 17, 2024

Plan of correction: Administrator will send letter of statement for understanding of this regulation and will conduct staff training .All POC documents are due by POC date-04/18/24.

Type of visit: Case Management - Incident

On 04/15/24, Licensing Program Analyst (LPA) Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 04/05/24. LPA met with Operations Director, Galina Chikivchuk and explained reason for visit. The facility submitted an incident report (LIC624) and SOC341 to the Department on 04/08/24. Incident report indicated a staff at the facility slapped a resident while in care on 04/05/24 . During today’s visit, LPA conducted interviews with 6 residents ,3 staff members and reviewed records. No citations are issued at this time however LPA may return at a later date should additional information be needed or available. Exit interview conducted and copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 15, 2024

Type of visit: Case Management - Incident

On 04/15/24, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 03/15/24 for resident (R1) for medication error as reported by facility on 03/21/24 by Incident Report ( LIC624). LPA met with Operations Director, Galina Chikivchuk and explained the reason for visit. After staff interviews and records reviewed, it was determined that staff (S1) gave extra medication dose of Divalproex Sodium during med pass on 03/15/24 around 8am. Incident report stated that S1 accidentally added an extra pill of Divalproex Sodium in R1s medication box during morning med pass on 03/15/24 around 6am while dispensing the morning medications for R1. Facility reported this medication error to R1s family, physician and other agencies as required. Incident Report indicated that R1s doctor ordered a hold on the Divalproex Sodium until further notice after this incident on 03/15/24. Based on this information, deficiency is cited per California Code of Regulations, Title 22, and listed on LIC 809D. Failure to submit Proof of Correction (POC) by Plan of Correction date may result in civil penalties. Exit interview conducted. Appeal rights provided. Copy of the report left at facility.the state’s words, verbatim · CDSS document, Apr 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Apr 16, 2024

87465-Incidental Medical and Dental Care-(c)-If the resident's physician has stated in writing that the resident is unable to…(2)Once ordered by the physician the medication is given according to the physician's directions…..this requirement is not met as evidence by; Based on the gathered information, it has been concluded that staff (S1) gave 1 extra tablet of Divalproex Sodium to R1 on 03/15/24 around 8AM, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2024

Plan of correction: Licensee/Administrator agrees to conduct medication distribution training for all staff and will provide LPA with training information. Administrator has already trained the staff (S1) who administered the medication to R1 by error and other staff. All POC documents are due by 04/16/24.