Corina Elderly Home 2

Allegation investigated: Staff is financially abusing resident Staff hits resident

This report is amended to remove confidential information. On 9/15/2026 at 9:15 am, Licensing Program Analysts(LPA), Reza Jamaly arrived unannounced to deliver amended investigationfindings regarding the allegations noted above. LPA with Administrator (AD) Corina Dragnea and explain the purpose of the visit. During the course of the investigation, LPAs conducted interviews, made observations, and reviewed resident records 1. Staff is financially abusing resident. On 7/20/2026, LPA interviewed the AD regarding the allegation of financial abuse involving R1. AD stated that the facility does not manage R1's personal cash directly. The Licensee explained that, upon R1's admission to the facility, placement agency provided $300 on behalf of R1 to the facility. AD explained that, at R1's request, the facility created a tracking sheet to document R1's expenditures and maintains receipts for purchases made on behalf of R1. Unsubstantiated page 2 the AD also indicated that, at R1's request, the facility keeps R1's identification documents and assists R1 with transportation to the bank. AD reported that on 5/19/2026, $16.29 was spent for R1's meal at Wendy's Restaurant, consisting of a $4.12 chocolate Frosty and a $12.17 medium meal. AD also reported that the facility purchased a pair of shoes for R1 from Costco for $31.00. AD confirmed that receipts were available for both expenditures. The remaining balance was reported as $252.70 plus coins. AD further stated that R1 had previously made similar allegations of missing money at prior facilities. AD indicated that R1 has difficulty participating in activities and that staff attempt to keep R1 engaged through activities, games, and outings. On 7/20/2026, LPA interviewed R1 regarding the allegation. R1 denied being financially abused. R1 stated that personal purchases are made independently and that eating out does not occur frequently. R1 confirmed eating out on one occasion and purchasing soda and cookies. LPA asked R1 how much money was currently available. R1 stated, "$300." LPA asked whether R1 understood that facility expenses were deducted from the $300. R1 stated that the arrangement was understood but reported that no document had been signed. LPA asked R1 who manages personal finances. R1 stated that no one manages the money and that personal finances are managed independently. R1 stated that staff assist with transportation to the bank approximately once a month and that payment to the facility is made by personal check. On 7/22/2026, LPA Jamaly contacted the placement agency Case Manager (CM) which assisted with R1's placement at the facility and asked the CM how much money R1 had at the time of placement. The CM stated that the exact amount was not recalled but estimated the amount to be approximately $40 and confirmed that the Administrator counted the money. The CM reported that R1 had made similar complaints regarding a previous facility. The CM stated that R1 had experienced behavioral issues at previous facilities and had been moved between multiple facilities. The CM stated that R1 had been evicted from four previous facilities due to behavioral concerns and that similar concerns had been ongoing for several years. The CM also reported that R1's daughter resides out of state and is aware of R1's circumstances. The CM stated that the current facility provides appropriate care for R1 and that R1 appears satisfied with the current placement. The CM stated that the allegation of financial abuse was not believed to be true. page 3 During LPAs' observations on 7/20/2026 and 7/22/2026, R1 was observed repeatedly and loudly calling for staff assistance. LPA checked on R1 and asked whether assistance was needed. R1 stated that the reason for the request had been forgotten. LPA reviewed R1's records, including LIC 405, Records of Clients/Residents' Safeguarded Cash Resources. LIC 405 documented that the facility received $300 for R1 on 5/8/2026. Records documented an expenditure of $16.29 on food at Wendy's Restaurant and $31.00 for shoes purchased from Costco. LPA observed receipts corresponding to the documented expenditures from Wendy's Restaurant and Costco. LPA also observed and counted the remaining safeguarded cash, which totaled $252.70 plus coins. LPA reviewed LIC 602A dated 5/14/2024 and requested an updated LIC 602A. The Administrator stated that R1 was admitted to the facility on 5/1/2026 and that an updated LIC 602A was not available. The Administrator provided a Kaiser Independent Living System (LIS) ALF Transition Assessment dated 2/5/2026. The assessment documented that R1 was unable to understand financial concepts, recognize currency, or make decisions regarding spending. The assessment further documented that R1 was unable to manage bills, budgeting, or personal purchases and that financial matters were handled by an R1 representative. The assessment also documented that R1 was unable to independently shop, identify personal needs, navigate a store, or understand purchasing decisions, and that staff and family assisted with shopping for clothing, hygiene supplies, and personal items. Based on LPAs' interviews, observations, and review of records, the investigation did not establish that staff financially abused R1. The available evidence showed that the facility documented expenditure, maintained receipts, and maintained a cash balance consistent with the documented transactions. R1 denied financial abuse and reported independently managing personal finances while receiving staff assistance with transportation to the bank. The preponderance of the evidence standard has not been met. Therefore, the allegation that staff financially abused R1 is determined to be UNSUBSTANTIATED. 2. Staff hit resident On 7/20/2026, LPA interviewed this allegation. AD stated that the AD is routinely present at the facility and has not observed or received information indicating that staff hit R1. AD denied the allegation. page 4 AD reported that R1 frequently calls staff for assistance and repeatedly asks the same questions due to cognitive impairment. AD also stated that staff attempt to respond to R1's needs and provide assistance. On 7/20/2026, LPA interviewed R1 regarding the allegation. LPA asked R1 whether R1 felt safe at the facility. R1 stated, "I feel safe, they help me with what I need." LPA asked R1 whether any staff member had hit R1. R1 stated that memory was not functioning well and that R1 did not think anyone had hit R1. R1 further stated that disagreements sometimes occur between R1 and staff but stated that staff do not hit R1. R1 stated that staff treat R1 well. On 7/20/2026, LPA interviewed Staff 1 (S1) who stated that S1 was not involved with R1's finances and had not heard information regarding either allegation. S1 stated that R1 has demonstrated forgetfulness and that S1 had not observed anyone hitting R1. S1 did not believe the allegations were consistent with S1's observations. LPA interviewed Staff 2 (S2) who stated that R1 had not complained about staff stealing money or hitting R1. S2 reported that, following R1's placement at the facility, R1 had made statements regarding money being stolen at previous residences. S2 stated that no complaints regarding stolen money at the current facility had been heard. S2 reported that R1 recently expressed interest in a pair of shoes belonging to S2 and requested a similar pair. S2 stated that the request was discussed with the Administrator, the Administrator agreed to purchase the shoes for R1, and the shoes were purchased from Costco. S2 stated that the Administrator paid for the purchase. S2 denied observing anyone hit R1. On 7/22/2026, at approximately 2:00 PM, LPA Jamaly contacted placement agency Case Manager (CM) who assisted with R1's placement at the facility. The CM stated that there was no knowledge of the allegation that staff had hit R1, CM did not believe the allegation that staff hit R1 was true. Based on LPAs' interviews, observations, and review of available records, the investigation did not establish that any staff member hit R1. R1 denied being hit and stated that staff provide assistance and treat R1 well. Interviews with the Administrator, S1, S2, and the CM did not provide corroborating information to support the allegation. The preponderance of the evidence standard has not been met. Therefore, the allegation is determined to be UNSUBSTANTIATED. An exit interview was conducted with the Administrator Corina, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 22, 2026 · control 27-AS-20260714163530

Type of visit: Required - 1 Year

On 7/20/2026, at 9: AM Licensing Program Analysts (LPAs) Reza Jamaly arrived unannounced at the facility to open a complain and conduct the required annual inspection. LPAs met administrator Corina Dragea and explained the purpose of the visit, assisted LPAs touring to the facility. Facility is cleared for 6 non-ambulatory residents with hospice waiver for 4 residents. Administrator certificate expires on 9/2/2027. Firstly, LPA Jamaly inspected the physical plant including but not limited to the common area, kitchen, dining area, 6 resident's bedrooms, resident bathrooms, garage and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPAs inspected the kitchen and observed a sufficient supply of at least a seven-day supply of nonperishable food and a two-day supply of perishable food. Sharp knives were secured in a locked kitchen cabinet and inaccessible to resident. LPA inspected two refrigerator and freezers, one located in kitchen and lone in garage. LPA observed a bottle of Dijon Mustard (condiment) in a refrigerator located in garage which was expired on May 2025, administrator stated that this is mine and I forgot to throw it away and took it, LPA took picture of it, Technical violation issued on LIC 809D. LPA inspected 6 resident's bedrooms and observed bedrooms to be properly furnished with appropriate bedding and lighting. Resident's bathrooms observed to be cleaned, grab bars and non-slip mats were observed to be secure and in good condition. The hot water temperature measured 108.1 at one of the resident bathroom sink, which is within the required range of 105°F to 120°F. Continues on LIC 809C on page 2 page 2 Facility temperature was checked at living room and observed to be 77 degree F. There are no bodies of water present. Smoke detectors and carbon monoxide detectors were found at the facility. One fire extinguisher, located in living room and in hallway, was last serviced on 2/24/2026. LPA Jamaly observed the facility to be free of odor, clean and in good repair. LPA observed that the facility maintained a public telephone in the living room and that all required licensing posters were properly displayed Cleaning supplies and other toxic substances were observed in garage and garage door were locked, inaccessible to resident and administrator unlocked garage's door for LPA inspection. Medication were observed to be stored in a locked cabinet in the kitchen and inaccessible to residents. The first aid kit was inspected and contained all required supplies. LPA requested resident and staff records for review. LPA reviewed 3 out 6 resident's file and found them to be complete. Two (3) staff files were reviewed and found to be complete. A review of personnel records confirmed that all staff members and other individuals required to undergo caregiver background checks had received criminal record clearances and were properly associated with the facility. The following documents were requested and will be emailed to the LPA by 7/27/2026 no later than 5:00 PM LIC 308 – Designation of Administrative Responsibility Copy of the Administrator Certificate LIC 610 – Emergency Disaster Plan Proof of Current Liability Insurance LIC 500 – Personnel Report LIC 309 – Administrative Organization Based on today's inspection, the facility was found to be out of compliance with applicable Title 22 regulations. The deficiencies are documented on the attached LIC 809-D Deficiency Report. An exit interview was conducted with administrator Corina Dragnea, and copies of the LIC 809 Report, LIC 809-D Deficiency Report, and Appeal Rights were provided to the facility representative.the state’s words, verbatim · CDSS document, Jul 20, 2026

Type of visit: Required - 1 Year

On 06/11/2025 unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Sommer Hayes. The LPA identified themselves and the purpose of the visit and asked to speak to the Designated Facility Administrator (DFA). LPA was met by Corina Dragnea and a brief interview followed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. The current census is 6. LPA Hayes toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA Hayes toured the facility with the Designated Facility Administrator (DFA), Corina Dragnea. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable and 2 days of perishable food supplies. There is enough clean plates, cups and bowls and cutlery to meet capacity. Continued on 809-C Opened packages in the refrigerator were dated appropriately. All pantry items were dated as well. Water temperature measured 106.9 degrees F within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguisher inspected were charged on 05/28/25 by Fire Code Safety Equipment. A smoke detector in living room was tested and working. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secured. The medication administration record (MAR) was reviewed. The garage is not accessible to residents and contained non-perishable food supplies and cleaning supplies locked in a cabinet and a refrigerator. LPA observed the backyard of the facility to be clean and free of obstruction. There was a shaded area for residents to enjoy and a walking path. Fencing was in good repair. There were no bodies of water. A first aid kit was observed containing a first aid manual, tweezers, scissors and gauze. The facility living room was clean and free of obstruction. The temperature reading was 77 degrees Fahrenheit per Title 22 regulations. The seating is efficient seating for the number of residents in this facility. LPA observed 7 sharp objects accessible to residents found in the front yard and in an unlocked kitchen drawer. Per California Code of Regulations, Title 22, 1 deficiency was observed during today’s visit. Exit interview was conducted. A copy of this report was provided to DFA, Corina Dragnea.the state’s words, verbatim · CDSS document, Jun 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 7/2/24 at 12:10pm. LPA met with Corina Dragnea, Administrator and stated the purpose of todays visit. LPA observed the Administrator Certificate for Corina Dragnea expires 9/2/25. License fees are current. The most current emergency drill was conducted on 7/1/24. The facility is licensed for a capacity of 6 non-ambulatory residents of which 4 may receive hospice care services. There is 1 residents receiving hospice care services 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 but not a 7-day non-perishables. The temperature inside the facility was observed to be at 76*F which is within the required range of 68-85*F. The hot water temperature was measured at 120.0*F which is within the required range of 105-120*F. Licensee turned down the water heater and began a load of laundry using hot water to ensure the safety of the residents. 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. LPA reviewed 2 staff and 4 resident files during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Current Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Emergency Disaster Plan LIC610E-Submit Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Submit Articles of Incorporation/Organization, Constitution and bylaws-NA 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-Current First aid/CPR certificates-Current Liability Insurance-Submit Infection Control Plan-Submit Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 2, 2024