Chino Hills Senior Living

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Tamara Pitch and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (94) current census (72). LPA was accompanied by Facility Administrator,to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-Room office inaccessible to residents in care. During the walk through LPA observed ceiling in second floor to be in disrepair, In addition, while inspecting residents bedrooms LPA observed walls to be in disrepair. Throughout the walk-through LPA observed Exit signs that need to be repaired. LPA will be issuing deficiency for maintenance and operation. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, deficiencies were issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Tamara Pitch.the state’s words, verbatim · CDSS document, Aug 31, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 11, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on observation, interviews, the licensee did not adhere to regulation listed above by not ensuring that the facility is maintained in good repair, which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: The Licensee has agreed to read regulation: 87303(a) and provide training for all staff. The licensee will conduct repairs in the rooms and areas where LPA found to be in poor condition. The licensee will provide LPA with proof of training and photos, invoices or the repairs completed by POC date 9/11/2026.

Allegation investigated: Staff failed to obtain immediate medical services. Staff mishandled a resident's medications.

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Tamra Pich and explained the purpose of the visit regarding the allegation stated above. Investigation was conducted by department staff which included review of records and witness interviews. Based on the evidence, Resident 1 (R1)’s assessment dated July 18, 2025, shows that R1 did not require additional status checks and only needed standby assistance with transfers. R1 was also identified as a fall concern. Hospice services were initiated on July 4, 2025, and a physician’s report dated August 14, 2025, noted that R1 lacked hazard awareness and was a fall risk due to an unsteady gait and poor foot balance. On November 18, 2025, R1 experienced an unwitnessed fall and was found on the hallway floor yelling for help. The Med-Tech observed no injuries and assisted R1 back into resident wheelchair. Substantiated The following day, November 19, 2025, R1 sustained a witnessed fall and complained of pain when left leg was moved. Records indicate that Tylenol and Ativan were administered, and Ibuprofen was given for pain. However, 911 was not called, despite facility protocol requiring emergency services when a resident reports pain after a fall. On November 20, 2025, x rays revealed a left acetabulum fracture, and Norco was prescribed for pain management.Based on the evidence facility did not seek immediate medical attention after R1 sustained a fall and complained of severe pain and was only provided with Ibuprofen for pain management. Second allegation: Staff mishandled a resident's medications. Regarding the allegation stated above, LPA conducted a record review of R1's file. During the review of records, LPA found that on 11/19/2025, R1 sustained a fall and subsequently complained of pain. On 11/20/2025, records indicate that R1 was administered 600 mg of Ibuprofen instead of Tylenol for pain management. The medication administration record documented the result as "semi-effective." Additionally, records indicate that R1 was administered Diclofenac Sodium 1% gel for left knee and hip pain. The documented result of the medication was "not effective." On 11/24/2025, records indicate that R1 was administered Hydrocodone-Acetaminophen for pain. The documented effectiveness of the medication was listed as "unknown." Based on the review of R1's records, LPA found documentation indicating that R1 received multiple pain medications following the fall, with some medications documented as semi-effective or not effective in managing R1's reported pain. Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 Regulations, from division 6, chapter, article 6, is, cited on the attached LIC 9099 D. An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to Facility Administrator Tamara Pitch. Regarding the allegation stated above, LPA conducted an inspection of the facility's food supply. During the inspection, LPA observed that the facility had an adequate supply of food and snacks to meet the needs of the residents in care. LPA also found that the facility receives food deliveries twice a week, on Mondays and Friday’s, from US Foods. LPA conducted interviews with Residents #2 through #6. Residents #2 through #6 stated that the food provided by the facility was satisfactory. Residents also reported that the facility provides snacks and that they had no concerns regarding the food provided by the facility. Based on the inspection of the facility's food supply and interviews with Residents #2 through #6, LPA did not find evidence to substantiate the allegation that the facility failed to provide adequate food service. LPA has determined that the above allegations are Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Tamara Pitchthe state’s words, verbatim · CDSS document, Aug 24, 2026 · control 56-AS-20260206102323

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(2) · Plan of correction due date: Aug 25, 2026

Incidental Medical and Dental Care 87465 (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the residents’ need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidence by: Based on observation, record review, the Licensee did not adhear to the regulation stated above by not providing R1 with immidate medical assistance, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 24, 2026

Plan of correction: The Licensee has agreed to read regulation: 87465 (2) and provide training to all care staff. The licensee will provide LPA with proof of training signed and dated by all staff by POC 8/25/2026.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87468.1(a)(2)(3)(8) · Plan of correction due date: Aug 25, 2026

Personal Rights of Residents in All Facilities 87468.1 …. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: ….(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment…. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination…. (8) Deny or restrict medical or nonmedical care that is appropriate to a resident’s organs and bodily needs or provide medical or nonmedical care to the resident in a manner that, to a similarly situated reasonable perneeds orly demeans the resident’s dignity or causes avoidable discomfort. This requirement is not met as evidence by: Based on observation, record review, the Licensee did not adhear to the regulation stated above by not providing R1 with adequate and responsive pain medication to help treat R1 pain, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 24, 2026

Plan of correction: The Licensee has agreed to read regulation: 87468.1(a)(2)(3)(8) and provide training to all care staff. The licensee will provide LPA with proof of training signed and dated by all staff by POC 8/25/2026.

Allegation investigated: Staff do not provide residents with food of good quality

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Business Office Manager Lizeth (Lisa) Gomez and explained the purpose of the visit regarding the allegations listed above. First allegation: Staff do not provide residents with food of good quality. Regarding the allegation stated above, LPA conducted an interview with Staff #3 LPA went over the allegation with S#3 regarding “Staff not providing residents with food of good quality” Staff #3 informed LPA that staff is aware of the concerns as many residents along with staff have addressed the concerns regarding the food. LPA conducted interviews with Resident #2, Resident #3, and Resident #4, LPA discussed the allegation with the residents and R#2-4 informed LPA that the food quality is very poor and that the temperature of the food when being served is cold. LPA obtained photos of the food that was being served and observed that the food was overcooked, appeared to be burnt and had excess of oil. Based on the evidence gathered during the investigation, the above allegations are Substantiated. Substantiated A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 regulations General Food Service Requirements 87555 (a)(b)(8), from division 6, chapter, article 6, is, cited on the attached LIC 9099 D. An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to the Facility Office Manager Lizeth (Lisa) Gomez, at the conclusion of the visit. Regarding the allegation stated above, LPA conducted an interview with Resident #5 LPA went over the alleged allegation with Resident #5 and resident informed LPA that Staff #4 has not handled resident in a rough manner. Resident #5 further expressed gratitude towards Staff #4 and denied the incident of being shoved into the elevator by Staff #4. LPA conducted an interview with Staff #4 LPA went over the alleged allegation with S#4 and staff denied handling Resident #5 in a rough manner. Furthermore, Staff #4 informed LPA about assisting Resident #5 into the elevator however, Staff #4 denied shoving Resident #5 into the elevator. Third allegation: Staff do not answer resident's call button in a timely manner. Regarding the allegation stated above, LPA conducted interviews with Resident #2, Resident #3, Resident #4, and Resident #5, LPA went over the alleged allegation with Residents #2-5 and all informed LPA that while during certain circumstances where staff are assisting other residents the wait time for assistance can take roughly about 30 minutes- 40 minutes. However, Resident #2-5 informed LPA that during emergencies staff will assist right away. LPA conducted an interview with Resident #4 pertaining to an incident involving a possible convulsion that Resident #4 sustained. Resident # 4 informed LPA that resident does not have recollection of the incident however, Resident #4 informed LPA that resident was transported to a local hospital and received treatment. LPA conducted an interview with S#3 who informed LPA that the wait time to respond to signal systems can take about 30 minutes however, Staff #3 informed LPA that the wait time can take longer for non-emergency calls. LPA discussed the incident with Staff #3 involving Resident #4 and Staff #3, confirmed the incident and informed LPA that staff assisted Resident #4 with medical treatment. Based on corroborating evidence the department has determined that the above allegations are Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Business Office Manager Lizeth (Lisa) Gomez at the end of the visit.the state’s words, verbatim · CDSS document, Feb 25, 2026 · control 56-AS-20251119112210

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a)(b)(8) · Plan of correction due date: Mar 20, 2026

General Food Service Requirements 87555....(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner....(b) The following food service requirements shall apply:....(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidence by: Based on interviews, and record review the Licensee did not comply by adhering by General Food Service Requirements and providing food of poor quality to all residents in care, which can pose a potential Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: The Licensee has agreed to read over the General Food Service Requirement regulation and will address all concerns with their food service director. Licensee will provide training for all kitchen staff addressing all food service concerns. Licensee will provide LPA with proof of training and will also provide LPA with a plan of action to correct the concerns regarding the Food Service. Plan and training will be emailed to LPA by POC date of 03/20/2026.

Allegation investigated: Staff do not ensure that residents' medications are distributed as prescribed Staff do not ensure that facility is maintained sanitary Staff do not ensure that facility is maintained in good repair Staff do not provide residents with housekeeping services

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Business Office Manager Lizeth (Lisa) Gomez and explained the purpose of the visit regarding the allegations listed above. First allegation: Staff do not ensure that residents' medications are distributed as prescribed. Regarding the allegation stated above, LPA conducted an interview with Resident #1 family member who informed LPA that on two separate occasions (11/17/2025 & 12/02/2025) medications were left unsupervised for residents to take. Family member informed LPA that on 11/17/2025 medications did not belong or that were prescribed to Resident #1 were delivered to Resident’s room and left on resident’s kitchen counter for resident to take. On 12/2/2025 LPA was informed that medication was left in foyer by coffee station and later returned to the nurse’s station for safe keeping. LPA collected photo evidence of the medication that was incorrectly administered to Resident #1 along with the medication that was left unsecure. Second allegation: Staff do not ensure that facility is maintained sanitary. Regarding the allegation stated above LPA conducted a walkthrough of the facility along with a walkthrough of Resident’s #1 for the purpose of the allegation regarding “Facility is not maintained sanitary. Substantiated Regarding the allegation stated above LPA conducted a walkthrough of the facility along with a walkthrough of Resident’s #1 for the purpose of the allegation regarding “Facility is not maintained sanitary. During the walkthrough of Resident #1 room LPA observed that Resident #1 restroom was unsanitary. LPA observed that the toilet seat in resident’s restroom was smeared with feces in addition, LPA observed that the bar of soap, along with other beauty products that were sitting on the restroom vanity were smeared with feces. LPA continued the walkthrough into Resident#1 bedroom throughout the walkthrough LPA observed Resident #1 laundry basket to be in unsanitary and soiled. LPA also observed that resident’s shoes were all soiled with feces. Third allegation: Staff do not ensure that facility is maintained in good repair. Regarding the allegation stated above, LPA conducted an interview with Resident #1 family member who informed LPA that as of 11/21/2025 facility ceiling was in disrepair. Family informed LPA that the facility has not placed floor signs to alert staff and residents concerning the wet floor. In addition, R#1 family member informed LPA that the facility placed trash cans and towels across that hallway. On 11/24/2025 LPA conducted an announce visit to address the concerns pertaining to facility ceiling being in disrepair. LPA conducted a walkthrough and observed that the ceiling located on the second floor was in disrepair. Staff #2 informed LPA maintenance is aware; however, management could not provide LPA with a work order request for ceiling repairs. Fourth allegation: Staff do not provide residents with housekeeping services. Regarding the allegation stated above LPA conducted a walkthrough of Resident #1 bedroom for the purpose of “Staff not providing residents with housekeeping services”. The walkthrough was facilitated by Staff #1, During the walkthrough LPA observed that Resident #1 restroom was unsanitary. LPA observed that the toilet seat in resident’s restroom was smeared with feces in addition, LPA observed that the bar of soap, along with other beauty products that were sitting on the restroom vanity were smeared with feces. LPA informed S#1 regarding housekeeping services Staff #1 informed LPA that housekeeping services are provided daily and Resident #1 has fecal incontinence. LPA informed S#1 that Resident #1 may need a re-appraisal and require assistance with toileting. Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 regulations Maintenance and Operation 87303 (a), Personal Rights of Residents in All Facilities 87411 (a) (2) & (3), Incidental Medical and Dental Care 87465 (1)(B)(2), from division 6, chapter, article 6, is, cited on the attached LIC 9099 D. An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to the Facility Office Manager Lizeth (Lisa) Gomez, at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 56-AS-20251119112210

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(1)(B)(2) · Plan of correction due date: Mar 13, 2026

Incidental Medical and Dental Care 87465 ....(1) Medications shall be centrally stored under the following circumstances:... (B)....Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed....(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidence by: Based on interviews, review of records, the licensee did not ensure to follow the regulation pertaining to the supervision and administration of medication for residents, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: The Licensee has agreed to read over "Incidental Medical and Dental Care" Regulation and provide training on how to properly dispense and keep medication secure, to all staff managing medication. Lincensee will provide proof of training and email all trainings to LPA by POC date 3/13/2026.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87468.1(a)(2) · Plan of correction due date: Mar 13, 2026

Personal Rights of Residents in All Facilities 87468.1 ....(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on interviews and review of records, the licensee did not ensure to follow Personal Rights Violation pertaining to the sanitation of resident #1 restroom, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: The Licensee has agreed to read over Regulation: "Personal Rights of Residents in All Facilities" And provide training on ensuring that all residents are accorded safe, healthful and to be in comfortable accommodations. training will be given to all care staff along with housekeeping. Licensee will provide proof of training and email all training courses to LPA by POC date 3/13/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b)(3) · Plan of correction due date: Mar 13, 2026

Maintenance and Operation 87303....(b) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.....(3) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidence by: Based on interviews, review of records, the licensee did not ensure to follow the regulation Maintenance and Operation by ensuring to keep the facility in good repair, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: The Licensee has agreed to read over Regulation: "Maintenance and Operation" And provide training to all staff along with maintenance to ensure to report repairs/damages and ensure repairs are made right away. Lincensee will provide proof of training and email all trainings to LPA by POC date 3/13/2026.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87468.1(a)(3) · Plan of correction due date: Mar 13, 2026

Personal Rights of Residents in All Facilities 87468.1...(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: ...(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence by: Based on interviews and review of records, the licensee did not ensure to follow Personal Rights Violation by ensuring to provide proper housekeeping and ensuring to maintain proper sanitation to resident #1 restroom, which poses an immediate Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: The Licensee has agreed to read over Regulation: "Personal Rights of Residents in All Facilities (a)(3)" And provide training to ensure that all residents are free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature. training will be given to all care staff along with housekeeping. Licensee will provide proof of training and email all training courses to LPA by POC date 3/13/2026.

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff are not meeting residents personal hygiene needs. Staff do not ensure residents are provided with fresh clean linens. Staff are not providing enough supervision to prevent self harming behavior. Staff are not dispensing medication as prescribed.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Julie Dion and explained the purpose of the visit. The investigation consisted of interviews, record review, and observation. First allegation: Staff are not meeting residents’ personal hygiene needs. Regarding the allegation LPA conducted interviews with Staff #1 and Staff #2 LPA went over the allegation with S#1 and S#2, Staff #1 and S#2 informed LPA that facility had a meeting with R#1 responsible party regarding concerns addressing to the allegation. Staff #1 and Staff #2 informed LPA that facility cannot force R#1 to take showers, concern that was addressed to R#1 responsible party. Staff #1 and Staff #2 informed LPA that staff encourages R#1 to shower, and brush teeth, and at times encouragement is successful however, other times R#1 refuses. On 8/28/2025, LPA attempted to conduct an interview with R#1 however, R#1 refused and asked to be left alone. Unsubstantiated On 10/6/2025, LPA conducted a second attempt to interview R#1 LPA went over the allegation with R#1 and R#1 informed LPA that the last time resident showered was a few hours ago. R#1 informed LPA that R#1 likes to shower independently and does not want to be helped or forced. LPA conducted a bathroom inspection LPA observed two bath towels hanging on towel bars LPA also observed that both towels appeared to be damp and used in addition, LPA observed a toothbrush and toothpaste in R#1 bathroom. Second allegation: Staff do not ensure residents are provided with fresh clean linens. Regarding the allegation LPA conducted a room inspection in R#1 room during the inspection LPA observed R#1 room to be clean, and free of odors. In addition, during the inspection LPA observed that R#1 linens along with pillowcases were clean and free of odors. LPA conducted an interview with S#2 who informed LPA that R#1 receives laundry services once a week and as needed as part of R#1 care plan. Third allegation: Staff are not providing enough supervision to prevent self-harming behavior. Regarding the allegation LPA conducted an interview with S#2 who informed LPA that when a Pre-appraisal was conducted for R#1 that R#1 already had a behavior of pulling of the hair. In addition, S#2 informed LPA that R#1 responsible party informed facility about R#1 behavior. S#2 informed LPA that staff cannot prevent or stop R#1 from the pulling of the hair behavior as R#1 displays the behavior when R#1 is alone in their room. S#2 informed LPA that anxiety medication was prescribed however, family does not want to move forward with anti-depressant medication for R#1. Fourth allegation: Staff are not dispensing medication as prescribed. Regarding the allegation LPA conducted a walkthrough of R#1 room during the walkthrough LPA observed R#1 sleeping in addition, LPA observed a set of clothes that was placed next to R#1 bed in addition, LPA observed a pair of compression socks sitting on top of R#1 clothes. S#1 informed LPA that a set of clean clothes along with resident compression socks are always placed next to resident bedside. LPA went into resident’s bathroom and LPA did not observe a medicated shampoo to be in R#1 shower. S#1 informed LPA that because R#1 shampoo is medicated that the shampoo needs to be stored in med-room and dispensed by med team. LPA observed a refusal log and S#1 informed LPA that R#1 medicated shampoo was issued for five-weeks, and R#1 refused to utilize shampoo. S#1 informed LPA that a new order needs to be issued for resident. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Julie Dion at the end of the visit.the state’s words, verbatim · CDSS document, Oct 6, 2025 · control 56-AS-20250826145931

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Julie Dion and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (94) current census (70). LPA was accompanied by Facility Administrator,to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-Room office inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Julie Dion.the state’s words, verbatim · CDSS document, Oct 6, 2025

Allegation investigated: Resident sustained unexplained injuries while in care. Staff left resident in a soiled diaper for a long period of time. Staff did not clean resident's bedroom floor. Staff did not safeguard resident's personal items. Staff do not ensure that resident is provided with clean clothng as needed.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Business Office Manager Lizeth (Lisa) Gomez and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records. First allegation: Resident sustained unexplained injuries while in care. Regarding the allegation “Resident sustained unexplained injuries while in care” LPA conducted an interview with Resident #1 regarding the allegation and Resident #1 informed LPA that the injurie[s] on R#1 (L) shin and knee are old injuries that R#1 sustained during an accidental fall. Resident #1 denied abuse and informed LPA that injuries sustained are old injuries. LPA conducted a review of records and discovered through facilities (Unusual Incident/Injury Reports), that Resident #1 has been found on the floor sitting next to the bed or wheelchair; Resident#1 denied any falls and stated that Resident had crawled out of bed. LPA conducted an interview with Facility Resident Service Director who informed LPA that no falls have been reported for Resident #1 however, Resident #1 has been displaying behaviors on different occurrences (3/19/2025 and 4/01/2025), throughout the day where resident is found sitting on the floor and denying falls. Unsubstantiated Service Director informed LPA that no injuries were observed on R#1 during (3/19/2025 and 4/01/2025) incidents. Second allegation: Staff left resident in a soiled diaper for a long period of time. Regarding the allegation “Staff left resident in a soiled diaper for a long period of time” LPA conducted an interview with Resident #1 regarding the allegation, Resident #1 informed LPA that caregivers change resident diaper/pull-up when needed. LPA asked resident if staff has left resident on a soiled diaper for a long period of time Resident#1 informed LPA that during the times resident does not want to be bothered is when resident diaper/pull-up does not get changed. LPA conducted interview with Staff #1 and Staff #2 and both informed LPA that on several occasions Resident #1 has refused care. LPA conducted a review of records and discovered that on: (3/26, 3/27, 3/28, 3/29, 3/30, and 4/2), Resident #1 has refused care. Third allegation: Staff did not clean resident's bedroom floor. Regarding the allegation “Staff did not clean resident's bedroom floor.” LPA conducted a walkthrough of Resident #1 room and observed floors to be clean and free from biohazard (fecal matter), or any waste that can pose as a health risk to Resident #1. In addition, Resident #1 room was free of odors and LPA observed R#1 room to be free from any bodily fluids. LPA conducted record review and discovered through housekeeping schedule that Resident #1 room gets clean once a week every Sunday. Fourth allegation: Staff did not safeguard resident's personal items. Regarding the allegation “Staff did not safeguard resident's personal items” LPA conducted an interview with Resident #1 regarding the allegation LPA asked Resident #1 if resident was able to list and describe the personal items that went missing. Resident #1 was not able to list or describe the personal items that went missing. Resident #1 informed LPA that Resident was not sure about the items that went missing. Fifth allegation: Staff do not ensure that resident is provided with clean clothing as needed. Regarding the allegation “Staff do not ensure that resident is provided with clean clothing as needed.” LPA conducted an interview with Resident #1 regarding the allegation Resident #1 informed LPA the resident’s sister picks-up residents’ laundry and washes Resident #1 Laundry. Resident #1 informed LPA that resident sister has not picked-up resident’s clothes to be washed. LPA conducted a record review and discovered that on 3/28/25 Resident #1 responsible party refused to take Resident #1 laundry. During review of record LPA discovered that on 12/20/2023 facility provided a service update to all residents along with resident’s responsible parties informing that as of March 1, 2024, facility will be providing two laundry service options: (1 load per week=$100/month and 2 loads per week=$200/month), Staff #1 informed LPA that laundry services are not free and that its an additional charge. During further review LPA discovered that Resident #1 was issued a 30-day notice due to non-payment and having an outstanding balance of $17,140.00. Staff #1 informed LPA that Resident #1 outstanding balance also includes non-payments for laundry services. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated. Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Business Office Manager Lizeth (Lisa) Gomez at the end of the visit.the state’s words, verbatim · CDSS document, Apr 3, 2025 · control 56-AS-20250327105844

Allegation investigated: Staff did not properly maintain the facility Staff do not properly report incidents involving a resident Staff do not meet the needs of a resident

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Julie Dion and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records. First allegation: Staff did not properly maintain the facility. Regarding the allegation, LPA conducted a facility walkthrough accompanied by facility administrator. During the walkthrough LPA observed facility to be clean, in good repair, and operating in safe conditions for residents in care. LPA conducted an inspection inside Resident #1 room and observed room to be clean, well-organized, and free from bodily fluids. Second allegation: Staff do not properly report incidents involving a resident. Regarding the allegation “Staff do not properly report incidents involving a resident” LPA requested records pertaining to Resident #1 regarding R#1 incident reports. During record review LPA discovered that on 11/6/2024 R#1 sustained a fall which resulted in R#1 loosing front tooth. Unsubstantiated In addition, LPA discovered that facility contacted local paramedics to evaluate R#1, incident report also reported that POA spoke to paramedics and requested for R#1 not to be taken to hospital. Since the last incident LPA observed that the last incident involving R#1 was reported on 11/11/2024, incident was also reported to R#1 POA. Third allegation: Staff do not meet the needs of a resident. Regarding the allegation “Staff do not meet the needs of a resident” LPA requested documentation pertaining to Resident #1 care needs. During record review LPA discovered that facility conducted an assessment to determine the level of care for R#1. Facility implemented Falls intervention, by conducting more status checks for R#1 in addition, facility implemented escorts by ambulation with wheelchair for R#1. LPA conducted an interview with Resident #1 who informed LPA that resident likes the facility and has no concerns regarding care staff. Resident#1 informed LPA about feeling safe at the facility. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Julie Dion at the end of the visit.the state’s words, verbatim · CDSS document, Feb 6, 2025 · control 56-AS-20241118091753

Allegation investigated: Facility is not kept free of insects and rodents Facility serves poor quality food

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Julie Dion and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records. First allegation: Facility is not kept free of insects and rodents. Regarding the allegation “Facility is not kept free of insects and rodents” LPA conducted a walkthrough of the facility during the walkthrough LPA inspected facilities kitchen area and LPA observed facility to be clean, organized, and free of insects and rodents. LPA collected pest control invoices and observed that facility utilizes Terminix as a company of service who service the facility every Friday. LPA observed that facility is free of insects and rodents. LPA conducted interviews with R#1-3 and all informed LPA that they have not witnessed or seen any insects or rodents around the facility. Second allegation: Facility serves poor quality food. Unsubstantiated Regarding the allegation “Facility serves poor quality food “LPA observed and inspected the quantity and quality of food on (2) separate facility visits 11/22/2024 and 2/6/2025. LPA conducted a review of food service of meals served. LPA collected a copy of the current menu, along with the alternative menu. LPA toured the facility and observed the meals that are being served reflected on what was on the menu for the week. LPA observed food to be of adequate quality. Meals appeared to be fresh and balanced. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Julie Dion at the end of the visit.the state’s words, verbatim · CDSS document, Feb 6, 2025 · control 56-AS-20220629090628

Allegation investigated: Facility failed to meet residents care needs Staff did not treat resident with dignity or respect

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Julie Dion and explained the purpose of the visit. The investigation consisted of interviews and review of records. First allegation, Facility failed to meet residents care needs. LPA conducted a file review on Resident #1 for the allegation: “facility failed to meet resident care needs”, during file review LPA obtained and reviewed video footages of Resident #1 LPA observed Resident #1 to be complaining of pain on two separate occasions to staff LPA observed that on both occasions staff disregarded Resident#1 complaint towards pain walked out of Resident#1 room without asking the resident if they were in need of medical help or assistance. Second allegation, Staff did not treat resident with dignity or respect. Substantiated Regarding the allegation “staff did not treat resident with dignity of respect” LPA reviewed video footage of Resident #1 and observed that on multiple occasions Resident #1 was questioned by staff for yelling for help in addition, LPA also observed staff reprimanding Resident #1 for having staff going into residents’ room all night. Based on the evidence gathered during the investigation, the above allegations are Substantiated. Substantiated: A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Personal Rights 80072 (3); Personnel Requirements – General 87411 (a) from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights. to Facility Administrator Facility Administrator Julie Dion. Regarding the allegation “resident sustained a pressure injury due to neglect in care from staff”: LPA conducted interviews with staff regarding the allegation stated above, staff indicated that Resident#1 did not have a pressure injury however, staff did indicate that Resident #1 had redness and skin irritation, in which resident’s skin irritation was being treated with cream. Staff indicated to LPA that facility has no record on file for the pressure injury that is being indicated, because Resident #1 did not sustain a pressure injury. LPA conducted an interview with Resident #1 Primary Care Provider (NP), who confirmed to being the primary care provider from admission to resident#1 release. Nurse Practitioner stated that Resident #1 did not have a pressure injury but rather redness and skin irritation. Nurse Practitioner informed LPA that Resident#1 skin irritation was being treated with cream. NP informed LPA that Resident#1 skin irritation and skin break had eventually healed. Third allegation, Staff did not return all of resident's medication at discharge. LPA conducted a file review of Resident#1 medication release LPA observed a list of medication pertaining to Resident #1 in addition, LPA observed a date along with a signature from Resident#1 authorized representative acknowledging the release/return of Resident#1 medication. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Julie Dionthe state’s words, verbatim · CDSS document, Aug 23, 2024 · control 56-AS-20240429145055

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Sep 20, 2024

Personnel Requirements – General 87411 (a)...Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidence by: Based on interviews and record review, facility did not meet Personnel Requirements for Resident #1, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 23, 2024

Plan of correction: Administrator has agreed to go over the Personnel Requirement-General regulation and provide training with all care staff. Administrator will ensure that training is signed and dated by all staff and provide proof to LPA Guerrero by POC date 9/20/2024.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 80072(3) · Plan of correction due date: Sep 20, 2024

1) Personal Rights 80072 (3).... To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of punitive nature, including but not limited to: interference with the daily living function, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication, or aids to physical functioning. Based on interviews and record review, facility did not meet Personnel Rights for Resident #1, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 23, 2024

Plan of correction: Administrator has agreed to go over the Personnel Rights regulation and provide training with all care staff. Administrator will ensure that training is signed and dated by all staff and provide proof to LPA Guerrero by POC date 9/20/2024.

Allegation investigated: Facility roof is in disrepair.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Facility Administrator Julie Dion and explained the purpose of the visit. The investigation consisted of Observation, interviews, and review of records. First allegation, Facility roof is in disrepair. On 2/9/2024 LPA conducted a walkthrough of the facility dining room area and observed that a flyer indicating “Dining room is under repair” was posted on the entrance of dining the dining room door. LPA observed that the dining room was enclosed and observed building material to be present. Facility administrator informed LPA that the dining room area had a roof leak and that they are in the process of repair. Facility Administrator informed LPA that residents along with family members were made aware of the repairs and informed all residents that meal accommodations will be delivered to each resident’s rooms until the dining room leak repair is complete. LPA observed invoices along with city inspections invoices, indicating roofing repairs. Unsubstantiated LPA conducted interviews with Residents, and all stated that they were informed of the repairs and for the mean time all meals are being delivered to their rooms while the dining room area is repaired. On 5/15/2024 LPA conducted a second walkthrough of the facility dining room area and observed that the roof was repaired, and no new damage was observed. LPA observed that the dining area was open and accessible for all residents. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated. Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Julie Dion.the state’s words, verbatim · CDSS document, May 15, 2024 · control 56-AS-20240206105318

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Julie Dion and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (94) current census (63). LPA was accompanied by Facility Administrator,to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-Room office inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Julie Dion.the state’s words, verbatim · CDSS document, May 15, 2024

Allegation investigated: Staff did not ensure that residents were administered their medications as prescribed. Staff member does not have required training to provide care to residents.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Office Manager Lizeth Gomez and explained the purpose of the visit. The investigation consisted of interviews and review of records. First allegation, Staff did not ensure that residents were administered their medications as prescribed. During interviews and review of records LPA observed that medications was administered to all resdients however, due to staffing coflict residents medication was administered late based on Med Variance report. Second allegation, Staff member does not have required training to provide care to residents. During interviews and review of records LPA observed training certificates for all Med-Techs along with staffing support to be on file. Based on documentation and trainings facility staff have the qualifications to provide care to residents. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Office Manager Lizeth Gomez at the end of the visit.the state’s words, verbatim · CDSS document, Feb 9, 2024 · control 56-AS-20231109090240

Allegation investigated: Facility not adequately cleaned. Staff do not provide adequate food services to residents.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Office Manager Lizeth Gomez and explained the purpose of the visit. The investigation consisted of interviews and review of records. First allegation, Facility not adequately cleaned. During interviews and review of records LPA observed that housekeeping is completed on daily basis. LPA conducted a walkthrough of the facility and observed facility to be clean and clear of obstructions. Second allegation, Staff do not provide adequate food services to residents. During interviews, record review and observations, LPA conducted a walkthrough of facility kitchen an observed kitchen to be clean and observed all kitchen appliances to be clean and sanitized. LPA inspected non-perishable and perishable food supply and observed food to be in good standing based on expiration dates. LPA conducted interviews with kitchen staff, and all stated that any left-over food gets tossed after two hours no food gets re-stored. Unsubstantiated LPA collected facility menu and observed that facility offers alternative food options for residents. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated. Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Office Manager Lizeth Gomez at the end of the visit.the state’s words, verbatim · CDSS document, Feb 9, 2024 · control 18-AS-20211228082003

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced case management visit during complaint control number 56-AS-20231109090240. LPA met with Office Manager Lizeth Gomez and explained the reason for the visit. During initial visit facility failed to provide special incident report (SIR), reporting the administration of medication to be given late to residents due to staffing conflict. Based on this matter, one (1) one deficiency was cited per Title 22, Division 6, of the California Code of Regulation. An exit interview was conducted where this report (LIC 809) was discussed and and copy was provided to Office Manager Lizeth Gomez.the state’s words, verbatim · CDSS document, Feb 9, 2024

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

Reporting Requirements.. (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:... (1) 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 requirement is not met a evidence by: Based on record review, the licensee did no ensure to follow the proper procedures to report CCL office that medication was administered late to all residents due to staffing conflicts.the state’s words, verbatim · CDSS document, Feb 9, 2024

Plan of correction: Administrator has agreed to read over the regulation pertaining to Reporting Requirements and provide training to all staff. The completion of training signed and dated by all staff will be emailed to LPA Guerrero on POC date of 3/1/2023.