Angel's Guest Home #1

Allegation investigated: Facility is in disrepair. Licensee does not ensure that the facility provides a safe environment for the residents.

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegations. LPA identified herself, explained the purpose of the visit and nature of the complaint to Caregiver Zlota Levine. Administrator Monica Allan later joined the visit. On October 11, 2023 the Department received this complaint which alleged facility is in disrepair and licensee does not ensure that the facility provides a safe environment for the residents. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) Regarding the allegation that facility is in disrepair, the reporting party specifically stated concerns regarding the state of the garage and alleged the water heater was leaky. During unannounced visits, LPA observed the facility to be clean, sanitary and in good repair. LPA did not observe the water heater to be leaky nor anything concerning the water heater. LPA observed the garage to have appropriate storage for extra supplies and holiday decor. Additionally, the washer and dryer machine are in the garage. LPA observed them to be in working condition. Per interviews with staff, the residents do not go into the garage. There was no evidence collected at the time this investigation was initially opened to indicate the facility was in disrepair. Regarding the allegation that licensee does not ensure that the facility provides a safe environment for the residents, during unannounced visits, LPA did not observe anything making the facility environment unsafe. LPA observed medications locked and inaccessible to residents. LPA observed a small koi pond in the backyard which is surrounded by a fence which was in good repair, at least 5 feet high, locked and of sufficient strength to withstand impact. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. There was no evidence collected at the time this investigation was initially opened to indicate an unsafe environment. The Department has investigated the above mentioned allegations. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated. An exit interview was conducted with Caregiver Zlota Levine, to whom a copy of this report and the Licensee’s Rights (LIC9058 3/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 15, 2026 · control 08-AS-20231011112743

Allegation investigated: Staff gave resident discontinued medication Staff did not destroy discontinued medication Staff did not follow physician's orders

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above-mentioned allegations. LPA identified herself, explained the purpose of the visit and nature of the complaint to Caregiver Zlota Levine. Administrator Monica Allan later joined the visit. On October 4, 2024 the Department received this complaint which alleged staff gave Resident #1 (R1) discontinued medication, staff did not destroy discontinued medication, and staff did not follow physician’s orders. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] The Department’s investigation included a facility tour, a review of records, and interviews with staff. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) Regarding the allegation that staff gave R1 discontinued medication, the Reporting Party specifies that R1 was given oxycodone. Per staff interviews and records reviewed, at the time of the alleged incident the facility did not keep a Medication Administration Record (MAR). Records collected at the time this investigation initially opened did not include anything to indicate R1 was given discontinued medication. Regarding the allegation that staff did not destroy discontinued medication, records reviewed did not include any physician’s order for discontinuing oxycodone. Per the Centrally Stored Medication record for R1 around the time of this allegation, R1 was prescribed oxycodone with a prescription fill date of 1/11/24 and expiration date of 9/25. While there are no records indicating medication was destroyed, there are no physician's orders on file from that time to warrant the medication to be destroyed. Regarding the allegation that staff did not follow physician’s orders, records reviewed did not include any physician’s order for discontinuing oxycodone. The Department has investigated the above mentioned allegations. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated. An exit interview was conducted with Caregiver Zlota Levine, to whom a copy of this report and the Licensee’s Rights (LIC9058 3/22) were provided.the state’s words, verbatim · CDSS document, Sep 15, 2026 · control 08-AS-20241004124648

Type of visit: Office

Regional Manager (RM) Jerry Romero, Licensing Program Manager (LPM) Simon Jacob, and Licensing Program Analyst (LPA) Angelica Boyles met with Patricia Kroeger, Keith Kroeger, and Monica Allen virtually for an office meeting to grant an Emergency Approval to Operate the facility in response to the death of the Facility Licensee, Catherine McEvoy. Prior to the meeting, the Department received documentation of verification of death of the Licensee. During the meeting LPM stated a Certificate of Emergency Approval to Operate would be granted contingent upon the Department receiving proof of control of property. The certificate is valid for 60 days and will expire upon the issuance of a provisional license, or denial of application for licensure. LPM Reviewed the application documents and advised that Patricia must submit a completed application for licensure to the Department's Centralized Applications Bureau (CAB). Patricia must also comply with all applicable laws and regulations and ensure that the needs of all residents are met. This report was emailed to Patricia Kroeger.the state’s words, verbatim · CDSS document, Aug 5, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Marisela Garcia -Centeno conducted an unannounced Health and Safety visit due to a reported death by Administrator, Monica Allen of the Licensee Catherine Mcevoy on July 31, 2026 . LPA was greeted by, identified herself to, and explained the purpose of the visit with Staff, Zlota Levine. During the visit, LPA spoke with (next of kin/staff) Patricia Kroeger on the telephone. Staff present had current criminal record clearances. The facility has a licensed capacity of six (6) residents. During today’s visit, the facility had a census of five (5) residents, all of which were not present at facility. One resident is on hospice services. Per staff, the Licensee/Administrator for the facility passed away on July 31, 2026 at the facility. During the visit, LPA discussed with the licensee's designee, Patricia Kroeger the procedures for continuing to operate the facility. In addition, LPA confirmed with that all five (5) residents were under the care and supervision by facility staff being operated by Administrator, Monica Allen. A set meeting with Patricia Kroeger to discuss the Emergency Approval to Operate the facility will be scheduled this week pending availability by CCL management.. No health and safety concerns were observed during the visit. No deficiencies were cited during the visit. An exit interview was conducted with Caregiver, Zlota Levine to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 3, 2026

Allegation investigated: Questionable Death Financial abuse by staff

On 04/09/2026, LPA Grace Donato conducted a telephone interview with the facility to deliver findings. LPA spoke Licensee Catherine McEvoy and explained the purpose of the call. For the allegation of questionable death, resident (R1) was sent to hospital on 3/15/2025. According to records review, it was stated that R1 was brought to the hospital by ambulance from the facility where the paramedics were told R1 was last seen well around 6:00 pm on 3/14/2025. Staff told paramedics R1 was normally alert and oriented but now only responds to his/her name. R1 was placed on comfort care while in the hospital and death was pronounced on 3/21/2025. Regarding the allegation of financial abuse by staff, R1 moved into the facility on or about 8/30/2023. R1 signed the resident agreement and agreed to pay. Starting in March 2024, R1 did not pay the full rent to the facility. R1 asked a family member (F2) to meet at the facility and informed F2 that R1 wanted to sell the mobile home. R1 hired his/her own realtor. R1 found the realtor with the assistance of the Licensee. page 1 of 2 Unsubstantiated On 6/28/2024, R1 paid Licensee for past due rent. After that, R1 paid a lower rate at the facility as Licensee lowered it. Checks were written for personal items like clothing as R1 did not have enough clothing. Other checks were made for picking up personal items and Christmas gifts for R1’s family. According to the physician’s report and hospital records, R1 did not have a diagnosis of dementia. Those interviewed at the facility, and the realtor stated R1 did not appear to have memory issues. The signatures on documents appeared to match those R1 signed for the facility. Despite having a DPOA, R1 managed his/her own finances for the duration of stay at the facility. Based on interviews, observations and records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Report is reviewed and copy is provided. page 2 of 2the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 08-AS-20250319093816

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit for a required annual inspection. LPA was greeted by, identified herself to, and explained the purpose of the visit to caregiver Zlota Levine. LPA also met with Licensee Catherine McEvoy. LPA and caregiver toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order and bathroom sinks were compliant temperatures. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled and stored in a locked area. However, LPA observed medications placed in weekly pill boxes and other individual containers. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. (CONTINUED ON LIC 809-C) (CONTINUED FROM LIC 809) The facility features a small koi pond in the backyard. The water feature is surrounded by a fence which was in good repair, at least 5 feet high, locked and of sufficient strength to withstand impact. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per Licensee, no firearms or ammunition are stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility except for a current Administrator's Certificate. Licensee reported that there is not an up to date Administrator's Certificate for her or any staff. LPA reviewed staff and resident records/files. Files reviewed contained the required documentation. Confidential records were stored in locked areas. Two deficiencies are being cited per Title 22 California Code of Regulations (please refer to 9099-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Licensee , to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 3, 2026

Allegation investigated: Facility was not maintained clean and sanitary.

Licensing Program Analyst (LPA) Correia conducted an follow up complaint visit to deliver the finding regarding the above mentioned allegatiion. LPA was greeted at the front entrance by Caregiver Meza, identified herself, and explained the purpose of the visit. The Department's investigation consisted and a facility tour. It was alleged the facility was not clean and sanitarty. During the Departments initial visit on October 8, 2021, LPA conducted a facility tour. LPA observed the facility to have accumulated clutter thoughought the premises, the countertops and floors appeared to lack regular sanitation. Additionally, reminents of dead pests were observed in the kitchen cupboards and drawers, as well as the kitchen floor and windowsill. LPA Correia conducted an exit interview with Caregiver Meza. At the time of the exit interview with Caregiver Meza was given a copy of this report, LIC 9099, LIC 9099-D, and Licensee Rights (LIC9058 01-2016), and signature on this report acknowledges receipt of the rights. Substantiated [Continuation of LIC 9099] An interview conducted with the Licensee revealed R1's records, who no longer resided at the facility, were buried somewhere in the facility garage and was unable to produce them during the initial visit on October 8, 2021. The Licensee stated R1's file was at the facility, but they needed time to find it. LPA conducted a follow up complaint visit on February 7, 2023, to obtain R1’s records, however the Licensee was still unable to produce R1’s records to aid in the investigation. During an additional visit to the facility on March 23, 2023, the Licensee was still unable to produce R1's records, subsequently during the visit a citation was issued in a case management visit for not being able to produce R1's records per Title 22 regulation. Due to lack of evidence the above allegation was determined to be Unsubstantiated. An unsubstantiated finding means that although the allegation may have happened there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of this report, Appeal and Licensee Rights (LIC 9058 01/16) were provided to Caregiver Mesa, whose signature below confirm receipt of these rights.the state’s words, verbatim · CDSS document, Apr 4, 2025 · control 08-AS-20211001153702

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Apr 4, 2025

The facility shall be clean, safe, sanitary and in good repair at all times. ...maintenance services and procedures for ... employees and visitors. Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This regulation was not met as evidenced by: Based on LPAs observations the facility had accumalated clutter, and surfaces including counter tops and floors were observed to be unsanitary at the time of visit. This posed a potential health risk to 5:5 residnets in care.the state’s words, verbatim · CDSS document, Apr 4, 2025

Plan of correction: During today's visit LPA observed the facility was well kempt. Staff have put cleaning procedures in place, and the Licensee cleared out a lot of the clutter. Deficiency had beens cleared.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Caregiver Zlota Levine and was granted entry into the facility. The facility is licensed to serve six (6) residents; of which five (5) can be non-ambulatory, two (2) receiving Hospice services, and one (1) resident may be bedridden. All five (5) Residents were present during the visit. During today's visit LPA Correia, accompanied by Caregiver Meza conducted a facility tour. LPA observed smoke and carbon monoxide detectors were present and operable. The fire extinguisher was last inspected on April 3,2025. The internal ambient temperature was comfortable and within regulation. The required posting were appropriately displayed, and the facility had a working land line. Sharps, toxins, and medications were locked and inaccessible to Residents in care. An overall inspection of the facility began today however due to time constraints LPA was unable to complete the visit and will return later to conduct the remaining portion of this inspection. No deficiencies were cited during today's visit. This report was discussed with Caregiver Meza A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Apr 4, 2025

Allegation investigated: - Staff did not ensure facility was free from pests

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Zlota Levine, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with caregiver Levine and Licensee Cathy Mcevoy who later arrived and joined the visit. The Department’s investigation consisted of interviews with staff, review of pertinent records, and LPA observations of the facility grounds. On July 22, 2024, it was alleged that staff did not ensure that the facility was free from pests. It was specifically alleged that the facility had cockroaches and fleas throughout the facility. Interview with staff said they are aware that the facility owner does have a pest control company come out every so often to render services. Staff mentioned that they have also bathed the dogs. (Continuation on LIC9099-C) Unsubstantiated (Continuation of LIC9099) Per the Licensee, they do have a pest control company come out to the facility bi-monthly to treat for cockroaches and fleas. Licensee did mention that a staff saw a flea on one of their dogs and they immediately addressed the issue with resident families and on their own facility cat and dog. Per the licensee, all the pets were treated within one week of the notifications of the fleas. The pest control company’s notice shows they do render services for pests which includes fleas and cockroaches. Licensee said that they have contacted their pest control company to schedule another appointment for August 1, 2024. Per staff and the Licensee, all their facility pets have received treatments for fleas. A review of records revealed that the facility does have a pest control company that renders services to the facility bi-monthly. Invoices show that they have recently had their pest control company come out to treat the facility on July 1, 2024. The facility provided a former invoice for May 2024 for pest control services rendered. The facility provided invoices for three of the four pets that received treatment from Veterinary Hospitals. The fourth pet did have a home treatment placed on them which staff provided the oral and topical treatments they have been dispensing to that pet. The invoices for the Veterinary Hospitals showed that they treated their pets for fleas and ticks. On July 30, 2024, LPA toured the facility and observed that there were only dead cockroaches on trappings located between the refrigerator and a countertop, and under the kitchen sink where only vases are kept. LPA did not observe any cockroaches that were alive anywhere throughout the facility. LPA inspected each of the resident’s rooms, bathrooms, dining room, living room, garage, outside patio area, pond area, and both sides of the facility. The facility was clean and sanitary, but only needed to clean the area(s) where the trappings were located which staff cleaned while LPA was at the facility. All pet supplies were organized in their designated area’s. LPA did not observe the pets scratching themselves for fleas while at the facility. Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be unsubstantiated. The report was discussed, and an exit interview was conducted with Licensee Cathy Mcevoy. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Mcevoy at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Jul 30, 2024 · control 08-AS-20240722145317