Noble Living II

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter conducted an unannounced case management to amend a Complaint investigation 08-AS-20240403143343, LIC9099, LIC9099-C issued on April 16, 2026. LPA met with Administrator Nora Garcia, via telephone and explained the purpose of the visit. The complaint investigation closed on April 16, 2026, is being amended to remove confidential information that was erroneously in the report. A copy of this report is being emailed to ADM for signature. ADM stated she will mail a signed physical copy to her local CDSS CCL office. ADM stated she will also send a signed copy to LPA via email. No deficiencies cited during todays visit. This Report was reviewed with Administrator Nora Garcia. A signed copy was provided.the state’s words, verbatim · CDSS document, Aug 20, 2026

Allegation investigated: Questionable death Staff did not provide medication assistance to resident in care Staff did not feed resident in care Staff did not provide drinking water to resident in care Staff did not ensure resident's diapering needs were met Staff did not ensure resident's oxygen administration needs were met Staff denied visitations to residents in care

(This report is being amended on August 20, 2026, to remove confidential information.) Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced investigation visit to deliver the investigation finding via telephone call and met with Administrator Nora Garcia. On April 3, 2024, the Department received a complaint allegation that a questionable death occurred. It has also been alleged Staff did not provide drinking water to resident in care / Staff did not feed resident in care. It has been alleged that resident R1 was neglected during the months of December 2018 to April 2019, resulting in R1’s death. On April 5, 2024, Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to open a complaint investigation. During the visit, LPA obtained copies of records. Page 1 Out of 8 Unsubstantiated On April 10, 2024, the Department interviewed Administrator (ADM) Nora Garcia. ADM stated every year around April, upon the anniversary of R1’s death, witness W1 posts online about the facility, expressing his/her anger with the facility and the fact that R1 had passed away. ADM stated R1 was on Bridge Hospice and the facility contacted W1 to let him/her know that R1 was transition to his/her end. ADM stated R1 was on hospice and the facility followed R1’s Plan of Care. ADM stated they did not have a copy of R1’s plan of care. ADM stated they were not pushing liquids as R1 was dying and on morphine. ADM stated when R1 first came to the facility on December 02, 2018. ADM stated R1 was sent to the hospital on March 21, 2019 because he/she wasn’t swallowing well and R1 came back on March 29, 2019, where he/she was placed on hospice care. ADM stated R1 was on a pureed diet. ADM stated on April 4, 2019, hospice notified W1 that R1 was transitioning to his/her end. ADM stated W1 came to the facility on April 4, 2019 and canceled hospice care and sent R1 to the hospital, where R1 died on April 7, 2019. On April 18, 2024, the Department interviewed Witness (W1). W1 stated a care giver, name unknown, neglected R1, which lead to R1’s death. W1 stated he/she went to visit R1 on April 4, 2019 and the care giver, name unknown, had not given R1 his/her morphine. W1 confirmed that R1 was under hospice at the time. W1 stated he/she received a call from hospice, and was informed that R1 wasn’t doing well, and to visit R1. W1 stated when he/she saw R1, it seemed R1 was gasping for air, so W1 asked the care giver to give R1 his/her oxygen mask. W1 stated he/she asked the caregiver about R1’s oxygen and they didn’t seem to care and ignored W1. W1 stated he/she would visit R1 and the care giver, name unknown, would place his/her water bottle behind R1 so R1 couldn’t reach his/her water bottle. The Department asked W1 how many times he/she saw the water bottle behind R1’s back. W1 could not provide an answer. The Department asked W1 how often he/she visited R1. W1 stated maybe 2 times a week. The Department asked W1 if he/she ever offered R1 water when he/she visited. W1 stated he/she could not recall. The Department asked W1 if R1 would drink water on his/her own. W1 did not know. The Department asked W1 if R1 was eating puree or chopped food. W1 did not know. The Department asked W1 if R1 had a swallowing disorder, where someone has a difficult time swallowing. W1 stated he/she didn’t know. The Department asked W1 if hospice had explained to W1 that R1 was at his/her end of life. W1 could not answer the question. Page 2 Out of 8 (This report is being amended on August 20, 2026, to remove confidential information.) On April 23, 2024, the Department interviewed Witness W2. W2 stated he/she never witnessed any neglect at the facility. W2 stated W1 felt the facility wasn’t taking care of R1. On May 14, 2024, the Department interviewed Witness W3. W3 stated, W1 had alleged that on April 4, 2019, the facility had not given R1 Medication M1. W3 stated he/she wasn’t there and did not witness what W1 told him/her. W3 stated he/she saw R1 at the facility two times. W3 stated he/she didn’t see anything out of the ordinary and cannot verify any information W1 said happened. W3 stated it seemed the care givers were taking good care of R1. The Department asked W3 if there was something he/she saw at the facility that he/she didn’t like or if he/she saw R1 mistreated. W3 stated no. On May 14, 2024, the Department interviewed resident R2 and R3. R2 stated he/she liked living at the facility. R2 stated he/she likes the food at the facility and gets enough to eat. Due to neurocognitive disorder, R3 was unable to provide relevant information during the interview. On April 10 and 15, 2026, Licensing Program Analyst Manuel Monter interviewed staff S1-S3. 3 Out of 3 staff (S1-S3) stated residents at the facility were provide meals and water. 3 Out of 3 staff (S1-S3) stated there hasn't been an instance where residents were neglected their meals or water. Based on a review of all documentation and interviews conducted during the complaint investigation process, it was reported on April 3, 2024, five years after R1 had passed away, that R1 had been neglected by the facility from December 2018 through April 2019, which led to R1’s death. However, R1 was on Uni-Care Home Health for a short time from 12/02/2018 through 01/28/2019, then in Sharp Grossmount Hospital from 03/21/2019 through 03/29/2019, then after R1 was discharged and placed on Bridge Hospice through 04/04/2019. W1 was notified by Bridge Hospice that R1 was transitioning toward the end of his/her life on 04/04/2019. When W1 came to see R1, he/she canceled Bridge Hospice and sent R1 back to Sharp Grossmount Hospital where he/she died on 04/07/2019. There is not enough corroborating evidence to show Neglect/Lack of Care and Supervision regarding the questionable death of resident R1. The family had placed R1 on comfort care due to his/her poor prognosis and his/her Physician Orders for Life-Sustaining Treatment (POLST) described for comfort-focused treatment, therefore the allegation of Neglect/Lack of Care and Supervision regarding the questionable death is deemed unsubstantiated. Page 3 Out of 8 There is not enough corroborating evidence regarding staff not feeding resident R1 while in the facilities care. Based on investigation there is not enough corroborating evidence find any Neglect/Lack of Care and Supervision of R1 by the facility staff resulting in not feeding R1, therefore, the allegation is deemed Unsubstantiated. There is not enough corroborating evidence regarding staff not providing drinking water to resident R1. Based on investigation, there is not enough corroborating evidence to find any Neglect/Lack of Care and Supervision of R1 by the facility staff resulting in his/her dehydration, therefore, the allegation is deemed Unsubstantiated. Staff did not provide medication assistance to resident in care / Staff did not ensure resident's oxygen administration needs were met On April 3, 2024, the Department received a complaint alleging Staff did not provide medication assistance to resident in care / Staff did not ensure resident's oxygen administration needs were met On April 5, 2024, Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to open a complaint investigation. During the visit, LPA obtained copies of records. On April 18, 2024, the Department interviewed Witness W1. W1 stated a care giver (name unknown) neglected R1. W1 stated on April 4, 2019, the care giver (name unknown) had not given R1 his/her Medication M1. W1 stated when he/she went to see R1, it seemed as if R1 was gasping for air, so he/she asked the care giver to give R1 his/her oxygen mask. W1 stated they didn’t seem to care and they ignored W1. W1 stated he/she had to call the doctor and ask if R1 should have his/her oxygen and the doctor said yes. On April 23, 2024, the Department interviewed Witness W2. W2 stated he/she never witnessed any neglect. W2 stated W1 felt R1 wasn’t getting his/her Medication M1. W2 stated one time he/she went there, and R1 seemed to be in pain and the caregiver said he/she could not administer the morphine and W1 had to call the doctor in order for the facility to give R1 the M1. Page 4 Out of 8 On May 14, 2024, the Department interviewed Witness W3. W3 stated, W1 had alleged that on April 4, 2019, the facility had not given R1 Medication M1. W3 stated he/she wasn’t there and did not witness what W1 told him/her. W3 stated he/she saw R1 at the facility two times. W3 stated he/she didn’t see anything out of the ordinary and cannot verify any information W1 said happened. W13 stated it seemed the care givers were taking good care of R1. The Department asked W3 if there was something he/she saw at the facility that he/she didn’t like or if he/she saw R1 mistreated. W3 stated no. On May 14, 2024, the Department interviewed resident R2 and R3. R2 stated he/she liked living at the facility. Due to neurocognitive disorder, R2 and R3 were unable to provide relevant information during the interview. On April 30, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Nora Garcia. ADM stated she thinks she knows where and what the context is regarding the allegation that the facility was not administering medication originates from. ADM stated sometime several years ago, there was an incident where W1 was upset, claiming R1 needed M1, stating R1 was in pain. ADM stated R1 had already given M1. ADM stated W1 had contacted the doctor asking for R1 to have more M1. ADM stated she remembers W1 and the hospice nurse discussing the M1 and the hospice nurse explaining to W1 that R1 had already been given M1 that day. ADM stated there hasn’t been a time when R1 was not assisted with his/her oxygen. On April 3, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she isn’t aware how many times or when R1 was not administered medication M1. W1 stated a staff member he/she can’t identify didn’t give R1’s M1 and stated that staff member couldn’t find it. LPA asked W1 if he/she knew if R1 had already been administered M1, before he/she arrived at the facility that day. W1 stated he/she doesn’t know if R1 had been given a dose of M1 prior to him/her arriving to the facility that day. W1 stated he/she doesn’t think the oxygen was ever given. W1 stated he/she doesn’t know who is supposed to administer the oxygen. LPA asked W1 if he/she spoke with the hospice agency when he/she had concerns about the oxygen and M1. W1 stated he/she did call them but doesn’t know if he/she discussed the M1 or oxygen. Page 5 Out of 8 On April 10 and 15, 2026, Licensing Program Analyst Manuel Monter interviewed staff S1-S3. 3 Out of 3 staff (S1-S3) stated they have never observed or are aware of any instance where a resident was provided their medications. 3 Out of 3 staff (S1-S3) stated they have never observed residents being neglected their oxygen needs or assistance with their oxygen needs. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Staff did not ensure resident's diapering needs were met On April 5, 2024, Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to open a complaint investigation. During the visit, LPA obtained copies of records. On April 23, 2024, the Department interviewed Witness W2. W2 stated he/she never witnessed any neglect. On May 14, 2024, the Department interviewed Witness W3. W3 stated he/she saw R1 at the facility two times. W3 stated he/she didn’t see anything out of the ordinary and cannot verify any information W1 said happened. W3 stated it seemed the care givers were taking good care of R1. The Department asked W3 if there was something he/she saw at the facility that he/she didn’t like or if he/she saw R1 mistreated. W3 stated no. On May 14, 2024, the Department interviewed resident R2 and R3. R2 stated he/she liked living at the facility. Due to neurocognitive disorder, Residents R2 and R3 were unable to provide relevant information during the interview. On March 30, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator Nora Garcia. ADM stated the staff check and change all the residents, including R1 every 2 hours. ADM stated she is not aware of any instance where the residents changing needs were neglected. Page 6 Out of 8 On April 3, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated he/she believes the facility wasn’t changing R1. W1 stated after R1 had passed, he/she had a conversation with a friend who stated, maybe R1 was not feed / given liquids so they wouldn’t need to change his/her diaper. W1 stated because he/she thinks R1 wasn’t feed and given liquids, its leads him/her to believe R1 was not fed to avoid changing diapers. LPA ask W1 if he/she ever found R1 was not changed or left soiled for an extended period. W1 stated he/she doesn’t know. On April 10 and 15, 2026, Licensing Program Analyst Manuel Monter interviewed staff S1-S3. 3 Out of 3 staff (S1-S3) stated they are not aware of any instance where a residents changing needs were neglected. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Staff denied visitations to residents in care On April 5, 2024, Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to open a complaint investigation. During the visit, LPA obtained copies of records. On April 18, 2024, the Department interviewed Witness W1. W1 stated the facility had limited his/her visiting hours on when he/she could visit R1. On May 14, 2024, the Department interviewed resident R2 and R3. R2 stated he/she liked living at the facility. Due to neurocognitive disorder, Residents R2 and R3 were unable to provide relevant information during the interview. On March 30, 2026, LPA Manuel Monter interviewed Administrator Nora Garcia. ADM stated they never denied family from visiting. ADM stated the visiting hours for the facility is 9am-7pm. ADM stated visiting family members can stay as long as possible as long as it doesn’t disturb others. ADM stated if a resident is in the last weeks of their life, the family members can stay as long as they like. Page 7 Out of 8 ADM stated one time she did tell the W1, that he/she would need to leave because he/she was screaming and yelling, about R1 not being fed. ADM stated he/she came to the facility and told W1 to calm down, if he/she didn’t calm down, he/she would need to leave. ADM stated she told W1 that he/she is causing a ruckus and disturbing the other residents. On April 3, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W1. W1 stated at an unknown date/ time, there was a resident in hospice that was crying, stating his/her family were not allowed to visit. W1 stated he/she thought it was mean this was happening. W1 stated he/she doesn’t know the name of that resident. W1 stated the visiting hours are from 7:00pm – 7:30pm. W1 stated he/she didn’t know about this occurring to W2 or W3. W1 stated there were no incidents of him/her raising his/her voice in the facility. W1 stated he/she didn’t have any problems with the home. On April 10, 2026, Licensing Program Analyst Manuel Monter interviewed Witness W2. W2 stated regarding visiting R1, that he/she wasn’t personally denied from visiting. W2 stated he/she would visit around 4:30pm. On April 10 and 15, 2026, Licensing Program Analyst Manuel Monter interviewed staff S1-S3. 3 Out of 3 staff (S1-S3) stated the staff has never bared visitors from visiting. S1 and S2 stated if the families want to visit past 7, they can visit as well. S1 and S2 stated if a resident is in there last days before passing, then the families can come at all hours of the day. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. This Report was reviewed with Administrator Nora Garcia. LPA Monter informed Administrator Nora Garcia that a PDF copy of the signed report by LPA Monter will be emailed to ADM's for her signature and a signed copy returned to LPA Monter. ADM stated she will send the signed original report to the San Diego Regional Office. Page 8 Out of 8 End Of Report.the state’s words, verbatim · CDSS document, Apr 16, 2026 · control 08-AS-20240403143343

Allegation investigated: Facility staff did not meet resident's medical needs Facility staff did not allow resident to speak with family

On September 26, 2025, Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted a telephone conference with Administrator Nora Garcia to present investigative findings. The Department’s investigation included a facility tour, record review, and interviews with staff and external sources. On November 26, 2024, Community Care Licensing (CCL) received a complaint alleging that a resident (R1) required medical attention due to a persistent cough, and that staff did not take R1 to the doctor. It was specifically alleged that when an outside source spoke with R1 on the telephone, R1 sounded congested with a persistent cough. (Continue at LIC9099C) Unsubstantiated (continue at LIC9099) Interviews revealed that the outside source initiated a 911 call, resulting in law enforcement conducting a health and safety check on R1. However, record review and interviews determined that R1 did not require medical attention. During a visit on December 5, 2024, R1 was observed without any signs of illness. Although R1 was not alert to time, place, or self, they were observed interacting with staff and residents, watching television, and engaging socially. No cough or flu-like symptoms were observed during the two-hour visit. Staff and resident interviews confirmed that R1 had not been observed with a cough or flu-like symptoms. Staff reported that R1’s vitals were checked daily, with no concerns identified, and that R1 had not expressed any discomfort. Staff further indicated they remain vigilant in monitoring residents and act immediately when changes in condition occur. The investigation did not yield evidence that staff failed to meet R1’s medical needs. It was also alleged that on November 26, 2024, staff blocked an outside source from calling the facility to speak with R1. During the facility visit on December 5, 2024, LPA reviewed the facility’s phone log and phone system. Phone records confirmed that calls from the outside source’s number were received during November and December 2024, and no numbers were blocked on the facility’s phone. The phone log reflected call histories with varying durations, ranging from one to six minutes. Staff interviews denied the allegation, and multiple interviews with outside sources did not identify concerns about restricted resident phone access. The investigation did not yield evidence to support this allegation. The investigation found no corroborating evidence that staff failed to meet R1’s medical needs or that staff denied R1 the ability to speak with family or outside sources. Based on the investigation—including record reviews, staff interviews, and external sources—there is insufficient evidence to substantiate the allegations. Therefore, the allegations are deemed Unsubstantiated. (continue at LIC9099C) (Continue from LIC9099C) An exit interview was conducted with Administrator Nora Garcia. A copy of this report and the Licensee Appeal Rights (LIC 9058, 03/22) were provided via email at nora@nobleliving.org. Electronic confirmation of receipt was obtained.the state’s words, verbatim · CDSS document, Sep 26, 2025 · control 08-AS-20241126155127

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Renita Hall conducted an unannounced annual required visit to the above-mentioned facility. Upon arrival, LPA met with the Caregiver and was later joined by the Administrator. The facility operates as a Residential Care Facility for the Elderly, ages 60 and over, that serves the Dementia care residents. A facility tour was conducted, which included indoor activity areas, restrooms, kitchens, and outdoor space. All areas were clean, safe, and in good repair. Furniture and equipment were in good condition and appropriate for the clients in care. The facility has sufficient space and seating for all clients, with no exit obstructions. The restrooms were equipped with grab bars and adequate supplies. The hot water temperature was measured within the required range of 105°F to 120°F. Staff prepared meals, and menus were available at the time of the visit. A random sample of client files was reviewed. Files contained current physicians’ reports, admission agreements, emergency information, needs and services plans, and other required documentation. Staff records reviewed contained criminal record clearance, health screening, current first aid/CPR certification, and required training. The activity schedule was reviewed and observed to be posted. Clients were engaged in individual activities during the visit. Supervision was observed to be appropriate, and staff were seen interacting with clients in a respectful and supportive manner. LPA interviewed staff and clients present. No concerns were noted. The facility’s emergency disaster plan was observed to be current and posted. Fire extinguishers were serviced within the past year, and smoke/carbon monoxide detectors were operable. No deficiencies were cited during today’s visit. An exit interview was conducted with the Administrator, and a copy of this report, along with the Licensee Rights (LIC 9058), was provided to the Administrator. Her signature on this form confirms receipt of the documents.the state’s words, verbatim · CDSS document, Aug 18, 2025

Allegation investigated: Staff isolated resident for an extended period of time Staff are not meeting resident's toileting needs Staff are not meeting resident's hygiene needs Staff do not treat resident with dignity or respect

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to deliver findings regarding the above-mentioned allegations LPA was allowed entry by Nora Garcia, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings with the Administrator. On November 13, 2023 allegations were made against the staff of Noble Living II LLC regarding the mistreatment and neglect of residents. The specific allegations include staff isolating a resident for an extended period of time, staff not meeting the resident's toileting and hygiene needs, and staff failing to treat the resident with dignity and respect. On November 15, 2023, LPA interviewed the residents and staff members who may have witnessed or had relevant information regarding the incidents. LPA reviewed relevant documentation, including resident care plans, incident reports, and any other relevant records. LPA observed the facility's operations, staff interactions with residents, and the overall environment. {Continued on 9099C} Unsubstantiated After conducting interviews residents and staff members, no evidence was found to support the claim that the resident was isolated for an extended period of time. The resident's statements were inconsistent, and no witnesses could corroborate the allegation. During the investigation, the resident's care plan and documentation were reviewed. It was found that the resident's toileting needs were being addressed according to the established care plan. No witnesses or additional evidence were found to support the claim that staff were neglecting the resident's toileting needs. The investigation revealed that the resident's hygiene needs were being met as per the care plan. Staff members responsible for the resident's care reported following proper hygiene protocols and providing necessary assistance. No evidence was found to substantiate the claim that the resident's hygiene needs were being neglected. Interviews conducted with staff members and observations of their interactions with the resident did not provide any evidence to support the claim that the resident was being mistreated or disrespected. Staff members consistently reported treating the resident with dignity and respect, and no witnesses could confirm otherwise. Based on the investigation findings, the allegations made against the staff of Noble Living II LLC regarding the mistreatment and neglect of the resident are unsubstantiated. There is no evidence to support the claims that the staff isolated the resident, failed to meet their toileting and hygiene needs, or treated them without dignity or respect. A finding that is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Nora Garcia, Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Director and his signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Aug 22, 2024 · control 08-AS-20231113123805

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced Required 1 year Annual Visit. LPA was allowed entry by Nora Garcia, Administrator . LPA identified herself and disclosed the purpose of the visit with the Administrator. Physical Environment: The facility was found to be clean, well-maintained, and free from any safety hazards. Adequate lighting and ventilation were observed in all areas of the facility. All necessary safety equipment, such as fire extinguishers and emergency exits, were present and in good working condition. The facility's outdoor spaces were properly maintained and accessible to residents. Staffing and Training: The facility had a sufficient number of qualified staff members to meet the needs of the residents. The staff member was observed to be professional, courteous, and knowledgeable in their respective roles. All staff members had completed the required training and certifications per the licensing regulations. Staffing schedules were posted and adhered to, ensuring adequate coverage at all times. Continued on 809C Resident Care and Services: Residents' care plans were reviewed and found to be comprehensive and up-to-date. Medication administration was observed to be in accordance with the facility's policies and procedures. Residents' nutritional needs were met, and the meals provided were nutritious and well-balanced. Recreational activities and social engagement opportunities were available to residents regularly. Health and Safety: Regular health assessments and monitoring of residents' well-being were conducted by qualified healthcare professionals. Infection control measures were in place and followed by staff members. The facility had established protocols for emergencies and evacuation plans were readily available. Overall, the facility was found to comply with the licensing regulations. An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) was provided to Administrator. Her signature on this form confirms receipt of the documents.the state’s words, verbatim · CDSS document, Aug 22, 2024