Canyon Guest Home

Allegation investigated: - Faciltiy staff did not use the residents potural assistive device

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 caregiver Karina Colins. LPA stated the purpose of the visit and reviewed the findings of the complaint with Administrator Gaurav “ Gary” Rathi. The Department’s investigation consisted of interviews with staff and resident, and records review of relevant documents pertinent to this investigation, and LPA observations. On July 21, 2026, it was alleged that the facility staff did not use the residents’ postural support device. According to the facility documents, residents #1 (R1s) Discharge documents dated June 6, 2026, said they are alert and oriented. Progress Notes from their Senior Service Agency, dated June 11, 2026, annotates that the resident has an underlying medical condition that according to Mayo Clinic, symptoms may cause movement disorders. (Continuation on LIC9099-C) Unsubstantiated (Continuation of LIC9099) According to R1s notes, their neurologic system admits tremors/jerking movements, but their orientation is x3, has no speech issues and their memory is fair. It does annotate that R1 does have sporadic jerking movements. Their Physician’s Report (LIC602) show, R1 does have an underlying medical condition that cause cognitive impairment as well as another medical condition that can cause movement disorders. Their physical health shows that R1 has motor impairment. Their LIC602 also says that R1 is able to communicate and follow directions/instructions. R1’s overall metal health is good and does not have any behavioral expressions. It was specifically alleged that the facility staff did not use the residents postural supportive device. Interviews with staff #1 (S1) and staff #2 (S2) confirmed that the assistive device supports are not used for the resident at the facility. They do place the assistive device supports when the resident leaves the facility premise for example when they go see their primary care physician (PCP). According to S1, they do not want R1 to get hurt with their assistive device when they have uncontrolled movements and it also gives R1s legs freedom to move. According to S2 they do require R1 to have their supportive device on the wheelchair for R1s safety when they leave the facility. S2 said that R1 gets seen approximately three times per week and is currently being reviewed to obtain physical therapy services which are currently pending. LPA spoke with R1 who said that they did not like the assistive device due to movement restrictions and no “freedom” to move, but said they are indifferent to the device. Interview with Administrator said that R1 denies to place the device on their wheelchair on multiple occasions. They have to reason with them to place them on when they leave the facility. On July 28, 2026, LPA observed that R1 did not have the postural device on their wheelchair while they were at the facility. When their Senior Service Center came to pick up R1, S1 and Administrator Gary Rathi placed the postural supports on the wheelchair for their transport. The supportive device was extended to the maximum length and the residents knees were bent upwards and looked as if the device was not long enough as R1 is tall. Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and resident 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 Administrator Guarav “Gary” Rathi. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Administrator Rathi at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Jul 28, 2026 · control 08-AS-20260721155709

Allegation investigated: Staff do not ensure residents are accorded personal privacy while in care Staff do not ensure residents are treated with dignity while provided with dressing assistance

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit to investigative a complaint and deliver findings. LPA was granted entry into the facility and met with Administrator Gary Rathi to whom LPA explained the purpose of the visit. Community Care Licensing (CCL) has investigated the above listed complaint allegations. The investigation consisted of LPA observations, review of records, staff and outside source interviews. It was reported to CCL that staff at the facility may be taking photos of residents during personal care and that cameras might be placed inside resident bedrooms. No specific residents, dates, or further information were provided.LPA interviewed the assistant administrator (AA), who stated that they and new staff recently took over the facility. AA denied that staff take photos of residents while they are undressed and stated that no such instructions have ever been given. AA also stated they were not aware of any cameras inside resident bedrooms or any plans to install them. Unsubstantiated LPA interviewed Staff 1 (S1), who has worked at the facility for approximately three weeks. S1 explained that staff take photos mainly of meals, activities, and limited medical issues. S1 stated that when medical photos are taken, they only show the specific body area needing documentation and do not include residents’ faces or full bodies. S1 recalled a few examples, such as documenting a rash on a resident’s arm and a coccyx sore on a resident who has since passed away. S1 denied ever taking or seeing staff take photos of residents while they were unclothed. LPA interviewed Staff 2 (S2), who has worked at the facility for two weeks. S2 stated that most responsible parties provided written permission for staff to take photos for meals, activities, and medical concerns. One resident did not have consent, and staff only document that resident’s needs in writing. S2 reported that the new staff have been documenting medical issues that existed before they arrived, including the coccyx sore on the deceased resident. S2 denied any practice of taking photos during dressing or changing and stated they have not heard of any plans to install cameras in resident rooms. LPA interviewed an outside source (OS) who visits the facility every day and is familiar with the residents and staff. OS reported they have observed the facility before and after the new staff took over and described the new team as more engaged, organized, and attentive. OS stated the atmosphere now appears calmer and more structured, with a greater focus on meaningful engagement for residents with dementia. OS provided several examples of positive resident changes. OS described a resident who previously sat disengaged but now participates in simple group activities when encouraged by staff and shows more emotional comfort, such as smiling or responding to sensory items. OS described another resident who historically showed frequent distress but now appears calmer and less reactive, crediting staff for using gentle redirection and reassurance.OS reported hearing positive comments from multiple responsible parties who feel staff are more involved and communicative than before. OS stated that one responsible party asked them directly how they felt about staff taking photos of residents. OS said they told the responsible party that they support appropriate photo documentation because it helps families stay informed and helps staff monitor changes. OS stated they have only seen photos of meals, activities, and minor medical issues and that all photos appeared appropriate and respectful. OS stated they have never seen or heard of staff taking photos of residents who were undressed or of their private areas. LPA interviewed the administrator (ADM). ADM stated that staff regularly take photos of residents’ meals, activities, clothing, and rashes when needed for documentation. ADM stated that staff do not take full-face photos of residents, and if a face is captured, it is blurred. ADM reported that verbal and written consent was obtained from all responsible parties or POAs except for one resident, and that no photos are taken of that resident. ADM stated that no residents have cameras in their rooms and that there are no plans to install cameras in bedrooms. ADM also stated that many residents have rashes in their private areas and that staff monitor these regularly, sometimes taking photos of the rash and the cream applied, and only with responsible party consent. A review of records revealed that five residents had signed written consent forms allowing the facility to take photos or videos strictly for care-related reasons. The form explains that photos may be used to help staff understand behaviors, communicate with healthcare providers, and document medical issues. It also states that photos are kept private, stored securely, only shared with the resident’s care team, and that consent is voluntary and may be revoked at any time. One resident’s responsible party declined consent, and no photos are taken for that resident. Based on interviews and review of records, there is no evidence to support the allegations that staff violate residents’ privacy or dignity during care. At this time, all allegations are unsubstantiated. An exit interview was conducted with Gary Rathi. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Gary Rathi whose signature below verifies receipt of these rights.the state’s words, verbatim · CDSS document, May 14, 2026 · control 08-AS-20260507142442

Type of visit: Case Management - Other

On 5/4/2026, Licensing Program Manager (LPM) Robyn Clark and Licensing Program Analyst (LPA) Debbie Correia conducted a virtual case management meeting with Licensee Dan Raphael of Canyon Guest Home and Buyer Representative Rathi Gaurav, who will be taking an ownership interest in the facility. During the meeting, the Department clarified the status of the facility license and provided consultation regarding Health and Safety Code section 1569.19, Title 22 CCR section 87109 (Transferability of License), and section 87112 (Conditions for Forfeiture of a License). The Licensee confirmed that an updated Control of Property would be submitted to the Department on 5/4/2026. Additionally, the updated LIC 309, Change of Administrative Organization no later than 5/5/2026. This concluded the case management meeting, and no deficiencies were cited during today’s visit. An exit interview was conducted with the attendees who were informed that a copy of the report and appeal rights will be provided via email at the conclusion of the visit, and confirmation of receipt will be required.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) arrived unannounced and met with Assistant Administrator Gaurav to begin the inspection. The inspection included a review of staff files, resident records, and personnel documentation. Based on a review of staff records and interviews, it was determined that one staff was working at the facility without having their criminal record clearances transferred and/or associated to the facility, as required by California Code of Regulations (CCR), Title 22, Section 87355(e)(3). This section mandates that all individuals subject to background review shall have a valid criminal record clearance or exemption associated to the specific licensed facility prior to working, being present, or providing care and supervision. Failure to ensure proper criminal record clearance and association poses a immediate health and safety risk to residents in care. A review of resident records further revealed that notification to residents and/or their Responsible Parties regarding a bona fide offer was not completed within regulatory time frames, as required by CCR, Title 22, Section 87109(b). This regulation requires facilities to notify residents or their Responsible Parties in writing of a bona fide offer within the specified period, ensuring they are provided sufficient information to make informed decisions regarding continued placement and services.. Due to time constraints, the inspection could not be completed today and will be continued at a later date. An exit interview was conducted with Assistant Administrator Gaurav, who was informed that copies of the report (LIC 809 and LIC 809D) and appeal rights (LIC 9058) would be provided at the conclusion of the visit. The signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, Required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Stephani Tita. The facility's license shows a maximum capacity of six (6) residents, all of whom must be non-ambulatory. The facility is approved for five (5) hospice residents. During today’s inspection there were six (6) residents in care. LPA and caregiver Ronald Rafanan toured the interior and exterior of the facility and inspected each room. Administrator Daniel Raphael arrived later during the visit. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink 1 read 105F and bathroom sink 2 read at 108F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per caregiver Ronald Rafanan, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed two (2) staff and zero (0) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Daniel Raphael to whom a copy of this report was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Feb 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA identified himself and disclosed the purpose of the visit to Caregivers Marilou Delapena and Eva Estanol. The facility was Licensed for a capacity of six (6) non-ambulatory residents, with a hospice waiver of five (5). The LPA, accompanied by caregiver, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. The facility had extra linens, sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, and stored in locked areas. No pools, nor bodies of water were observed on the premises. Per staff, no firearms, nor ammunition were kept at the facility. Carbon monoxide detectors were operational. Facility telephone, a fire extinguisher, and a first aid kit were present. Required licensing postings were observed in visible areas of the facility. The LPA interviewed staff and reviewed multiple staff and client records/files. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Caregiver Delapena, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.the state’s words, verbatim · CDSS document, Jan 29, 2024

Allegation investigated: Staff does not ensure toileting assistance is provided to resident in care Staff allow resident to stay in soiled clothing for an extended period of time.

Licensing Program Analyst (LPA), Renita Hall conducted an unannounced complaint visit opened complaint, and delivered findings regarding the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Marilou De Le Pena, House Manager to discuss the purpose of the visit. On January 10, 2024, the department received a complaint that: the staff does not ensure toileting assistance is provided to the resident in care and staff allow the resident to stay in soiled clothing for an extended period. The Reporting Party: RP was interviewed to obtain their account of the events and stated that the resident was on Hospice and could stand to use the toilet but with assistance and admitted that Resident 1 (R1) legs are contracted and one leg is weaker than the other. A review of records indicated that R1 is non-ambulatory with incontinence impairment with a secondary diagnosis of Parkinson's disease and Dementia. Continued on 9099C Unsubstantiated The staff interviewed stated that R1 needed a two-person assist due to the non-ambulatory status of the resident. Staff used the Hoyer lift to properly change and clean R1 in the bed to reduce the number of injuries to staff and fall risks to R1. Staff followed incontinence changing schedule for R1. The Department’s investigation consisted of interviews with staff, outside sources, and a review of records. The allegations that staff does not ensure toileting assistance is provided to the resident in care and that staff allows the resident to stay in soiled clothing for an extended period have not been corroborated with interviewees. Based on interviews, and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marilou De Le Pena, House Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the House Manager and her signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Jan 16, 2024 · control 08-AS-20240110153616