Tree of Life Retirement Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required visit and inspection of the facility. At the time of arrival, LPA was greeted by one (1) caregiver on duty, and four (4) residents present. Administrator Chamila Ruwanpathirana and Caregiver/Facility Manager, Fred DeLorenzo arrived shortly thereafter. LPA informed staff of the visit. Entrance interview conducted: The facility is a one-story Residential Care Facility for the Elderly (RCFE). The facility accepts residents with a dementia diagnosis; has a waiver for three hospice residents; and a fire clearance for six non-ambulatory residents and one bedridden resident. Currently, there is one resident on hospice residing in the facility. There are currently four (4) residents residing in the facility. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations and food service. LPA observed fire extinguisher was last serviced on 2/18/2026. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. LPA observed the kitchen floor, walls and stove need to be cleaned. The backyard has a patio table with chairs and an umbrella. LPA observed an inadequate amount of perishables for two days. Administrator stated they were scheduled to do food shopping at the time of the inspection. LPA observed a sufficient amount of non-perishables for seven days. Snacks and beverages are available. Sharps are kept in a locked drawer located in the kitchen island. Please continue to 809-C, Page 2 The front yard consists of a walkway, sitting area, and a lawn and garden area. The backyard consists of a large, concrete surface with a sitting area with one table and chairs. The front yard and backyard are conducive to visitations with family and friends. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The washer, dryer, and cleaning supplies are kept in a locked laundry room and is inaccessible to residents in care The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet. Residents participate independently in music entertainment, puzzles, games, baking, and outings to parks, restaurants, religious services, and other local attractions. Administrator stated the facility will be introducing an occupational therapy program to include a program to bring miniature ponies to the facility as an interactive program for residents in care. There are five private bedrooms. Bedroom #1 has a private bath. Bedrooms 2, 3, and 4 have a bathroom off the hallway shared by all residents. Bedrooms #5 and 6 have a shared bathroom off the hallway. The bathrooms have secure grab bars and no skid flooring. Each bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. All persons associated with the facility have criminal record clearance. Administrator certificate is valid. Records reviewed indicate all personnel records are current and up-to-date. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 809-D). Technical violations issued. Exit interview conducted. Due to technical difficulties, report and appeal rights sent via email.the state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 14 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff acted inappropriately with resident(s). Staff do not provide proper care to residents.

Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Chamila Ruwanpathirana and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 09/03/2025 from 11:15 am to 1:00 pm, where LPA conducted interviews and obtained relevant documents. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Christine Ferris. Investigator Ferris attempted to interview former Resident 1 (R1), but was unsuccessful. During today’s visit, LPA conducted interviews with staff and residents from 1:45 pm to 3:15 pm. On the allegation: Staff acted inappropriately with resident(s): It was alleged that in April 2025, Staff 1 (S1) kissed R1 against their will, and pressured residents to drink vodka. R1 was unable to be interviewed, despite multiple attempts to contact them. Please continue to 9099-C, Pg 2. Unsubstantiated Administrator stated R1 resided at the facility for three years but had since moved out. Administrator stated R1 called and asked them to take R1 places after moving out. Administrator also stated R1 called and threatened the administrator’s family, said inappropriate things to the administrator, and called during the middle of the night. Interviews conducted revealed staff have not acted inappropriately and were happy with the care they receive from the staff. On the allegation: Staff do not provide proper care to residents: It was alleged that caregivers do not provide proper care to residents. No other details were provided. Administrator stated they are at the facility every day and take care of their residents. Facility Manager stated R1 had been homeless and greatly improved their quality of life during their time while residing at the facility. Facility Manager further stated R1 indicated they were ready to live on their own and Facility Administrator and Manager assisted R1 with R1’s move-out. Interviews conducted revealed residents are receiving proper care and are content with living in the facility. Based on the information obtained, the allegations are deemed Unsubstantiated at this time. Exit interview conducted. Copy of report issued at the time of the visit.the state’s words, verbatim · CDSS document, Jan 27, 2026 · control 29-AS-20250903084857

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required visit and inspection of the facility. At the time of arrival, LPA was greeted by one (1) caregiver on duty, and five (5) residents present. Administrator Chamila Ruwanpathirana and Caregiver/Facility Manager, Fred DeLorenzo were present. LPA informed Administrator of the visit. Entrance interview conducted: The facility is a one-story Residential Care Facility for the Elderly (RCFE). The facility accepts residents with a dementia diagnosis; has a waiver for three hospice residents; and a fire clearance for six non-ambulatory residents and one bedridden resident. Currently, there is one resident on hospice residing in the facility. There are currently five (5) residents residing in the facility. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations and food service. LPA observed fire extinguisher was last serviced on 2/6/2025. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The inside of the facility was seen to be in good repair. The backyard has a patio table with chairs and an umbrella. The kitchen area was sufficiently stocked with two-day perishables and non-perishables for seven days. Snacks and beverages are available. Sharps are kept in a locked drawer located in the kitchen island. Please continue to 809-C, Pg 2. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. The front yard consists of a walkway, sitting area, and a lawn and garden area. The backyard consists of a large, concrete surface with a sitting area with one table and chairs. The front yard and backyard are conducive to visitations with family and friends. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The washer, dryer, and cleaning supplies are kept in a locked laundry room and is inaccessible to residents in care The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet Residents participate independently in music entertainment, puzzles, games, baking, and outings to parks, restaurants, religious, and other local attractions. There are five private bedrooms. Bedroom #1 has a private bath. Bedrooms 2, 3, and 4 have a bathroom off the hallway shared by all residents. Bedrooms #5 and 6 have a shared bathroom off the hallway. The bathrooms have secure grab bars and no skid flooring. Each bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. All persons associated with the facility have criminal record clearance. Administrator certificate is valid. Records reviewed indicate all personnel records are current and up-to-date. Records reviewed revealed two residents are missing a Needs and Services Plan and one resident is missing a Pre-Appraisal and/or Appraisal. Exit interview conducted. Technical violations issued. A copy of the report was issued at the time of the visit.the state’s words, verbatim · CDSS document, Jul 11, 2025

The state marks this report as 10 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not provide timely medical care to resident.

Licensing Program Analyst (LPA) Kristin Kontilis conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Administrator Chamila Ruwanpathirana and explained the purpose of the visit. During the investigation, LPA Kontilis conducted an initial visit on 6/12/2024 from 9:40 am to 1:40 pm. LPA toured the facility, conducted interviews with staff and residents, and obtained documents. On the allegation: Staff did not provide timely medical care to resident. It was alleged that a resident fell out of bed during the night, but staff did not respond until the next morning. Facility manager stated Resident 1 (R1) fell out of bed, even though they had a half rail. They believe R1 scooted down around the rail, took a few steps then fell. The night staff heard the fall and called the manager and administrator immediately. The night staff assisted R1 back to bed and checked on them. R1’s arm was swollen, and they called 9-1-1 at that time as well as R1’s responsible party. R1 was put in a soft cast and returned to the facility. Please continue to 9099-C, Pg 2. Substantiated Staff stated while passing morning medications, they found R1 on the ground. They assisted R1 back to bed, and R1 did not indicate any pain. Staff indicates they found R1 around 6:30 am to 7:00 am. Around 7:30 am or 7:40 am, staff checked on R1 and saw the arm was swollen and they believed it to be broken. Staff called the administrator. Administrator stated she arrived at the facility around 7:30 am or 8:00 am. Administrator called hospice first, stating “we are not supposed to call 9-1-1 if they are on hospice.” The hospice nurse came and 9-1-1 was called. R1 also experienced another fall from a chair. Manager stated the pad on the chair slipped out and R1 slid forward, and it happened very quickly. R1 hit their head on the floor and 9-1-1 was called. R1 received stitches and returned to the facility. Administrator stated they called hospice, and hospice indicated to call 9-1-1. Administrator stated again this is the procedure when a resident is on hospice. For medical emergencies that are not directly related to a resident’s terminal illness and reason for hospice services, the licensee must call 9-1-1 and seek medical attention for the resident. Based on the information obtained, R1 received untimely medical attention on two occasions, as evidenced by the delay to contact the administrator and/or hospice before calling 9-1-1. Therefore, the allegation is deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. Due to technical difficulties, report and Appeal Rights were emailed to Administrator. staff or residents drinking alcohol in the facility. Residents interviewed stated they have never seen staff drinking, and never smelled alcohol. Residents also stated they had never been offered alcohol. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Due to technical difficulties, report and Appeal Rights were emailed to Administrator.the state’s words, verbatim · CDSS document, Jul 2, 2024 · control 29-AS-20240605132235

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87469(c)(3) · Plan of correction due date: Jul 3, 2024

87469(c)(3) Advanced Directives. Specifically for a terminally ill resident that is receiving hospice services…For emergencies not directly related to the expected course of the resident’s terminal illness, the facility staff shall immediately telephone emergency response (9-1-1). This requirement was not met as evidenced by: Based on interview, the licensee did not comply with the section cited above when they did not seek immediate emergency medical assistance for R1, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 2, 2024

Plan of correction: Administrator agrees to submit a signed statement of understanding of 87469. Administrator agrees to review CCR 87649 in its entirety with facility staff.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required visit and inspection of the facility. At the time of arrival, LPA was greeted by one (1) caregiver on duty, and five (5) residents present. Administrator Chamila Ruwanpathirana and Caregiver/Facility Manager, Fred DeLorenzo were present. LPA informed Administrator of the visit. Entrance interview conducted: The facility is a one-story Residential Care Facility for the Elderly (RCFE). The facility accepts residents with a dementia diagnosis; has a waiver for three hospice residents; and a fire clearance for six non-ambulatory residents and one bedridden resident. Currently, there are three residents on hospice and there is one resident who is bedridden residing in the facility. There are currently five (5) residents residing in the facility. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The inside of the facility was seen to be in good repair. The backyard has a patio table with chairs and an umbrella. Facility Manager stated a schedule will be created to keep the patio free of debris. LPA observed fire extinguisher was last serviced on 3/2/2023. Facility Manager stated the extinguisher will be serviced no later than 6/5/2024. The kitchen area was sufficiently stocked with two-day perishables and non-perishables for seven days. Snacks and beverages are available. Sharps are kept in a locked drawer located in the kitchen island. Snacks and beverages are readily available for Residents. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Please continue to 809-C, Pg 2. The front yard consists of a walkway, sitting area, and a lawn and garden area. The backyard consists of a large, concrete surface with a sitting area with one table and chairs. The front yard and backyard are conducive to visitations with family and friends. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The washer, dryer, and cleaning supplies are kept in a locked laundry room and is inaccessible to residents in care The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet. Residents participate independently in music entertainment, games, baking, and outings to parks, restaurants, religious, and other local attractions. There are five private bedrooms. Bedroom #1 has a private bath. Bedrooms 2, 3, and 4 have a bathroom off the hallway shared by all residents. Bedrooms #5 and 6 have a shared bathroom off the hallway. The bathrooms have secure grab bars and no skid flooring. Each bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. . All persons associated with the facility have criminal record clearance. Administrator certificate is valid. Records reviewed indicate all personnel and residents' records are current and up-to-date. The following deficiencies were observed (see LIC809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies by the correction due date may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued at the time of the visit.the state’s words, verbatim · CDSS document, Jun 4, 2024