Bonita Springs Senior Living

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Administrator, Dulce Cera and stated the purpose of today's visit. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 1 room in the backyard which was locked and used for storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 16 resident rooms, living room, dining room, kitchen and activity room. 16 Out of 16 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in random bathroom sinks where inspected and the water temperature ranged from 116.0 - 119.3 degrees F. Fire extinguisher was observed and inspected on 08/14/2025. Facility fire sprinkler was inspected by third party vendor on 12/11/2025 and passed the inspection. The last disaster drills were conducted on 01/29/2026 and 02/28/2026. Elevator were inspected by third party vendor on 11/25/2025 and no issue was noted. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. Technical Violations were provided. This report was reviewed with Administrator, Dulce Cera and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Mar 27, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Licensee is financially abusing resident as refund was not provided after death of resident.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai spoke with the Administrator (ADM) Dulce Cera and met with Case Manager (CM) Melissa Diatte and Human Resources (HR) Aisha Syed stated the purpose of today’s visit. ADM provided verbal authorization for Aisha Syed to sign today's report on ADM's behalf. On 01/29/2026, the Department received a complaint with the above allegation. On 02/05/2026, the Department conducted an initial investigation at the facility. It was alleged the resident’s responsible party was not provided with a refund after resident passed away. The Department was not provided with resident’s name or other information, but it was stated the resident only stayed at the facility for less than a month. Continuation on LIC 9099-C, Page 1 of 3. Unfounded Page 2 of 3. On 02/05/2026, LPA Rai interviewed staff (S1) and Administrator (ADM) Dulce Cera. Both staff reviewed the facility records to review the list of residents that passed away at the facility in 2025. Both staff stated resident (R1) was a resident who stayed at the facility for less than a month in 2025. Both staff stated R1 moved to the facility on 10/02/2025 and R1 was admitted to hospice services at the facility the same day. Both staff stated R1 passed away at the facility on 10/08/2025 under Hospice services and in terms of the addendum to Admission Agreement, the facility is not issuing a refund, but in this case, they made an exception. Both staff stated R1’s responsible party was provided with a refund check, and it was cashed out within the week. Based on review of R1’s Admission Agreement effective admission date 10/02/2025, page 5 out of 16, “in the event of your death, a pro-rated refund of prepaid rates will be made from the date that all of your personal belongings are removed from your room. Refunds will be processed within fifteen (15) days. R1’s admission agreement is signed by R1’s responsible party (RP). Based on review of R1’s Addendum to Admission Agreement, “No Refund for Hospice Admissions: In the Event that a resident is admitted to the Facility wile already under the care of hospice agency, the Facility shall not issue any refunds of paid fees in the event of the resident’s discharge or death.” and it was signed by R1’s responsible party on 10/01/2025. Based on review of R1’s refund check dated 10/20/2025, the check was issued to R1’s responsible party and memo on the check stated, “Refund of room and board charges for R1”. Based on review of facility’s bank records, R1’s refund check dated 10/20/2025 was cashed out on 10/23/2025. During today’s visit, LPA Rai interviewed 4 staff (S1-S3), including Administrator (ADM) Dulce Cera. LPA Rai wanted to clarify the amount of money issued on the refund check. ADM stated the amount decided for R1’s refund check was 30% of the monthly rate and preadmission fee. ADM stated R1’s responsible party was agreeable to the amount of the refund check as the check was cashed, and no issues were brought up to ADM. Page 3 of 3. The Department has completed the investigation of the above allegation. Based on interviews conducted and record reviews, the Department has found that the above allegation were UNFOUNDED, meaning that the allegation were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Human Resources (HR) Aisha Syed and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 26-AS-20260129130847

Type of visit: Prelicensing

On March 12, 2025 at 2:00 PM, Licensing Program Analysts (LPA) Kenneth Madrigal and Steve Chang conducted a Pre-licensing visit. LPAs met with Syeda Omer, Owner and Dulce Cera, Administrator (ADM) and was granted access to the facility. LPAs toured the facility inside and out with the ADM and the owner. On the first floor, there are 11 resident bedrooms with each room having its own bathroom, one medication room, lobby area, recreation activity room, shower room, bathrooms, kitchen area, dining room, office, lounge, two small bathrooms, one accessible bathrooms, and 5 emergency exits. On the second floor, there are 5 resident rooms, and two emergency exits. LPAs observed the rights rights, resident council, theft policy, emergency disaster plan, and other forms that are viewed for display at the facility hallways. LPAs observed the areas for storing the locked medication and knifes area. ADM stated that there no will be "live in staff", and there are no staff bedrooms. There is a fire alarm and carbon monoxide system that connects to all the fire alarms in the facility. LPAs observed a storage room in the backyard that the Owner stated that she does not have access to that space and does not own that property as the Owner is leasing the building, she does not have ownership of that storage room for the next 1 year to 1 year and half per the owner's contract. The current submitted floor plan to CAB Analyst and the physical plant on today's visit has minor differences. The designated rooms in the floor plan does not match the physical plant. ADM provided an updated floor sketch plan to LPAs. LPAs advised to submit this updated sketch floor to CAB Analyst. The current phone number on Field Automation System (FAS) is no longer in service. ADM stated that they have purchased a new phone line for the facility which is (669) 242 - 7150 and the facility is now using the new phone number and it was tested by ADM and LPAs. The fridge temperature was 40 degrees F, the freezer temperature was recorded at 0 degrees F, and the water temperature is 120 degrees F. The fire extinguisher was last serviced on June 10, 2024. Component III was presented to the ADM and the owner. LPAs provided a resource, Technical Support Program (TSP) with a URL link to ADM and the owner of the facility. An exit interview was conducted with ADM and the owner and a copy of this report was provided to them.the state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 32 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Cera Dulce, Administrator; Syeda Omer, Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 27, 2025