Roundhill Care Homes

Type of visit: Case Management - Health Checks

On 6/3/2026 at 1:50 PM, Licensing Program Analyst (LPA) A. Gomez conducted a Health & Safety inspection as a result of the department receiving notice that the licensee passed away. LPA met with Backup Administrator, Ana Breen and explained the purpose of the visit. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 110.4 degrees F in the hallway bathroom. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Facility grocery shops on a weekly basis. Resident's medications were kept locked in cabinet. Smoke detectors and carbon monoxide detector observe. First-aid kit was complete. Fire extinguisher was last serviced on 10/14/2025. Pool observed to be locked and secured. Indoor and outdoor passageways are free of obstruction. Facility currently has one (1) resident. There were two (2) caregivers on duty at the time of the inspection. LPA spoke with Backup Administrator, Ana Breen who is next of kin who states that they would like to begin the Emergency Approval to Operate (EAO) procedures and has submitted documents to the department. Backup Administrator states that they will submit additional required documents as soon as possible/available and will file an application for a new license. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 3, 2026

Type of visit: Case Management - Other

On 5/20/2026 at 1:30PM Licensing Program Analyst (LPA) arrived to the facility unannounced to conduct a case management for observations made during the case management on 3/23/2026. LPA met with Administrator, Ana Breen and explained the purpose of the visit. While conducting the case management on 3/23/2026 LPA observed that the Licensee/Administrator was not of good health and unable to perform their necessary duties. Backup Administrator stated that their condition was temporary and that they should be in good health in the next few months. LPA returned to assess the condition of the Licensee/Administrator and observed that their condition remains the same. Ana explained that they are planning on taking over the facility/ License and will reach out to CAB. While conducting the case management LPA also observed the following: LPA observed kitchen cluttered throughout. LPA advised the Administrator to finish renovations and organizing and to notify CCLD upon completion. Expected completion July 17, 2026 No deficiencies cited at this time and a copy of this report provided.the state’s words, verbatim · CDSS document, May 20, 2026

Type of visit: Case Management - Other

On 3/23/2026 at 1:00PM Licensing Program Analyst (LPA) arrived to the facility unannounced to conduct a case management for observations made durring the annual visit on 1/28/2026. LPA met with Administrator, Ana Breen and explained the purpose of the visit. While conducting the annual visit on 1/28/2026 LPA observed that the Licensee/Administrator was not of good health and unable to perform their necessary duties. Backup Administrator stated that their condition was temporary and that they should be in good health by the beginning of March 2026. LPA returned to assess the condition of the Licensee/Administrator and observed that their condition remains the same. While conducting the case management LPA also observed the following deficiencies: THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed expired food in the refrigerator and not stored properly LPA observed kitchen cluttered throughout, and carpets unclean with odor LPA observed unlocked paint cans on the kitchen floor and a pair of scissors in a black holster. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2) · Plan of correction due date: Apr 23, 2026

(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in the facility being maloudorous, and Kitchen cluttered which poses a potential health and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 23, 2026

Plan of correction: By POC Facility agrees to organize and sanatize the facility and notify CCLD

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(8) · Plan of correction due date: Apr 23, 2026

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in having expired and improperly stored food in the refrigerator which poses a potential health and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 23, 2026

Plan of correction: By POC Facility agrees to organize food and clean out the refridgerators and notify CCLD

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Apr 23, 2026

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in in having accesable paint and scissors in the kitchen which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 23, 2026

Plan of correction: By POC Facility agrees to organize to ensure adequete space for dangerous items and notify CCLD

Type of visit: Required - 1 Year

On 1/28/2026 at 8:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Ana Breen and explained the purpose of the visit. The facility’s fire clearance was approved for all residents may be non-ambulatory. LPA toured facility with Ana Breen including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 1 bedrooms are occupied by the residents and 3 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. Pool observed locked and secured. A comfortable temperature is maintained at 76 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 10/14/2025. LPA is requesting a new emergency disaster plan be drafted. LPA reviewed 1 residents records. LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. Report Continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed that the facility is cluttered and not sanitary; dust/cobwebs throughout; bathroom with urine on the toilet seat; Facility is malodorous throughout * LPA observed a pair of grey and orange scissors unlocked in kitchen and chemicals in bathroom * LPA observed expired food in the refrigerator and not stored properly; expired garlic, raw meat dripping on veggies, and uncovered open food.* LPA observed the floor in disrepair in the dining/sitting area.; Toilet seat in bathroom is broken LPA observed trash is not properly being disposed of (Piled on top of trash bin in kitchen in open paper bags) ***Civil Penalties issued for repeat violations 3 X $250 *** Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/03/2025: LIC 500 Personnel Report Change of Administrator Documents Emergency Disaster Plan LIC610E The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 28, 2026

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 2/10/2025 at 9:20 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Ana Breen and explained the purpose of the visit. The facility’s fire clearance was approved for all residents may be non-ambulatory. LPA toured facility with Ana Breen including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 1 bedrooms are occupied by the residents and 3 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. Pool observed locked and secured. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 11/19/2024. Emergency Disaster Plan was last posted on 02/10/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/15/2025. At 11am, LPA reviewed 1 residents records. At 11:30 am, LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. At 1:00pm, LPA reviewed a sample of resident’s medications. Report Continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed that the facility is cluttered and not sanitary; dust throughout LPA observed a pair of green scissors unlocked LPA observed expired food in the refrigerator and not stored properly; expired broccoli and uncovered open food. LPA observed unlocked medications in the refrigerator ***Civil Penalties issued for repeat violations 3 X $250 *** Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/03/2025: LIC 500 Personnel Report Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 10, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Facility is in disrepair. Staff did not ensure facility is clean and sanitized. Facility did not follow proper reporting requirements.

On 11/19/2024 at 3:00 pm, Licensing Program Analyst (LPA) A Gomez arrived unannounced to deliver amended report findings in regard to the allegations above. LPA met with Administrator, Ana Breen and explained the purpose of the visit. On the allegation of "Facility is in disrepair," LPA conducted multiple visits to assess the condition of the facility. During the initial visit on 5/09/2024, LPA observed a slow drip from the kitchen sink, which had a bucket placed underneath to catch the water. However, the sink was still operational, and the slow drip did not interfere with the facility’s daily operations. Report Continues on LIC9099-C Unsubstantiated The Administrator confirmed that the leak had been ongoing for approximately a week and was actively working to repair it. LPA also inspected the rest of the facility, including bathrooms, common areas, and the front and back yards, and found no other issues of disrepair. On 8/01/2024, during a follow-up visit, LPA confirmed that the kitchen sink had been fully repaired and no longer required a bucket to catch the water. On the allegation of "Staff did not ensure the facility is clean and sanitized," LPA conducted inspections on 5/09/2024 and 8/01/2024. During both visits, LPA observed that the facility was clean, well-maintained, and free from any visible signs of unsanitary conditions. The bathrooms, kitchen, common areas, and both the front and back yards were all in satisfactory condition with no issues regarding cleanliness or sanitation. There were no reports or evidence of pests or contamination during the visits. On the allegation of "Facility did not follow proper reporting requirements," during the initial visit on 5/09/2024 LPA spoke with the Administrator who stated that the kitchen sink had a slow drip for less than a week before LPA conducted the initial visit. LPA requested plumber invoices/quotes by 5/16/2024. The facility subsequently submitted the requested documents, and LPA reviewed them before the follow-up visit on 8/01/2024. The reports showed that the facility had gotten a quote for repair on 5/4/2024. During the visit on 8/01/2024, LPA also confirmed that the kitchen sink had been fully repaired and no longer required a bucket to catch the water. The facility was within their reporting time frame when LPA conducted the visit on 5/09/2024. LPA was unable to receive any proof from RP to substantiate the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 20, 2024 · control 15-AS-20240502154143

Type of visit: Case Management - Other

On 11/20/2024 at 4:02PM Licensing Program Analyst (LPA) arrived to the facility unannounced to deliver an Amended report for complaint 15-AS-20240502154143. LPA met with Administrator, Ana Breen and explained the purpose of the visit. LPA delivered the amended report. All Allegations went Unsubstantiated. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 20, 2024

Type of visit: Required - 1 Year

On 03/26/2024 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Ana Breen and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory. LPA toured facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 4 bedrooms are available for residents and 2 bedrooms is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. The pool is locked and secured. A comfortable temperature is maintained at 78 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 111.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is not a minimum of one week supply of nonperishable and 2-day of perishable foods once expired and spoiled food was discarded. Centrally stored medication and sharps were not locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 12/29/2023. Emergency Disaster Plan was last reviewed on 10/05/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 02/16/2024. At 11:00AM, LPA reviewed 1 of 1 residents records. At 11:30AM , LPA reviewed 3 of 3 staff records and 3 of 3 have current first aid training and arenassociated to the facility. Report continues on LIC 809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:00 AM during facility tour LPA observed that food in refrigerator is spoiled and expired. There was spoiled bok choy, tomatoes, bagged salads, uncooked sausages, uncooked corned beef, asparagus, bell peppers, uncooked tri-tip, and uncooked hot dogs among other foods. LPA advised administrator to dispose of the spoiled food as well as the food that was cross contaminated. (repeat violation) 87555(b)(8) At 10:05 AM during facility tour LPA observed unlocked knife and a pair of scissors in the top oven. Also the sharps cabinet was unlocked and contained a butcher knife. (repeat violation) 87309(a) At 10:05 AM during facility tour LPA observed the oven to be missing the knobs for function. At 10:07 AM during facility tour LPA observed animal fecal matter smeared on floor At 10:14 AM during facility tour LPA observed a disorganized closet with unlocked Combat Roach killing gel.(repeat violation) 87309(a) At 10:16 AM during facility tour LPA observed a bottle of Lisinopril 10MG on table in common area. (repeat violation) 87465(h)(2) At 10:18 AM during facility tour LPA observed a broken latch on sliding door in R1's room. Door was also cushioned with pad used for incontinence. (repeat violation) 87303(a) At 10:18 AM during facility tour LPA observed layers of cobwebs in R1's bedroom at the top of sliding door. At 10:20 AM during facility tour LPA observed infestation of ants in laundry room as well as a mildew odor Report continues on LIC 809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT CONTINUED: At 10:25 AM during facility tour LPA observed a screen door with holes and in disrepair 10:00AM -10:29AM Facility was observed unsanitary throughout. Dirt on walls, floors, grease on kitchen appliances, odor throughout facility, surfaces sticky. (repeat violation) 87303(a) At 11:30 AM during file review LPA observed that R1's physicians report states that they are bedridden and facility is not cleared for bedridden (Immediate $500 civil penalty) ***An Immediate $500 civil penalty is being assessed for fire clearance violation*** *** A $250 civil penalty is being assessed for each repeat violation ($250 X 4)**** The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 26, 2024

The state marks this report as 11 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

LPAs K. Nguyen and A. Gomez arrived unannounced to conduct a case management regards to LIC 500. LPA was not able to reach the Administrator. LPAs spoke with Zella Cristobal and explained the purpose of the visit. Zella stating, she was a visitor who came to visit her brother, and when asked if there’s any staff in the facility she stated “NO” only her. Zella was listed as a volunteer on the LIC 500. Later Delze Cristobal arrived. LPA spoke with Administrator, Ana Breen. arrived at 10:35am. LPAs requesting document to be submit to CCLD by 2/1/24: -Care plan for all residents LPAs toured the facility/ Observations at 10:15am: - Medication was left unlocked inside the First Aid cabinet. - Knife left out on the kitchen counter on the cutting mat. Knife left out by the sink. Dishwasher was left open knife was observed to be unlocked. - Chemical was left unlocked in the bathroom cabinet and laundry mat. - Pool gate was not lock. - Refusing entry LPAs observed a deficiency violation which have been cited (see LIC 809d) on 10/05/23. Immediate $500x3 and repeated violation $250 is assess today. Deficiencies, Plan of Corrections, Civil Penalties, Appeal Rights discussed with Ana Breen. A copy of civil penalty is issue and appeal right provided to Administrator.the state’s words, verbatim · CDSS document, Jan 25, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jan 26, 2024

87309 Storage Space: (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients... (b) Medicines which are centrally stored shall be stored as specified in Section 87465 and separately from other items specified in (a) above... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by leaving: - Medication was left unlocked inside the First Aid cabinet. - Knife left out on the kitchen counter on the cutting mat. Knife left out by the sink. Dishwasher was left open knife was observed to be unlocked. - Chemical was left unlocked in the bathroom cabinet which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Administrator will review regulation and submit a self-certified stating that AD review and understand the regulation. Administrator will lock all chemical and medicine and submit proof to CCLD by the due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(e) · Plan of correction due date: Jan 26, 2024

(e) Swimming pools and other bodies of water shall be fenced and in compliance with state and local building codes. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having an unlocked pool area which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: By POC date Administrator agrees to have items in backyard removed or placed in a locked storage and submit photographic proof to CCLD

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.32 · Plan of correction due date: Jan 26, 2024

1569.32 Spot inspections Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this chapter. This requirement is not met as evidenced by: Volunteer staff refused to let LPA in when asked.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: LPA went over the regulation with Administrator to provide education to informed AD upon regulation.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1548(c)(3) · Plan of correction due date: Feb 1, 2024

1548 (c)(3) Civil penalties; regulations setting forth appeal procedures for deficiencies This requirement is not met as evidenced by: LPA confirmed with Zella a voluneer at the facility that there was no staff present during the time LPA arrived.the state’s words, verbatim · CDSS document, Jan 25, 2024

Plan of correction: Administrator will insure to hire more staff. Administrator will review the regulation and submit a self-certifiy that AD review the regulation to CCLD by POC date.

Type of visit: POC

On 11/30/2023 at 9:30am, Licensing Program Analysts (LPAs) A. Gomez and L. Hall arrived unannounced to conduct proof of correction (POC) visit. LPAs met with Ana Breen, Administrator, and explained the purpose of the visit. LPA A Gomez conducted a POC visit on 11/03/2023 and cited facility for the following: · 87303(a) Care Persons with Dementia- LPAs observed today swimming pool fenced and locked · 87555(b)(8) General Food Service Requirements- LPAs observed today food of good quality and labeled appropriately. · 87303(a) Maintenance and Operation- LPAs observed the facility to be clean and in good repair · 87307(d)(6) Personal Accommodations and Services- LPAs observed the facility and yard to be free of obstruction LPAs observed that all deficiencies are now clear. Exit interview conducted and a copy of this report providedthe state’s words, verbatim · CDSS document, Nov 30, 2023