A Faithful Home of Covina

Allegation investigated: Staff did not seek medical attention for resident. Staff did not provide adequate supervision to residents in care. Staff has inappropriate interaction with resident. Administrator does not have qualifications.

***This licensing report supersedes the previous licensing report dated 06/16/26 to add an additional allegation and to clarify information obtained during the complaint investigation. The investigation findings will remain the same*** On 02/23/26, LPA Vaid requested and obtained for review the following documents, staff and resident roster, R1's face sheet/ID, physician report, needs and services, medication record and medication administered record, physician orders for medications. Interviewed staff #1-#3. Interviewed clients R#2- and R#3. Unusual Incident report dated 02/14/2026 and 03/01/26. LPA collected staff and resident roster. Interviewed staff and residents. On 06/16/2026, Licensing Program Analyst (LPA) Vaid conducted subsequential visit to the facility and was met by Lead Caregiver- Glen Oriemo explained the reason for the visit, administrator was notified. Administrator was unavailable. LPA Vaid and Caregiver Oriemo toured the facility and did not observe any health or safety concerns. On today’s visit, Licensing Program Analyst (LPA) Vaid conducted subsequential visit and met with lead caregiver Glen Oriemo, discussed the visit. Glen informed the administrator and assisted with tour of the facility, no health and safety concerns observed. LPA Vaid spoke with Administrator on telephone and discussed visit. CONTINUED ON 9099C........... Unsubstantiated ***This licensing report supersedes the previous licensing report dated 06/16/26 to add an additional allegation and to clarify information obtained during the complaint investigation. The investigation findings will remain the same*** The investigation revealed the following: Allegation: Staff did not seek medical attention for resident. It is alleged that a resident informed staff of not feeling well and resident requested medical attention, however staff did not seek medical attention for resident. Interviews with three (3) of three (3) staff deny the allegation. Staff stated an incident occurred on 02/14/26 between R1 and R2. R2 clipped R1’s toenails and injured R1’s toe. Staff stated upon hearing R1’s calls for assistance, staff provided R1 with first aid and staff called 911. R1 was taken to hospital by first responders. Staff #1 (S1) stated when residents request medical attention, the staff notify the resident’s physician and await further orders from the physician. Staff provide residents with PRN medication for pain when needed. Staff stated residents are always transported for medical treatment when needed. Staff stated that residents can also call for emergency services, if residents feel ill. Staff do not interfere with residents seeking medical attention. Three (3) of four (4) residents stated getting medical attention when required. Staff call to obtain medical assistance for residents when necessary. Based on interviews and records review, there is no evidence to corroborate this allegation. Allegation: Staff did not provide adequate supervision to residents in care. It is alleged that a resident entered another resident’s room with nail clippers, cut residents toenails and the resident needed to call staff for assistance. Three (3) of three (3) staff deny the allegation. Staff #1 (S1) stated residents are free to roam the facility and visit other residents’ rooms via invitation. S1 reported that on 02/14/26, an isolated incident occurred between R1 and R2. R2 was invited by R1 into R1’s room, R2 offered to cut R1’s toenails. R1 refused R2’s offer and yelled for help as R2 cut and tore off R1’s toenail. Upon staff hearing R1’s request for help, staff immediately responded and went to R1’s room to assist R1. S1 called 911, while R2 administered first aid to R1. Staff redirected R2 away from R1 multiple times. R2 attempted to interfere with staff giving 1st Aid to R1. Staff #3 (S3) separated R2 from R1. Staff informed R2 that R1’s nails are to be trimmed by a Podiatrist. S1 stated that R1 and R2 have no previous history of aggression toward one another. Three (3) of four (4) residents could not corroborate this allegation. Two (2) of four (4) residents stated residents receive adequate care and supervision from staff. Based on staff and residents’ interviews, there is no evidence to corroborate this allegation. CONTINUED ON 9099C................. ***This licensing report supersedes the previous licensing report dated 06/16/26 to add an additional allegation and to clarify information obtained during the complaint investigation. The investigation findings will remain the same*** Allegation: Staff has inappropriate interaction with resident. It is alleged that staff make inappropriate comments to residents, staff threaten residents by referring to federal law and tell a resident that the resident does not pay to reside in the facility due to receiving government subsidy payments. Interviews with three (3) of three (3) staff deny the allegation. Staff stated they are providing residents with comfortable care and staff are meeting the residents’ needs. Staff stated they treat residents with dignity and respect and provide residents with words of positive affirmation. Interviews with three (3) of four (4)residents could not corroborate the allegation. Two (2) of four (4) residents’ stated the staff are respectful and staff do not have inappropriate interaction with residents. Based on staff and residents’ interviews and observations, there is no evidence to corroborate this allegation. Allegation: Administrator does not have qualifications. It is alleged that Administrator is not qualified to serve as the facility administrator and is making safety-related decisions that Administrator is not qualified to make. Interviews with three (3) of four (4) staff deny the allegation. Staff #1 (S1) stated not being the Administrator for the facility, and works as the Lead Caregiver of the facility. LPA Vaid spoke to Facility Administrator on file for the facility operations. The Administrator stated that S1 has been the Lead Caregiver at the facility for over four (4) years and is knowledgeable regarding the facility protocols and procedures. Administrator stated being informed by S1, S2, S3 during emergencies and serious incidents that affect the resident’s care. Administrator stated being the facility’s back-up Administrator for 1.5 years and is making safety-related decisions upon the facility operations, staff oversight/training and residents care. S4 stated having completed the residential care for the elderly administrator certificate program. Administrator certificate Effective 02/07/2025, expiration 02/06/2027. Interviews with five (5) of five (5) stated S4 is the administrator residents communicate their issues. Based on records review and interviews, there is no evidence to corroborate this allegation. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation(s) are unsubstantiated. Exit interview was conducted with staff, Glen Oriemothe state’s words, verbatim · CDSS document, Aug 14, 2026 · control 28-AS-20260223144352

Allegation investigated: Staff did not seek medical attention for resident. Staff did not provide adequate supervision to residents in care. Staff has inappropriate interaction with resident.

Licensing Program Analyst (LPA) Vaid conducted subsequential visit to the facility and was met by lead caregiver- Glen Oriemo explained the reason for the visit, administrator was notified. Administrator at personal appointment, unavailable. LPA Vaid and caregiver Oriemo toured the facility and did not observe any health or safety concerns. LPA collected staff and resident roster. Interviewed staff and residents. On 02/23/26, LPA Vaid requested and obtained for review the following documents, staff and resident roster, R1's face sheet/ID, physician report, needs and services, medication record and medication administered record, physician orders for medications. Interviewed staff #1-#3. Interviewed clients R#2- and R#3. Unusual Incident report dated 03/01/26. The investigation revealed the following: Unsubstantiated Allegation: Staff did not seek medical attention for resident. It is alleged that the staff did not seek and provide resident with medical attention when resident requested medical attention. Three of three staff deny this allegation, when residents request medical attention, the staff notifies the residents physician and awaits further orders, the residents is given PRN for pain when needed. Staff stated residents are always transported to the medical facilities when prompted by the residents’ medical authorizations, and/or the state of the Residents health condition during the time of the emergency. Three of four residents stated getting medical attention when they require it, staff call the medical agencies when necessary. Based on interviews and records review, there is no evidence to corroborate this allegation. Allegation: Staff did not provide adequate supervision to residents in care. It is alleged that the facility is not providing adequate supervision to the residents in care resulting in a resident attempting to attack another resident, and staff did not act quickly enough to stop the attack. Three of three staff deny this allegation, S1 stated residents are free to roam the facility and visit others residents’ rooms via invitation. Staff stated rushing to R1’s room having heard R1’s request for help, S3 separated R2 from R1’s room and S1 called 911 while R2 administered first aid to the wound site. Staff stated redirecting R2 away from R1 multiple times. R2 stated having attempted to interfere with staff giving 1st Aid to R1. Insisting R2’s past medical training. Three of four residents could not corroborate this allegation. Two of four residents acknowledge paramedics arriving. Based on staff and residents’ interviews, there is no evidence to corroborate this allegation. Allegation: Staff has inappropriate interaction with resident. It is alleged that the staff are having inappropriate interactions with residents and making disparaging remarks about the residents’ physical condition. Three of three staff denied this allegation, staff stated they are providing residents with comfortable care and assisted living needs and services, Staff stated they treat residents with dignity and respect and words of positive affirmation. Three of four residents could not corroborate this allegation, two of four residents’ stated the staff is respectful and does not have inappropriate interaction with residents. Based on staff and residents’ interviews and observations, there is no evidence to corroborate this allegation. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation(s) are unsubstantiated. Exit interview was conducted with staff, Glen Oriemo.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 28-AS-20260223144352

Allegation investigated: Staff did not administer medication as prescribed Staff did not provide an adequate amount of meals to a resident in care. Staff did not complete required training. Staff did not prevent medications from being inaccessible to residents in care. Staff did not maintain a comfortable temperature for residents in care. Staff did not ensure that resident is provided adequate bedding.

Licensing Program Analyst (LPA) Vaid conducted subsequent visit to the facility to deliver the findings for the above-mentioned allegations. LPA Vaid toured the facility with House lead caregiver Glen Oriemo and did not observe any health and safety concerns. Administrator was unavailable. Obtained residents and staff rosters. On 02/02/2026, Licensing Program Analyst (LPA) Vaid conducted initial investigation and was met by Administrator Glen Orimeo and the reason for the visit was discussed. LPA Vaid toured the facility with the administrator and did not observe any health or safety concerns. LPA Vaid requested and obtained for review the following documents, staff and resident roster, residents physician report, R1-medication record and medication administered record, physician orders for medications, admissions agreement. Three (3) Unusual incident reports, weekly bathing schedules for January 2026 and February 2026, staff cleaning schedule log for January and February 2026, weekly linen changing schedules for February 2026, three (3) employee certificates with training dates, R1 letter to Administrator, email with R1's home health regarding new topper mattress qualification. The investigation revealed the following: Unsubstantiated 1.Regarding the allegation: Staff did not administer medication as prescribed. It is alleged that the facility staff is not administering residents’ medication as prescribed by residents’ physicians. Three of three staff deny this allegation. Staff stated residents are administered the correct dosage of medications as prescribed by the residents’ physician orders. Staff stated medications are provided to residents within 10-15 minutes before and after meals as taken. Staff stated the medication cannot be altered to satisfy the residents’ requests. Changes in medication dosage need to be approved by the residents’ primary physician and/or the pain management physician. Three of four residents stated the staff administers the medications to residents on time and as prescribed. Based on records review and interviews, there is no evidence to corroborate the allegation. 2.Regarding the allegation: Staff did not provide an adequate amount of meals to a resident in care. It is alleged that the facility staff are not providing residents will adequate amount of food in the residents’ meals. Three of three staff deny this allegation. Staff stated each resident is served meals according to resident’s dietary plan, as per physician orders. Staff stated R1 was placed on a 48 -hour liquid diet by physician’s orders after treatment of R1’s health condition. The staff stated R1 argued with staff to provide a solid meal after becoming unsatisfied with the liquid diet ordered by R1’s physician. Three of four residents stated being served adequate food serving with their meals. Based on records review and interviews, there is no evidence to corroborate the allegation. 3. Regarding the allegation: Staff did not complete required training. It is alleged that the facility staff has not completed required training for caregivers and medication technician and are not trained to perform caregiver and medication administration duties. Three of three staff deny this allegation. According to staff records reviewed, the facility staff have all the required training and certificates of completion for their duties performed. Three of four residents could not corroborate the allegation. Residents are not aware of the training required by the facility staff. Based on records reviewed and interviews, there is no evidence to corroborate the allegation. 4.Regarding the allegation: Staff did not prevent medications from being inaccessible to residents in care. It is alleged that facility staff are not locking the medication cabinet and are not preventing medications from being inaccessible to the residents in care. Three of three staff deny this allegation. The staff stated that the medications are locked in a cabinet inside the staff office. The staff allowed to administer medications have access to the medication’s cabinet keys, only. Staff stated the residents are inaccessible to the locked staff office and are inaccessible to the locked medications cabinet. Three of four residents stated not being aware. Based on observations and interviews, there is no evidence to corroborate this allegation. CONTINUED ON 9099C............ 5.Regarding the allegation: Staff did not maintain a comfortable temperature for residents in care. It is alleged that the facility does not maintain a comfortable temperature for the residents in care and staff are refusing to operate the air-conditioner when residents’ room becomes hot. Three of three staff deny this allegation. S1 stated the air conditioner is kept at a comfortable temperature during the summer and winter months for all residents residing at the facility. Residents experiencing increased temperatures within the residents’ room are provided with a circulating fan to help cool the residents’ room. Three of four residents stated their room temperature is comfortable, and residents were observed having circulating fans in their rooms. Based on observation with State Issued thermometer, LPA Vaid measured temperature in the facility, and each resident rooms and temperature is at 76 deg-78 deg F. Residents were observed comfortably in the facility. Two residents observed with fans on to regulate the temperature to the resident’s preference. Based on observations and interviews, there is no evidence to corroborate the allegation. 6.Regarding the allegation: Staff did not ensure that resident is provided adequate bedding. It is alleged that the staff are not providing residents with adequate bedding, residents’ bedsprings are broken and staff are not replacing the mattress. Three of three staff deny this allegation. S1 stated R1’s home health care agency has been notified of the bedding issue, S1 stated the mattress is intact and springs are not poking through the bedding materials. According to S1’s correspondence with R1’s home-health agency, R1’s health criteria requirements are being evaluated by R1’s home-health agency for bed-overlay / topper on top of a hospital mattress. Staff stated they have provided R1 with a topper mattress for R1’s comfort until R1’s home-health agency can approve R1’s request. Three of four residents could not corroborate this, residents R2-R4 are not aware of this happening. Based on records review and interviews, there is not enough evidence to corroborate this allegation. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated. Copy of this licensing complaint report was provided to staff Glen Oriemo.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 28-AS-20260128145756

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced annual inspection visit. LPA met with Glen Oriemo , Lead Caregiver. Administrator was not available to join today. The facility is licensed to serve 6 non-ambulatory residents (age range from 60 years old and over), including 1 bedridden. Facility has hospice care waiver for 4 residents. The annual fees were current. LPA explained the purpose of today's visit and the inspection to the administrator via telephone, Caregiver Oriemo assisted with the facility tour. During the visit, Care tools, staff/resident interviews and physical plant were conducted; food supply, staff/residents files and medications were reviewed. The facility is a single-story home located in a residential neighborhood consisting of 6 residents bedrooms, 2 bathrooms, a living room, a dining area, kitchen, laundry area in the garage, a garage, and an outdoor activity area at the backyard. The yard has a shaded area and free of debris/ hazard. Bathrooms are clean and operational. Sufficient supply of 2-day perishable and 7-day non-perishable foods. Adequate linen and personal hygiene supply. Smoke detectors are combined with carbon monoxide detectors and are operable and in compliance. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. The facility has one (1) fire extinguisher that is fully charged in kitchen. Cleaning supplies and toxic substances are inaccessible locked in hallway closet. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. There are no firearms or weapons stored at the facility The resident bathrooms have the required grab-bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. Continued on 809C................... The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. Staff files were reviewed and included Criminal clearance record, and health screening with TB, all staff have a valid CPR/First Aid certificate. Four (4) resident files were reviewed and included physicians report, TB clearance, and appraisal needs and service plans. Last fire/earthquake drill was conducted on04/13/2026. Infectious control plan was reviewed. Disaster plan was reviewed on 05/02/2026. Two (2) staff and three (3) residents were interviewed. Resident medications were reviewed. Medications are centrally stored and locked MAR log is used. The last Fire/ Emergency Drill was conducted on 04/26/2026. Auditory devices are operable. Administrator certificate is current and expires on 02/06/2027. No deficiencies cited per California Code of Regulations, Title 22, Division 6. Exit conference is conducted. Report LIC 809 and 809C is discussed and provided to Lead caregiver, Glen Oriemo.the state’s words, verbatim · CDSS document, May 11, 2026

Allegation investigated: Staff are not administering topical medication as prescribed. Staff isolates resident. Staff do not ensure that resident's room is cleaned. Staff do not ensure that resident has clean linens.

Licensing Program Analyst (LPA) Sanjay Vaid conducted a complaint investigation on the allegations listed above. LPA arrived unannounced and met with the Lead caregiver, Glenn Oriemo. The purpose of the visit was explained. LPA Vaid obtained copies of the resident and staff rosters, toured the facility, and reviewed documents for Resident #1 (R1). Interviews were conducted with Staff #1 - #2 and Residents #1- #4. The investigation revealed the following: Allegation: Staff are not administering topical medication as prescribed. It is alleged that the staff are not administer medication to #R1 as prescribed and staff are applying the incorrect medication dosage. R1 stated the doctor did not provide the correct dosage. Two of two staff deny this allegation, staff stated medication is the correct dosage and tropical medication applied to R1 twice daily as prescribed by the physician and staff follow the doctors’ written orders as prescribed. S1 stated they will contact R1’s physician to confirm the medication order as prescribed to R1. Continued on 9099C......................... Unsubstantiated Three of four residents could not corroborate this allegation, residents interviewed stated staff provide medications to residents as prescribed by doctors’ written orders. Review of R1’s medication orders state tropical medication to be applied twice daily. Based on records reviewed, interviews with staff, residents and witnesses. Although the allegation 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. Allegation: Staff isolates resident. It is alleged that the facility staff are isolating resident #R1. Two of two staff deny this; staff stated they interact with all residents during medication time, mealtimes, activities and during assisted daily living services provided. Residents are encouraged to roam the facility grounds freely. LPA Vaid observed R1 able to roam the facility, R1 was observed being able to transfer from bed to wheelchair and can leave the facility unattended. Three of four residents interviewed stated they are not left in isolation by staff, residents stated they interact with the staff daily and are able to freely wander the facility grounds and are not left in isolation. Based on observations and records review, although the allegation 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. Allegation: Staff do not ensure that residents’ room is cleaned. It is alleged that the facility staff are not ensuring resident #R1 room is regularly cleaned. Two of two staff deny this allegation, according to the staff the residents’ room is cleaned weekly or as needed. According to R1’s admissions agreement R1’s room is scheduled for housekeeping weekly or as needed. LPA observed staff performing housekeeping during the tour of the facility. LPA Vaid observed the smell of cleaning agent in R1’s room during interview with R1. Three of four residents stated that staff clean their rooms regularly or as needed. One of three witnesses stated visiting the facility daily and that the residents’ room and the facility are kept clean and sanitary. Based on observations, and interview with staff, residents and witnesses, although the allegation 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. Continued on 9099C....................... Allegation: Staff do not ensure that resident has clean linens. It is alleged that staff are not ensuring resident #R1 has clean bedding linens. Two of two staff deny this allegation, staff stated residents’ bed linens are changed weekly, sometimes more frequently at residents’ request. S2 stated changing residents’ bed linens weekly or when needed. S2 stated having changed linens for R1 twice last week upon request from R1. LPA Vaid observed extra clean linens available in hallway closet. Three of four residents could not corroborate this allegation, residents stated bed linens are changed weekly and have received extra linen changes due to their personal needs. One of three witnesses stated visiting the facility daily and observed clean linens and bedding provided. LPA Vaid observed clean linen on residents’ bed during tour of the facility. Based on observations and interviews with staff, residents and witnesses, although the allegation 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. Exit interview was conducted and copy of licensing complaint report was provided to the facility staff whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Apr 20, 2026 · control 28-AS-20260413153224

Allegation investigated: . Illegal eviction. 2. Staff damaged residents personal property. 3. Staff do not ensure resident is treated with dignity and respect. 4. Staff do not ensure resident has access to the internet in the facility. 5. Licensee did not ensure resident's personal property was inventoried. 6. Staff do not ensure care needs are being met in a timely manner.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegations listed above. LPA arrived unannounced and met with the Lead caregiver, Glenn Oriemo. The purpose of the visit was explained. LPA obtained copies of the resident and staff rosters, toured the facility, and reviewed documents for Resident #1 (R1). Interviews were conducted with Staff #1 - #4 and Residents #1 #3. The investigation revealed the following: Allegation – illegal eviction. It is alleged that the staff hacked into Resident #1’s bank account and caused the rent checks to bounce, which made R1 to be behind in rent payments. LPA obtained and reviewed a copy of the 30-day eviction letter to R1. The dates and reasons for the eviction were listed and deemed valid. Unsubstantiated LPA interviewed staff who denied having access to R1’s bank account which caused R1 to not pay rent on time. Staff stated that the main reason for the eviction was due to R1 causing health and safety risks to others at the facility. LPA interviewed R1 who denied causing any harm to others and indicated that the rent was not paid in full. The other residents interviewed was never served an eviction notice. There is insufficient evidence to corroborate this allegation. Allegation - Staff damaged resident’s personal property. It is alleged that staff broke 2 of the resident’s iPads. LPA interviewed four (4) staff, and all stated they did not break any of the residents’ personal items. Staff interviewed indicated that Resident #1 (R1) does not allow staff to touch the personal belongings in the room. Staff stated that R1 would yell at staff and accuse staff of breaking things. Staff noted that they will only go into R1’s room when R1 is home to clean the room if allowed. LPA interviewed three (3) residents. Two (2) out of three (3) never had anything taken or broken by the staff. One (1) stated that the staff dropped both iPads while cleaning the room. There is insufficient evidence to corroborate this allegation. Allegation - Staff do not ensure resident is treated with dignity and respect. It is alleged that staff are mean and threw a can of soda at the resident. In addition, staff would say things like “if you don’t like it here, then leave.” LPA interviewed staff who all denied mistreating the residents. Staff stated that R1 tends to yell at staff, but staff do not raise their voices or yell back. Staff received training on resident rights and to use de-escalation techniques to manage residents’ behaviors. Staff stated they do not threaten the residents but only explain to them that he/she can move if not happy at the home. Two (2) out of three (3) residents interviewed like residing at the facility and feel that the staff are nice and treat them with respect. There is insufficient evidence to corroborate this allegation. Allegation - Staff do not ensure resident has access to the internet in the facility. It is alleged that the Wi-Fi was turned off to punish the resident. LPA toured the facility and observed a television in each room and in the living room. Per staff, the televisions are equipped with internet access and are working properly. The Wi-Fi is also provided for their electronic devices. Staff explained that R1 wanted access to Netflix and asked the staff to enter their information to access the account. According to staff, the resident has their own email and password for the website. LPA interviewed three (3) residents. One (1) out of the three (3) stated that the Wi-Fi in the room is not working and cannot access anything on the iPad. Another resident stated that the internet service has been working and has no issues going on the tablet. There is insufficient evidence to corroborate this allegation. Allegation - Licensee did not ensure resident's personal property was inventoried. It is alleged that the owner did not do an inventory of the resident’s personal property upon moving in. Per the staff, Resident #1 (R1) did not allow staff to check any belongings upon moving in, therefore, no items were listed on the resident personal property and valuables form. LPA reviewed the property and valuable form for R1 and did not see any items listed. LPA observed several devices and items in R1’s room. R1 stated that the staff never wrote down what items were brought to the facility but also mentioned that the resident did not want any staff looking or touching his/her personal belongings. Another resident interviewed could not remember if any items were listed on the form but stated that there were only a few non-valuable things brought to the facility. Based on information gathered, there is insufficient evidence to corroborate this allegation. Allegation - Staff do not ensure care needs are being met in a timely manner. It is alleged that it will take the staff 45 minutes to bring a glass of water for the resident. LPA toured the facility and observed call buttons in the residents’ rooms and a water dispenser in the living room. Per staff, when a resident presses the button, it will alert the staff, and staff can see which room number is calling. Staff denied taking a very long time to tend to the residents’ needs. Staff explained that sometimes the call may take a few minutes due to assisting another resident in the shower/toilet but never 45 minutes. LPA interviewed three (3) residents, and two (2) stated that staff assist them with their needs in a timely manner. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted with Staff G. Oriemo. A copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Mar 10, 2026 · control 28-AS-20260302141558

Allegation investigated: Staff inappropriately speak to resident Staff do not follow infection control protocol

Licensing Program Analyst (LPA) Vaid conducted an intial unannounced vist to the facility, LPA Vaid was allowed entry by Administrator Glen Oriemo. LPA Vaid discussed the purpose of the visit with Administrator. LPA Vaid collected and reviewed the following document, staff roster, residents roster, residents' face sheet, physicians report dated 04/08/2025, infection control plan reviewed and dated 01/15/2026, R1 vitals log sheet dated 02/2026, physician’s orders for one prescribed medication dated 12/12/2025 and one PRN medication dated 02/01/2026. Interviewed staff, residents. Toured the facility with Administrator and did not observe any health and safety concerns. Regarding the allegation: Staff inappropriately speak to resident. It is alleged that the facility staff are speaking to residents in an inappropriate manner. CONTINUED ON 9099C................ Unsubstantiated Three of three staff interviewed deny this allegation. Staff stated they speak to all residents with respect and dignity and only raise their voice while speaking slowly to direct the residents who are hard of hearing. Staff stated they have never been rude or used anger towards the residents or the residents' needs. Staff stated they treat all the residents with kindness and love. Four of five residents interviewed cannot corroborate this allegation, according to residents interviewed stated the staff treat the residents with dignity and respect and treat the residents like family. Based on observations and interviews conducted, although the allegation 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. Regarding the allegation: Staff do not follow infection control protocol. It is alleged that the facility staff are not following the infection control plan and facility staff are not changing their gloves between residents. Three of three staff interviewed deny this allegation. Staff stated there are enough gloves and masks on hand. Staff stated they are changing gloves after assisting each resident, serving meals, cleaning the residents’ room and providing incontinent care. Staff stated they are using twelve to fifteen gloves each staff person per day, staff deny using the same gloves to assist residents. Staff stated using same gloves is unhealthy and against the infection control rules. Four of five residents interviewed could not corroborate this allegation. Residents interviewed stated they did not know of the infection control plan. Residents stated observing staff use gloves while assisting the residents with their assisted daily living needs. Review of the facility infection control plan outline infection control practices and semi-annual training. Gloving requirements are administered while assisting residents with grooming, incontinent care, and administering first aid. PPE products and supplies are kept at 3 months minimum supply. LPA Vaid observed staff changing gloves after assisting residents and tending to the residents needs. Based on observations between staff and residents, records review and interviews although the allegation 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. An exit interview was conducted and a copy of the licensing complaint report was given to Administrator Glen Oriemo.the state’s words, verbatim · CDSS document, Feb 17, 2026 · control 28-AS-20260213111631

Allegation investigated: Resident not accorded privacy by staff during telephone conversations Facility refused to accept resident back after hospitalization Staff not observing residents for changes in condition

Licensing Program Analyst (LPA) Alberto Lopez made an unannounced complaint visit to investigate the above allegations. LPA met with lead House Manager Glenn Oriemo and discussed the purpose of the visit. The investigation consisted of LPA reviewing and obtaining copies of staff and resident rosters, R1 Physicians Report, R1 discharge paperwork dated 12/28/2025, R1 face sheet and other pertinent documents, Interviewing three (3) staff (S#1 – S#3) and three (3) residents (R#1 – R#3). The investigation revealed allegation: Resident not accorded privacy by staff during telephone conversations. It is alleged that staff are not providing privacy to residents and listen to their phone conversations. LPA interviewed three (3) staff, and all three (3) staff denied the allegation. One staff member stated they are too busy to listen to residents’ conversations. LPA interviewed three (3) residents and two (2) of the three (3) residents could not corroborate the allegation. One (1) resident stated resident just knows staff are listening but provided no evidence. There is not enough evidence to substantiate this allegation. (continued) Unsubstantiated (continued from 9099) Allegation: Facility refused to accept resident back after hospitalization. It is alleged that on 12/28/2025 at around 1:00am, resident was brought back to facility by hospital transportation and was refused entry into the home. LPA interviewed three (3) staff, and all three (3) staff denied the allegation. All three staff stated that resident was allowed to come into the home. LPA interviewed three (3) residents, and all three (3) residents could not corroborate the allegation. R1 stated R1 was allowed entry when R1 arrived from hospital. R3 stated R3 was awoken when R1 arrived because R1 was being loud. R3 stated it was around 1:00am when resident arrived and allowed entry. There is not enough evidence to substantiate this allegation. Allegation: Staff not observing residents for changes in condition. It is alleged that staff are not checking in on resident to observe changes in conditions. LPA interviewed three (3) staff, and all three (3) staff denied the allegation. Staff stated that they do check on residents and if residents need assistance, they can push the call button to get help. LPA interviewed three (3) residents and two (2) of three (3) residents could not corroborate the allegation. One (1) resident stated that staff do not check on resident but did not provide witness, evidence or the change of condition to support this allegation. LPA observed staff providing care to residents during visit. One resident stated staff are always checking on residents. There is not enough evidence to substantiate this allegation. Based on statements, interviews conducted with staff, residents, review of resident's file and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 6, 2026 · control 28-AS-20251231103626

Allegation investigated: Staff are not ensuring that resident's hygiene needs are being met while in care. Staff do not ensure that residents are provided clean linens while in care. Staff do not ensure that resident is being provided comfortable accomodations while in care. Staff do not ensure that resident is being provided safe accomodations while in care. Licensee does not ensure that staff are adequately trained.

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced complaint visit to address the allegations listed above. LPA met with Pol Palomares, DSP for the facility, and explained the purpose of the visit. Assistant Administrator Glen Oriemo arrived shortly thereafter. The investigation consisted of the following: LPA conducted a tour of the facility including all resident bedrooms and the bathroom, interviewed residents #1 - 4 (R1 - R4), Staff #1 - 3 (S1 - S3), Witness #1 (W1), and also obtained the weekly shower schedule, linen change schedule, and copy of the admission agreement for residents, along with the staff trainings for the staff members. LPA attempted to interview Resident #5 (R5), however they were hospitalized at the time of the visit. The investigation revealed the following: In regards to the allegation that "Staff are not ensureing that resident's hygiene needs are being met, it is alleged that residents are not being assisted with showering, washing residents hair, and shaving of their legs. Unsubstantiated During interviews with the residents, three (3) out of four (4) did not corroborate the allegation. One of the residents stated that the staff have been helping them with all of their care needs including showering. Another resident stated that staff have been assisting them with bathing and that they have never had any issues with having their hygiene needs met. During interviews with staff, none of them corroborated the allegation. One staff stated that all residents are showered three (3) to four (4) times per week, or as needed and that they have a schedule for showering all residents to meet their hygiene needs. Another staff member also confirmed that they assist residents with showering at least three (3) times per week or per request of the resident. Review of the weekly bathing schedule for residents revealed that all have been showered at least three (3) times for the week of 12/15/2025 - 12/22/2025. In regards to the allegation that "Staff do not ensure that residents are provided clean linens while in care," it is alleged that staff are providing dirty linens to residents in care. During interviews with the residents, none of them corroborated the allegation. One of the residents stated their linens are always kept clean by staff. Another resident also corroborated that their linens are cleaned by staff. During interviews with the staff, none of them corroborated the allegation. One of the staff stated that linens are cleaned at least once per week for all residents as indicated on the admissions agreement, or as needed. Another staff member also stated that linens are cleaned at least once per week or more if they become dirty. During the tour of the resident bedrooms, all linens appeared to be clean upon inspection. The admissions agreement also specifies that linens are to be cleaned at least once per week by staff. In regards to the allegation that "Staff do not ensure that resident is being provided comfortable accommodations while in care," it is alleged R1 was provided a mattress in which they are able to feel their own bedsprings and therefore is not comfortable. During interviews with the residents, three (3) out of four (4) of them did not corroborate the allegation. One of the residents stated that their mattress is comfortable and they have no problems with it. Another resident stated that they believe their mattress is adequate. During interviews with the staff, none of them corroborated the allegation. One staff stated that R1's home health agency is working towards submitting a request for a hospital bed with a new mattress to R1's Primary Care Provider (PCP) for approval, and in the meantime the facility is providing R1 a temporary mattress. Another staff member also stated that the resident mattresses are comfortable and are working towards obtaining a new mattress for R1. During interview with W1 who works at R1's home health agency, they confirmed that they are working on submitting the request to R1's PCP in order to obtain a hospital bed with new mattress for R1. In regards to the allegation that "Staff do not ensure that resident is being provided safe accommodations while in care," it is alleged that R1 had been dropped while being assisted with a shower by a staff member. During interviews with residents, three (3) out of four (4) did not corroborate the allegation. One resident stated that they have never been harmed by any staff in any way while living in the facility. Another resident stated that they have never been hurt while residing in the facility. During interviews with staff, none of them corroborated the allegation. One of the staff members stated that none of the residents have been dropped or fallen in the shower recently. Another staff member stated that no incidents of residents being dropped in the shower have occurred recently, and that caregivers transfer residents from bed to wheelchair, then from wheelchair to shower chair to avoid any instances of residents falling while showering. During the tour of the restroom, LPA observed that the restroom has a slip-resistant mat and grab bars as required by Title 22 regulations. In regards to the allegation that "Licensee does not ensure that staff are adequately trained," it is alleged that staff do not have required training including CPR training. During interviews with residents, none of them corroborated the allegation. One resident stated that they believe staff are trained well and treat the residents well. Another resident also stated that staff are trained and perform their duties well. During interviews with staff, none of them corroborated the allegation. One of the staff stated that they all have undergone required training including medication administration training. Another staff stated all staff have CPR certificates along with required dementia care training. During record review of staff training, LPA observed that all staff have required CPR training along with required annual training related to dementia care, hospice care, restricted health conditions, postural supports, and medication administration. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 23, 2025 · control 28-AS-20251218170054

Allegation investigated: Staff left residents unattended Staff are mismanaging residents medications Staff are not meeting residents needs at night Staff inappropriately turned off residents call lights at night Staff are not providing a comfortable temperature for residents Staff doesn't treat resident with dignity Staff are not providing adequate food service to residents Staff are inappropriately charging residents for assistance Staff did not ensure the facility was free of pests Staff did not ensure residents room was kept clean

Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit to the facility and was met by Caregiver Mary Jane Oriemo and the purpose of the visit was discussed. The initial visit was conducted on 07/01/25 and included the following: Licensing Program Analyst (LPA) Glenn Trueman conducted an initial 10-day complaint visit to the facility and was met by Caregiver Jane Oriemo and the purpose of the visit was discussed. Shortly thereafter Assistant Administrator Glenn Oriemo and Administrator Jeanine Palomares arrived. LPA Trueman reviewed Resident R1's file and requested, Admissions Agreement. Physician's Report, Appraisal Needs and Services Plan, Emergency ID Face Sheet and MAR's Log for June 2025. Staff and Resident Roster to be submitted. Interviews were conducted with Resident R1 and R2. Attempts were unsuccessful to interview Resident R3 and Resident R4 who didn't respond to questioning. Interview was conducted with Administrator telephonically. Interviews were conducted with Caregiver Jane Oriemo and Staff S1. At today's visit 12/19/25 Resident's R1 and R2 were interviewed. Unsubstantiated Staff S1 and Staff S2 along with Staff Mary Jane Oriemo were interviewed. LPA reviewed file of Resident R1 and daily food requests from Resident R1 from 01/23/25 to 12/14/25 were submitted. Weekly Bathing Schedule, Weekly Changing Schedule and Physician's Order for medication dated 10/23/2025. In regards to the allegation Staff left residents unattended, based on interviews conducted and information gathered it was revealed that facility has adequate day and night staff to tend to residents needs. Review of Personnel Report (LIC 500) has 3 caregivers on schedule 7AM to 7PM, 1 caregiver 7 PM to 7AM and 1 on call for each shift. During tour of the facility including the garage LPA observed a staff bedroom in the facility and in the garage was 1 twin bed. Staff stated that S3 or another staff are in the staff bedroom to assist residents and in the garage is Staff Mary Jane Oriemo. Resident R2 stated there is overnight staff to assist residents. Although the allegation 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. In regards to the allegation Staff are mismanaging residents medications, based on interviews conducted and information gathered physician's order 10/31/25 states to give the medication once every 72 hours for Resident R1. Resident R2 stated he always has gotten his meds and it has always gone smoothly. Medication Log (MAR's) for June and July 2025 list all medications as being administered for Resident R1. Staff stated that the rules are followed strictly and Resident R1 does not want to go by the doctor's orders and will get upset if staff does not give additional medication before the 72 hours. Although the allegation 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. In regards to the allegation Staff are not meeting residents needs at night based on interviews conducted and information gathered staff stated that bedtime meds have been administered and requests for food at night are also served. LPA reviewed MAR's Log on 07/01/25 and 12/19/25 and confirmed night time meds were administered. Interview with Resident R2 who stated that Staff S3 is always here at night time and has provided assistance. Tour of the facility LPA observed 1 bed in staff room adjacent to resident rooms. Although the allegation 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. In regards to the allegation Staff inappropriately turned off residents call lights at night, based on interviews conducted and information gathered LPA toured the facility on 07/01/25 and 12/19/25 and did observe in the office a functioning call light system. Staff stated that the resident hits their call button and it lights up in the office. Said there are always sufficient staff to respond in a timely manner. Resident R2 stated that staff are always present and respond if needed regarding the call light. Although the allegation 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. In regards to the allegation Staff are not providing a comfortable temperature for residents, based on interviews conducted and information gathered during visit on 07/01/25 and 12/19/25 the facility was at a comfortable temperature meeting Title 22 Regulations. Staff stated that the air conditioning system was set at 75F. Also stated R1 opens the door and doesn't get the full effect of the air conditioning. Staff also stated that they can't make it cooler because some of the residents get very cold. Resident R2 said the temperature has always been comfortable. Although the allegation 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. In regards to the allegation Staff doesn't treat resident with dignity, based on interviews conducted and information gathered Resident R2 stated that staff are good and treat the residents well. Said R1 is the one who is rude to staff. Stated they are treated with dignity. Staff stated they always provide care and are kind treating all with dignity and respect. Administrator stated that there are many residents whose family has sent them compliments about their treatment of residents. LPA confirmed the letters were given. Although the allegation 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. In regards to the allegation Staff are not providing adequate food service to residents based on interviews conducted and information gathered daily food requests from Resident R1 from 01/23/25 to 12/14/25 were submitted and included a well balanced variety of foods. Staff stated that staff always gave Resident R1 all that was on the food list and never complained. LPA toured the kitchen and food supply 07/01/25 and 12/19/25 and there was a well balanced supply of chicken, fish, beef and pork. Resident R2 said that there is always a well balanced variety of meals and has received everything from the weekly list that was submitted. In regards to the allegation Staff are inappropriately charging residents for assistance conducted and information gathered Admission Agreement dated and signed by Resident R1 on 12/27/24 Listed Under Optional Services and checked declined it states that transportation and additional escort $30 for 1st 10 miles and .90 cents per mile thereafter. Additional escort other than the driver will be charged $20 an hour and billed to the resident in the next invoice. Resident R2 stated he is aware of the extra fee. Staff stated that their job is to provide care and supervision at the facility and therefore can't leave for an extended amount of time and sacrifice care for the other residents. Although the allegation 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. In regards to the allegation Staff did not ensure the facility was free of pests, based on interviews conducted and information gathered during tour of the facility on 07/01/25 and 12/19/25 the facility was clean and there was not any pests that were observed in client bedrooms, kitchen and living room. Resident R2 stated that there has not been any roaches and only has observed crickets. Staff stated that Resident R1 will leave the door open and crickets will come in, but not roaches or other insects. Although the allegation 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. In regards to the allegation Staff did not ensure residents room was kept clean, based on interviews conducted and information gathered review of the Cleaning Schedule Log checks off being completed under Clean and Replace for Bed Linen and Linen cover for Resident R1 and also review of HC Temp and Cleaning Log checked off as completed for Resident R1 for regular daily cleaning and also high touch surfaces. LPA observed all rooms to be clean and in good repair on visits conducted on 07/01/25 and 12/19/25. Resident R2 said they clean the room every week. Staff stated that rooms are cleaned every week and signed off by staff on the Cleaning Log showing which rooms were completed. Although the allegation 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, Dec 19, 2025 · control 28-AS-20250625121930

Allegation investigated: Facility staff verbally abusing resident Facility staff not assisting resident with their ADLs

Licensing Program Analyst (LPA) S Vaid conducted a subsequential complaint visit to the facility and was met by Direct staff Person(DSP)-Jane Oriemo. Glen Oriemo, assistant administrator, was notified and the purpose of the visit was discussed. On 6/17/2025, LPA Vaid requested, obtained and reviewed the following documents. Staff and resident rosters, physicians report, pre-placement appraisal, Needs and service plan, Emanate Health visit dated 6/16/25, admissions agreement, weekly linen changing schedule, weekly bathing schedule, AFHC COVID 19 cleaning and disinfection log, 06/01/25 to present. Contact number for Home Health agency. The investigation revealed: CONTINUED ON 9099C............ Unsubstantiated Regarding the allegation: Facility staff verbally abused resident. It is alleged that staff verbally abused a resident in care by calling the resident degrading names and yelling at them. Four (4) out of four (4) staff interviewed deny this allegation, the staff stated they are all professionals’ caregivers here they do not call the residents names but treat them with respect and dignity, and have never raised their voice at the residents, only raised voice when residents cannot hear them. According to R1’s needs and service plan dated 7/15/24, R1 has hearing problems and needs hearing aid. During interview with R1, they did not wear their hearing device. LPA was made to speak loudly. Four (4) of five (5) residents interviewed could not corroborate this allegation, residents stated the staff does not yell at them nor make fun of their medical condition. Residents stated staff makes them feel safe and comfortable. Based on interviews conducted, records reviewed, and observations made. Although the allegation 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. Regarding the allegation: Facility staff not assisting resident with their ADLs. It is alleged that the facility staff are not assisting R1 with their ADLs (assisted daily living) needs and not providing R1 with a wheelchair and R1 is being forced to walk on their own. Four (4) out of four (4) staff interviewed deny this allegation, staff stated the wheelchair R1 brought with them when they moved in was repossessed by previous skilled nursing facility. Administrator stated new wheelchair was purchased on behalf of R1 by new Home Health agency. LPA observed wheelchair in R1’s room. According to the weekly bathing schedule for month of June 2025, R1 refused to shower nor allow staff to assist R1 with their ADLs. Staff stated they will attempt throughout the day to convince residents to bathe. Four (4) of five (5) residents interviewed stated they are assisted by staff with ADLs and get assisted with walking when needed. Based on interviews conducted, records reviewed, and observations made. Although the allegation 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. Copy of this report was signed and provided to Jane Oriemo, Direct staff Person (DSP)the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 28-AS-20250609100405

Allegation investigated: Staff do not ensure residents bedding is clean and orderly

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced complaint visit to investigate the allegations listed above. LPA met with Jenine Orimeo, administrator for the facility, and explained the purpose of the visit. The investigation consisted of the following: LPA obtained copies of the staff and resident roster, reviewed the medications and physician orders for Residents #1 - 5 (R1 - R5), obtained the admissions agreement for R1, obtained serious incident reports involving R1, hospital discharge paperwork for R1, interviewed R1 - R4, and also interviewed Staff #1 - 4 (S1 - S4). LPA attempted to interview R5, however they were not at the facility and at the facility at the time of the visit. The investigation revealed the following: In regards to the allegation that "Staff do not ensure residents bedding is clean and orderly," it is alleged that R1 has not had their bed sheets cleaned and that it has dried blood stains on it. Substantiated During interviews with the residents, three (3) out of four (4) did not corroborate the allegation. One resident stated that they have never been locked out of the facility by the staff. Another resident stated also stated that they have never been locked out of the facility in the past. During interviews with the staff, none of them corroborated the allegation. One of the staff members stated that they were coordinating with the hospital social worker to determine if R1 required a higher level of care before admitting them back to the facility, however they did not lock them out of the facility. Another staff member also explained that they did not lock R1 out of the facility and had allowed her to return following their hospitalization. During the visit LPA confirmed R1 had returned to the facility and was present during the visit. In regards to the allegation that "Staff are not dispensing medication as prescribed," it is alleged that the R1 was not obtaining their medication as prescribed. During interviews with the residents, none of the residents corroborated the allegation. One of the residents stated that they are obtaining their medications, however they need to make an appointment with their physician in order to obtain a prescription for one of their medications. Another resident interviewed stated that they have had no issues obtaining their medications. During interviews with the staff, none of them corroborated the allegation. One of the staff interviewed stated that R1 was recently hospitalized and was provided with new orders that superseded R1's existing orders because they interacted with each other, but they are dispensing R1's medication as prescribed. Another staff member also explained that they are administering the hospital medication orders to R1 and that R1 has an upcoming scheduled appointment with their physician to update their orders. The incident reports involving R1 confirm their recent hospitalization beginning on 5/23/2025. In regards to the allegation that "Staff are not providing adequate transportation services to clients," it is alleged that R1 is not being assisted to their medical appointments by staff. During interviews with the residents, three (3) out of four (4) did not corroborate the allegation. One of the residents interviewed stated that their family take them to their medical appointments and have had no issues with obtaining transportation. Another resident interviewed stated that they have not had problems from getting assistance from facility staff in taking them to medical appointments. During interviews with the staff, none of them corroborated the allegation. One staff interviewed stated that R1 had declined transportation services which is outlined as an optional service in their admissions agreement. During record review of R1's admissions agreements, it was revealed that they declined the transportation optional service in their admissions agreement. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided. During interviews with the residents, one (1) out of four (4) residents corroborated the allegation. One of the residents reported that they did have stains on their bed that hadn't been cleaned. The other residents of the facility stated that their linens had been cleaned in a timely manner. During interviews with the staff, none of them corroborated the allegation. One staff interviewed stated that they do clean the bedsheets of residents and that it is performed once per week. Another staff interviewed also indicated that the bedsheets of residents are cleaned once per week or immediately whenever they become soiled. LPA inspected the beds of the residents of the home and found that R1's bedsheets do have red stains. Photographs were taken of the stains on the bed as well. Based on LPA interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegations, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 is being cited on the attached LIC9099D. Exit interview was held and a copy of the report along with the appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 3, 2025 · control 28-AS-20250527081606

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(C) · Plan of correction due date: Jun 9, 2025

(a) Living accommodations and grounds shall be related to the facility's function. (...) The following rules shall apply: (3) Equipement and supplies (...) the licensee shall assure provision of: (C) Clean linen, including (...) top bed sheets (...) to ensure that clean linen is in use (...) at all times. The regulation is not bed as evidenced by: Based on observation, LPA determined that the bed sheets of R1 have multiple stains on them that resemble blood stains, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 3, 2025

Plan of correction: Administrator is to ensure that clean linens are available to residents at all times. Administrator is to change or clean the linen in R1's room and send proof of correction to LPA by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met Caregiver Glenn Oriemo at approximately 8:15 AM and explained reason for visit. Administrator Jenine Palomares and Licensee Thang Duong were both out of town. The facility is licensed to serve 6 non-ambulatory residents (age range from 60 years old and over), including 1 bedridden. Facility has hospice care waiver for 4 residents. The facility is a single-story home located in a residential neighborhood consist of 5 resident's bedrooms ,1 staff room, 2 bathrooms, a living room, a dining area, kitchen, laundry area in the garage, a garage, and an outdoor activity area at the backyard. All resident bedrooms were toured. Each bedroom has a bed, linen, dresser, and lighting. R2 had bed rails with no physician’s order on file. Smoke detectors/carbon monoxide detectors were observed in each room and throughout facility. The facility has one (1) fire extinguisher that is fully charged in kitchen. Cleaning supplies and toxic substances are inaccessible locked in hallway closet. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility The resident bathrooms have the required grabs bars and non-skid mats. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The common areas include the living room and dining area are clean and have the required furniture. The facility does not have a swimming pool or large body of water. There is a shaded seating area for the residents in back yard. Passageways and exits are free of obstruction. LPA observed an unpermitted room addition along with a full side bed and dressers in garage. Four (4) staff files were reviewed and included Criminal clearance record, and health screening with TB all four (4) staff did not have a valid CPR/First Aid certificate. Five (5) resident files were reviewed and included physicians report, TB clearance, and appraisal needs and service plans. Last fire/earthquake drill was conducted in April of 2025. Infectious control plan was reviewed. Two (2) staff and three (3) residents were interviewed. Resident medications were reviewed and R4 was missing medication. Medications are centrally stored and locked MAR log is used. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809Ds. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, May 1, 2025

Allegation investigated: Resident sustained pressure sore(s) while in care of staff. Staff not properly cleaning resident resulting in multiple UTI’s. Staff does not keep facility free from pests. Staff does not clean resident’s room. Staff did not assist resident in a timely manner. Staff not following resident’s meal plan. Staff did not properly prepare resident’s food. Resident sustained injury while in care. Staff does not notify resident’s authorized representative of changes in resident’s medical. Staff did not provide resident with proper toiletries causing resident skin to be irritated. Staff left hazard chemicals accessible to residents. Facility does not post menu. Staff does not have planned activities for residents.

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint visit to investigate the complaint allegations listed above. During today’s visit, LPA met with staff#2 (S2), staff in charge. The purpose of today's visit was explained to S2 at the facility and Licensee Thang Duong over the phone. The initial investigation visit was conducted on 10/17/24 and the subsequent visit was conducted on 01/07/25. The investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#2 (R2) to resident#6 (R6); attempted but unable to contact and interview resident#1 (R1); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters and resident files of resident #1 (R1) with relevant information. The investigation revealed of the following: (-continued on LIC 9099C- pg 2) Unsubstantiated Regard the allegation of resident sustained pressure sore(s) while in care of staff, it was alleged that resident sustained pressure ulcers. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents stated staff had provided proper care to them and none of them have pressure injuries. Per staff interviews, all three (3) staff denied the allegation. It revealed staff would proper care to residents according to residents’ care needs to prevent pressure injuries or bedsores. Per record review, resident who claimed to have pressure injuries was under home health care. The facility staff had a log to document the care provided to resident, such as reminded or assisted resident to reposition and provided cares to clean resident’s bottom per home health nurse notes. LPA recalled the observation from the other visits prior to resident’s discharge, staff had assisted resident to get up from the bed to the recliner and reminded resident to turn in bed from left to right/right to left. Thus, there were not preponderance of evidence showing resident sustained pressure sore(s) while in care. Regard the allegation of staff not properly cleaning resident resulting in multiple UTI’s, it was alleged staff did not take a resident to the bathroom causing resident to have UTIs. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents stated staff would assist them to use the bathroom as needed and clean them afterward. None of the residents had UTI while in care. Per staff interviews, all three (3) staff denied the allegation. It revealed staff would assist residents who needed toileting assistance to go to the bathroom and provided proper cleaning to residents. Per record review, staff had kept track of providing toileting assistance to the resident who claimed to have UTIs, such as changing urine pads in bed when wet and assisting resident to get up going to the bathroom. Therefore, there were not preponderance of evidence showing staff failed to clean resident resulting in multiple UTI’s. Regard the allegation of staff does not keep facility free from pests, it was alleged that staff members were leaving the kitchen / garage door open causing flies and mosquitoes to fly in resident’s room. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed they did not observe flies and mosquitos in their rooms. Their rooms did not have pest issues. Per staff interviews, all three (3) staff denied the allegation. (-continued on LIC 9099C- pg 3 ) It revealed staff would keep the doors closed to prevent flies to fly in or pest issues. Per observation, kitchen door and garage doors were closed during all investigation visits. Thus, staff did not fail to keep the facility free from pests. Regard the allegation of staff does not clean resident’s room, it was alleged staff did not mop resident’s room floor and keep resident’s room tidy. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed staff cleaned their rooms daily and mopped the floor at least once a week or as needed. Their rooms were clean and tidy. Per staff interviews, all three (3) staff denied the allegation. It revealed staff would mop the resident’s room floor every morning as a daily routine and mop the floor another time during the day as needed. Per observation, residents’ rooms were clean and no trash on the floors. The facility’s floor, including all residents’ rooms, was observed to be cleaned and was not sticky when walked on it. Therefore, residents’ rooms were observed to be tidy and clean. Regard the allegation of staff did not assist resident in a timely manner, it was alleged staff did not come to assist resident within a reasonable amount of time. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed staff would come to assist them in about 5 – 10 minutes after they called for help. Sometimes, when staff was assisting other residents, staff would notify the resident who called for assistance that staff was aware the resident’s call and would provide assistance promptly. Per staff interviews, all three (3) staff denied the allegation. It revealed staff would assist residents as soon as they were called. Per observation, staff responded to residents’ calls promptly during the visits. Therefore, staff would assist resident in a timely manner. Regard the allegation of staff not following resident’s meal plan, it was alleged that staff did not provide meal to resident per resident’s meal plan. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed staff had followed resident’s meal plan to provide meal to them. Sometimes, residents would ask for alternative meals and staff were able to provide it to them. (-continued on LIC 9099C- pg 4 ) Per staff interviews, all three (3) staff denied the allegation. It revealed staff had followed resident’s meal plan when providing meal to residents. Therefore, staff had followed resident’s meal plan. Regard the allegation of staff did not properly prepare resident’s food, it was alleged staff failed to completely puree the meat on the food tray provided to a resident. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed they were not on a pureed food diet. Staff would prepare residents’ meals accordingly. Alternate food menu was available. Per staff interviews, all three (3) staff denied the allegation. Staff was trying to provide a variety of food to resident who was on a soft food diet, such as tuna fish sandwiches, which the tuna fish was not necessarily completely pureed. Per record review, resident needed soft food diet. Therefore, staff had properly prepared resident’s food to resident who had special diet need. Regard the allegation of resident sustained injury while in care, it was alleged resident had an unwitnessed fall while in care. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed either residents had never have fallen while in care or staff would provide immediate assistance to residents and notify their responsible parties immediately. Per staff interviews, all three (3) staff denied the allegation. Staff would assist residents if residents fell. As reported by resident’s responsible party, the resident did not call for assistance prior to falling. Staff had provided immediate assistance to resident when staff aware of the resident’s fall. Staff had notified administrator and resident’s responsible parties. Per record review, administrator had reported the incident to licensing and notified resident’s responsible party. The facility had taken a follow up action and an action of prevention for future occurrence. Therefore, staff had taken proper action after the unwitnessed fall of a resident. Regard the allegation of staff does not notify resident’s authorized representative of changes in resident’s medical, it was alleged that facility staff did not notify resident’s responsible party about resident’s medical change, such as losing weight. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed staff would notify residents and their responsible parties immediately if residents had medical changes. (-continued on LIC 9099C- pg 5 ) Per staff interviews, all three (3) staff denied the allegation. Staff would always discuss residents’ medical changes to authorized representatives. Per record review, staff had discussed the resident’s authorized representative about resident’s medical changes. In addition, that resident’s authorized representative had come to visit resident almost daily; therefore, the representative should be able to observe resident’s changes, such as weight lost. Therefore, staff did not fail to notify resident’s authorized representative of changes in resident. Regard the allegation of staff did not provide resident with proper toiletries causing resident skin to be irritated, it was alleged staff did not clean resident’s bottom with sensitive skin wipes which cause resident’s skin to turn red. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed residents did not have skin issues due to toiletries products. Per staff interviews, all three (3) staff denied the allegation. Staff had used the sensitive skin wipes to assist resident as instructed by the resident’s authorized representative. Per record review, administrator and staff had followed up with the home health nurse regarding the resident’s skin redness. Therefore, staff had provided resident with proper toiletries. Regard the allegation of staff left hazard chemicals accessible to residents, it was alleged staff left the cleaning products in the bathroom accessible to residents. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed residents did not aware of the bathroom cleaning products left in the bathroom. Per staff interviews, all three (3) staff denied the allegation. Staff stated they cleaned the bathroom with cleaning products and would have the products in the bathroom while cleaning. Staff would lock the cleaning supplies in a locked storage room after use. LPA did not observe hazard cleaning chemicals in the bathroom. Those products were observed to be locked in the storage room. Therefore, the cleaning supplies and hazard chemicals were not accessible to residents. Regard the allegation of facility does not post menu, it was alleged the resident’s food menu is not visible for residents. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. (-continued on LIC 9099C- pg 6 ) Residents’ interviews revealed residents could see the food menu when they walked in the kitchen. Per staff interviews, all three (3) staff denied the allegation. Staff stated the food menu was posted in the kitchen wall. LPA observed a food menu was posted on kitchen’s wall and was visible when walked in the kitchen. Therefore, a resident’s food menu was posted in the facility kitchen. Regard the allegation of staff does not have planned activities for residents, it was alleged staff did not abide by the contact and planned activities for residents. Per resident interviews, five (5) out of five (5) residents could not corroborate the allegation. Residents’ interviews revealed residents had planned activities twice a week or so. Residents stated, sometimes, they did not want to participate even staff came to invite them. Per staff interviews, all three (3) staff denied the allegation. There was an activity coordinator from an outsource agency who came to the facility on a regular basis to encourage residents to participate activities. Staff could not force residents to participate if they did not want to. Per observation from different visits of the facility, LPA observed an activity coordinator came to the facility doing activities with residents on different days. Residents were invited to participate but a few residents declined the invitation. Therefore, staff had planned activities for residents. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted with S2 and findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 28-AS-20241010120330

Allegation investigated: Staff is not accepting resident discharged from hospital.

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint visit to investigate complaint allegation. LPA met and explained the purpose of today's visit to staff#3 (S3). The initial complaint visit was conducted on 11/14/24. The investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#1 (R1) to resident#4 (R4); attempted but unable to interview resident#5 (R5); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters; and resident files for resident #1 (R1) with relevant information. Regarding the allegation that staff is not accepting a resident discharged from hospital, it was alleged that staff did not accept resident#5 back to the facility after discharged from the hospital. The investigation revealed of the following: (-Continued on LIC 9099 C-) Substantiated Per resident interviews, four (4) out of four (4) residents could not corroborate the allegation. All residents stated they were able to return to the facility after discharged from hospitals or medical appointments. Per staff interviews, all three (3) staff denied the allegation. It revealed staff would accept residents from hospital upon discharged if the residents' care needs were within the level of care that the facility could provide. Per administrator, Thang Duong, explained, resident#5's level of care had changed which was above the level of care the facility could provided. Per record reviews, administrator was unable to provide any medical assessment, proof of medical changes/prohibited health condition, or any documents showing resident#5's level of care was changed or changed to the level above the care that the facility could provide. As of today, 11/26/24, the facility has not accept resident#5 back to the facility. Thus, the facility violated resident's personal rights. Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D. Exit interview held with staff#3 (S3). A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 28-AS-20241107171143

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(b)(1) · Plan of correction due date: Nov 29, 2024

(b) All residents in all residential care facilities for the elderly shall be protected from all of the actions... A licensee or facility staff may not take any of the following actions…of a resident: Deny admission to a facility … or discharge or evict a resident from a facility. This requirement was not met by evidence of: The facility did not accept resident #5 back to the facility after discharged from hospital.the state’s words, verbatim · CDSS document, Nov 26, 2024

Plan of correction: Administrator will review Title 22 regulations and provide a written statement by POC date confirming their understanding of the citation issued. Administrator shall obtain resident’s medical assessment to determine whether there is probable cause not accepting resident back to the facility.

Allegation investigated: Staff did not arrange transportation for resident following doctors visit.

Licensing Program Analyst (LPA) Tao conducted an unannounced complaint visit to investigate the complaint allegation. During today’s visit, LPA met and explained the purpose of today's visit to administrator assistant, Elizah Arganosa. The investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#1 (R1) to resident#4 (R4); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters; and resident files for resident #1 (R1) with relevant information. Regarding to the allegation, staff did not arrange transportation for resident following doctors' visit, it was alleged that staff failed to arrange transportation for a resident to return to the facility after doctor’s appointment. The investigation revealed of the following: (- Continued on LIC 9099 C-) Unsubstantiated Per residents' interviews, four (4) out of four (4) residents could not corroborate the allegation. Three (3) residents stated staff helped them to arrange transportation to medical appointments. One resident said resident's responsible party arranged the transportation from the resident. Per staff interviews, all three (3) staff denied the allegation. It revealed staff assisted three (3) residents to arrange transportation to and from doctors’ appointments and one resident had the responsible party to arrange for the resident. Per record review, the incident report dated 10/28/24 indicated resident’s transportation was arranged by the responsible party but the driver failed to pick up the resident after the doctor appointment. Therefore, the responsible party called 911 for help. Thus, staff did not fail to arrange transportation for resident following doctors visit. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegation mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with administrator Steven and findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Nov 14, 2024 · control 28-AS-20241105194857

Allegation investigated: . Staff not providing resident with meals in a timely manner. 2. Staff does not provide nutritious meals to residents. 3. Staff deprived resident of additional servings of food. 4. Staff discriminates against resident.

Licensing Program Analyst (LPA) Cynthia Chan conducted the complaint investigation on the allegations listed above. LPA arrived unannounced and met with Staff, Roldan Kiseo. Administrator, Steven Duong, arrived shortly after to assist with the visit. The purpose of the visit was explained. LPA obtained copies of the staff and resident rosters, toured the facility, and interviewed Staff and Residents. The investigation revealed the following: Allegations - Staff not providing resident with meals in a timely manner, Staff do not provide nutritious meals to residents, and Staff deprived resident of additional servings of food. The administrator and staff were interviewed regarding the food service provided to residents. They stated that residents are served 3 meals a day and provided with snacks. Breakfast is served to them depending on their wake-up times. Unsubstantiated They get lunch around noon and dinner about 5:30pm. If a resident chooses to eat at different times, they will provide them the meals when they want it. Staff stated they cook a variety of nutritious foods for them. They ask the residents what they like to eat and will go shopping for the items. Their meals include a meat, grain, vegetables, fruits, and juice. LPA observed fresh fruits and vegetables and frozen meats in the refrigerator. Staff stated they use fresh ingredients and seldom canned goods. If a resident requests for more servings, staff will give it to them. LPA interviewed 2 residents who stated they get 3 meals a day plus snacks. They are provided more if they want it. They stated the meals include meats, rice, vegetables, and fruits. Allegation - Staff discriminates against resident. It is alleged that Staff stated that a resident is “fat enough and doesn’t need much food.” LPA interviewed the Administrator and Staff. Staff interviewed denied saying the phrase and stated that Resident #1 (R1) will comment on his/her own weight. They stated they do not deprive resident(s) any food. They will ask residents what they like to eat and make it for them. Staff stated they treat the residents the same and with respect. Two residents were interviewed, and they do not feel discriminated living here. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights was provided.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 28-AS-20241028162318

Allegation investigated: Staff did not allow resident visiting at the facility.

Licensing Program Analyst (LPA Alberto Lopez conducted an unannounced complaint investigation for the allegation listed above. LPA met with Glenn Oriemo, Lead Caregiver. LPA explained the purpose of today's complaint investigation visit. The investigation consisted of the following: LPA obtained staff roster, resident roster, visiting log for 10/2024, Facility Visiting Policy, DSS clearance for W1, interviewed four (4) residents ((R#1-R#4), One (1) resident was sleeping, three (3) staff (S#1-S#3), and interviewed two (2) Witness (W#1-W#2), and conducted a tour of physical plant. The investigation revealed: Regarding allegation: Staff did not allow resident visiting at the facility. It is alleged that W2 arrived at the facility to visit on 10/23/2024 and was not allowed entry into the facility. LPA interviewed three (3) staff and all three (3) denied the allegation. S1 stated that W2 has never been refused entry to facility. (Continued on 9099C) Unsubstantiated (continued from 9099) LPA reviewed visitor sign in log for the month of 10/2024 and it showed that W2 made visit on 10/08/2024, 10/11/2024, 10/16/2024, 10/18/2024, 10/22/2024, and 10/25/2024. There is no evidence that W2 was refused entry on 10/23/2024. S1 denied that facility denied entry to W2 on 10/23/2024. S1 stated that W2 did not show up at facility on 10/23/2024. LPA interviewed four (4) residents and four (4) of four (4) could not corroborate the allegation. All four residents interviewed stated that they are allowed to have visitors. Based on the information obtained during the investigation, interviews with staff, and residents, the investigation did not reveal any evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with Glenn Oriemo, Lead caregiver, and findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Oct 28, 2024 · control 28-AS-20241024085450

Allegation investigated: Facility has leaking water. Facility equipment pose a hazard to residents. Staff does not ensure call button accessible to resident.

Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegations listed above. LPA met Elizah Arganosa, administrator assistant. LPA explained the purpose of today's complaint investigation visit. The investigation consisted of the following: LPAs obtained staff roster, resident roster, interviewed resident#1 (R1) and resident#2 (R2), interviewed staff #1 (S1) and conducted a physical plant. The investigation revealed the following: In regard of allegation that facility has leaking water, it was alleged that a pipe outside the front door that is leaking water. LPA interviewed staff and staff corroborated the allegation. LPA toured the facility and observed a pipe outside the front door was leaking water during the visit. The facility was not in good repair. (-continued in LIC 9099C-) Substantiated In regard of allegation that facility equipment poses a hazard to residents, it was alleged that the audio devices on the back door that access to the patio was not operable. LPA interviewed staff and staff corroborated the allegation. LPA tested the audio devices on the patio door and observed that it did not sound off when the patio door opened. Thus, it poses a hazard to residents. In regard of allegation that staff does not ensure call button accessible to resident, it was alleged that the call button was not accessible to resident. LPA interviewed residents and revealed that their call buttons were not within their reach and not accessible to them. Per staff interview, staff denial the allegation. LPA toured the residents’ rooms and observed the call buttons were either left on the “beside table” against the bed or attached to the drawer next to the bed where residents could not reach. Therefore, the call buttons were not accessible to residents. Based on LPAs’ observations and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D. An exit interview was conducted with Elizah Arganosa, administrator assistant. A hard copy of this report and appeal right were provided.the state’s words, verbatim · CDSS document, Oct 17, 2024 · control 28-AS-20241010120330

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 25, 2024

The facility shall be clean, safe, sanitary and in good repair at all times. The requirement is not met by evidence of: A pipe outside the front door was leaking water and the audio devices on the back door that access to the patio was not operable. Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 17, 2024

Plan of correction: Licensee agreed to provide the repair the leaking water pipe and the audit device on the patio door by POC due date. Licensee agreed to provide the proof of the repair to Licensing.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 25, 2024

To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. The requirement is not met by evidence of: The call button was not accessible to residents. Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 17, 2024

Plan of correction: Licensee agreed to provide a necklace to attach to the call buttons and make it accessible to the residents by POC due date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not ensure resident was receiving adequate fluid intake while in care. Staff do not ensure resident is provided bathing assistance. Staff do not ensure resident is provided clean clothing. Staff do not ensure resident is provided with toileting assistance. Staff did not ensure an adequate care needs assessment plan was conducted for resident in care. Facility is not following doctor order for medications. Faciliity is not adivsing residents responsible party of residents health status. Facility staff are failing to store resident items in resident’s room in a safe manner. Faciliity did not accept resident back ot facility upon discharge from hospital.

***This report serves as an amendment and supersedes the original complaint investigation report created on 07/16/24. The findings remain as unsubstantiated. *** Licensing Program Analyst (LPA) Tao conducted a subsequent, unannounced complaint visit for delivering finding. The initial unannounced 10-day complaint visit was conducted on 11/15/23 and a subsequent visit was conducted on 07/16/24. During today’s visit, LPA met and explained the purpose of today's visit to administrator,. Investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#1 (R1) to resident#4 (R4); attempted but unable to interview resident #5 (R5); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters; and resident files for resident #1 (R1) with relevant information. (-continued in LIC 9099 C-) Unsubstantiated ***This report serves as an amendment and supersedes the original complaint investigation report created on 07/16/24. The findings remain as unsubstantiated. *** The investigation revealed the following: In regard to staff did not ensure resident was receiving adequate fluid intake while in care, it was alleged that resident was dehydrated due to not having sufficient fluid intake. Per resident interviews, four (4) out of five (5) residents interviewed revealed staff treated residents nicely and provided them fluid, including coffee, teas, and water, three times daily with meals and three to four times daily with medication. One (1) out of five (5) residents was sleeping and unable to be interviewed. During the interview, all residents were able to verbalize their needs. Per staff interviews, all three (3) staff denied the allegation. It revealed staff provided residents with water/fluid with meals and medication multiple times a day. Besides, a jar of water or a 8 oz cup of water with lid was provided in each room near resident’s bed. Per observation, residents had fluid during mealtimes and medication, and additional fluid, such as a jar of drinking water for resident’s consumption, was observed in each room. Thus, there were not preponderance of evidence showing resident did not receive adequate fluid intake while in care. In regard to staff do not ensure resident is provided bathing assistance, it was alleged that facility did not clean resident correctly and did not provide showers to resident. All four (4) residents interviewed revealed residents were bathed at least twice / weekly or more as needed. Per staff interviews, all staff denied the allegation. It revealed residents had their bathing schedules. Residents were scheduled to be bathed daily. Staff would clean residents after changed diapers or as needed. Sometimes, residents would and had rights to decline to be bathed. Per observation, residents were observed to be clean with no foul odor. Thus, staff did not fail to provide bathing assistance to resident while in care. In regard to staff do not ensure resident is provided clean clothing, it was alleged that staff did not ensure resident was placed in clean clothing every day. All four (4) residents interviewed revealed residents had their clothes changed daily. Per staff interviews, all staff denied the allegation. It revealed residents’ clothes were changed daily. Staff would encourage residents to change clothes if residents declined to be changed. As mentioned above, residents were observed to be clean with no foul odor. Thus, resident is provided with clean clothing. (-continued in LIC 9099 C-) ***This report serves as an amendment and supersedes the original complaint investigation report created on 07/16/24. The findings remain as unsubstantiated. *** In regard to staff do not ensure resident is provided with toileting assistance, it was alleged that staff allowed resident to sit in soiled diaper and did not provide toileting assistance. All four (4) residents interviewed revealed staff would change residents’ diapers when got soiled and change their clothes as needed. Residents would tell staff when they needed to go to the bathroom or staff would check on residents throughout the day. Per staff interviews, all staff denied the allegation. It revealed staff would check on residents who needed toileting assistances or check resident’s diaper every 2 hours or so. Staff had in-service training on residents’ right and proper care to elderly. Per observation, staff would ask and assisted residents to go to the bathroom during the investigation visit. Thus, residents were provided with toileting assistance. In regard to staff did not ensure an adequate care needs assessment plan was conducted for resident in care, it was alleged administrator did not do proper care needs assessment on resident when resident was ready to discharge from the hospital. All four (4) residents interviewed revealed staff would assess them or checked and asked them questions upon their returns to the facility after discharged from hospitals. Per staff interviews, all staff denied the allegation. Administrator would assess resident when resident was ready to discharge from the hospitals. Per record review, resident’s assessment was conducted, and progress notes were updated regularly. Thus, adequate care needs assessment plan was conducted for resident in care. In regard to facility is not following doctor orders for medications, it was alleged that the staff allowed resident to sleep and did not waking resident up to ask resident to take the medication as prescribed. All four (4) residents interviewed revealed staff would wake them up for medication and they were not aware of any missing medication. Per staff interviews, all staff denied the allegation. Staff had followed doctor’s instruction on providing the prescribed medication to residents. Per record review, resident’s medical records did not show missing medication. Staff had in-service training on residents’ medication administration. Per observation, staff would wake up residents for taking medication. Thus, facility is following doctor orders for medications. (-continued in LIC 9099 C-) ***This report serves as an amendment and supersedes the original complaint investigation report created on 07/16/24. The findings remain as unsubstantiated. *** Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with administrator, Steven, and findings were discussed. A copy this report was provided at the time of visit. ***This report serves as an amendment and supersedes the original complaint investigation report created on 07/16/24. The findings remain as unsubstantiated. *** In regard to facility staff are failing to store resident items in resident’s room in a safe manner, it was alleged that resident’s items were placed up high which items may have risks of falling on resident. All four (4) residents interviewed revealed their items were not placed up high and they did not recall any items had fallen on them. Per staff interviews, all staff denied the allegation. Staff were aware of the safety needs when storing residents’ items. Per record review, staff had in-service training on residents’ safety. Per observation, residents’ items were not stored up high. Passageways and walkways in the facility / residents’ rooms were free from obstructions. Therefore, residents’ rooms were furnished appropriately and in compliance. In regard to facility is not advising residents responsible party of resident’s health status, it was alleged that staff did not inform the resident’s doctor and responsible party regarding a resident’s health status. All four (4) residents interviewed revealed staff would inform their responsible parties about their physical health status. Per staff interviews, all staff denied the allegation. Administrator and staff would notify residents / responsible parties if there were updates about resident’s health condition changes. Per record review, resident’s records were updated with medical and physical care needs. Staff had in-service training on reporting residents’ physical / medical changes. Therefore, there were not preponderance of evidence showing facility staff failed to notify residents responsible party of resident’s health status. In regard to facility did not accept resident back to the facility upon discharge from hospital, it was alleged that staff did not accept resident back to facility after being discharged from hospital. All four (4) residents interviewed revealed staff would accept them back after discharged from hospitals. Per staff interviews, all staff denied the allegation. Administrator had accepted the resident back after discharged from the hospital. Per record review and LPA’s observation, resident had returned and residing at the facility. Therefore, facility had accepted the resident after discharged from hospital. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. (-continued in LIC 9099 C-)the state’s words, verbatim · CDSS document, Jul 18, 2024 · control 28-AS-20231107092544

Allegation investigated: Staff did not ensure resident was receiving adequate fluid intake while in care. Staff do not ensure resident is provided bathing assistance. Staff do not ensure resident is provided clean clothing. Staff do not ensure resident is provided with toileting assistance. Staff did not ensure an adequate care needs assessment plan was conducted for resident in care. Facility is not following doctor orders for medications. Facility is not advising residents responsible party of resident’s health status. Facility did not accept resident back to the facility upon discharge from hospital.

Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegations listed above. During today’s visit, LPA met and explained the purpose of today's visit to administrator assistant, Elizah Arganosa. Investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#1 (R1) to resident#4 (R4); attempted but unable to interview resident #5 (R5); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters; and resident files for resident #1 (R1) with relevant information. The investigation revealed that: In regard to staff did not ensure resident was receiving adequate fluid intake while in care, it was alleged that residents were dehydrated due to not having sufficient fluid intake. (-continued in LIC 9099 C-) Unsubstantiated The investigation revealed the following: Per resident interviews, four (4) out of five (5) residents interviewed revealed staff treated residents nicely and provided them fluid, including coffee, teas and water, three times daily with meals and three to four times daily with medication. One (1) out of five (5) residents was sleeping and unable to be interviewed. During the interview, all residents were able to verbize their needs. Per staff interviews, all three (3) staff denied the allegation. It revealed staff provided residents with water/fluid with meals and medication multiple times a day. Besides, a jar of water or a 8 oz cup of water with lid was provided in each room near resident’s bed. Per observation, residents had fluid during mealtimes and medication, and additional fluid, such as a jar of water, was observed in each room. Thus, there were not preponderance of evidence showing resident did not receive adequate fluid intake while in care. In regard to staff do not ensure resident is provided bathing assistance, it was alleged that facility did not clean residents correctly and did not provide showers to residents. The investigation revealed the following: all four (4) residents interviewed revealed residents were bathed at least twice / weekly or more as needed. Per staff interviews, all staff denied the allegation. It revealed residents had their bathing schedules. Staff would clean residents after changed diapers or as needed. Sometimes, residents would and had rights to decline to be bathed. Per observation, residents were observed to be clean with no foul odor. Thus, staff did not fail to provide bathing assistance to resident while in care. In regard to staff do not ensure resident is provided clean clothing, it was alleged that staff did not ensure residents were placed in clean clothing every day. The investigation revealed the following: all four (4) residents interviewed revealed residents had their clothes changed daily. Per staff interviews, all staff denied the allegation. It revealed residents’ clothes were changed daily. However, residents had rights not to be changed. Staff would encourage residents to change clothes if residents declined to be changed. As mentioned above, residents were observed to be clean with no foul odor. Thus, resident is provided with clean clothing. In regard to staff do not ensure resident is provided with toileting assistance, it was alleged that staff allowed resident to sit in soiled diaper and did not provide toileting assistance. The investigation revealed the following: all four (4) residents interviewed revealed staff would change residents’ diapers when got soiled and change their clothes as needed. (-continued in LIC 9099 C-) Residents would tell staff when they needed to go to the bathroom or staff would check on residents throughout the day. Per staff interviews, all staff denied the allegation. It revealed staff would check on residents who needed toileting assistances or check resident’s diaper every 2 hours or so. Staff had in-service training on residents’ right and proper care to elderly. Per observation, staff would ask and assisted residents to go to the bathroom during the investigation visit. Thus, residents were provided with toileting assistance. In regard to staff did not ensure an adequate care needs assessment plan was conducted for resident in care, it was alleged administrator did not do proper care needs assessment on resident when resident was ready to discharge from the hospital. The investigation revealed the following: all four (4) residents interviewed revealed staff would assess them or asked them questions upon their returns to the facility after discharged from hospitals. Per staff interviews, all staff denied the allegation. Administrator would assess resident when resident was ready to discharge from the hospitals. Per record review, resident’s assessment was conducted and progress notes were updated regularly. Thus, adequate care needs assessment plan was conducted for resident in care. In regard to facility is not following doctor orders for medications, it was alleged that the staff allowed resident to sleep and did not waking resident up to ask resident to take the medication as prescribed. The investigation revealed the following: all four (4) residents interviewed revealed staff would wake them up for medication and they were not aware of any missing medication. Per staff interviews, all staff denied the allegation. Staff had followed doctor’s instruction on providing the prescribed medication to residents. Per record review, resident’s medical records did not show missing medication. Staff had in-service training on residents’ medication administration. Thus, facility is following doctor orders for medications. In regard to facility is not advising residents responsible party of resident’s health status, it was alleged that staff did not inform the resident’s doctor and responsible party of the resident’s health status. The investigation revealed the following: all four (4) residents interviewed revealed staff would inform their responsible parties about their physical heath status. Per staff interviews, all staff denied the allegation. Administrator and staff would notify residents / responsible parties if there were updates about resident’s health condition changes. Per record review, resident’s records were updated with medical and physical care needs. Staff had in-service training on reporting residents’ physical / medical changes. Therefore, there were not preponderance of evidence showing facility staff failed to notify residents responsible party of resident’s health status. (-continued in LIC 9099 C-) Facility did not accept resident back to the facility upon discharge from hospital, it was alleged that staff did not accept resident back to facility after being discharged from hospital. The investigation revealed the following: all four (4) residents interviewed revealed staff would accept them back after discharged from hospitals. Per staff interviews, all staff denied the allegation. Administrator had accepted the resident back after discharge from the hospital. Per record review and LPA’s observation, resident had returned and residing at the facility. Therefore, facility had accepted the resident after discharged from hospital. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with administrator and findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Jul 16, 2024 · control 28-AS-20231107092544

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Elizah Arganosa, Administrator assistant. The facility is licensed to serve 6 non-ambulatory residents (age range from 60 years old and over), including 1 bedridden. Facility has hospice care waiver for 4 residents. The annual fees were current. LPA explained the purpose of today's visit and the inspection to the administrator. During the visit, Care tools, staff/resident interviews and physical plant were conducted; food supply, staff/residents files and medications were reviewed. The facility is a single-story home located in a residential neighborhood consist of 6 residents bedrooms, 2 bathrooms, a living room, a dining area, kitchen, laundry area in the garage, a garage, and an outdoor activity area at the backyard. The yard has a shaded area and free of debris/ hazard. Bathrooms are clean and operational. Sufficient supply of perishable and non-perishable foods. Adequate linen and personal hygiene supply. Smoke detectors are combined with carbon monoxide detectors and are operable and in compliance. The last Fire/ Emergency Drill was conducted on 05/09/24. Auditory devices are operable. Medications are centrally stored, and locked. Client and staff records have required documentation. Hot water temperature was measured at 115.3 degrees Fahrenheit. Administrator certificate is current and expires on 06/02/25. Deficiencies were observed and cited per California Code of Regulations, Title 22. See LIC 809D for deficiencies. An exit conference was conducted with Elizah, administrator assistant. LIC 809s and appeal rights were provided.the state’s words, verbatim · CDSS document, May 21, 2024

Allegation investigated: Staff slapped resident. Staff did not report incidents as required.

Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegations listed above. During today’s visit, LPA met and explained the purpose of today's visit to administrator, Elizah Arganosa. Investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); interviews of residents from resident#1 (R1) to resident#4 (R4); attempted but failed to interview resident #5 (R5); failed to interview resident #6 (R6) since R6 was out; interview with visitor#1 (V1); reviews of resident#1’s record, and physical plant was conducted. LPA obtained copies of staff/resident rosters; and resident files for resident #1 (R1) with relevant information. (-continued in LIC 9099 C-) Unsubstantiated The investigation revealed that: In regard of the allegation staff slapped resident, it was alleged that facility staff slapped resident while in care. The investigation revealed the following: four (4) out of five (5) residents interviewed revealed staff treated residents nicely with respect and had never slapped them. One (1) out of five (5) residents was non comprehend and unable to be interviewed. Per resident interviews, residents were able to verbalize their needs. Per staff interviews, all three (3) staff denied the allegation. Per visitor interview, it revealed staff were treating residents nicely and did not observe staff hitting or slapping residents. Per file review, residents’ progress notes did not indicate resident had reported being slapped by staff. Staff had in-service training on residents’ right and abuse prevention. Per observation, residents looked fine and had open conversation with staff regarding the care they needed. Thus, there were not preponderance of evidence showing staff slapped resident. In regard of the allegation staff did not report incidents as required, it was alleged that staff did not report resident’s falls to licensing. The investigation revealed the following: three (3) out of five (5) residents interviewed revealed residents had never fallen while in care. One (1) out of five (5) residents interviewed revealed resident had fell twice, uninjured, since moved in. Staff provided immediate care to resident after the falls. Per staff interviews, all three (3) staff stated only one (1) resident had fell since admitted to the facility. Staff provided immediate care to resident after the falls and reported the resident’s falls to administrator and administrator reported the incidents accordingly. Per file review, two (2) incident reports, dated 10/20/23 and 02/13/24, regarding the resident who claimed had fell twice were reported to licensing. Per staff training review, in-service training on reporting incidents was conducted. Thus, there were not preponderance of evidence showing staff did not report incidents as required. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with administrator and findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Apr 2, 2024 · control 28-AS-20240328143029