A Place Like Home 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 (S1) at 8am. LPA met with Administrator Designee (AD) Khatera Bahadory at 9:15am and explained the purpose of the visit. AD shared with LPA that AD recently purchased the facility in February 2026 and the facility will be undergoing a Change of Ownership. The facility is a five bedroom, three bathroom residence with a fire clearance for six non-ambulatory residents in which one may be bedridden in bedroom #2. The facility has a hospice waiver for six residents. Currently there are five residents in care and four were receiving hospice services. LPA toured the kitchen and observed sharps, knives and chemicals/ cleaning supplies were stored beneath the kitchen sink and were secured. The refrigerator/freezer had more than two-days of perishables, fresh fruits and vegetables were observed, and there was seven-days of non-perishable supplies. LPA observed pantry and there were no items that were expired. The kitchen appliances were in working order. The facility temperature was 70 degrees Fahrenheit, was clean and odorless. During the tour LPA observed resident bedrooms which had the required furnishings. Bed rail orders were on file. LPA tested the hot water temperatures in two of two resident bathrooms. The hot water temperature ranged from 113.3 to 113.5 degrees Fahrenheit. Bathrooms had grab bars and non-skid mats and covered trash bins. Carbon monoxide and smoke detectors were inspected and were operational. The fire extinguisher was charged and inspected on March 25, 2025. The last fire drill was conducted on February 3, 2026. A Technical Violation was provided for documentation not in the file. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the property and observed a shaded seating area. An Additional Dwelling Unit (ADU) also is on the property lot with a separate address. The ADU is a licensed facility, A Place Like Home 8, RCFE #306006750. There were no hazards or obstruction of pathway and there were two exterior self latching gates. Audible alarms were in working order and are activated at night. The PUB 475 poster was posted in the hallway with facility theft and loss policy, Emergency Disaster Plan, Client rosters and visiting hours. LPA provided AD with fees payment information which AD will pay. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA observed the First Aid Kit and the facility has a First Aid Manual. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on December 14, 2027. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Khatera Bahadory, Administrator Designee and a copy of the report, LIC 9102-TV and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Mar 12, 2026

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 do not ensure resident receives toileting assistance - Staff allow resident to be left in soiled clothing for extended periods of time - Staff are using medication as a form of restraint on resident in care - Staff do not ensure resident is spoken to in an appropriate manner - Staff do not ensure resident is accorded privacy during personal phone conversations - Staff pushed resident in care - Staff do not ensure resident is provided feeding assistance - Staff does not ensure resident receives bathing assistance

On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by Administrator (AD) Maria Avila and explained the reason for the visit. The Department received a complaint on September 25, 2025. During the investigation, LPA Tea spoke to facility staff, residents, resident family members and other witnesses and reviewed and collected pertinent documents and information. It was alleged that staff do not ensure resident receives toileting assistance. Per interviews with family members of residents, three out of four have agreed that residents receive the toileting assistance they need. One family member interviewed said they at least check on the resident every three hours. Many of them agree that when they visit their loved ones at the facility, they do not have any odors or smell and (Complaint Investigation report continued on LIC9099C) Unfounded notice no bed sores of any kind on the residents. One family member understands that despite they wish their family member to use the bathroom independently, unfortunately the resident has to wear diapers, but they commend the staff for doing a wonderful job with the incontinence care and toileting assistance. One of the staff interviewed said they have a schedule they follow with the toileting and incontinence care. They assist, change and check residents for the toileting assistance and incontinence care in the morning, before lunch and before dinner. Nighttime shift staff check them before the daytime shift staff leaves. Sheila Ben, one of the administrators interviewed, said her staff are very hands on with the residents in toileting assistance. From her nursing background perspective, Administrator Ben said that patients would have wounds, and they would smell. For her and her other administrator Maria Avila it is unacceptable for the residents to have bad hygiene. It was alleged that staff allow resident to be left in soiled clothing for extended periods of time. From LPA Tea’s observation during the initial investigation, residents were in clean clothes. Their beds and rooms were clean and odor free and there are no signs or evidence of residents in soiled clothing. Both residents that the LPA have spoken to said they never had soiled clothing or sat in soiled clothing. Four out four family members of residents interviewed have agreed that their family has always been presentable and dressed in clean clothing and never in soiled clothing. Two out of two staff interviewed have similarly stated that residents are clean and checked every so often. They change them every day. One staff member stated that they reposition their bed bound residents and apply lotions. Both ADs Ben and Avila stated their staff go above and beyond for the residents. AD Ben mentioned the hospice staff that come to the facility advocates for hygiene and gives them reminders. It was alleged staff are using medication as a form of restraint on resident in care. LPA reviewed the physician’s orders for resident medications, and the facility has been following the doctor’s order. It is well documented in the MAR record and used in the recommended dosage. Staff would check with the administrator and the hospice for medications such as Lorazepam to calm the residents with dementia who have agitated behavior. One family member interviewed does have a family member who is a licensed pharmacist and goes over the medication dosage of the resident. Another family member interviewed regarding medication said they have a discussion with the doctors and the facility about the right dosage of medication given to their family member at the facility. They work and communicate with them and confirm they are not over medicating the resident, it is very transparent. (Complaint Investigation report continued on LIC9099C) It was alleged staff do not ensure resident is spoken to in an appropriate manner. Three out four family members of residents have confirmed that the staff are nice and talk respectfully to the residents. One staff member said some residents are hard of hearing and they must maximize their voice, in which AD Ben agrees that some residents are hard of hearing. Both residents that were interviewed confirmed as well that staff talk to them nicely. It was alleged that staff do not ensure resident is accorded privacy during personal phone conversations. Three out of four residents confirm that their family members who reside at the facility are given privacy and space. At the time of the visit, LPA observed visiting family members are accorded privacy and given the space to talk and interact with them privately. Staff even close the doors of the residents’ rooms to give them privacy. Regarding personal phone conversations, one resident is not cognitive to hold the phone, both staff interview confirmed they would have to hold the phone for the resident. Sometimes the resident would just press buttons and hang up on the person who is on the other line. A family member confirmed the resident does not have the capacity to physically hold a phone, cognitively the resident does not even know who they are or the relations to the family member. It was alleged that staff pushed resident in care. Three out of four family members confirmed that they have never seen or heard any residents being pushed. One family member thought it was nonsense that the great staff would do such a thing. All staff interviewed confirmed that they would never push residents. One staff mentioned that if they were physical with residents, family members would see marks or bruises on the residents. AD Ben said there has never been a fall incident that has been reported and not only that there is zero tolerance for that kind of behavior at their facilities. A witness said a resident observed another resident being pushed. LPA interviewed the resident who had allegedly witnessed another resident pushed and LPA observed that the resident was cognitively impaired to remember and speak due their progressive health condition. It was alleged that staff do not ensure resident is provided feeding assistance. Per interviews with family members of residents, three out of four confirmed that residents are provided assistance with feeding. A couple of them mention that staff go above and beyond, doing 1:1 feeding with the residents and are amazed with the care from the staff. Another family member mentioned that the staff makes sure the resident is fed, and since they have been at the facility the resident has never developed a UTI, like the previous (Complaint Investigation report continued on LIC9099C) facilities they were at. AD Avila said the allegation was completely not true because most of the staff assist the residents with feeding, even if the ones who are very independent, the staff helps them during meals. It was alleged that staff does not ensure resident receives bathing assistance. Four out four family members interviewed confirm that their loved ones at the facility receive bathing assistance. One family member even mentioned that they even help shave the resident. They all said the residents are clean, in which from LPA’s observation during the investigation concludes that residents are clean. One family member said the staff go above and beyond with their loved ones. One resident confirms they assist them in the shower. Four out four staff interviewed confirmed that they give bathing assistance more than they should. One staff member said they give extra baths to the residents, especially when the family comes to see the residents. The staff wants to have the residents look presentable, and the family to enjoy their time with the residents and show how well taken care of the residents are. They do not wait for hospice assistance with baths. AD Ben said her staff does a good job cleaning their residents, even their toes and feet are so clean, which she is proud of. Therefore, based on LPA's observations, interviews conducted, and records reviewed the allegations mentioned above have been determined UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis. No deficiencies cited at this time and an exit interview was conducted with Administrator Maria Avila. A copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 24, 2025 · control 22-AS-20250925110451

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Licensee (LE) Maria Avila and Administrator (AD) Sheila Ben. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on September 14, 2024, for a total capacity of six non-ambulatory clients, in which one maybe bedridden. The fire clearance was approved by a fire inspector from the Orange County Fire Authority on September 26, 2024. The facility is a one-story home with five bedrooms, three bathrooms, a living room, a kitchen, a dining area, and attached two car garage. There are two side exit gates on both sides of the house that are self-latching and unlocked. There is a shaded seating area for clients in the backyard and LPA did not observe any obstacles or hazards. There are activities such as games and puzzles for residents to play and participate in. LPA observed Administrator certificate, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall in the kitchen and living room area. The See Something, Say Something poster (PUB 475), Long Term Care Ombudsman poster, and Personal Rights were posted up on the wall by the dining area. Resident bedrooms had the required furnishings. Bedrooms with sliding doors had working door alarms. LPA observed all beds had linens and blankets. Smoke detectors and carbon monoxide detectors tested operational. Hot water temperatures in the bathrooms measured around 107.7 Fahrenheit degrees. Toxins were secured and locked underneath the kitchen sink along with the sharps stored in a separate plastic container. All additional toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients and will be stored in the garage. Medications will be stored in a locked cabinet in the kitchen with resident files. The first aid kit with all the required elements and first aid guidebook was observed in the dining area on top of a cabinet table. Records Prelicensing Report continuation on LIC809-C will also be stored alongside with medication in the cabinet. Licensee has mention she might purchase a separate cabinet to store resident and facility files. A phone is in the kitchen for clients to use. A supply of two day/seven-day of perishable and non-perishable food was observed. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. Emergency food and water and additional supplies were observed to be well stocked in the kitchen pantry and garage. There is a laptop in the kitchen for the residents to use. The fire extinguisher is in the dining area and is fully charged and serviced on September 6, 2024. The facility is ready to be licensed. LPA conducted the Component Three Orientation with Licensee Maria Avila and Administrator Sheila Ben. Licensee was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was provided to the Licensee and Administrator.the state’s words, verbatim · CDSS document, Mar 17, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Interview Method: Telephone interview On 2/19/2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 19, 2025