Aaspen Villagecare II

Allegation investigated: Facility staff prevented resident from seeing physician of choice Facility staff did not ensure resident had appropriate clothing Facility staff did not assist resident with transferring to wheelchair

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation and deliver findings on the above allegations. LPA met with House Manager, Amanda Roberts, who was informed of today’s visit. The investigation consisted of LPA observations, reviewing pertinent records, and interviews with relevant parties. Regarding the allegation, facility staff prevented resident from seeing physician of choice, there is not enough evidence to corroborate this allegation. Interview with resident #1(R1) indicates that staff did not prevent them from seeing a physician of their choice. Interviews with five (5) staff indicate that they did not prevent R1 from seeing a physician of choice. Regarding the allegation, facility staff did not ensure resident had appropriate clothing, there is not enough evidence to corroborate this allegation. Interview with (R1) indicates that they had appropriate clothing to wear. Interviews with five (5) staff indicate that they did ensure R1 had appropriate clothing. Unsubstantiated Regarding the allegation, facility staff did not assist resident with transferring to wheelchair, interviews with three (3) residents and five (5) staff indicate there is not a preponderance of evidence to corroborate the allegation that staff did not assist resident with transferring. Based on the Department’s investigation, the above allegations are Unsubstantiated. A finding that a complaint is Unsubstantiated means that 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. An exit interview was conducted where reports (LIC 9099 & LIC9099C) were discussed, and a copy was provided to House Manager Roberts at the conclusion of the visit. Based on the Department’s investigation, the allegations that facility staff prevented resident from having visitors and prevented resident from receiving phone calls is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099, LIC9099C, LIC9099-D) were discussed and provided with appeal rights to House Manager Roberts at the conclusion of the visitthe state’s words, verbatim · CDSS document, Feb 11, 2026 · control 56-AS-20240301121823

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(21) · Plan of correction due date: Feb 18, 2026

87468.2(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents...shall have all of the following personal rights:(21)To consent to have their relatives and other individuals of their choosing visit during reasonable hours, privately, and without prior notice. This requirement is not met at evidenced by: The licensee did not comply with the section cited above by staff restricting R1’s visits without consent from resident, which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: The Licensee/Administrator has agreed to provide staff with inservice training on the regulation cited and submit documentation of training to the licensing agency by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87468.1(a)(14) · Plan of correction due date: Feb 18, 2026

87468.1(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(14) To have reasonable access to telephones, to both make and receive confidential calls. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by facility staff restricting R1’s telephone calls without resident’s consent, which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: The Licensee/Administrator has agreed to provide staff with inservice training on the regulation cited and submit documentation of training to the licensing agency by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an announced visit to the facility to conduct a required comprehensive annual inspection. LPAs were greeted and granted entry by the House Manager Amanda Roberts, The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (15) and current census of (0) residents. Last resident residing at facility was on 7/05/25. LPAs conducted an overall inspection of the facility, which included, but was not limited to, the following: The facility is currently under construction, the facility has no swimming pool or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. Facility has eight (8) bedrooms and four (4) bathrooms. The facility has a small food supply, the kitchen is being used to cook food for Aaspen Village Care (366423788). No deficiencies were cited during today's inspection. An exit interview was conducted where this report was discussed and a copy provided to House Manager Amanda Roberts at the conclusion of the visit,the state’s words, verbatim · CDSS document, Jan 26, 2026

Allegation investigated: Staff does not ensure residents are provided a comfortable temperature.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Chris Tanabe, and discussed the purpose of the visit. LPA was unable to conduct a walkthrough of facility due to being closed for renovations and no residents in care. LPA conducted two (2) staff interviews, staff informed LPA the facility temperature was kept between 72-74 Degrees F. LPA conducted one (1) resident interview informing LPA the facility temperature was not always hot, the facility kept a machine that blew out cold air throughout the facility. Based on LPA’s previous visit, the facility temperature was kept at a comfortable temperature. Based on observation, interviews, and pertinent documents the allegation is unsubstantiated. An Unsubstantiated complaint means, that 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. An exit interview was conducted with Administrator Chris Tanabe and a copy of this report was provided at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 7, 2025 · control 56-AS-20250702113737

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a) · Plan of correction due date: Jul 11, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation and interviews, the administrator/Licensee did not comply with the section cited above by not ensuring facility is free of pests. This violation poses a potential health and safety risk to residents/staff in carethe state’s words, verbatim · CDSS document, Jul 7, 2025

Plan of correction: Administrator contacted exterminator to notify all residents have been removed from the facility and will schedule a day to return and spray the entire facility. An invoice will be provided to LPA when visit is conducted.

Type of visit: POC

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a Plan of Correction (POC) visit to follow up on documents that the Department requested. LPA met with Administrator Chris Tanabe and discussed the purpose of the visit. On 06/27/2025 an Office meeting was conducted with Licensee Khan Mushtaq, the Department requested documentation to be submitted by 06/30/2025. Facility staff have not provided documentation to Department, LPA has given staff an extension to submit LIC 500, LIC 9020, copies of letters to residents rescinding eviction, list of residents who relocated and where they moved to by 07/11/2025. Administrator Chris Tanabe provided LIC 500 and LIC 9020 to LPA day of visit. Based on observation no deficiencies were cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where the Licensing reports were discussed and copies of the reports were provided to Administrator Chris Tanabe.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Office

On June 27, 2025, the Department held an informal office meeting to discuss the status of all Aaspen Village Care facilities. In attendance was Regional Manager (RM) Leslie Mendiveles, Licensing Program Manager (LPM) Karen Clemons, Licensing Program Analyst, (LPA) Sarina Ramirez and Licensee Khan Mushtaq. During today's meeting the following was discussed: 1. The status of the facility operation. 2. Eviction Procedures/Plan of Closure 3. Notification in Compliance with Title 22 4. Licensee/Administrator Responsibilities/ Staffing 5. Accountability of Licensee Governing Body 6. Residents in care. The Licensee informed the Department the facility will not be closing, however facility is currently under renovations and three (3) residents in care will be relocated to sister facility Aaspen Village Care 366423788. The following was requested: LIC 500, LIC 9020, Dates of when the renovations will begin and estimated completion, copies of letters to residents rescinding eviction, list of residents who relocated and where they moved to. All documents requested are due by Monday June 30,2025. The following documents were provided to Licensee: Accountability of Licensee Governing Body, Administrator Qualifications and duties, Eviction Procedures, Transfer of Resident upon forfeiture of License or Change in use of facility. On 4/29/25 House Manager Amanda Roberts and Administrator Chris Tanabe emailed LPA copies of eviction letters to residents regarding renovations. The letters were not approved and the licensee agreed to resend the letters and provide licensing with corrected copies of a temporary relocation notice. In the future the Licensee has agreed to follow Title 22 procedures regarding facility closure. An exit interview was conducted with the Licensee and a copy was provided at the conclusion of the meetingthe state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarina Ramirez arrived at the facility to amend documents originally delivered on 06/09/25. LPA toured the facility, the hole in the ceiling has not been patched nor tested for what appears to be black mold. LPA explained to Caregiver the black mold needs to be tested immediately and provide results to LPA as soon as possible. LPA also informed Caregiver, the Licensee has yet to contact CCLD regarding the status of both Aaspen Village Care Facilities. LPA provided a copy of a correspondence addressed to Licensee regarding an office meeting scheduled. The amendment was signed by Caregiver Faith Grant and was provided a copy of the amended report at the conclusion of the visitthe state’s words, verbatim · CDSS document, Jun 19, 2025

Allegation investigated: Staff did not inform authorized representative of residents death

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegations mentioned. LPA met with House Manager Denise Colvin and explained the purpose of the visit. LPA's investigation involved interviews and records review. It is alleged staff did not inform Authorized Representative of Resident 1 (R1) death. LPA never received clarification on who R1 was. LPA conducted interviews with staff stating when residents pass the Administrator follows up with their responsible parties. Administrator provided documentation to corroborate the attempted communication to R1’s authorized representative. Based on LPAs record review, interviews, and lack of evidence the above allegation is Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means 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. An exit interview was conducted, and this report was discussed and provided to House Manager Denise Colvin Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 9, 2025 · control 56-AS-20250401124750

Allegation investigated: License did not adhere to eviction protocs with residents in care.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegation mentioned. LPA met with House Manager Denise Colvin and explained the purpose of the visit. The Department's investigation involved observations, interviews, and records review. The allegation indicates Administrator/Licensee did not adhere to eviction protocols with residents in care. During the investigation, LPA Ramirez was able to obtain evidence to corroborate the allegation above. LPA conducted six (6) resident interviews, four (4) residents indicated that the Administrator did provide sixty (60) days written notice of eviction due to the facility renovations. Four (4) staff interviewed informed LPA residents were given (60) day evictions notices. Records review indicated that the Administrator provided Eviction Notice to residents on April 28, 2025 and residents were requested to vacate the facility by June 28,2025. Substantiated Based on LPA Ramirez interviews, observation, and records review, the preponderance of evidence standard has been met, and therefore the above allegation of eviction protocols were not met is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC9099D. An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to house Manager Denise Colvin.the state’s words, verbatim · CDSS document, Jun 9, 2025 · control 56-AS-20250520085037

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.682 · Plan of correction due date: Jun 28, 2025

1569.682 Transfer of resident upon forfeiture of license or change in use of facility; duties of licensee; closure plan; duty of department upon licensee’s failure to comply; civil penalties(a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license...or a change of use of the facility pursuant to the department’s regulations, take all reasonable steps to transfer affected residents safely and to minimize possible transfer trauma……..(b) If seven or more residents of a residential care facility for the elderly will be transferred...the licensee shall submit a proposed closure plan to the department for approval. The department shall approve or disapprove the closure plan, and monitor its implementation...(6) Until the department has approved a licensee’s closure plan, the facility shall not issue a notice of transfer or require any resident to transfer. This requirement was not met as evidenced by: Based upon record review and interviews, Administrator/Licensee did not submit closure plan to CCLD for approval. This violation posed a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Jun 9, 2025

Plan of correction: Administrator was advised to discuss with Licensee to submit closer plan and updated eviction notices to be approved by CCLD. Administrator was advised once the closure plan is submitted and approved, eviction dates are reset.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a Health and Safety check. LPA met with House Manager Denise Colvin, and discussed the purpose of the visit. LPA Ramirez toured the facility and observed an open, unpatched hole in the ceiling of the facility heading towards the kitchen. Facility has a sign posted on the entrance of the doorway reading “No residents are allowed in the kitchen area. This is for the safety of residents and staff.” LPA conducted interviews with residents and resident 1 (R1) informed LPA they recently changed rooms due to their old room having bed bugs, LPA observed R1 itching and several red bumps throughout R1’s chest. Staff informed LPA an exterminator came to spray the facility a week prior, however no invoice was given and was told a technician would return for a second spray and no one has returned. Based on observation deficiencies were cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where the Licensing reports were discussed and copies of the reports with Appeal Rights was provided to House Manager Denise Colvin.the state’s words, verbatim · CDSS document, Jun 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80087(a) · Plan of correction due date: Jun 20, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation and interviews, the administrator/Licensee did not comply with the section cited above by leaving an open hole which also may have black mold in the facility ceiling and not ensuring facility is free of pests. This violation poses an immediate health and safety risk to residents/staff in carethe state’s words, verbatim · CDSS document, Jun 9, 2025

Plan of correction: Administrator is advised to get the black mold tested , provide proof of invoice/results and patch the open hole in the ceiling and provide proof to LPA by POC due date

Allegation investigated: Staff did not ensure that facility has an adequate amount of food in refrigerator and freezer for the residents Staff did not ensure that there is substance or variety in the food served to the residents Staff did not ensure that food served to the residents matches what is on the menu Staff is not following the residents' special diets

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met House Manager, Denise Colvin and Administrator, Chris Tanabe and informed the purpose of the visit. Regarding the allegation, staff did not ensure that facility has an adequate amount of food in refrigerator and freezer for the residents, LPA observed an adequate amount of food in facility refrigerators and freezers. Administrator and staff interviews reveal they do ensure that facility has an adequate amount of food in refrigerator and freezer. Five (5) residents interviews reveal they are provided sufficient amount of food during meal service. Regarding the allegation, staff did not ensure that there is substance or variety in the food served to the residents, LPA observed a variety of perishable and non-perishable food stored at the facility. Administrator and staff interviews reveal they do ensure that there is substance or variety in the food served to the residents. Unsubstantiated Four (4) out of five (5) resident interviews reveal that there is substance and/or variety in the food served to them. Regarding the allegation, staff did not ensure that food served to the residents matches what is on the menu, interviews with the Administrator and staff reveals the facility prepares a sample menu. Menus are changed and food is bought according to resident's request and special events. Three (3) out of (5) residents interviews reveal that they do not request to see a menu but staff do ask for suggestions of meals they will like to be served. Regarding the allegation, staff is not following the residents' special diets, interviews with the Administrator and staff deny not following the residents' special diets. Interviews with five (5) residents reveal not enough evidence to corroborate the allegation. Based on the investigation findings, the allegations are Unsubstantiated. An Unsubstantiated meaning that 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. An exit interview was conducted and a copy of this report with appeal rights was provided to Administrator Tanabe at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 19, 2025 · control 56-AS-20250512153450

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with House Manager Lora Statler, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (15), a current census of (11). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility does not have a swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities The facility is equipped with operating smoke detectors/carbon monoxide alarms, working laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in three (3) resident bathrooms measured between 105.2 and 108 degrees F. Five (5) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, facility sketch, personal rights, emergency disaster plan with telephone numbers, and Ombudsman poster. Food Service: Facility kitchen and dining area are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Four (4) Staff files reviewed were observed to be complete. Four (4) Resident files reviewed were observed to be complete. Based on observations and record review technical assistance and violations were issued, but no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report along with LIC 902 was discussed and provided to House Manager Lora Statler.the state’s words, verbatim · CDSS document, Jan 21, 2025

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Lora Statler, House Manager and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (15) and a current census of (9) residents in care. The facility has a hospice waiver for (6) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. Outdoor area is fenced and sufficient for resident activities. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured between 105 to 112 degrees F. Resident’s bedrooms have sufficient lighting and furniture in good repair. Facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted: facility license, Ombudsman poster, "Oxygen in use" signs, disaster evacuation plan and emergency telephone numbers. Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerators and freezers are operating in a healthful manner. Sharps, pesticides and other cleaning solutions were kept locked and stored away from food areas. Care & Supervision: Facility has 24-hour/7 days a week care staff. Record Review: The last emergency drill was conducted on 12/13/23. Administrator’s certification expires on 4/14/2024. LPA review of staff files reveal, the facility did not maintain record of CPR training for staff #2 (S2), staff #3 (S3), and staff#4 (S4). The facility did not maintain a criminal background clearance and health screening for staff#1(S1). LPA review of resident files reveal, resident #1 (R1) had an incomplete residential appraisal on file. LPA facility record review reveals, the facility did not maintain record of liability insurance. Medical Related Services: All medication is centrally stored and kept locked. Based on LPA observations and record review, deficiencies and civil penalties are being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where reports (LIC809/LIC809-D/LIC9102) were discussed and copies with Appeal Rights were provided to the House Manager at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 18, 2023