Agape Cottage

Allegation investigated: Facility illegally evicted a resident in care. Staff did not properly feed a resident in care. Staff restrained residents in care.

On July 1, 2026, the Department of Social Services (DSS) staff conducted an unannounced visit to the facility to continue the investigation of the above allegations and to deliver the findings. The department was greeted by Care Provider, Corazon Sevilleno and the purpose of the visit was explained. The facility currently has six residents in care. The investigation consisted of the following: On April 30, 2024, the Department conducted an initial unannounced visit to investigate the listed allegations. During that visit, it was determined that further investigation was required. On June 30, 2026, the Department returned unannounced to continue the investigation. During that visit, the Department obtained and reviewed the following documents: staff roster (dated 3/20/26), resident roster (undated), R1’s Physician’s Report (dated 2/19/24), Admission Agreement (dated 4/19/23), medication list (dated 12/29/23), R2’s Resident Appraisal (dated 5/13/20), staff training records covering resident rights, postural supports, special needs of older adults, medication, and end of life issues/hospice (dated 2/16/24–3/27/25), handwritten correspondence from R1’s POA (spouse) to the former administrator (dated 5/1/24), text messages between the POA and former administrator (various dates), and R2’s Physician’s Certification for Hospice Benefit (dated 1/7/22). On June 30, 2026, the Department toured the facility and interviewed the Licensee (A1), two staff members (S1–S2), and Witness 1 (W1), the former administrator. On July 1, 2026, the Department interviewed three residents (R3–R5). Page 1 of 5 Unsubstantiated The investigation revealed the following: Allegation: Facility illegally evicted a resident in care. The complaint alleges that the facility issued R1 an eviction notice requiring him to leave by April 30, 2024, and threatened to call law enforcement if he did not comply. It was further alleged that the eviction was due to an unwitnessed fall. During the June 30, 2026, interview at 1:30 p.m., the Licensee (A1) denied issuing any eviction or threat of eviction, stating instead that R1’s family wanted him to move because the facility was not a good fit. W1, the former administrator, also denied the allegation. W1 stated that R1’s family chose to relocate him and provided DSS with a handwritten note from the POA dated May 1, 2024, stating that a new placement had been found. W1 additionally reported that the family raised financial concerns, as reflected in text messages between W1 and the POA. Of the two staff interviewed, one denied that R1 was evicted and stated that the family located a new facility for him. The second staff member was new and could not provide relevant information. One staff member also reported that while R1 sometimes demonstrated aggressive behavior, he was never asked to leave. Staff denied that R1 experienced any falls while in care. The Department reviewed the handwritten note from R1’s POA, the text messages referenced above, and the Admission Agreement (dated 4/19/23). R1 was unavailable for interview, as he no longer resided at the facility and has since passed away. He was on hospice at the time of his death. Page 2 of 5 Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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 did not properly feed a resident in care. The complaint alleges that a staff member continued feeding R2 while she was choking. On June 30, 2026, A1 denied the allegation, stating that there were no reports of choking involving R2. Of the two staff interviewed, one stated that R2 was capable of feeding herself and had never experienced a choking incident at the facility. The second staff member was new and unable to provide information. W1 also denied the allegation and indicated there were no reports of R2 choking during her stay. The Department reviewed R2’s Physician’s Report (dated 1/2022), Resident Appraisal (dated 5/13/20), and Physician’s Certification for Hospice Benefit (dated 1/7/22). On July 1, 2026, three residents (R3–R5) were interviewed. All three reported that they are treated well, have never been fed too quickly or in a manner that caused choking, and feel safe and cared for in the facility. Page 3 of 5 R2 was not available for interview, as she has since passed away. Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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 restrained residents in care. The complaint alleges that R1 was placed in a wheelchair with a belt to prevent him from slipping. A1 denied the allegation, stating that R1 was never restrained, that he understands postural supports require a physician’s order, and that staff do not use restraining devices on any resident. W1 similarly denied the allegation and confirmed his understanding of the requirement for physician authorization for postural supports. Of the two staff interviewed, one stated that R1 never used any restraining device and did not use a wheelchair. The second staff member was new and unable to provide information. On July 1, 2026, all three residents interviewed (R3–R5) stated that they have never been restrained and have never observed any resident being restrained at the facility. Page 4 of 5 The Department reviewed R1’s Physician’s Report (dated 2/19/24), Admission Agreement (dated 4/19/23), medication list (dated 12/29/23), and staff training records regarding resident rights, postural supports, special needs of older adults, medication, and end-of-life/hospice care (dated 2/16/24–3/27/25). Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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. There were no deficiencies cited during today’s visit. Exit interview conducted and copy of report provided. Page 5 of 5the state’s words, verbatim · CDSS document, Jul 1, 2026 · control 18-AS-20240429090513

Type of visit: Required - 1 Year

On 4/28/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required visit to the facility. LPA Flores met with staff Corazon Sevilleno and explained the purpose of the visit. LPA Flores was granted entry into the facility and a tour was conducted alongside staff Corazon. During the inspection, LPA Flores observed the following: The facility is a single-story structure which consisted of (6) six resident bedrooms, garage, kitchen, living room, dining room, and laundry room. The office documented on the facility sketch has now been converted to a staff bedroom. Resident bedrooms were observed to be equipped with the required bedding, furniture, and functional lighting. Bathrooms were required with grab bars and slip resistant material in the designated areas. LPA observed a fully charge fire extinguisher mounted on the wall near the kitchen. The kitchen was observed to be organized and sanitary. LPA observed a drawer equipped with a lock designated for knives and other sharp items. LPA observed a cabinet equipped with a locked designated for disinfectants and other cleaning solutions. Medication was observed to be centrally stored and made inaccessible to residents and unauthorized representatives. LPA observed books and other activities stored in the TV room. Carbon monoxide and smoke detectors were observed to be fully operable. Water temperature was measured within the required limits. Laundry services are provided on-site. LPA observed a locked cabinet which stored detergents. The facility maintained adequate supply of towels and linen for resident-use. Per Administrator Rose Sumadsad, there are no firearms and/or ammunition on the premises. A records review was conducted for (4) four out of (4) four residents. (3) Three of (4) four resident files were missing Appraisals/Needs and Service Plans and Functional Capabilities assessments. (3) Three staff record were reviewed. Records included but not limited to personnel records, health screening with TB results, background and fingerprint clearance, valid first-aid/CPR certification, and relevant training's. Health and safety concerns were address with Administrator and will be cited on the attached LIC809D. An exit interview was conducted and a copy of the LIC809/D along with appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conclude the annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. Resident record review began. Three (3) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables is missing from files, and personal rights notification. This facility is meeting documentation requirements. LPA began review of employee records. Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening missing and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is not sufficient for safety and comfort. Water temperature measured 125 degrees F and warning labels are posted. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. (Continued on next page) (Continued from Page 1) LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 4/17/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 03/18/2025. Based on the information received during this visit today, there are no deficiencies that is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the Alexandria Contreras at the time of the exit interview.the state’s words, verbatim · CDSS document, May 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. The following domains were completed during the inspection: Infection Control, Operational Requirements, Planned Activities, and Disaster Preparedness. Due to time constrains, LPA will need to return to complete the inspection. Based on the information received during this visit today, there are no deficiency that is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with Corazon Sevillno, and a copy provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Apr 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began. Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables is missing from files, and personal rights notification. This facility is not meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is not sufficient for safety and comfort. Water temperature measured 129.6 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. Several window screens need to be replaced. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted and food prep areas are clean and organized. (Continued on next page) LPA began review of employee records. Five (5) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening missing and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 03/11/2024. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 03/1/2024. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are four (4) deficiencies is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Apr 30, 2024