Alliance Health RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:24AM. LPA met with staff. Administrator Sara Golfeiz arrived at 11:05AM. Entrance interview conducted. Beginning at 11:15AM, the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON SPACES/AMENITIES: Common areas include the living room and family room. Common areas were appropriately furnished and in good condition. There is a functioning telephone on the premises. Emergency exiting plans/sketch, emergency telephone numbers, and required postings are posted in the entryway. BEDROOMS: The facility has six (6) bedrooms of which four (4) are designated for single-resident use, one (1) is designated for shared-resident use, and one (1) is a staff room. Staff room remains locked at all times. All bedrooms were furnished appropriately with clean linens, furnishings, and sufficient lighting. All bedrooms have exits to the exterior with functioning auditory exit alarms. Administrator stated permits were secured to convert one resident room to a resident room and a staff room. Documents were submitted to CCL upon completion of construction earlier in the month. LPA Dulek will follow up with the case-LPA related to these documents and fire clearance. BATHROOMS: The facility has five (5) bathrooms; three (3) are for resident use and two (2) are for staff use. LPA observed resident restrooms to be equipped with grab bars near the toilet and shower/tub and Report continued on LIC 809-C. slip-resistant surfaces in the shower/tub. LPA tested hot water temperatures in various resident bathrooms and measured within the required range. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the living room. No bodies of water were observed on the premises. The facility has a self-latching and self-closing exit gate located on the side passageway. KITCHEN/GARAGE/LAUNDRY: Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. Knives and sharps are stored inaccessible. Cleaning supplies are not stored in the kitchen. LPA observed a fire extinguisher in the kitchen that was fully charged and last purchased 10/19/2024. During today's visit, Administrator purchased new fire extinguisher. LPA toured the locked garage attached to the kitchen. LPA observed an additional refrigerator/freezer, a washer and dryer, cleaning supplies, and emergency water supply. RECORD REVIEW: Beginning at 11:41AM, LPA began record review. LPA reviewed six (6) out of six (6) resident and five (5) out of five (5) personnel files for documents including but not limited to: resident bed rail orders, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident files and staff files were in order. MEDICATION REVIEW: Medications are centrally stored in the kitchen and inaccessible. At 01:59PM, LPA reviewed medications for two (2) residents. All medications reviewed were properly documented and appeared to be administered as prescribed. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's emergency disaster plan and infection control plan. Administrator stated that emergency disaster drill was last conducted in spring 2025. Administrator stated going forward, emergency disaster drills will be conducted quarterly. Administrator will update the document and send to CCL. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Jan 22, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Resident's previous admission agreement is not being upheld

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegation listed above 10:45AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 11:03AM. Entrance interview conducted. During today's visit, LPA conducted a brief physical plant tour at 10:47AM, interviewed two (2) staff and one (1) resident between 10:51AM-02:50PM, and reviewed and obtained copies of pertinent documents between 11:10AM-11:25AM. During the initial visit on 02/19/2025, LPA conducted a brief physical plant tour, conducted interviews with two (2) staff members, three (3) residents, and attempted an interview with one (1) resident, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegations with Administrator. REPORT CONTINUED ON LIC9099-C. Substantiated It was alleged that the facility was not upholding Resident #1 (R1)’s admission agreement that R1 signed upon admission. LPA reviewed R1’s admission agreement signed and dated 11/17/2020 for the now-closed facility Eden Garden “C”, INC. (facility #197603977). The facility underwent a change of ownership (CHOW) which went into effect on 01/15/2025. R1 was admitted under the initial facility’s house rules and policies, which included a pet-policy allowing pets and R1’s dog. The house rules and policies of the current facility has a no-pet policy and no cameras allowed in resident rooms. R1 was admitted under an agreement that allowed them to have their pet and a pet camera in their room to monitor their dog when away from the facility. R1 was told that they were no longer allowed to have their pet or their pet camera. However, R1 was grandfathered into the current facility with the initial facility’s policies. R1 did not sign the current facility’s admission agreement due to the no-pet and no-camera policy and was told by the Administrator that their pet was no longer allowed to reside in the facility despite having a physician’s order for their emotional support animal (ESA). At this time, there are no regulations regarding ESAs or service animals in facilities. However, per regulation, residents have the right to refuse to sign the new admission agreement, meaning that the old admission agreement needs to be upheld. On 02/07/2025, R1 was issued an eviction notice based on the premise that they “have not signed the required admission agreement, which is necessary document for continued residency at this facility.” The Department reviewed this eviction notice and deemed it unlawful. Licensee was notified on 02/07/2025 that the eviction notice shall not be in effect as it does not fall under eviction criteria of CCR Title 22 Section 87224. The Administrator rescinded this notice on 02/19/2025 during LPA’s initial visit. LPA explained that residents cannot be forced/coerced into signing documents they do not want to, and that the facility must respect and uphold the admission agreement R1 initially signed. LPA further explained that licensees have the right to determine their own pet policy and camera policy as those are up to their discretion and Licensees have the right to not accept prospective residents with pets/cameras. However, the facility cannot attempt to evict R1 or tell them to relocate their pet due to new policies after a CHOW. Based on interview and record review, the allegation “Resident's previous admission agreement is not being upheld” is deemed SUBSTANTIATED at this time. Administrator was unable to stay for the remainder of the visit and designated staff Christian Trambulo to sign the report. LPA delivered report telephonically to Administrator. The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted. Appeal rights and a copy of the report was provided. It was alleged that Administrator increased Resident #1 (R1)’s rate by $200 without proper 60-day notice. Administrator stated that they got a notification that SSI was increased (PIN 24-13-CCLD) by around $100 effective 01/01/2025. Residents were informed on 01/01/2025 about the increase but it was not charged until February 2025. Administrator issued a 60-day notice for the $200 increase to R1’s rent stating the reason as a “prior admission discount as not being applicable” and a $100 rate increase for “SSI/Medicare.” R1 confirmed the $200 discount from previous licensee which made R1’s monthly rate less than the SSI payment standard for basic services. All licensees were notified that effective 01/01/2025, the payment schedules for SSI/SSP recipients will be increased, meaning that the amount that licensees can charge for basic services a month increased. The amount was increased to $1420.07. Section 87507(g)(4) of the California Code of Regulations, Title 22, states “(g) Admission agreements shall specify the following: (4) Modification conditions, including the requirement for the provision of at least 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes.” Section 1569.655(c) of the Health and Safety Code states “(c) If a licensee increases rates for a recipient under the State Supplementary Program for the Aged, Blind and Disabled, described in Article 5 (Commencing with Section 12200) of Chapter 3 of Part 3 of Division 9 of the Welfare and Institutions Code, the licensee shall meet the requirements for SSI/SSP rate increases, as prescribed by law.” Health and Safety Code Section 1569.655(a) was also updated to require no less than 90 days’ prior written notice to residents regarding rate increases effective 01/01/2025 instead of a 60-day notice. However, a 90-day notice is not required for SSI/SSP rate increases as those are determined statewide. A 90-day notice was required and was issued by the Administrator for the removal of the discount that was issued by the previous licensee. LPA reviewed R1’s bank statements to confirm that R1 receives enough SSI/SSA to afford the increased standard for basic services. LPA also confirmed that R1 was not being charged more than $1420.07, the basic services rate allowed for SSI recipients. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff did not provide proper notice of rent increase” is deemed UNSUBSTANTIATED at this time. Report Continued on LIC9099-C. It was further alleged that the Administrator was evicting R1 for failure to sign the admission agreement. On 02/07/2025, R1 was issued an eviction notice based on the premise that they “have not signed the required admission agreement, which is necessary document for continued residency at this facility.” The Department reviewed this eviction notice and deemed it unlawful. Licensee was notified by LPA on 02/07/2025 that the eviction notice shall not be in effect as it does not fall under eviction criteria and that R1 shall be informed that the notice is void. The Administrator rescinded this notice on 02/19/2025 during LPA’s initial visit. LPA explained that residents cannot be forced/coerced into signing documents they do not want to, and that the facility must respect and uphold the admission agreement R1 initially signed. LPA further explained that the facility cannot attempt to evict R1 for exercising their personal right to refuse. While an unlawful eviction notice was issued on 02/07/2025, R1 was not unlawfully evicted, and the notice was rescinded on 02/19/2025. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Unlawful eviction” is deemed UNSUBSTANTIATED at this time. Administrator was unable to stay for the remainder of the visit and designated staff Christian Trambulo to sign the report. LPA delivered report telephonically to Administrator. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 29-AS-20250213143506

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(3) · Plan of correction due date: Aug 6, 2025

(a) ...residents...shall have all of the following...: (3) To be encouraged and assisted in exercising their rights...as residents...Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above as R1's right to refuse to sign the new admission agreement was not free from coercion and their previous agreement was not upheld. This posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: On 02/19/2025, licensee rescinded the eviction notice issued to R1 for refusing to sign the new admission agreement. Licensee agreed to submit a statement of understanding of the section to CCL by 08/06/2025.

Allegation investigated: Resident is not being accorded dignity in their personal relationships with staff

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegation listed above 10:45AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 11:03AM. Entrance interview conducted. During today's visit, LPA conducted a brief physical plant tour at 10:47AM, interviewed two (2) staff and one (1) resident between 10:51AM-02:50PM, and reviewed and obtained copies of pertinent documents between 11:10AM-11:25AM. During the initial visit on 04/29/2025, LPA interviewed three (3) residents and attempted interviews with two (2) residents, interviewed two (2) staff members and Administrator, conducted a physical plant tour, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegations with Administrator. CONTINUED ON LIC9099-C. Unsubstantiated It was alleged that Staff #1 (S1) is disrespectful in their communication with Resident #1 (R1) and threatened to dispose of R1’s personal belongings. LPA interviewed staff and residents related to this allegation. Two (2) out of three (3) residents interviewed indicated that the staff are kind and helpful. One (1) resident interview revealed concerns of staff communication regarding personal belongings. Staff interviews revealed that staff and resident communications are respectful, but that there was no space to store facility supplies because R1 was storing personal belongings in the garage and hallway closet. Administrator stated that R1’s belongings in their room also blocked the exit path and were potential fire hazards/clearance concerns as mentioned by the fire department. During today’s visit, LPA observed R1’s belongings were moved from the hallway closet by R1 and that R1’s personal belongings in the garage were significantly reduced to allow for other storage. LPA observed text communications between S1 and R1 and did not observe concerns about staff being disrespectful. All staff interviewed denied ever hearing any other staff not treating residents with respect. During today’s visit, LPA interviewed staff and residents related to this allegation and no concerns regarding the allegation were noted. Based on interviews and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Resident is not being accorded dignity in their personal relationships with staff” is deemed UNSUBSTANTIATED at this time. Administrator was unable to stay for the remainder of the visit and designated staff Christian Trambulo to sign the report. LPA delivered report telephonically to Administrator. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 29-AS-20250428083513

Allegation investigated: Staff are sleeping in common areas Staff does not ensure resident's door is in good repair

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct an initial complaint investigation for the allegations listed above 10:00AM. Upon arrival, LPA met with staff and Administrator Sara Golfeiz who arrived at 10:12AM. Entrance interview conducted. During today's visit, LPA interviewed three (3) residents and attempted interviews with two (2) residents between 10:02AM-11:35AM, interviewed two (2) staff members and Administrator between 10:20AM-10:55AM, conducted a physical plant tour between 10:12AM-11:12AM, reviewed and obtained copies of pertinent documents relevant to the investigation between 10:35AM-10:50AM, and discussed allegations with Administrator at 11:40AM. Report Continued on LIC 9099-C. Substantiated It was alleged that Staff #1 (S1) sleeps on the couch in the family room at nights. LPA observed the family room to be free of S1’s belongings and other items that suggest S1 primarily sleeps in the family room. However, three (3) of three (3) resident interviews, S1, and Administrator confirmed that S1 sleeps on the couch during the night shift. S1 temporarily shares a room with a resident but prefers to sleep in the common area instead as it is more central to the other residents. Administrator has obtained approved building permits for a staff room addition which will begin construction in the near future. Administrator stated that a signal system can be installed so that S1 can sleep in the shared bedroom while also having a method to be contacted by other residents for assistance. Based on interviews, the allegation “Staff are sleeping in common areas” is deemed SUBSTANTIATED at this time. It was further alleged that the fire door in bedroom #4 does not self-close. LPA inspected the door at 11:11AM and observed that the door closer on the top of the door was not attached to the door frame and that the molding and framing on the top of the door was loose and a potential hazard. Administrator confirmed that the door closer was installed around January 2025 and stopped functioning two (2) months after installation. Administrator stated that the door closer and door framing will get fixed during the facility’s renovation and staff room construction, as the current molding cannot support the door closer. Based on observation and interview, the allegation “Staff does not ensure resident's door is in good repair” is deemed SUBSTANTIATED at this time. The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Administrator was informed that failure to correct the deficiencies may result in civil penalties. Administrator designated staff Christian Trambulo to sign the report. Exit interview conducted. Appeal rights and a copy of the report was provided. It was alleged that the sink in the hallway resident bathroom does not deliver hot water. LPA ran the hot water in the bathroom between 10:14AM-10:19AM until the water measured at 106.2 degrees Fahrenheit. LPA observed that it took five (5) minutes for the water in the sink to reach the required range of 105-120 degrees F. Staff stated that it takes a while for the water to get hot. Residents interviewed stated they had access to hot water and had no concerns of hot water access. Administrator stated that a new water heater has been purchased and is in the garage until it can get installed during the facility’s upcoming renovation. Based on interviews and observation, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. 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 above allegation “Resident faucets do not deliver hot water” is deemed UNSUBSTANTIATED at this time. Administrator designated staff Christian Trambulo to sign the report. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 29, 2025 · control 29-AS-20250428083513

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: May 6, 2025

87307 Personal Accommodations and Services (a) ...The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility...This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as Staff #1 (S1) sleeps on the couch in the family room which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 29, 2025

Plan of correction: Administrator stated that S1 will sleep in their shared bedroom and not in common areas until the staff room is constructed. Administrator plans to implement a signal system so that S1 can assist resident's requests without having to sleep in a central common area. POC cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 6, 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... This requirement is not met as evidenced by Based on observation and interview, the licensee did not comply with the section cited above as the door in bedroom #4 did not have a functioning door closer which poses a potential health, safety, and personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Apr 29, 2025

Plan of correction: Administrator stated that the door closer will be repaired during the facility's upcoming renovation. Administrator will submit proof of the planned service request to CCLD by 05/06/2025.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angela Barutyan conducted a pre-licensing visit to this property at 10:30AM. LPA met with applicant Sara Golfeiz. This application is for a Change of Ownership Application (CHOW) and the current licensed facility has residents in care. The applicant has obtained fire clearance for six (6) bedridden with a total capacity of six (6) residents. Applicant completed component II interview on 10/17/2024. During today's visit, applicant component III with the LPA. Beginning at 10:33AM, LPA inspected the proposed facility for Fire Safety, Personal Accommodations, and Food Service. All hard-wired combination smoke alarm and carbon monoxide detectors were tested at 11:40AM and function properly at this time. Fire extinguisher was observed to be fully charged and purchased on 10/19/2024. Paint, windows, blinds, and floors are in good repair. There are no firearms on the premises. The common living room, family room, and dining area are clean and properly furnished. A properly screened fireplace was observed in the family room. A working telephone is present. The proposed facility has five (5) bedrooms of which four (4) are designated for private-resident use and one (1) is designated for shared-resident use. All resident bedrooms observed were furnished and contained beds, chairs, bedside tables, and lamps. All beds have appropriate linens. There is also an ample supply of linen, towels and paper products. The proposed facility has five (5) restrooms; four (4) are for resident-use and one (1) is for staff and visitor use. LPA observed night-lights present in the hallways. Hot water was measured in all five (5) restrooms and measured within the required range. Report continued on LIC 809-C The kitchen contained a sufficient supply of dishes, glasses and utensils. A seven-day supply of non-perishable food is present, as well as, a seven-day supply of emergency water. Knives were stored in a locked drawer. A locked medication cabinet was observed in the facility kitchen. First aid kit was observed and was complete. A locked garage was observed by the kitchen to contain extra storage space, cleaning supplies, additional refrigerator and freezer, as well as the laundry area. Building and grounds were observed. Patio area contains a shaded seating area for resident use. Outdoor exit gate was observed to be self-closing and self-latching at this time. All passageways were observed to be clear of hazards. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 19, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 10 Census (if any clients in care): 6 Method: Telephone call with CAB COMP II Participants: Sara Golfeiz, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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, Oct 17, 2024