An Angel Garden II

Allegation investigated: Staff are mismanaging resident's medication Staff are not meeting resident's diapering needs

On 09/10/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Administrator Youngsuk Cho and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The current census is 5. A brief interview was conducted with Administrator Cho. It was alleged that staff are mismanaging resident’s medication. The investigation consisted of observations, record reviews, and interviews with facility staff, outside agencies, and the resident’s responsible party. During a facility visit on 07/10/2026, LPA Lee conducted a medication audit for all five residents in care and identified medication discrepancies involving four of the five residents. LPA Lee observed five medications that had been pre-poured for the evening medication pass. CONTINUED LIC 9099-C Substantiated Administrator Cho stated that a hospice social worker observed the practice and advised staff that double briefing was inappropriate and could be considered neglect. Administrator Cho reported that the facility immediately discontinued the practice. A review of R1’s LIC 625, Appraisal/Needs and Services Plan, did not identify double briefing as part of R1’s required incontinence care. Based on interviews and records reviewed, the allegation that facility staff are not meeting residents incontinence needs is SUBSTANTIATED. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Administrator Cho and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility. An exit interview was conducted with Administrator Cho and the LIC 9099 report was provided to the facility at the end of the visit. LPA Lee also observed four small Ziploc bags containing multiple medications taped to the medication cabinet. The Administrator stated that she had prepared the bags as medication samples to guide staff in administering residents’ medications while she was out of state in December 2025. LPA Lee further observed that resident 2’s (R2’s) Medication Administration Record (MAR) had been initialed through 07/30/2026 before the medications were administered. A review of resident 1’s (R1’s) November 2025 MAR showed that Senna 8.6 mg was prescribed to be administered at bedtime but was not administered from 11/01/2025 through 11/30/2025. The MAR documented that Senna was held from 11/01/2025 through 11/10/2025 due to lose or watery bowel movements and from 11/11/2025 through 11/29/2025 due to a coccyx wound. The hospice order permitted staff to hold Senna when R1 experienced loose stools; however, there was no physician’s order authorizing staff to hold the medication due to R1’s coccyx wound. R1’s December 2025 MAR showed that Senna was held from 12/01/2025 through 12/04/2025 and administered on 12/05/2025. The MAR again documented that the medication was held due to R1’s coccyx wound, although there was no physician’s order authorizing Senna to be held for that reason. In a letter sent to LPA Valerio on 12/16/2025 at 12:55 p.m., Administrator Cho stated that staff observed persistent watery bowel movements and worsening of R1’s coccyx wound. Due to these symptoms, Senna was placed on hold beginning 10/27/2025 and remained on hold. However, there was no physician’s order authorizing staff to hold the medication due to the coccyx wound. Based on observations, interviews, and records reviewed, the facility pre-poured residents’ medications, used unsecured medications as samples, initialed MARs before medications were administered, failed to maintain complete and accurate medication records, and withheld medication for a reason not authorized by the physician’s order. Therefore, the allegation that facility staff mismanaged residents’ medications is SUBSTANTIATED. A preponderance of the evidence establishes that the alleged violation occurred. It was alleged that facility staff are not meeting residents incontinence needs. The investigation consisted of interviews with facility staff, outside agencies, and resident’s responsible party, as well as a review of relevant records. LPA Lee received an email from Administrator Cho on 08/24/2026 at 2:17 PM she acknowledged that staff placed two incontinence briefs on R1 after leakage occurred the previous day, while R1 was seated in a wheelchair. PAGE 2 CONTINUED LIC 9099-C The evidence reviewed did not establish that staff administered Lorazepam in excess of the physician’s order or otherwise overdosed R1. Therefore, the allegation that staff overdosed resident is UNSUBSTANTIATED. It was alleged that staff are not using a two-person assist for resident resulting in injuries. The investigation consisted of record reviews and interviews with facility staff, outside agencies, and two residents ’responsible parties. During a facility visit on 12/12/2025, LPA Valerio observed two staff members present with three residents in care. During another visit on 07/10/2026, LPA Lee observed three staff members present with five residents in care. During today’s visit, LPA Lee observed two facility staff with five residents in care. Facility staff denied the allegation and stated that at least two staff members are present at the facility at all times. One resident’s responsible party reported consistently observing two to three staff members during their visits and expressed no concerns regarding staffing. LPA Lee reviewed the facility’s LIC 500 Personnel Report, which indicated that two staff members were scheduled during each shift. R1’s LIC 625 Appraisal/Needs and Services Plan indicated that R1 required two-person assistance with transfers, showering, and toileting. However, the records reviewed did not show that R1 sustained hematomas or other injuries to R1’s arms or legs due to staff not providing the required assistance. Based on the interviews and records reviewed, there was insufficient evidence to establish that staff are not providing two person assist for the resident resulting in injuries; therefore, the allegation is UNSUBSTANTIATED. The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator Cho and the LIC 9099 report was provided to the facility at the end of the visit.the state’s words, verbatim · CDSS document, Sep 10, 2026 · control 27-AS-20251208143528

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 24, 2026

87465(a)(4) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by: Based on observation and file review, the Licensee did not ensure R1 was being administer their senna medication. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Sep 10, 2026

Plan of correction: Administrator agrees to complete incidental medical services in-service training for all staff, including training on the five rights of medication administration. The facility will submit the training materials, staff sign-in sheet, and a signed statement confirming that staff have read and understand the applicable regulation. POC is due by 5:00 p.m. on 09/24/2026.

Allegation investigated: Resident sustained unexplained injuries while in care Staff did not seek medical attention for injured client Staff uses medication restraint on residents in care Staff places time restrictions on residents visitors

Licensing Program Analyst (LPA) Sommer Hayes arrived unannounced to deliver findings on this complaint investigation. LPA Hayes met with Administrator, Youngsuk Cho and explained the purpose of the visit. The census is 3 with 2 facility staff. This investigation consisted of observation, interviews, and record review. LPA Hayes interviewed facility administrator Youngsuk Cho, a hospice nurse (HN), and a resident’s responsible party (PZ1) and R2. LPA obtained the following records for resident 1 (R1) & resident 2 (R2) to assist during the course of this investigation: · LIC 601 Identification and Emergency Information · LIC 625 Appraisal and Needs and Service · LIC 602A Physician Report . LIC 603 Preplacement Appraisal · Admissions Agreement Continued on 9099-C Unsubstantiated · LIC 624 Special Incident Report (SIR) . Medication Administration Record First allegation: Resident sustained unexplained injuries while in care This investigation consisted of observation, interviews, and record review. It was stated that R1’s family member had unexplained bruising on their knees. Staff 1 (S1) stated that the bruises on R1 were old bruises, and those bruises were not recent. LPA Hayes interviewed PZ1 and asked them if they were aware of any conversation or incident with their family member or S1 regarding unexplained injuries with their family member or other residents in the facility and they said they were not aware of this. LPA interviewed Nurse 1 (N1) and they stated the allegation that a resident sustained unexplained injuries that they have no specific knowledge of this. LPA Hayes observed that R1 was admitted in the facility on 02/12/25 through records review of the Admissions Agreement. LPA Hayes learned that R1 was taken out of the facility shortly after this incident involving R2 on and left the facility on 03/10/25. LPA Hayes also observed no additional incident reports involving R1 was sent to the Department by this facility Administrator. No additional evidence was found for this allegation. The preponderance of evidence standard has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. Second allegation : Staff did not seek medical attention for injured client This investigation consisted of observation, interviews, and record review. LPA Hayes interviewed one staff, R2’s POA (PZ1), R2 and the Hospice Nurse (N1) and the Reporting Party (RP). The Reporting Party (RP) alleged that the Administrator was negligent for failing to call Emergency Medical Services (EMS) for the injured resident. PZ1 stated that when the incident occurred, Staff 1 (S1) immediately contacted them and sent photographs of the resident’s injury. PZ1 reported that after reviewing the photographs, the injury did not appear to “be that bad”. PZ1 stated, “It was not that bad. It didn’t look like she needed to go to the hospital.” Through a file review, LPA Hayes confirmed that S1 is a licensed registered nurse. LPA Hayes attempted to interview R2 regarding their experience. They stated that they did not go to the hospital after the injury. LPA Hayes interviewed (N1) and they stated that regarding the allegation that staff failed to seek medical attention, they did not have specific knowledge of how that situation was handled. The preponderance of evidence standard has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. Continued on 9099-C Third allegation: Staff uses medication restraint on residents in care. This investigation consisted of observation, interviews, and record review. LPA Victoria Brown interviewed S1, and they denied using medication to restrain residents. They stated they were a licensed medical professional and never have done this. R2’s responsible party (PZ1) stated they are unaware of any medication restraints. Their mother and other residents seem to be fine and engaged when they visit. N1 stated that S1 did not request medication changes, and none were necessary, as R1 was declining rapidly. According to N1 there were no concerns about medication restraints, the facility was very conservative with medication use. N1 stated all medications were administered under hospice direction. Medication counts were accurate, and no discrepancies were found. N1 also stated that S1 is a licensed nurse. LPA Hayes reviewed the Medication Administration Record (MAR) R1 and R2 and observed no deficiencies or issues. The preponderance of evidence standard has not been met; therefore, the above allegation that staff uses medication restraint on residents is found to be UNSUBSTANTIATED. Fourth allegation: Staff places time restrictions on residents’ visitors. PZ1 reported that this allegation is not true. During their visits, they observed family members spending time with residents at the facility without any pressure or direction to leave at a specific time. PZ1 stated that on one occasion, they spent approximately six hours at the facility playing cards with their family member without any interference or time limitations imposed by staff. S2 stated that visitors were never restricted from visiting the facility. S2 explained that there was a miscommunication regarding parking in or around March 2025. The only limitation communicated to visitors involved parking restrictions in the surrounding neighborhood. The gated community where the facility is located is in new development. A Homeowner’s Association (HOA) officer informed visitors that parking on the street was limited to one hour at a time. The HOA officer reportedly took photographs of vehicles, which caused concern and frustration among some visitors. The Administrator clarified that these parking limitations were imposed by the HOA and not by facility staff and did not restrict visitation time inside the facility. Parking at that time was limited to 1 hour on the street. N1 said due to restrictions imposed by the HOA and facility administration, hospice staff were often required to wait outside until another healthcare provider had left before being allowed entry. Since then, the HOA officer has apologized to families about miscommunication. Families are now able to park at the facility during operating hours. Continued on 9099-C LPA Hayes interviewed R2, who stated they do have visitors, but they do not know if the facility asks them to leave. A review by LPA Hayes of visitor logs from February 2025 and March 2025 showed no documentation indicating any visitation time restrictions. LPA Hayes observed the LIC 603A, Resident Appraisal states that family members visit R1 almost every day and support. Admissions statement signed for R1 states visiting hours for this facility is between the hours of 9:00am to 7:00pm and if guest will be visiting after 8:00pm or before 8:00am, “we ask that they ring the doorbell and they will be let in by staff.” The preponderance of evidence standard has not been met; therefore, the above allegation staff places time restrictions on residents’ visitors is found to be UNSUBSTANTIATED. No deficiencies were cited during today’s visit. An exit interview was conducted with Youngsuk Cho, Licensee/Administrator. A copy of the report was given to the Licensee/ Administrator, Youngsuk Cho. This is an amended report. Licensing Program Analyst (LPA) Sommer Hayes amended this report to remove an extra page that was inadvertently included during the original visit to this facility. This page is intentionally left blank due to a report amendment. An additional page was inadvertently included in the original report for this facility visit.the state’s words, verbatim · CDSS document, Dec 18, 2025 · control 27-AS-20250310145801

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Arvin Villanueva arrived to conduct an unannounced Post Licensing inspection on 8/25/2025. LPA met with Youngsuk Cho and stated the purpose of the visit. This visit was conducted along with the annual visit. CARE Tool was conducted in the annual report. LPA conducted physical inspection including but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA conducted record reviews of 3 resident records and 3 staff records. Exit interview held with Administrator and a copy of report was given.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Required - 1 Year

On 8/25/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met initially met with staff on duty and explained the purpose of the visit. The Licensee/Administrator Youngsuk Cho (S1) was notified and arrived shortly after. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents. Per fire clearance, all residents may be non-ambulatory. Facility has a hospice waiver for 2 residents. Initial Observation: Upon arrival LPA was greeted by staff on duty (S2). Present during this visit were 3 residents in care, with one staff on duty. 1 resident was in the living room area, 1 resident was observed sitting at the dining table doing activity and 1 resident was in their bedroom. LPA observed required posters and facility license at the entrance. Room temperature was at 74 degrees Fahrenheit upon arrival. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 4 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. 1 resident bedroom is currently vacant. LPA measured the hot water temperature in the 1 of 2 bathrooms to be at 117 degrees Fahrenheit. Both resident bathrooms were observed to be in clean and good repair at this time. Fire extinguisher was observed in the kitchen/dining area and was last inspected on 7/17/2025. Smoke and carbon monoxide detectors were observed throughout. {LIC809-1} In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Proper storage of food items were observed. Kitchen refrigerator and freezer were maintained at regulatory temperature. LPA observed medications and lancet to be stored in a kitchen drawer that did not have a lock. Insulin medications and injections were observed in the kitchen refrigerator, not locked. Another medication, Mucinex, was observed in another drawer. Per S1, that belongs to a staff and immediately removed the medication and placed it in the staff room. Inside the kitchen dishwasher, LPA observed a knife and scissors and were not locked. Outdoor area was inspected. LPA observed outdoor furniture for resident use. Emergency walkways were observed to be unobstructed. Fence and gate were in good condition. LPA provided advisory to place a ramp by the exit door to the patio. Per S1, she removed the existing ramp for her other facility, since current residents can ambulate. Per review of 3 of 3 resident’s LIC602A, all residents are non-ambulatory. S1 further stated that she will purchase one for this facility. Advisory was also provided for S1 to ensure garage is not accessible to residents if they choose to store chemicals and other dangerous items in the garage. Record Reviews: Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Advisory was provided to ensure residents with restricted health conditions have their restricted health care plan. Advisory was also provided to Licensee to ensure each resident have PRN Authorization Letter signed by their physician. Medication review of 1 residents, include review of physician orders for over-the-counter medications. Review of 3 staff files (S2, S3, S4) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts quarterly drill. Emergency Procedure Plan was reviewed. Advisory was provided to ensure Administrator will review the plan at least annually or as needed. {LIC809-2} Interviews: LPA interviewed 1 staff and attempted to interview one resident but LPA is unable to understand resident’s language. LPA requested a copy of current Liability Insurance Certificate, LIC500 and LIC308 to be emailed to LPA at arvin.villanueva@dss.ca.gov. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited. Exit interview was conducted with S1 to discuss plan of correction and appeals. A copy of the report and appeal rights were provided upon exit. {LIC809-3}the state’s words, verbatim · CDSS document, Aug 25, 2025

The state marks this report as 9 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) Christina Valerio arrived announced to conduct the Pre-Licensing Visit and complete Component III. LPA met with Licensee Youngsuk Cho, and explained the purpose of the visit. The facility has an approved fire clearance to service individuals aged 60 years and older, approved for six (6) non-ambulatory residents. Non-ambulatory residents may reside in bedrooms 2, 3, and 4. The facility has a hospice waiver for two (2) resident. LPA Valerio reviewed the facility's Emergency Disaster Plan and Infection Control Plan. The facility has a dementia care plan on file. LPA, LPM, and Licensee conducted a walk-through of the physical plant inside and out to ensure compliance with Title 22 regulations. LPA observed resident bedrooms to be fully furnished, clean, and organized. Resident bathrooms were observed to be stocked with hygiene supplies, a trash can, skid mats, hand rails, and shower chair. Hot water was measured at 107.4 degrees, which is within the required range of 105-120.0. Common areas were fully furnished. LPA Valerio observed where medications, cleaning supplies, files, and sharps will be locked and inaccessible to residents. Exterior areas were observed to be furnished with areas for outside activities. No emergency exits were obstructed. Fire extinguisher, carbon monoxide detectors, and fire extinguisher were in working condition. The facility is equipped with interconnected smoke alarms in all sleeping rooms and hallways leading to sleeping rooms and all dwelling areas. The home is fully sprinklered. Component III was conducted and completed. Licensee had no further questions. Pre-Licensing is complete and this facility has no deficiencies. An exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 16, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Youngsuk Cho CEO/Administrator Interview Method: Telephone interview On September 3, 2024, 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 the 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, Sep 3, 2024