Angel's Haven Care Assisted Living Elsinore

Allegation investigated: Staff lock residents inside the facility.

Licensing Program Analyst (LPA) Andrew Martinez made an unannounced visit to the facility to initiate a complaint investigation and deliver findings for the above allegation. LPA met with Caregiver, Gilbert Oteyza, and explained the purpose for today's visit. The investigation consisted of observations, record reviews, and interviews with pertinent parties. Regarding the allegation - Staff lock residents inside the facility: During facility tour, LPA observed a child-proof door lever latch lock located on the inside of the entryway (front) door. LPA interviewed two (2) staff caregivers (S1, S2), both of whom stated the lever latch lock was installed to safeguard Resident 1 (R1) from eloping again as they like to open doors and have prior elopement history. LPA observed the front door is equipped with a signal system to notify staff when door has been opened. Based on today's investigation, the above allegation is SUBSTANTIATED. A SUBSTANTIATED finding is defined as a violation has occurred based on the preponderance of available evidence. An exit interview was conducted where this report LIC9099, LIC9099D and Appeal Rights were discussed and a copy provided to Caregiver, Gilbert Oteyza. Substantiatedthe state’s words, verbatim · CDSS document, Apr 29, 2026 · control 56-AS-20260422110040

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(e)(4) · Plan of correction due date: Apr 30, 2026

(e) Licensees that use delayed egress devices on exterior doors... shall meet the following... requirements: (4) Residents who... indicate a desire to leave the facility following redirection shall be permitted... with staff supervision. The facility did not meet this requirement as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section sited above by installing a child-proof door lever latch lock on the entryway (front) door making it inaccessible to residents in care wich poses an immediate health, safety or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: Licensee shall remove the child-proof door lever latch lock from the inside of the front door within 24 hours. Licensee shall submit photographic proof of the removal of latch lock, review the stated regulation, and submit a statement of understanding of regulation reviewed to LPA via email by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Staff Armando Ramirez. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, of whom two (2) may be bedridden. Hospice waiver for three (3). During today’s inspection there were fiveaq (5) residents in care. LPA with Staff Ramirez toured the interior and exterior of the facility and inspected each room. LPA observed the exterior perimeter gate to be locked with a padlock. Records review revealed that the facility does not maintain a fire clearance approval for locked exterior doors or perimeter fence gates. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Staff Ramirez, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records. Review of facility records revealed that the facility did not have documentation of required quarterly drills. Confidential records were stored in locked areas. Two deficiencies were cited and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for the fire clearance violation and noted on the attached LIC421IM form. A plan of correction was jointly formulated, and an exit interview was conducted with Staff Ramirez, to whom a copy of this report, LIC809-C, LIC809-D, LIC421IM and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Dec 23, 2025

Allegation investigated: Staff are not meeting resident's hygiene needs. Due to staff neglect, resident sustained pressure injury while in care. Staff are not meeting resident's toileting needs.

On 09/11/2025, Licensing Program Analyst (LPA) Beena Singh conducted an unannounced complaint visit to the facility to deliver findings. LPA met with Facility Staff-Care Giver Gilbert Oteyza and discussed the purpose of the visit. The investigation consisted of observations, record reviews and interviews with pertinent parties. Regarding the First allegation, Staff are not meeting resident's hygiene needs. LPA Singh observe staff at the facility taking care of the hygiene needs of the residents. LPA Singh Interviewed two (2) staff and two (2) residents, Two(2) out of two(2) staff and two(2) out of three (3) Clients stated there are no concerns with staff not meeting hygiene needs of the residents. Also,Staff and residents stated that staff take good care of the hygiene needs of the residents in care. Second allegation: - Due to staff neglect, residents sustained pressure injury while in care. LPA Singh reviewed resident care records and observed staff providing good care to residents. Interviews with two (2) staff and two (2) residents reveal there are no concerns with staff care and no staff neglects residents and staff help residents in moving or transferring from bed, no issues of pressure injury. Unsubstantiated LPA Singh reviewed R#1’s records review and Resident #1 (R#1) record review showed a history of UTIs (urinary tract infections) and cellulitis. This medical history puts R#1 at a higher risk for skin breakdown. Despite this risk, staff are actively taking measures to prevent skin issues. Staff ensures R#1 is kept clean and dry and assist with turning in bed. It was also noted that R#1 prefers to use a bedpan without help from facility staff. Home Health care visited R#1 once a week and R#1 developed blisters on the legs after staying in the hospital for a week admitted on 07/28/2025, R#1 has been discharged from hospital to home on 08/06/2025. Home health visited facility twice a week for the wound care after R#1 sustained blisters during R#1's stay in the hospital. Third allegation: - Staff are not meeting residents’ toileting needs. Interviews with two (2) staff and two (2) residents reveal there are no concerns with Staff are not meeting residents’ toileting needs. Staff always help the residents in meeting the toileting needs of the residents in care. It was also noted that R#1 preferred to use a bedpan without help from facility staff. Based on the Department's investigation, the allegations- Staff are not meeting resident's hygiene needs, Due to staff neglect, resident sustained pressure injury while in care and Staff are not meeting resident's toileting needs above are Unsubstantiated. A finding of UNSUBSTANTIATED 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 where this report was discussed and a copy provided to Facility Staff-Care Giver Gilbert Oteyza.the state’s words, verbatim · CDSS document, Sep 11, 2025 · control 56-AS-20250729201506

Type of visit: Prelicensing

On 12/16/2024 at 01:00 PM, Licensing Program Analyst (LPA) Melody Brown conducted an announced pre licensing visit for change of ownership at the facility. This is an announced Pre-Licensing visit conducted with Applicant/Administrator Ricardo Garcia who assisted in the tour of inside and outside of facility and the evaluation. LPA Melody Brown made a second (2nd) announced prelicensing visit this date. The follow up visit was made to confirm that all corrections have been made. The following: “Staff Training on Medication, Criminal Record Clearance obtained for Staff #3 (S3) and Transfer/Associate Staff #1 (S1) and Staff #2 (S2) criminal record clearance to the facility. All were found to be corrected on this visit date, 12/16/2024. However, due to S2 pending criminal record clearance transfer to the facility, Administrator/Applicant Garcia informed LPA Brown that they did not allow S2 to work at the facility until S2 criminal background clearance was transferred to the facility. LPA Brown cross reference Guardian database and noted S2 "In process" status. Staff #4 (S4) was observed working at the facility with criminal background clearance. The facility was evaluated in accordance with the CCR, Title 22 California Code of Regulations. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure. Applicant/Administrator Garcia will be notified once facility is licensed. An exit interview was conducted, and a copy of this report (LIC809) was discussed and provided with Applicant/Administrator Ricardo Garcia.the state’s words, verbatim · CDSS document, Dec 16, 2024

Type of visit: Prelicensing

On 12/04/2024 at 08:45 AM, Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to the facility for the purpose of a Change of Ownership evaluation. LPA met with Administrator/Applicant Ricardo Garcia and Administrator Johnny Mazariegos. An initial application for change of ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 06/13/2024 for a total capacity of six (6). Fire clearance was granted on 05/17/2024 for four non-ambulatory and two (2) bedridden residents. LPA Brown observed the following: Structure: Facility was a one-level house with five (5) bedrooms, three (3) resident/staff bathrooms, living room, dining area, laundry room and kitchen. There was an attached car garage observed.. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. Bedrooms: Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: The three (3) resident/staff bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. At 09:45 AM, LPA tested the water temperature in the resident/staff shared bathrooms. LPA verified water temperature was measured at 108.6 degrees Fahrenheit. LPA Brown observed one resident/staff shared bathroom without non-slip mat in the bathtub/shower. Technical Assistance issued. During the visit, Administrator/Applicant Garcia purchased non-slip mat for one (1) resident/staff shared bathroom. Also, LPA Brown observed no night lights maintained in hallways and passages to non-private bathrooms. Technical Assistance issued. During the visit, Administrator/Applicant Garcia purchased the required night lights. ***CONTINUED ON LIC 809C*** ***CONTINUED FROM LIC 809*** Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There is more than seven (7) days’ supply of perishable foods and more than two (2) days’ supply of non-perishable foods. There was adequate seating for meals for all residents. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies are stored in the laundry room. Living/Family room: There was a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Side gates on left side of the facility. All outdoor pathways were free of obstructions. Dementia Care: LPA Brown reviewed the facility’s Dementia Care Plan during the Visit. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted. There was Ombudsman poster and Let-Us-No poster observed. LPA Brown observed Personal Rights posted in a common area. General items: One (1) fire extinguisher was charged, smoke alarms and carbon monoxide detectors were tested and were observed to be in working order. Resident records were stored in a locked cabinet in the kitchen. First Aid kit missing a tweezer. Technical Assistance issued. Administrator/Applicant Garcia purchased tweezer during the visit. Locked area for medication storage was observed. ***CONTINUED ON LIC 809C*** ***CONTINUED FROM LIC 809C** LPA observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 951-246-0026. Infection Control Plan and Emergency Disaster Plan observed at the facility. Expired emergency food observed and no emergency supplies maintained at the facility. Technical Assistance issued. Administrator/Applicant purchased emergency food and stated to obtain and prepare emergency supplies during the visit. Component III was completed on this day as well. However, LPA Brown observed Staff #2 (S2) working at the facility but per documents review, S2 was not associated to the facility. Applicant/Administrator Garcia reported to LPA Brown that S2 started working at the facility on 09/2024. Also, LPA Brown observed Staff #1 (S1) criminal background clearance was not transferred to the facility prior to employment on 08/20204. Moreover, LPA Brown observed Staff #3 (S3) working at the facility and per documents review, S3 does not have criminal record clearance prior to employment on 07/2024. Technical Assistance issued. Additionally, LPA observed facility to have required single entry point with Sign In/Sign Out for Residents and Visitors upon entering the facility. LPA observed planned activities for the residents such as books and games. Menu for the residents was also noted. The facility was evaluated in accordance with the CCR, Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of residents in care. Pre-Licensing is incomplete and the following issues to be resolved by December 27 at 10:00 AM: Obtain criminal record clearance for Staff #3 (S3) Transfer/Associate Staff #1 (S1) and Staff #2 (S2) criminal record clearance to the facility. Conduct Medication Training on all staff. An exit interview was conducted, and a copy of this report, LIC809, LIC9102 were reviewed and provided to Administrator/Applicant Ricardo Garcia and Administrator Johnny Mazariegos.the state’s words, verbatim · CDSS document, Dec 4, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.