Arcadia Retirement Village

Allegation investigated: Staff are not ensuring residents’ needs are being met.

***This report supersedes report dated 05/21/2026. The purpose of this report is to change findings from substantiated to unsubstantiated for the allegation of staff are not ensuring residents’ needs are being met and to include additional information. All other findings remain the same. ****Licensing Program Analyst met with Paul Gonzon and explained the purpose of this visit. Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Activity Assistant Martha Gonzalez who assisted with today’s visit. Administrator Paul Gonzon was notified via telephone. SEE LIC9099C Unsubstantiated The investigation consisted of the following: During the initial visit conducted on 03/03/2026, LPA Sanjay Vaid conducted an unannounced visit and obtained copies of the resident and staff rosters, documents for Resident #1, and six (6) random residents, resident shower schedules, resident shower refusal logs for February to present, monthly menus, and Interviewed Staff #1-#3 and Resident #1-#4. During today’s visit, LPA Gutierrez checked kitchen food supply, toured six (6) random resident bedrooms, obtained staff roster, resident roster, reviewed R1’s file and obtained copies of R1’s service plan, family meeting notes, and shower schedule. LPA also obtained facility food menu, resident council meeting notes, and requests from Administrator to email a copy of Aprils housekeeping schedule for all employees worked. LPA interviewed Administrator, staff #1-staff #8 (S1-S8), and residents# 1-residents #7 (R1-R7). During today’s visit LPA delivered findings. In regard to the allegation” Staff are not ensuring residents’ needs are being met”, It is alleged that staff did not follow R1’s care plan for showering. During interviews with Administrator and staff two (2) staff stated that residents are getting showered according to their shower schedule .Two (2) staff indicated there are times that they miss scheduled showers because they are either short staffed or they don’t have clean towels During interviews with residents four (4) out of seven (7) stated that they do not need assistance with showers. One (1) R7 stated that he/she gets showered every day because that is there rights and they had assistance from CCLD to enforce that right. One (1) resident R1 stated they need to ask for showers and one (1) resident stated they ask for help occasionally and need to wait. During record review it was reviled that occurring to R1’s care plan they are to be showered twice a week, LPA obtained shower logs for the month of February and R1 should have been showered a total of eight times long indicated four showers, one refusal shower, and three missed showers from staff. LPA also collected notes from a meeting with facility staff and family dated 02/06/2026 indicating showers were to be given twice a week and two showers were missed after that meeting. It could not be concluded that the facility failed to follow R1’s care plan since there was documented evidence that R1 refused to be showered at times, and the facility maintained a shower log and documentation during these occurrences. Finally, of the residents interviewed, no residents stated they were not being provided with shower assistance nor was there any evidence confirming any resident had not been provided with a shower for thirteen days “Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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, therefore the allegations are UNSUBSTANTIATED.An exit interview was conducted, and a copy of this report and appeal rights was given to Paul Gonzon.the state’s words, verbatim · CDSS document, Jul 17, 2026 · control 28-AS-20260224120551

Allegation investigated: Staff leave residents in soiled diapers for extended periods of time. Staff did not adequately bathe resident in care.

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complaint visit in regard to the allegations listed above. LPA met with Executive Director Paul (Apolinario) Gonzon who assisted with today’s visit. The investigation consisted of the following: During the initial visit conducted on 06/12/2026, LPA Daniel Konishi requested a copy of staff and resident rosters. LPA conducted a tour of facility and common areas with the Executive Director. During today’s visit LPA Gutierrez interviewed staff #1- staff #7 (S1-S7), residents #1- residents #7 (R1-R7), and delivered findings. See LIC 9099C Unsubstantiated In regard to the allegation” Staff leave residents in soiled diapers for extended periods of time.”, It is alleged that R1 was left in a soiled diaper for approximately two hours. During interview with staff seven (7) out of seven (7) staff stated that residents are never left in soiled diapers for extended periods of time. All seven staff stated that residents are changed every two hours or more if needed. S5 stated that in the morning R1 will complain and state it’s too early and staff has to continue to ask until he/she will comply. During interview with residents six (6) out of the seven (7) interviewed stated they are not left in soiled diapers for extended periods of time. R4 stated that staff comes every two hours and he/she will call the front desk if extra help is needed. R1 stated that he/she has been left for twelve hours. LPA obtained copies of R1’s service plan that states toileting every two hours. LPA also obtained a log, and no missed diaper changes were observed, only one refusal on 06/13/26. In regard to the allegation” Staff did not adequately bathe resident in care”, It is alleged that during a bath R1 was told by caregivers that dried feces were still present from prior diaper change. During interview with staff seven (7) out of seven (7) staff stated that they have never witnessed or been told that staff has seen dried feces when bathing a resident. S2 stated that R1 will sometimes refuse to be bathed if a certain staff member does not do it. During interview with residents six (6) out of the seven (7) interviewed stated that staff does a pretty good job at assisting them with bathes. R1 stated that a caregiver changed him/her and by the next shift there was feces everywhere that was left over from last changing. R5 states it’s according to who gives them to you, but overall staff is good. LPA obtained documents that state R1 refused shower on 06/12/26. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to Paul Gonzon.the state’s words, verbatim · CDSS document, Jul 17, 2026 · control 28-AS-20260608100925

Allegation investigated: Staff are not allowing resident to review the admission agreement prior to signing Staff did not provide resident with the Admissions Agreement fee schedule for additional services Staff are not meeting resident's laundry needs.

Licensing Program Analyst (LPA) Vaid conducted subsequential visit to the facility and met with Executive Director, Apolinario Gozon and discussed the reason for the visit. Obtained staff and residents rosters. LPA Vaid interviewed staff and residents for the above-mentioned allegations. LPA Vaid obtained and reviewed the housekeeping and laundry schedules. On 02/02/2026, LPA Vaid met with Resident Services Director Brook Lamotte and Operation Director/ Administrator Lisa Pham. LPA Vaid requested and obtained the following documents: LIC 500 dated 02/02/26, resident roster dated February 2026. R1-R5 face sheet, physicians report, Individual Service Plan, admissions agreement with fee schedule for additional services for private and Assisted Living Waiver, monthly staff laundry schedule. Ombudsman contact information. The investigation revealed the following: CONTINUED ON PAGE 9099C.................. Unsubstantiated Regarding the allegation: Staff are not allowing residents to review the admission agreement prior to signing. It is alleged that the staff are not allowing residents to review the contents and thoroughly read the admissions agreement and are rushing the resident to sign the documents immediately. Five of five staff interviewed denied this allegation, staff stated the residents were all given a copy of the admissions agreement on 12/01/2025 when the new ownership took possession of the facility. LPA interviewed Staff who communicated with all residents regarding the new admission agreement due to the change of ownership. Per staff, they met with each resident and/or their responsible parties to review and sign the new admission agreement. Staff stated that they attempted to meet with R1 to review the document. However, R1 did not allow the staff any opportunity to go over the new contract and told staff that R1 will not sign it. Staff also stated that R1 was provided with another copy of the admission agreement upon request. LPA obtained a copy of the new admission agreement that was provided to R1. The contract appeared complete and indicated the residents’ name and charges. LPA interviewed R1 who stated that the staff only provided a copy of the blank admission agreement and told resident to sign the documents immediately. Staff stated that they have attempted to meet with R1 to review the document. However, R1 has not allowed the staff any opportunity to go over the new contract and has told staff that R1 will not sign admissions agreement. Staff also stated that R1 was provided with second (2nd) copy of the admission agreement upon request and third (3rd) copy on 01/06/2026. Eight of nine residents interviewed stated that the staff met with them to go over the new admission agreement and provided the rates. Based on records reviewed and interviews conducted, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. Regarding the allegation: Staff did not provide resident with the Admissions Agreement fee schedule for additional services. It is alleged that the staff are not providing resident with a fee schedule for extra services. Five of five staff interviewed denied this allegation, LPA interviewed Staff who met with residents and their responsible parties to review, discuss the admissions agreement and fee schedules for extra services (incontinent program, escort to physicians’ office, guest meals, emergency pendant replacement) and sign the admissions agreement. Staff stated that they have attempted to meet with R1 to review the document. However, R1 has not allowed the staff any opportunity to go over the new contract and has told staff that R1 will not sign admissions agreement. Staff also stated that R1 was provided with second (2nd) copy of the admission agreement upon request and third (3rd) copy on 01/06/2026. LPA obtained a copy of the new admission agreement that was provided to R1. The contract appeared complete and indicated the residents’ name and charges. Eight of nine residents interviewed stated that staff met with them and discussed the extra services provided and the service fees. CONTINUED ON PAGE 9099C................. R1’s fee schedule shows zero dollars for the extra services, R1 is charged a single monthly fee for their room rental with housekeeping and laundry services being included. Based on records reviewed and interviews conducted, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. Regarding the allegation: Staff are not meeting residents’ laundry needs. It is alleged that the staff are not meeting the resident’s laundry needs and staff are not being completed on residents assigned day. Five of five staff deny this allegation, according to the resident laundry schedule, R1 receives laundry services one day per week as scheduled. LPA interviewed staff who provide residents with laundry services, staff stated they sort, wash, dry , fold and hang residents clothes. According to the staff the goal is to keep the residents’ rooms from developing foul odor from dirty laundry accumulating in residents room. Eight of nine residents interviewed stated the staff provides laundry services on their scheduled days and will wash soiled bed linen as needed. R1 stated being independent and doing their own laundry. According to R1’s residents care summary, R1 has only elected additional services assistance with the housekeeping and to provide daily tidying up and trash removal. The staff stated they are ready to assist R1 should R1 require laundry services. Based on records reviewed and interviews conducted, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted and copy of this report was given to Executive Director, Apolinario Gozon.the state’s words, verbatim · CDSS document, Jun 9, 2026 · control 28-AS-20260130103652

Allegation investigated: Staff does not assist resident with transfer, resulting in resident being confined to bed. Licensee does not ensure staffing is adequate to meet residents' needs. Staff does not respond to resident's calls for help. Staff does not ensure resident receives medical care.

Licensing Program Analyst (LPA) Tao conducted an initial complaint investigation visit for the allegations listed above. LPA met with the Executive Director Paul (Apolinario) Gozon. The purpose of today's visit was explained. The investigation consisted of interviews of staff from staff#1 (S1) to staff#5 (S5), interviews of residents from resident#1 (R1) to resident#9 (R9), reviews of facility documents, and physical plant tour of the facility. The investigation revealed the following: In regard the allegation of facility staff does not assist resident with transfer, resulting in resident being confined to bed, it was alleged that resident did not get assistance to transfer from bed to wheelchair. (-continued on LIC 9099 C-) Unsubstantiated LPA interviewed nine (9) residents including residents who use wheelchairs and walkers. Per resident interviews, one (1) out of nine (9) residents interviewed stated staff did not assist resident to transfer from bed to wheelchair. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. Of those eight (8) residents, three (3) of them would need assistance with transferring and one (1) of them would need to use Hoyer Lift. They all received assistance as they needed. The other four (4) of them would not need assistance with transferring but would get it when they requested it. It revealed that staff would assist residents to transfer from beds to wheelchairs as needed. Per staff interviews, all staff could not corroborate the allegation. Staff interviews revealed would provide assistance with transferring to residents as residents needed it. Per record review, staff were trained to use the Hoyer Lift and in-service training related to assist residents with transferring was provided to staff. Per LPA’s observation during the physical plant tour, staff were attentive to assist residents. Staff provided transferring assistance to residents to go to activities and dining room. Thus, the staff assist residents with assistance for transferring. In regard the allegation of Licensee does not ensure staffing is adequate to meet residents' needs, it was alleged that the facility does not have sufficient staff to help residents with transferring needs. Per resident interviews, one (1) out of nine (9) residents interviewed stated the facility does not have enough staff to assist resident to transfer from bed to wheelchair. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. It revealed that residents got staff’s help when they needed it. Per staff interviews, all staff could not corroborate the allegation. Staff interview revealed that there are four (4) caregivers and one (1) med tech per AM and PM shift. There are two (2) caregivers and one (1) med tech during the night shift. Since the facility’s majority of residents were independent, not many residents need full care. Administrator stated the facility will employ additional caregivers by end of June since the resident census had increased. As staff stated, a resident preferred a particular staff to provide care and would decline other staff to assist. Therefore, it was not lack of staff but was a refusal to get staff’s assistance. Thus, there was not observed that the facility did not have adequate staffing. (-continued on LIC 9099 C-) In regard the allegation of staff does not respond to resident's calls for help, it was alleged that the facility staff does not respond to residents’ calls in a timely manner. Per resident interviews, one (1) out of nine (9) residents interviewed stated staff did not respond to calls for assistance. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. It revealed staff would provide answer residents’ calls timely. Per staff interviews, all staff could not corroborate the allegation. Staff interview revealed staff would need to respond to residents’ calls as soon as possible, usually within 10 minutes, to provide assistance. Per LPA’s observation, LPA tested the call buttons multiple times from random resident’s rooms. The responding time was from 2 minutes to 8 minutes. Thus, the staff would respond to residents’ calls in a timely manner. In regard the allegation of staff does not ensure resident receives medical care, it was alleged that the facility staff does not assist resident to go to doctor appointments for getting medical care. Per resident interviews, one (1) out of nine (9) residents interviewed stated staff did not assist the resident going to doctor appointment. Therefore, the resident was unable to get physician orders for medical equipment or treatments. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. It revealed that residents were able to get and see their doctors for treatments / medical cares. Per staff interviews, all staff could not corroborate the allegation. Staff interview revealed staff would keep track of residents’ appointments and follow up with their doctors for medical needs. Per record reviews, the resident who claimed that had not been seeing the doctor for months just had a doctor visit on the end of May. No additional medical equipment was stated on the physician notes. Thus, the staff had assisted the resident to receive medical care as needed. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director Paul (Apolinario) Gozon and findings were discussed. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 8, 2026 · control 28-AS-20260601120023

Allegation investigated: Staff are not ensuring residents’ needs are being met.

***This report supersedes report dated 05/09/2026. The purpose of this report is to correct the citation that was issued 11/22/2025 from HSC 1569.2(c)(4) to CCR 87464 (f)(4) all other findings remain the same. *** Licensing Program Analyst met with Paul Gonzon and explained the purpose of this visit. Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Activity Assistant Martha Gonzalez who assisted with today’s visit. Administrator Paul Gonzon was notified via telephone. The investigation consisted of the following: During the initial visit conducted on 03/03/2026, LPA Sanjay Vaid conducted an unannounced visit and obtained copies of the resident and staff rosters, documents for Resident #1, and six (6) random residents, resident shower schedules, resident shower refusal logs for February to present, monthly menus, and Interviewed Staff #1-#3 and Resident #1-#4. During today’s visit, LPA Gutierrez checked kitchen food supply, toured six (6) random resident bedrooms, obtained staff roster, resident roster, reviewed R1’s file and obtained copies of R1’s service plan, family meeting notes, and shower schedule. LPA also obtained facility food menu, resident council meeting notes, and requests from Administrator to email a copy of Aprils housekeeping schedule for all employees worked. LPA interviewed Administrator, staff #1-staff #8 (S1-S8), and residents# 1-residents #7 (R1-R7). During today’s visit LPA delivered findings. Substantiated In regard to the allegation” Staff are not ensuring residents’ needs are being met”, It is alleged that staff did not follow R1’s care plan for showering. During interviews with Administrator and staff two (2) staff stated that residents are getting showered according to their shower schedule .Two (2) staff indicated there are times that they miss scheduled showers because they are either short staffed or they don’t have clean towels During interviews with residents four (4) out of seven (7) stated that they do not need assistance with showers. One (1) R7 stated that he/she gets showered every day because that is there rights and they had assistance from CCLD to enforce that right. One (1) resident R1 stated they need to ask for showers and one (1) resident stated they ask for help occasionally and need to wait. During record review it was reviled that occurring to R1’s care plan they are to be showered twice a week, LPA obtained shower logs for the month of February and R1 should have been showered a total of eight times long indicated four showers, one refusal shower, and three missed showers from staff. LPA also collected notes from a meeting with facility staff and family dated 02/06/2026 indicating showers were to be given twice a week and two showers were missed after that meeting. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report and appeal rights were given to Martha Gonzalez.the state’s words, verbatim · CDSS document, May 21, 2026 · control 28-AS-20260224120551

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: May 16, 2026

87464 Basic Services (f) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. Based on interviews and record review, the facility failed to follow R1's care plan for showers that resulted in 3 missed showers for the month of february which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 21, 2026

Plan of correction: Administrator will develop a plan with all care staff to insure that shower schedule is followed and send plan to LPA by POC due date.

Allegation investigated: Staff do not ensure residents are served food of good quality, resulting in residents getting ill. Staff are not ensuring residents’ needs are being met.

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Activity Assistant Martha Gonzalez who assisted with today’s visit. Administrator Paul Gonzon was notified via telephone. The investigation consisted of the following: During the initial visit conducted on 03/03/2026, LPA Sanjay Vaid conducted an unannounced visit and obtained copies of the resident and staff rosters, documents for Resident #1, and six (6) random residents, resident shower schedules, resident shower refusal logs for February to present, monthly menus, and Interviewed Staff #1-#3 and Resident #1-#4. During today’s visit, LPA Gutierrez checked kitchen food supply, toured six (6) random resident bedrooms, obtained staff roster, resident roster, reviewed R1’s file and obtained copies of R1’s service plan, family meeting notes, and shower schedule. LPA also obtained facility food menu, resident council meeting notes, and requests from Administrator to email a copy of Aprils housekeeping schedule for all employees worked. LPA interviewed Administrator, staff #1-staff #8 (S1-S8), and residents# 1-residents #7 (R1-R7). During today’s visit LPA delivered findings. Substantiated In regard to the allegation” Staff do not ensure residents are served food of good quality, resulting in residents getting ill.”, It is alleged that facility is serving inedible meals that are not fresh and making residents sick. During interviews with Administrator and staff four (4) out of seven (7) stated that food is fresh and has not caused any resident to become ill. Three (3) staff indicated that several residents complain of diarrhea and upset stomach after eating food. During interviews with residents four (4) out of seven (7) stated that food is not good and has either made them sick or other residents, Two (2) residents stated that they were served uncooked chicken that resulted in them being sick. Three (3) residents stated food was good. LPA did a check of food, and it observed silk almond milk with an expiration date of 04/22/26, chicken tuna best if used by 02/07/26, and Alta Dena heavy cream expiration 05/05/26. In regard to the allegation” Staff are not ensuring residents’ needs are being met”, It is alleged that staff did not follow R1’s care plan for showering. During interviews with Administrator and staff two (2) staff stated that residents are getting showered according to their shower schedule .Two (2) staff indicated there are times that they miss scheduled showers because they are either short staffed or they don’t have clean towels During interviews with residents four (4) out of seven (7) stated that they do not need assistance with showers. One (1) R7 stated that he/she gets showered every day because that is there rights and they had assistance from CCLD to enforce that right. One (1) resident R1 stated they need to ask for showers and one (1) resident stated they ask for help occasionally and need to wait. During record review it was reviled that occurring to R1’s care plan they are to be showered twice a week, LPA obtained shower logs for the month of February and R1 should have been showered a total of eight times long indicated four showers, one refusal shower, and three missed showers from staff. LPA also collected notes from a meeting with facility staff and family dated 02/06/2026 indicating showers were to be given twice a week and two showers were missed after that meeting. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report and appeal rights were given to Martha Gonzalez. In regard to the allegation” Staff do not ensure residents’ rooms are cleaned.”, It is alleged that R1’s room had not been cleansed in months. During interview with Administrator, and staff four (4) out of six (6) staff stated rooms are cleaned every day with deep cleaning done once a month. Administrator stated that they were not fully staffed but have since hired more housekeepers and had utilized agencies for housekeepers during the time when they were short staffed. LPA confirmed that an outside agency was used to hire housekeepers and all three were fingerprinted and associated to facility with Guardian. During interview with residents Four (4) out of seven (7) felt staff does a good job at cleaning there rooms. Three (3) residents felt they are understaffed and don’t do a good job LPA conducted a tour of six (6) random bedrooms and did not find any rooms to be dirty and found no concerns “Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report and appeal rights was given to Martha Gonzalez.the state’s words, verbatim · CDSS document, May 9, 2026 · control 28-AS-20260224120551

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(a)(8) · Plan of correction due date: May 10, 2026

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. Based on interviews and obsevation, the facility had expired food that caused residents to become ill which posed a which posed an immediately health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 9, 2026

Plan of correction: Administrator will come up with a plan with the kitchen staff to insure all food is checked for experation dates and send plan to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.2(c)(4) · Plan of correction due date: May 16, 2026

Health and Safety Code section 1569.2(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care.(4)Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. Based on interviews and record review, the facility failed to follow R1's care plan for showers that resulted in 3 missed showers for the month of february which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 9, 2026

Plan of correction: Administrator will develop a plan with all care staff to insure that shower schedule is followed and send plan to LPA by POC due date.

Allegation investigated: Facility is shutting off the water without notice.

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Paul Gonzon who assisted with today’s visit. The investigation consisted of the following: During the initial visit conducted on 04/02/2026, LPA Sanjay Vaid conducted an unannounced visit and obtained copies of Staff roster, residents roster. LPA Vaid, Administrator Sievert and Operations Director Pham and Maintenance Director Lara toured the facility and did not observe any health and safety concerns. On 05/09/2026 LPA Gutierrez toured six (6) random resident bedrooms, obtained staff roster, and resident roster. LPA interviewed Administrator, staff #1-staff #8 (S1-S8), and residents# 2-residents #8 (R2-R8). LPA conducted a telephone interview with R1 During today’s visit, LPA Gutierrez delivered findings. Unsubstantiated In regard to the allegation” Facility is shutting off the water without notice”, It is alleged that R1 was using restroom and water was shut off without notice. During interview with Administrator, and staff nine (9) out of nine (9) staff stated that water has not been shut off. Administrator stated that if for any reason water needed to be shut off staff would inform residents 24 hrs. in advance and post signs. LPA asked if there was any maintenance logs that identified any plumbing issues or water interruptions and was told there was no logs because water has never been shut. During interview with residents five (5) out of the nine (9) interviewed stated water has not been shut off. R5 stated water was shut off but that was years ago for maintenance and that residents were notified. R1 stated that it was a long time ago. “Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to Martha Gonzalez.the state’s words, verbatim · CDSS document, May 9, 2026 · control 28-AS-20260326150127

Allegation investigated: Facility issued an illegal eviction to a resident in care. Facility accepted and retained residents beyond its' license limitations.

***This licensing report supersedes the licensing report delivered on 03/17/2026. The reason for the superseded report is to add additional information obtained during the investigation. The investigation findings will remain the same. *** On (04/27/2026), Licensing Program Analyst (LPA) Vaid conducted a subsequent visit to the facility and met with Executive Director Paul Gozon and discussed the purpose of the visit. LPA Vaid and Administrator conducted a facility tour and did not observe any health and safety issues. On 03/17/2026, Licensing Program Analyst (LPA) Vaid conducted initial investigation to the facility and met with Administrator, during the initial visit, LPA Vaid and Administrator conducted a facility tour. LPA Vaid requested , obtained and reviewed the following documents, staff roster, resident roster, Resident 1-R1-face sheet, physicians report, pre-filled admissions agreement and pre-filled arbitration documents, copy of service plan and resident assessment. LPA Vaid interviewed staff, residents and witnesses. CONTINUED ON 9099C....... Unsubstantiated ***This licensing report supersedes the licensing report delivered on 03/17/2026. The reason for the superseded report is to add additional information obtained during the investigation. The investigation findings will remain the same. *** Regarding the allegation: Facility issued an illegal eviction to a resident in care. It is alleged that the facility has issued illegal eviction to a resident in care and staff are harassing the resident for non-payment of R1’s monthly room rental. Interviews with four (4) of four (4) staff denied this allegation. According to interviews with staff and records reviewed, R1’s eviction is due to non-payment of monthly rent. According to R1’s records, the room rental has been grand fathered, and the current monthly rental rate will be honored and applied. The facility has agreed to honor the prior admissions agreement made with the prior management company. However, R1 has refused to accept and sign an Admissions Agreement with the current licensee. R1 refers to agreements made with the prior management company regarding payment of monthly rent. Staff interviewed stated they are not harassing residents, including R1 for non-payment of monthly rent. Staff stated they are working with the residents to peacefully resolve non-payment issues. Six (6) of seven (7) residents interviewed could not corroborate this allegation. Residents interviewed stated they are not being evicted, they are paying the monthly rental dues and residents are being harassed by staff for late rental payments. The investigation revealed the R1 is behind on monthly rent payments to the facility and did not reveal that staff are harassing residents in care for non-payment of rent. Based on interviews and records review, 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. Regarding the allegation: Facility accepted and retained residents beyond its' license limitations. It is alleged that the facility is retaining residents that do not meet the resident care facility criteria. The facility allowed two (2) young Hispanic adult males (twins brothers) who are not elderly and are not handicapped to reside at the facility. Therefore, the two males should not be allowed to reside in the facility. Additionally, the two Hispanic men are jamming the facilities’ Wi-Fi system and enter R1’s room with an illegal copied key. Interview with four (4) of four (4) staff denied this allegation. According to the staff, there are no residents residing in the facility that match that description of the Hispanic men. Only facility staff that need to enter and clean residents’ room have a master key. Staff stated they are not aware of any residents that fit the description of the two Hispanic twins and are admitted to the facility. Staff were not aware of a Wi Fi jamming device in the facility or aware of non-staff members entering residents’ rooms. CONTINUED ON 9099C.................. ***This licensing report supersedes the licensing report delivered on 03/17/2026. The reason for the superseded report is to add additional information obtained during the investigation. The investigation findings will remain the same. *** LPA Vaid observed the resident in room 203 is not Hispanic, and LPA observed room 205 is not occupied by a resident. LPA Vaid observed R1’s TV working and R1 was watching the news R1’s television set. LPA Vaid did not observe R1’s phone, however R1 received a call while R1 was being interviewed by LPA. LPA Vaid did not observe any Wi Fi was being jammed and did not observe a Wi Fi Jaming device in the facility. Six (6) of seven (7) residents interviewed could not corroborate this allegation. Residents are not aware of the licensee’s business operations and residents were unable to verify the identity of the two Hispanic male twins residing at the facility. Residents were not aware of a Wi Fi jamming device and were not aware of a non-staff person entering residents’ rooms. The investigation did not reveal that the facility is operating beyond the limits of the license. Based on interviews conducted, records review, and observations made, 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. Exit interview was conducted with Staff (Paul Gozon, Executive Director) and a copy of the licensing complaint report was provided to staff, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Apr 27, 2026 · control 28-AS-20260312113958

Allegation investigated: Staff refused to accept resident back into the facility upon hospital discharge.

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings. LPA met with Administrator Silvia Valdez and explained the reason for the visit. The investigation consisted of the following: On 2/10/26, LPA Chan conducted the initial visit. LPA obtained copies of the resident and staff rosters, documents for Resident #1, and interviewed five (5) Staff and seven (7) Residents. LPA also interviewed a Mental Health Therapist on 3/9/26. The investigation revealed the following: Allegation - Staff refused to accept the resident back into the facility upon hospital discharge. It is alleged that Resident #1 (R1) was ready for discharge on 1/30/26, but staff stated that the resident could no longer return to the facility. Substantiated LPA interviewed the hospital staff, facility staff, and residents regarding this allegation. LPA interviewed a personnel member from Olive View – UCLA Psychiatric, who confirmed that R1 was ready for discharge on 1/30/26 and did not have a change of condition or require additional care services. The hospital staff reported that they have been in contact with the facility to arrange for discharge and were informed that R1 cannot return to the facility. LPA also interviewed a mental health professional who stated that R1 appeared stable and was ready for hospital discharge. LPA interviewed the facility staff. Staff indicated that they received a call from the hospital to discharge R1 back to the facility. However, staff stated they were unable to reassess the resident and determined that it may not be safe for R1 to return to the facility due to suicidal ideation. Staff voiced that R1 is actively trying to hurt self, and that the facility does not have the staffing to provide adequate supervision for R1’s psychiatric needs. Upon review of the R1’s medical notes, the resident was hospitalized from 1/14/26 and was placed on a 5250 (14-day) hold to expire on 1/30/26. The records indicated that on 1/29/26, R1 was not currently endorsing Suicidal Ideation and had actively engaged in safety planning. Therefore, R1 was ready for discharge back to the facility. Based on interviews conducted and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted. The Plan of Correction was reviewed and developed with the administrator. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 3, 2026 · control 28-AS-20260203153254

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: Apr 10, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, (20) To be protected from involuntary transfers, discharges, and evictions. This requirement is not met as evidenced by: Based on interviews and record reviews, the facility did not accept R1 back to the facility which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 3, 2026

Plan of correction: Licensee shall review the regulation and adhere to it. A statement acknowledging this regulation by POC due date 4/10/26.

Allegation investigated: Staff do not ensure facility is free from pests Staff do not ensure facility is clean

Licensing Program Analyst (LPA) Vaid conducted initial investigation and was met by Business Office Manager (BOM) Almanza, and the reason for the visit was discussed. Administrator designee Madeliene Sievert and Lisa Pham, Regional Director of Operations and Jonathan Lara, Maintenance Director, arrived shortly after and assisted with the tour. LPA Vaid requested staff roster dated 03/31/2026, and a resident roster dated 04/01/26. 4-month Pest control invoices, December 2025-March 2026. LPA Vaid interviewed staff and residents. LPA Vaid toured and observed six random residents’ rooms. Regarding the allegation: Staff do not ensure facility is free from pests. It is alleged that staff are not ensuring the facility is free of roaches and vermin in residents’ rooms. Five of five staff deny this allegation. According to staff, residents have not reported pest problems to management. CONTINUED ON 9099C............. Unsubstantiated Pest control company is scheduled for monthly visits to observe and treat common areas like the dining hall, kitchen areas and activities room. S3 stated pest control sprays the common areas in the evenings, less foot traffic in common areas at night. Five (5) rooms treated for pest during the daytime hours when residents are awake. Five of eight residents stated they have not observed any pests like roaches and vermin in their rooms or the common areas as of late. Three of eight residents interviewed stated the observing the pest control technician performing their duties. Based on interviews, record review and observations, 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. Regarding the allegation: Staff do not ensure facility is clean. It is alleged that the staff are not keeping the facility clean and that staff are not ensuring residents have clean clothes. Five of five staff deny this allegation, staff stated the residents are being assisted with their laundry services, laundry staff assist residents sort, wash, dry and fold their clothes. Some residents do own laundry; some residents have family who take laundry home. Staff also stated they will assist residents to hang the laundry in residents’ closet. Six of eight residents stated the staff assists with keeping their rooms clean, housekeeping is performed three times per week, rooms are swept, mopped and trash is removed. Laundry schedule days are assigned to residents upon move-in. Staff stated residents’ laundry is cleaned regularly and sometime extra washing is done as needed. Based on interviews and observations, 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. An exit interview was conducted, and a copy of this licensing complaint report was provided to Lisa Pham, Director of Operations.the state’s words, verbatim · CDSS document, Apr 2, 2026 · control 28-AS-20260326113116

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Vaid conducted a unannounced 24-hour Health and Safety check. LPA Vaid met with Business Office Manager(BOM) Denise Esquivel and discussed the reason for the visit. The facility self reported and SOC 341 to the department. Incident report was sent to department within 7 days . LPA Vaid requested and obtained the following documents: Staff roster, resident roster, Resident 1-R1 face sheet, physicians report dated 02/29/2024, medications list. LPA Vaid obtained R1 Power of Attorney (POA) contact information- resident 1 is current in the hospital due to medical issues. LPA Vaid and Esquivel conducted an tour of the facility and did not observe any health and safety concerns. A copy of this report was provided to facility staff Business Office Manager Denise Almanza Esquivel.the state’s words, verbatim · CDSS document, Mar 19, 2026

Allegation investigated: Facility issued an illegal eviction to a resident in care. Facility accepted and retained residents beyond its' license limitations.

Licensing Program Analyst (LPA) Vaid conducted initial investigation to the facility and met with Administrator and discussed the purpose of the visit. LPA Vaid and Administrator conducted a facility tour and did not observe any health and safety issues. LPA vaid requested , obtained and reviewed the following documents, staff roster, resident roster, Resident 1-R1-face sheet, physicians report, pre-filled admissions agreement and pre-filled arbitration documents (unsigned by resident), copy of service plan and resident assessment. LPA Vaid interviewed staff, residents and witness. Regarding the allegation: Facility issued an illegal eviction to a resident in care. It is alleged that the facility has issued illegal eviction to resident in care. Four of four staff denied this allegation. CONTINUED ON 9099C....... Unsubstantiated According to interviews with staff and records reviewed R1’s eviction is due to non-payment of four months rental. According to records, the room rental has been grandfathered, the current rental rate will be honored and applied. It is the resident’s duty to contact the their retirement fund manager and make payment arrangements. The facility has agreed to honor the prior admissions agreement. R1 has refused to accept responsibility for the rental agreement and is citing agreements made with prior management company. R1 refuses to submit new/updated physician’s medical report to the new management company. According to the staff without the new physicians report the facility cannot render appropriate care the resident requires. Six of seven residents interviewed could not corroborate this allegation. Residents interviewed stated they are not being evicted, they are paying the rental dues and do not have further knowledge of the allegation. Based on interviews and records review, 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. Regarding the allegation: Facility accepted and retained residents beyond its' license limitations. It is alleged that the facility is accepting and retaining residents that do not meet the resident care facility criteria and are allowing two young males to reside at the facility. Per allegation the two Hispanic men are not 65 years of age and are not handicapped therefore are not allowed to reside in the facility. The two Hispanic men are jamming the Wi-Fi system and are entering R1’s room with an illegal copied key. Four of four staff interviewed denied this allegation. According to the staff no one matching that description resides at the facility. Master key are kept on staff people needing to enter and clean residents’ room. Observations made by LPA Vaid, the resident in room 203 is not Hispanic or of Mexican descent, room 205 is an empty room. LPA Vaid observed R1’s TV working and R1 watching the news. LPA Vaid did not observe R1’s phone, however R1 received a call while R1 was being interviewed by LPA. Six of seven residents interviewed could not corroborate this allegation. Residents are not aware of the licensee’s accepted and retained limitations and could not verify the identity of the two Hispanic male twins residing at the facility. Based on interviews conducted, records review, and observations made, 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. Exit interview was conducted and a copy of the licensing complaint report was provided to Administrator, Slivia Valdez. 2nd page was signed by Executive Director Paul Gozon.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 28-AS-20260312113958

Allegation investigated: Licensee is financially abusing resident. Staff did not safeguard resident's personal possessions.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Lisa Pham the Regional Director of Operations and explained the purpose for todays visit. The investigation consisted of the following: LPA obtained copies of staff and resident rosters, documents within Resident #1's (R1) file that include: Admission Agreement, copy of refund Check, and copy of returned mail. LPA conducted interviews with 4 Staff (S1-S4) and 7 Residents (R2-R8). (Continued on LIC9099-C) Unsubstantiated The Investigation Revealed the following: Allegation: Licensee is financially abusing resident. It is alleged that R1 moved out of facility on 12-06-2025 and was told they would receive a refund and has not received any refund yet. LPA interviewed 4 staff, and each denied the above allegation and stated that R1 did not provide a 30-day notice, left the facility early December 2025 and refund check was mailed in January 2026. LPA reviewed R1’s file and per R1’s signed Admission Agreement (dated 12/1/25) under section VIII. Termination, A. Termination by Resident. states that the admission agreement may be terminated at any time with or without cause by giving the Executive Director thirty days prior notice of termination. Resident will continue to be responsible for the full monthly fee until the 30-day period is expired. Since R1 did not provide the facility with the written 30-day notice, R1 was left responsible for December 2025 rent, therefore, no refund for the month of December is being issued. There is a refund being issued for the month of January 2026 along with petty cash that R1 left behind, check was issued on 1/14/2026 and mailed on 1/16/2026, the mailing address was provided to facility by the Ombudsman and was returned to sender/facility on 1/22/2026. LPA was provided proof of mail and check with post office stamp dates. During today’s visit Business Office Manager Denise confirmed check will be mailed to correct address that R1 provided LPA with before the end of day via certified mail. LPA contacted new licensed facility that R1 resides at, and Facility Manager confirmed receipt of February 2026 payment through Social Security and that they are the new payee for R1. LPA also interviewed 7 Residents, and each denied the allegation stating that they haven’t had any issues with payments or refunds. Allegation: Staff did not safeguard resident's personal possessions. It is alleged that facility staff did not safeguard R1’s belongings including a bible that R1 forgot to take when they moved out and staff state they don’t know where it is. LPA reviewed R1’s file and did not see a list of personal belongings to confirm if resident had the bible listed. Per interview with S4 it was explained when new management took over facility in December 2025, new admission agreements were signed and residents were asked if they would like to update their personal belongings list, R1 refused to update their personal belongings. Per interviews with S1-S4 each stated that R1 took all their belongings with them when they vacated the facility and left nothing behind, since then the room has been emptied and renovated, each staff denied seeing a bible in R1’s room. LPA interviewed 7 residents 5 out of 7 residents denied the allegation stating that they have not had any of their personal belongings tampered with or gone missing. Based on statements/interviews conducted with staff/residents, review of R1's file and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 5, 2026 · control 28-AS-20260130144654

Allegation investigated: Unlawful Eviction Staff threaten resident in retaliation for filing a complaint

Licensing Program Analyst (LPA) Vaid conducted 10-day complaint and met with Administrator Joe Salada and explained the reason for the visit. LPA Vaid requested, obtained and reviewed the following documents: LIC 500 staff roster, resident roster, Resident 1- facesheet, physicians report, resident appraisal,IPP, old admissions agreement and new unsigned admissions agreemnt, rental invoice for December 2025 and January 2026. Eviction notice for non payment. Three random residents admissions agreement and rental invoice, face sheet, physician report. Staff in-training -personal rights. Regarding the allegation: Unlawful eviction. It is alleged that the management company is trying to unlawfully evict the resident#1 (R1) for non-payment of rental agreement. Five (5) of five (5) staff interviewed deny this allegation. Continued on 9099C.......... Unsubstantiated According to staff, Resident has been given the admissions agreement three (3) times, Resident has refused to sign the new admissions agreement three times, Resident has refused to accept the new rental invoice dated 12/01/2025 and 01/01/2026 citing third party payment responsibility of the Residents' rental payment. The facility has reached out to Residents' retirement management company and requested payment of December 2025 and January 2026 rents, payment for December 2025 and January 2026 rents have not been received. Six of seven residents interviewed could not corroborate this allegation. Residents interviewed stated they are not being evicted and the residents are abiding by the house rules and paying month to month rent timely. One of seven Residents' stated facility management is attempting to unlawfully force Resident to sign new admissions agreement and collect unpaid rents. Based on interviews and record reviews, 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. Regarding the allegation: Staff threatened residents in retaliation for filing complaint. It is alleged that staff are retaliating against residents for filing complaints against the facility staff. Five of five staff interviewed deny this allegation. Staff stated they do not know the identity of residents making complaints to licensing and therefore do not retaliate against an unknown resident. Staff further stated they respect the residents and their right to file complaints against the staff for wrongdoings. Six of seven residents interviewed could not corroborate this allegation. One of seven resident interviewed stated they are being retaliated by staff for filing complaints and threatened for filing complaints. Six of seven residents interviewed stated they are not threatened by staff for making complaints. Three of seven residents stated they have made complaints to licensing without retaliation. Based on interviews conducted and records reviewed, 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. Exit interview was conducted and copy of this report was presented to Lisa Pham, Regional Director of Operations.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 28-AS-20260109131829

Allegation investigated: Staff verbally threatened resident with eviction. Staff provided an invalid admission agreement to resident in care.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with Lisa Pham, the Regional Director of Operations, to explain the purpose of the visit. LPA obtained copies of the staff roster, resident roster, and documents for Resident #1. LPA interviewed Staff #1 - #5 and Residents #1 - #7. Allegations - Staff verbally threatened resident with eviction. It is alleged that staff threatened to evict Resident #1 (R1) if R1 does not agree to sign the new admission agreement. LPA interviewed five (5) Staff. Staff stated they never told R1 that he/she will get evicted if the resident does not sign the new admission agreement. Staff stated that they respect the residents’ wishes and do not threaten any residents if they do not comply with things. Unsubstantiated LPA interviewed seven (7) residents. One out of the seven felt threatened by staff for not wanting to sign the admission agreement. The rest of the residents interviewed have not been threatened by staff and feel that the staff are good and nice. There is insufficient evidence to corroborate this allegation. Allegation - Staff provided an invalid admission agreement to resident in care. It is alleged that the resident was provided a new admission agreement and the fee amounts were left blank or incomplete. LPA interviewed Staff who communicated with all residents regarding the new admission agreement due to the change of ownership. Per staff, they met with each resident and/or their responsible parties to review and sign the new admission agreement. Staff stated that they attempted to meet with R1 to review the document. However, R1 did not allow the staff any opportunity to go over the new contract and told staff that R1 will not sign it. Staff also stated that R1 was provided another copy of the admission agreement upon request. LPA obtained a copy of the new admission agreement that was provided to R1. The contract appeared complete and indicated the resident’s name and charges. LPA interviewed R1 who stated that the staff only provided a copy of the blank admission agreement and told resident to sign. The other six (6) residents interviewed stated that the staff met with them to go over the new admission agreement and provided the rates. 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; therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted with Lisa Pham. A copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Jan 6, 2026 · control 28-AS-20251229131007

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Vaid conducted an unannounced post-licensing/annual inspection. LPA Vaid met with Julieanna Velasquez, Concierge and informed the Administrator Nirjara Acharya who arrived shortly after. The Residential Care Facility for the Elderly to serve the Elderly for 60 years and older. The requested capacity is 200, which includes 190 non-ambulatory residents and 10 may be bedridden. Facility may have 30 residents with Hospice wavier. License has a Dementia Care program. Structure: The facility is a stucco structure with 91 bedrooms, 91 bathrooms, 1 TV room, an administrative office, a restaurant style kitchen, a laundry room, a coin laundry room, a janitor storage room, an activity room, a dining room and two elevators. There is a covered patio area on the premises. The resident bedrooms are spacious and will easily accommodate the client's furnishings. Passageways, walkways, stairs and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Signal system: Facility has a signal system. It operates properly. Bedrooms for Residents: Bedroom has a chair, nightstand, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage of assistance devices such as walkers. Continued on 809C............... Bathrooms:All bathrooms have a working toilet, wash basin, bathtub/shower. Bedrooms for non-ambulatory residents are accommodated for residents in a wheelchair. Linens & Hygiene Supplies:Beds have the required linen/supplies which include pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in storage room. Emergency Phone Numbers, Exit Plan & Menu: Emergency Disaster Plan is posted at the lobby near the entrance. Menus are available for review. Free landline telephones and mobile phones are available for residents’ use and operable. Nineteen (19) fire extinguishers are available in the facility. They are located near kitchen door mounted on wall, hallways of each floor and TV lounge room. They are fully charged. Food Service:Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer in the kitchen. Food supply adequate stored and consists of two days of perishable and two weeks of non-perishable. Dishwasher in kitchen properly installed and functioning. Appliances:Stove burners, oven, microwave, washer, and dryer working. There are two refrigerators in the kitchen including a walk-in refrigerator and one additional refrigerator for food storage. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. Smoke Detectors:Smoke detectors are in residents’ rooms. They are operational and not hard-wired. Carbon monoxide detectors located in hallway of each floor and are operational. Toxins:Poisons, toxins, and cleaning supplies are locked in a room and inaccessible to residents. Continued on 809C............ Water Temperature:Tested at 114.5. degrees Fahrenheit. Medications, First-Aid Kit & Book:Medication cabinets and carts were locked in the medication room and not accessible to the residents. Residents & Staff Files:Applicant will not handle cash resources for residents. Records of staff and clients shall be stored in a locked cabinet in administrator’s office, and the section has been inspected along with the available records present. The facility has Liability insurance coverage. Reading Material, Games, Equipment & Materials:The facility has board games, books, bingo games, karaoke and other recreational materials for the residents’ use, commensurate with the plan of operation. Pool:Facility has no pool. Fire clearance:Fire Clearance with 0 ambulatory, 190 non-ambulatory and 10 bedridden was approved on 11/07/24. Residents’ bedrooms # 101- #119 are designated for bedridden rooms. No issues or deficiencies were observed. An exit interview was conducted with Nirjara Acharya, and a hard copy was provided.the state’s words, verbatim · CDSS document, Dec 23, 2025

Type of visit: Collateral

Licensing Program Analyst (LPA) Vaid conducted a collateral visit to the facility. The reasons for the visit were discussed with the facility Administrator, Nirjara Acharya.the state’s words, verbatim · CDSS document, Dec 23, 2025

Type of visit: Collateral

On 12/19/2025, LPA Pena conducted a collateral visit to the facility and met with Lisa Pham, new licensee's Regional Director of Operations. During the visit, LPA obtained a copy of the Staff and Resident rosters, and inadvertently delivered findings and cited deficiencies for a complaint investigation report intended for the previous licensee.the state’s words, verbatim · CDSS document, Dec 19, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. An application was submitted to CCLD on 10/24/24 for a change of ownership. LPA met Virgilio Agas, the current facility Administrator, and Arcadia Operations LLC’s officers including Adam Zenou, CEO; Moises Bercovich, Co-CEO; Nirjara Acharya, VP- Operations; Kevin Avalos, VP- Plant Operations; Jose Gonzales, VP- Culinary; Perry Burge, Regional Director of Culinary; Jonathan Lara, Regional Director of Plant operation. The applicant is Arcadia Operations LLC. The facility was previously licensed to Goldwater Sag Holdings, LLC with facility # 198603401. Applicant applied for Residential Care Facility for the Elderly to serve the Elderly for 60 years and older. The requested capacity is 200 which including 190 non-ambulatory residents and 10 may be bedridden. Facility may have 30 residents with Hospice wavier. Applicant has a Dementia Care program in application. Structure: The facility is a stucco structure with 91 bedrooms, 91 bathrooms, 1 TV room, an administrative office, a restaurant style kitchen, a laundry room, a coin laundry room, a janitor storage room, an activity room, a dining room and two elevators. There is a covered patio area on the premises. The resident bedrooms are spacious and will easily accommodate the client's furnishings. Passageways, walkways, stairs and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Signal system: Facility has a signal system. It operates properly. (-continued LIC 809 C -) Bedrooms for Residents: Bedroom has a chair, nightstand, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage of assistant devices such as walkers. Bathrooms: All bathrooms have a working toilet, wash basin, bathtub/shower. Bedrooms for non-ambulatory residents are accommodated for residents in a wheelchair. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in storage room. Emergency Phone Numbers, Exit Plan & Menu: Emergency Disaster Plan is posted at the lobby near the entrance. Menus are available for review. Free landline telephone and mobile phones are available for residents’ use and operable. Nineteen fire extinguishers are available in the facility. They are located near kitchen door mounted on wall, hallways of each floor and TV lounge room. They are fully charged and last service was on 11/7/24. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer in the kitchen. Food supply adequate stored and consists of two days of perishable and two weeks of non-perishable. Dishwasher in kitchen properly installed and functioning. (-continued in LIC 809 C -) Smoke Detectors: Smoke detectors are located in residents’ rooms. They are operational and not hard wired. Carbon monoxide detectors located in hallway of each floor and are operational. Appliances: Stove burners, oven, microwave, washer, and dryer working. There are two refrigerators in the kitchen including a walk-in refrigerator and one additional refrigerator for food storage. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. The temperature is in a range of 68 to 75 degrees Fahrenheit. Toxins: Poisons, toxins, and cleaning supplies are locked in a room and inaccessible to residents. Water Temperature: Tested at 114.5. degrees Fahrenheit. Medications, First-Aid Kit & Book: Medication cabinets and carts were locked in the medication room and not accessible to the residents. Residents & Staff Files: Applicant will not handle cash resources for residents. Records of staff and clients shall be stored in a locked cabinet in administrator’s office and the section has been inspected along with the available records present. The facility has Liability insurance coverage. Reading Material, Games, Equipment & Materials: The facility has board games, books, bingo games, karaoke and other recreational materials for the residents’ use, commensurate with the plan of operation. (- continued in LIC 809 C -) Pool: Facility has no pool. Bodies of water is located at the entrance which is not accessible to residents. Fire clearance: Fire Clearance with 0 ambulatory, 190 non-ambulatory and 10 bedridden was approved on 11/07/24. Residents’ bedrooms # 101- #119 are designated for bedridden rooms. Component III: Applicant requested to waive the Component III due to the applicant had done it from other pre-licensing visits. An exit interview was conducted with Adam and Nirjara, and a hard copy was provided. No issues or deficiencies were observed. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.the state’s words, verbatim · CDSS document, Dec 10, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 200 Census (if any clients in care): 81 COMP II Participants: Adam Zenou (Managing Member) & Nirjara Acharya (Administrator) Interview Method: Virtual interview via Microsoft Teams On November 26, 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 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, Nov 26, 2024