Arveah's Care Homes 4

Allegation investigated: Licensee is not following proper eviction procedures

On 10/02/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Leah Martinez-Davis and explained the purpose of the visit. There was two other staff members present, Jen Lausa and Wendy Martinez. Shortly after, Arvin Davis arrived. The purpose of this visit was to inform the facility and its representative that a complaint has been filed against it at this time. Current Census was 2. Brief interview with FDA Davis was conducted. Allegation: Licensee is not following proper eviction procedures It was alleged that the Licensee did not follow proper eviction procedures. Based on interviews conducted, it was learned that Resident 1 (R1) was admitted to the hospital due to a medical need. During R1’s hospitalization, the facility determined that R1 required a higher level of care and subsequently informed both the hospital and the resident that R1 would not be allowed to return to the facility. Upon further discussion, facility staff acknowledged that a proper eviction notice was not provided to the resident, as required. Based on the information gathered, the licensee did not follow proper eviction procedures. Substantiated As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Exit Interview was conducted and a copy of this report was provided to the facility at the end of this visit. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time.the state’s words, verbatim · CDSS document, Oct 2, 2025 · control 27-AS-20250924124949

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Oct 3, 2025

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) This is not met as evidenced by: Based on interview and record review, the licensee did not ensure that R1 and their responsible party was provided a proper eviction notice. This is a immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Licensee shall provide a 30-day notice to the resident in care. A copy of this 30-day notice shall be provided to the LPA by POC date. A statement acknowledgement by the POC date.

Type of visit: Case Management - Deficiencies

On 10/02/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a case management visit. LPA met with Facility Designated Administrator (FDA), Leah Martinez-Davis and explained the purpose of the visit. There was one other staff member present, Jen Lausa and Wendy Martinez. The purpose of this case management visit was in response to additional information learned during a complaint visit conducted on 10/02/2025. Based on interviews conducted, it was determined that Resident 1 (R1) was seen at the hospital in May 2025 for a medical appointment. During this time, the facility Administrator identified additional care needs, indicating a change in the resident’s condition. When LPA Pascua inquired about a new assessment, the facility was unable to provide documentation of an updated assessment reflecting R1’s current care needs. Furthermore, it was learned that the facility denied R1's return based on the newly identified care needs from May 2025. Based on the information gathered, the facility did not initiate or maintain an updated assessment for R1 at the time these new care needs were identified. Deficiencies are being cited from the California Code of Regulations (CCR). An exit interview was conducted and a copy of this report, an LIC-811, and appeal rights were given.the state’s words, verbatim · CDSS document, Oct 2, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a)87463(a) · Plan of correction due date: Oct 31, 2025

87463 Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This is not met as evidenced by: The licensee did not ensure that an updated appraisal was conducted upon identification that R1 had a change of condition. This poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: Licensee shall provide a statement of acknowledgement by POC date.A reappraisal shall be provided to LPA by 10/03/2025.

Type of visit: Required - 1 Year

On 08/13/2025 unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Sommer Hayes. The LPA identified themselves and the purpose of the visit and asked to speak to the Designated Facility Administrator (DFA). LPA was met by the Designated Facility Administrator, Wendy Martinez and a brief interview followed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 4 residents. The current census is 3. LPA Hayes toured the facility with the Designated Facility Administrator (DFA), Wendy Martinez. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable and 2 days of perishable food supplies. There is enough clean plates, cups and bowls and cutlery to meet capacity. Opened packages in the refrigerator were not dated appropriately. Staff were observed assisting residents with activities of daily living (ADLs), cleaning the home and engaging with residents in care. Residents were observed sleeping, watching television, and in their bedrooms. Water temperature measured 100.1 degrees F not within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers inspected were charged on 06/03/25 by River City Fire and in compliance. A dual smoke detector/carbon monoxide in hallway was tested and working. There was enough lighting in all common areas, resident rooms, and hallways. A first aid kit was observed containing a first aid manual, tweezers, scissors, gauze and Band-Aids. Continued on 809-C LPA Hayes reviewed 3 resident files and 2 staff records during this visit. Medication was centrally stored and secured. The medication administration record (MAR) was reviewed and found to be complete with accurate documentation of administered medications provided to residents. LPA Hayes observed the backyard of the facility to be clean and free of hazards. There was a shaded area for residents to enjoy. Fencing was in good repair. There were no bodies of water. The facility living room was clean and free of obstruction. The temperature reading was 72 degrees Fahrenheit per Title 22 regulations. The seating is efficient for the number of residents in this facility. LPA Hayes requested the following annual documents for the facility file: LIC 500 Personnel Report, LIC 308 Designation of Responsibility, LIC 610 Emergency Disaster Plan, LIC 999 Facility Sketch, Copy of Administrator’s Certificate. LPA provided the following technical advisories to the DFA, Wendy Martinez: --Water temperature needs to be within Title 22 regulations between 105- and 120-degrees F --Food in the refrigerator needs to be properly dated and labeled. Per California Code of Regulations (CCR) - Title 22, 0 deficiencies are being cited. An exit interview was held, and a copy of the report was provided to Designated Facility Administrator, Wendy Martinezthe state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 10/24/24 at 1:00pm to conduct a Required - 1- Year Visit. LPA was met by Rosaleah Martinez Davis and stated the purpose of todays visit. LPA was allowed entry into the home that is licensed for a capacity of 4 non-ambulatory residents of which 4 maybe bedridden and 3 may receive hospice care services. LPA and Rosaleah Martinez Davis toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed there are 3 residents at this time. LPA observed the dining area, bedrooms, bathrooms, storage areas, and laundry room. LPA observed area where knives are locked. LPA observed required furniture, and lighting throughout the facility. The temperature inside the facility measured at 74*F which is within the required range of 68-85*F. The hot water temperature was measured at 117.3*F which is within the required range of 105-120*F. LPA observed kitchen area that contained equipment for cooking and storage for items such as the nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s), smoke and carbon monoxide detector(s) in the home. Facility has central heating and air. Staff and resident files are made readily available for review. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees-Submitted prior to todays visit Criminal Record Clearances LIS536-Current Administrative Organization LIC309-Current Designation of Administrative Responsibility LIC308-Submit Personnel Report LIC500-Submit Affidavit Regarding Client/Resident Cash Resources LIC400-NA Surety Bond LIC402-NA Facility Floor Plan/Plot Plan LIC999-Current Fire Clearance (consistent with terms and limitations of license)-NA Qualifications of Administrator/Facility Manager-Pending copy received Articles of Incorporation/Organization, Constitution and bylaws-NA Partnership Agreement-NA Control of Property-Submit Emergency Disaster Plan LIC610-Submit Plan of Operation (Restricted Health Care Plan)-NA Admission Policies and Procedures-NA Health Screening Report-Facility Personnel LIC503-NA Bacteriological Analysis of Private Water Supply-NA In-service Training Program-NA Medication Procedures-NA Transportation Procedures-NA Job Description/Personnel Policies-NA Exemptions/Waivers and Exceptions-Current First aid/CPR certificates-Current Liability Insurance-(if applicable)Submit Infection Control Plan-Submit if applicable Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. Exit interview held. A copy of todays’ report provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

Type of visit: Post Licensing

On 10/4/23 at approximately 8:45am Licensing Program Analyst (LPA) Jennifer Fain and Licensing Program Manager (LPM) Liza King arrived at this facility unannounced to conduct a Post Licensing visit. LPA met with the administrator Rosa-Leah Martinez-Davis and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area and outside of the facility to ensure compliance with Title 22 regulations. Facility has 2 bedrooms and 2 bathrooms for resident use. Facility currently provides care for 2 non ambulatory residents. Facility Observation: Upon entry the residents were in their rooms. Resident 1 (R1) was resting. LPA observed children’s books to aid in stroke recovery in the room. R2 was watching a BB King concert on Youtube. R2 spoke about the music and was interested in LMP’s tattoos. R2 spoke of a desire to have a tattoo in the shape of a lightening bolt on the back. R2 was alert and conversational. During this inspection 2 resident files and 2 staffing files were reviewed for regulatory compliance. Staff files contained required contents including staff training requirements, with the exception of expired First aid and CPR training for 2 of 2 staff. Administrator will have staff complete training and email certifications. All staff noted on LIC 500 contained criminal background clearances. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Temperature on the heating and air unit read 74*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were tested and in working order. Fire extinguisher was checked 7/14/23. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and was accessible to staff. Facility does not contain any bodies of water. Facility has appropriate internet access available for resident use. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. The Care Tool was used during this visit. LPA requested an updated copy of LIC 308, LIC 500, Current Liability Insurance to be emailed to Jennifer.Fain@dss.ca.gov Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Rosa-Leah Martinez-Davis.the state’s words, verbatim · CDSS document, Oct 4, 2023

Type of visit: Case Management - Annual Continuation

On 10/4/23 at approximately 12:00pm Licensing Program Analyst (LPA) Jennifer Fain arrived at this facility unannounced to conduct a continuation of an annual inspection visit. LPA met with the administrator Rosa-Leah Martinez-Davis and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area and outside of the facility to ensure compliance with Title 22 regulations. Facility has 2 bedrooms and 2 bathrooms for resident use. Facility currently provides care for 2 non ambulatory residents. During this inspection 2 resident files and 2 staffing files were reviewed for regulatory compliance. Staff files contained required contents including staff training requirements. All staff noted on LIC 500 contained criminal background clearances. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Smoke and carbon detectors were tested and in working order. Fire extinguisher was checked 7/14/23. LPA observed doors open to cleaning supplies. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and was accessible to staff. Facility does not contain any bodies of water. Facility has appropriate internet access available for resident use. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA provided Technical Assistance (TA) including, but not limited to, exceptions and waivers, change of administration, hospice and dementia care. The facility is not in compliance with Title 22 Regulations, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with Rosa-Leah Martinez-Davis and a copy of the LIC 809 reports, LIC 809-D pages, and Appeals rights were provided.the state’s words, verbatim · CDSS document, Oct 4, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309 · Plan of correction due date: Oct 11, 2023

Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not ensure the doors to storage rooms with cleaning supplies were locked, which poses a potential Health, Safety or, Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 4, 2023

Plan of correction: Licensee will review and provide an attestation that they understand and will follow the regulation. Proof of correction will be emailed to LPA at jennifer.fain@dss.ca.gov by 10/11/23.