Azalea House

Allegation investigated: Staff illegally evicted a resident in care Resident developed prohibited health condition while at the facility Staff did not provide toileting assistance to the resident

At 11:15a.m., Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to complete an investigation and deliver findings of the above noted allegations. LPA met with Staff #1-#2 (S1-S2) and explained the reason for the visit. At approximately 11:30a.m. Administrator was contacted via-phone and later joined us. During initial visit on 12/12/25 at 10:15am., LPA Alvizar- Ettima requested and received copies of the facility resident and staff rosters. At approximately 10:30a.m., LPA and House Manager conducted a physical plant walk-through. Between 11:00a.m. – 2:15p.m., LPA conducted interviews with the Adm., House Manager and staff #1 (S1). LPA asked questions relevant to the investigation. At about 2:45p.m. LPA received Resident #1 (R1’s) Identification Inf., Appraisal/Needs, Physician Report, Adm. Agreement, and other pertinent information. On 06/02/26 LPA- Alvizar-Ettima reviewed Resident #1 (R1’s) records that Administrator provided. Cont. on LIC 9099-C Unsubstantiated Cont. from LIC 9099 During this visit at approximately 11:45a.m., LPA Alvizar- Ettima and Staff #1 conducted a physical plan tour and did not observe any immediate health and safety issues. Between 12:10a.m. – 1:30p.m. LPA interviewed two (2) residents and attempt to interview two (2) however due to their health condition it was unsuccessful. One (1) resident was asleep, and one (1) resident was out of the facility with family. Facility staff indicated that Resident #1 (R1) no longer resides in the facility. 1.) Staff illegally evicted a resident in care. It was alleged that R1 was illegally evicted because R1 has a stage 3 bedsore and after being discharged from hospital Administrator did not want to allow the R1 to return to the facility. All R1’s belongs from the room needed to be removed so Administrator could rent it to someone else. Administrator denied the allegation and stated that R1 was hospitalized due to medical concerns and was not denied re-entry to the facility. Administrator also stated that the Home Health RN and R1’s Nurse Practitioner had documented as a stage 3 wound. Staff interviews corroborated the Administrator’s statement. Staff reported that R1 was transported to the hospital for treatment and they were unaware of any eviction or refusal to readmit R1. Resident interviewed did not report concerns regarding resident evictions and were unaware of any incident of a resident being removed from the facility. No written eviction notice was issued to R1. A review of R1’s file and other facility records did not reveal any information to support the allegation. Based on interviews and documents review there is insufficient information to support the allegations. Therefore, the allegation is UNSUBSTANTIATED at this time. 2.) Resident developed prohibited health condition while at the facility. It was alleged that Resident #1 (R1) had a possible stage 3 bedsore and needed to be transported to hospital. However, R1 was admitted with a stage 2 pressure injury prior to admission to the facility. The Administrator and staff verified that at the time of admission resident had existing Stage 2 pressure injury. Staff provided assistance and reminders regarding repositioning and skin care to R1. However, R1 frequently refused assistance with repositioning and preferred to remain in bed for extended periods. Staff routinely encouraged repositioning and documented resident’s refusals. Other residents interviewed did not report concerns regarding the care provided by facility staff. A review of Internal Notes reflected that staff provided education and reminders regarding repositioning and skin integrity. Cont. on LIC 9099-C Cont. from LIC 9099-C Overall investigation revealed that although R1 developed prohibited health condition (Stage 3 pressure injury) there is no sufficient information to verify that R1’s skin condition was changed due to neglect in care and supervision. Therefore, based on interviews and records review this allegation is deemed to be UNSUBSTANTIATED at this time. 3) Staff did not provide toileting assistance to the resident. It was alleged that multiple times Resident#1 (R1) asked facility staff if they could use the bathroom and staff responded to R1 they are wearing a diaper and refused to take R1 to the bathroom. The Administrator and staff revealed that staff never refused bathroom assistance to R1. Staff routinely provided assistance with toileting and personal care. When paramedics were ready to transport R1 to the hospital R1 was reminded that they were wearing a diaper in case R1 needed to use it. Other Residents Interviewed did not expressed concerns regarding staffs care and supervision. LPA review of Internal Notes and other pertinent facility documentation did not reveal concerns regarding staff refusal to provide toileting assistance. During the visits, LPA observed staff present in resident care areas, appropriately supervising residents and responding to residents. Based on interviews, observation and records reviewed, there is insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety issues were noted. Exit interview was conducted. Copy of report was provided.the state’s words, verbatim · CDSS document, Jun 7, 2026 · control 31-AS-20251209161558

Type of visit: Case Management - Deficiencies

In conjunction with complaint investigation, Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a case management visit to address the deficiencies unrelated to the complaint. Prior to this visit during Complaint Investigation on 12/12/25, LPA Alvizar-Ettima reviewed resident R1’s physician report and noted that it was not signed by resident and resident’s physician. The Administrator was advised that the licensee shall obtain a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year. The complete document shall be part of the resident's record. At the time of this visit Administrator indicated that it was the only physician report that they had in R1’s record file. During this licensing visit, LPA Alvizar-Ettima discovered that staff#1, (S1) Luis Ernesto Mendez DOB: 08/07/1989 have been present without a Criminal Background Clearance and not Association to this facility. S1 has been working at facility since 11/10/25 providing care to the residents. LPA requested S1’s Identification Card and S1 stated that they did not have it. Later, S1 text Administrator a picture of their Republica De El Salvador identification card. LPA Alvizar-Ettima was informed that S1 has been transferred from La Casita Residential. LPA reviewed Licensing database and Criminal Background System and S1’s names did not appeared on Azalea House and Las Casita Residential facility records. S1 immediately left the facility. Administrator was advised that S1 cannot return until they have approved Criminal Background Clearance and Association to this facility. During today’s physical plan tour LPA, Alvizar-Ettima observed that the first bedroom where resident #2-#3 (R2-R3) reside was being cosmetically repainted. No health and safety concerns were identified. A technical violation was provided regarding Department notification requirements for future physical plant modifications. The Administrator acknowledged understanding. Under Title 22, Division 6. Chapter 8, following Citations and civil penalty and technical violation were issued and recorded on LIC809D. Exit interview was conducted, appeal rights provided and a copy of report was issued.the state’s words, verbatim · CDSS document, Jun 7, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3)c) · Plan of correction due date: Jun 8, 2026

87355 Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by staff #1 working in the facility since 11/10/25 and had no criminal record/ association to the facility. This poses an immediate hazard to the health and safety to residents in care.the state’s words, verbatim · CDSS document, Jun 7, 2026

Plan of correction: Administrator agreed that Staff #1 (S1) will not return until they have approved Criminal Background Clearance and Association to this facility. S1 immidiatelty left the facility and POA was cleared during today's visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Jun 22, 2026

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement was not meet as evidenced by. R1’s physician report was not signed by the doctor. This poses potential risk to health, safety and personal rights to residents in care.the state’s words, verbatim · CDSS document, Jun 7, 2026

Plan of correction: Administrator agreed to obtain Medical Assessment signed by their physician and person prior to acceptance as a resident. R1 no longer resides in the faciltiy.

Allegation investigated: Facility does not have a qualified administrator

This is an addendum of the Licensing Report previously issued on 11/05/2025. The document was amended to make corrections due to granting the appeal and dismissing citation. At 10:15a.m. Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to deliver the finding for the above noted allegation. LPA was greeted by House Manager and explained the reason for the visit. During this visit at approximately 10:40a.m. LPA and House Manager conducted a physical plan tour. During initial visit on 11/05/2025 at 9:30a.m. LPA Alvizar-Ettima met with Staff#1 (S1) and granted entry to the facility. Later, Ms. Hewitt joined and explained the reason for the visit. LPA Alvizar-Ettima requested the staff and residents’ roster S1 stated that they don’t know what the rosters were and have no access to staff files. At 10:15a.m., LPA and S1 conducted physical plant tour. On 12/04/2025 LPA Alvizar-Ettima conducted phone interviews with Staff #1-#2 (S1-S2) via-phone. Unsubstantiated Facility does not have a qualified administrator It was alleged that Staff #1 (S1) is unqualified, has no credentials, no training or classes as an Administrator. During this visit, LPA Alvizar- Ettima requested and reviewed the facility staff Administrator files. The staff training information also was requested for review. Interviews revealed that the Administrator may not be present in the facility all the time. However, qualified staff was present at the facility at the time of Administrator’s absence. Interview of staff and residents confirmed the information provided by the administrator. Investigation revealed that the facility had certified Administrator and during their absence there are other qualified personnel to oversee facility operations. A review of facility records verified the information revealed from the interviews. Based on the interviews and record review there is no pertinent information to verify this allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health and safety issues were noted. Exit interview was conducted and copy of report was provided.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 31-AS-20251030121001

Type of visit: Case Management - Deficiencies

This Case Management has was conducted in conjunction with complaint investigation (CC-#31-AS-20231024151628) to address the issues unrelated to the complaint. During Complaint Investigation, LPA Alvizar-Ettima discovered the following On 11/05/25 initial visit LPA interview S1, who stated that they were facility Administrator and Ms. Hewitt is the owner of the property. At about 10:45a.m. LPA interviewed Ms. Hewitt and Staff #2-#3 (S2-S3). During the interview Ms. Hewitt indicated that they are the Administrator and have proof of an active Administrator certificate. Ms. Hewitt acknowledged S1 as a House Manager but not designated Administrator. During interviews, Staff #2 - #3 (S2-S3) were hired recently and had no knowledge about S1’s job title and were unable to verify if S1 is Licensed Administrator. A review of S1’s facility file reveal that S1 did not have an Administrator certificate. Based on inspection, interviews and review records, it was concluded that S1 was representing themselves as a qualified administrator without having verifiable proof and/or current Administrator certificate on file. LPA explained Title 22 requirements and informed that no employee of the facility should make misleading statement. Deficiency was cited and recorded on LIC809D. Exit interview was conducted, appeal rights were discussed and a copy of report was issued.the state’s words, verbatim · CDSS document, Jan 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: Jan 12, 2026

87207 False Claims; No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. Based on interviews & records reviewed on 11/5/25, it was determined that Staff (S1) does not have an Administrator certificate to oversee daily operations. S1 stated they are an Administrator & no proof of Administrator certificate available in facility staff file. This poses a potential risk to the health, safety, and personal rights of residents in care.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Ms. Hewitt the Administrator of the facility clarified with S1 that she was not hired as an Administrator but a House Manager as indicated on S1's job application. LPA was present when S1 verbalized understanding. Plan of correction was corrected by due date.

Type of visit: Case Management - Other

Licensing Analyst Program (LPA) Antonia Alvizar-Ettima conducted an unannounced subsequent visit at the above address to issue citation from 11/05/25 Case Manager visit. LPA met the House Manager granted entry. Later, Administrator joined today's visit. On 11/5/25 visit In conjunction with unannounced complaint # 31-AS-20251030121001 visit to the facility.During inspection at 10:15a.m. LPA Alvizar-Ettima and Staff #1 (S1) tour the facility and observed that medication cabinet, sharps and toxic chemicals drawer were not locked during inspection. Staff #1 (S1) opened the medication cabinet without using a key. S1 stated that there was no key in the facility to lock the medication cabinet because Administrator took the key. LPA also observed that toxic chemicals were stored in an unlocked kitchen sink cabinet and that sharps were accessible in an unlocked drawer. S1 demonstrated that the drawer and cabinets were unlocked without the use of locking devices. S1 was unable to demonstrate proper use of the locking mechanisms for sharp and toxic chemicals. S1 indicated that the medication and chemical cabinet are “usually locked”, but were unlocked during the visit. LPA asked S1 whether they were trained in the use of locking devices. S1 stated yes they were trained but have not been locking or monitored that they were locked. At approximately 10:45a.m. Administrator confirmed that all staff will be re-instructed on secure storage of medication, sharps, and cleaning supplies. Administrator also illustrated that medication cabinet had a key and confirm they took the key with them. Based on observation and interviews it was concluded that facility failed to ensure that medication, sharps, and toxic chemicals were stored in locked areas inaccessible to residents. Deficiencies will be cited and recorded on LIC809D. . Exit interview conducted. Copy of report, and appeal rights issued.the state’s words, verbatim · CDSS document, Nov 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Nov 5, 2025

87465(h)(2) Incidental Medical and Dental Care (h)The following requirements shall apply to medications which are centrally stored (2)...shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the super vision of the centrally stored medication. Based on observation and interview there was no key in the facility to lock the medication cabinet at the time of my visit because Administrator took the key. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Nov 7, 2025

Plan of correction: At the time of visit 11/5/25 upon arrival of Administrator LPA observed Administrator illustrate that medication cabinet had a key and locked it. Administrator confirmed that all staff will be re-instructed on secure storage of medication. POC was cleared on the day of visit

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Nov 5, 2025

87309(a)Storage Space and Access (a) Except as specified in subsection (b) the licensee shall ensure that disinfectants, cleaning solutions... knives, sharp... which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage Based on observation and interview that toxic chemicals were stored in an unlocked kitchen sink cabinet and sharps were accessible in an unlocked drawer. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Nov 7, 2025

Plan of correction: At the of the visit 11/5/25 staff S1 was to proper use of the locking mechanisms were sharps and toxic chemicals are kept. Administrator confirmed that all staff will be re-instructed on secure storage of sharps, and cleaning supplies. POC was cleared on the day of visit

Type of visit: Case Management - Deficiencies

In conjunction with unannounced complaint # 31-AS-20251030121001 visit to the facility, Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a case management to address the deficiencies unrelated to the complaint. During inspection at 10:15a.m. LPA Alvizar-Ettima and Staff #1 (S1) tour the facility and observed that medication cabinet, sharps and toxic chemicals drawer were not locked during inspection. Staff #1 (S1) opened the medication cabinet without using a key. S1 stated that there was no key in the facility to lock the medication cabinet because Administrator took the key. LPA also observed that toxic chemicals were stored in an unlocked kitchen sink cabinet and that sharps were accessible in an unlocked drawer. S1 demonstrated that the drawer and cabinets were unlocked without the use of locking devices. S1 was unable to demonstrate proper use of the locking mechanisms for sharp and toxic chemicals. S1 indicated that the medication and chemical cabinet are “usually locked”, but were unlocked during the visit. LPA asked S1 whether they were trained in the use of locking devices. S1 stated yes they were trained but have not been locking or monitored that they were locked. At approximately 10:45a.m. Administrator confirmed that all staff will be re-instructed on secure storage of medication, sharps, and cleaning supplies. Administrator also illustrated that medication cabinet had a key and confirm they took the key with them. Based on observation and interviews it was concluded that facility failed to ensure that medication, sharps, and toxic chemicals were stored in locked areas inaccessible to residents. Due to time constraints LPA will returned to issue deficiencies. Exit interview conducted. Copy of report,.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Prelicensing

At 9:40a.m., Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an announced Pre-Licensing visit to the above facility and met with Administrator. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL). Fire Clearance was approved on 12/04/2024 for a maximum capacity of six (6) non-ambulatory residents, hospice waiver for two (2) residents age range 60 and over. The purpose of today’s visit is to inspect the facility to ensure that the physical plant is in compliance with rules and regulations of California Code of Regulations, Title 22, Division 6, Chapter 8. The facility is a single-story building in a residential community. The facility has two (2) fully charged fire extinguishers, locate in the entryway and laundry room. Fire extinguishers receipt dated May 02, 2025. A tour of the physical plant inside and outside was initiated at approximately 10:10a.m., and the following was observed: KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, dish washer, sink, stove and microwave. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6) residents. All knives and sharps are observed to be locked in a drawer in the kitchen and inaccessible to residents. LAUNDRY ROOM: The laundry room is located adjacent to the kitchen. The washer/dryer are new. Laundry supplies are kept inaccessible when not in use in a locked cabinet. BEDROOMS: There are four (4) bedrooms designated for residents to use. Bedroom #1-#2 are shared rooms, bedrooms #3-#4 are private rooms. All resident bedrooms are furnished with bed, chair, nightstand, dresser and required bedding and linen. Continue on LIC809-C Cont. from LIC 809 The bedrooms have sufficient closet space and have sufficient lighting. BATHROOMS: LPA inspected the bathrooms they are clean and in excellent condition. LPA observed three (3) bathrooms with grab bar and non-skid mats for residents and staff to use. Water temperature was within regulation ranging between 110.9°F – 116.1°F. LPA also observed sufficient quantity of toilet papers, soap and paper towels. COMMON AREAS: The facility maintains a comfortable temperature at 74°F. The living room has a television, recliner, couches, books, board games and magazines. The dining area has a table with six (6) chairs that were clean and properly furnished. MEDICATION: The medication and first aid kit will be kept in kitchen cabinet. All medication will be locked inaccessible to residents. The facility staff/resident files will be kept in a locked kitchen cabinet, inaccessible to residents. SMOKE DETECTORS/CARBON MONOXIDE: Four (4) smoke detectors were located in the bedrooms and throughout the facility. All smoke deters were dual carbon monoxide. They were tested and observed to be operational. SURROUNDING GROUNDS: The facility grounds were well landscaped and enclosed. The passageways and entrance to the facility were clear of obstruction. Entry and exit doors have a functional auditory alert when the doors open. There is an approved Accessory Dwelling Unit (ADU) on the left side of the facility. LPA observed appropriate outdoor furniture and sufficient yard for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. The facility has no bodies of water. Component III: Administrator, Amber Hewitt completed the Component III during today’s Pre-Licensing visit. Based on inspection and observation, the physical plant is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and the applicant will be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, May 2, 2025

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: AMBER HEWITT Interview Method: Telephone interview On January 23, 2025, 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 the understanding of the California Code Title 22 Regulations. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 23, 2025