California Manor Guest Home #1

Allegation investigated: Staff are misusing resident's funds

Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA Perez met with Caregiver, Ghassan Hamed, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff and witnesses and file reviews. On November 4, 2022, Community Care Licensing received a complaint alleging facility staff were misusing resident's funds. It was alleged that facility staff enrolled resident 1 (R1) in Social Security Income (SSI) and withdrew the funds to pay for rent that was already covered under Medi-Cal. Interview with Additional Witness 1 (AW1) revealed that they observed Administrator Najeh Hamed (A1) enroll R1 into SSA and not report the income properly to the Adult Day Program that was paying R1’s rent. AW1 alleged the lack of reporting allowed A1 to collect rent through SSI and the Adult Day Program. Interview with Najeh Hamed (A1) denied the allegations. A1 reported that staff do not have access to the residents funds, regardless if they are self payee, under conservatorship or under power of attorney representative. Continued on LIC 9099-C. Unsubstantiated A1 emphasized that staff do not have access to resident funds and that he is not aware of, nor has he observed, any staff mishandling resident funds. Interview with Witness 2 (W2) confirmed that R1 received their SSI stipend directly and that the monthly rent was sent directly to the facility. W2 reported A1 could not double charge R1 for rent through SSI. W2 reported no concerns regarding R1’s SSI funds. Interview with Witness 2 reported that no complaints or reports have been submitted regarding the allegation involving the residents, A1 or facility staff. A review of records confirmed that R1 received monthly SSI stipends consistent with the information provided by R1’s conservator. A review of R1’s P&I log was conducted, and the ledger matched the amounts reported as being sent by R1’s conservator. An attempt to obtain additional evidence from AW1 was made, however, no response was received. Based on record review, staff and witness interviews, the allegation that facility staff were misusing resident's funds is Unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided to facility representative.the state’s words, verbatim · CDSS document, Apr 6, 2026 · control 18-AS-20221104143419

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with Caregiver, Ghassan Hamed, who assisted with todays visit. The inspection included the following: The facility consists of two buildings. Building 8536 and Building 8548. Both building have a layout consisting of a kitchen and dinning area, a living room area, a garage, laundry area, a covered patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to staff, no weapons are stored in the home. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats present. LPA began review of client records. seven (7) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. LPA began review of personnel records- four (4) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 10/01/2026. LPA observed personnel records to be available and complete. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals and sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the kitchen allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications records reviewed appeared to be dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and in working order. Fire extinguisher was serviced on 10/24/2025. Emergency drills are conducted quarterly at the facility with the last drill on 01/18/2026 . Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Allegation investigated: Facility staff did not provide resident roster to Ombudsman.

Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA Perez met with House Manager Fermin Cornista, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of interviews with staff and witnesses, observations, and file reviews. On July 29, 2025, Community Care Licensing received a complaint alleging facility staff did not provide a Resident Roster (LIC 9120) to the Long-Term Care Ombudsman (LTCO). Throughout the investigation, LPA interviewed staff and residents and obtained supportive documentation to aid in determining the findings of the noted allegations. Interview with Witness 2 (W2) reported that on June 26, 2025, a copy of the LIC9120 was requested from Administrator Najeh Hamed. W2 reported Hamed indicated they would email the form. Continued on LIC 9099-C. Unsubstantiated W2 reported that due to email issues, it is unknown whether the roster was sent by Hamed and not received due to technical issues or if Hamed simply never emailed the form. W2 reported a document was provided that appeared either incomplete or outdated. It could not be confirmed if this was the current LIC9120. A copy of this document was not obtained. Interview with Administrator Hamed revealed that on June 26, 2025, Hamed recalls being asked for the LIC9120. The Administrator revealed they recalled a discussion where it was mentioned that some information was missing from the LIC9120 and it was requested that the information be added to the form. Administrator Hamed reported that a request to email the LIC9120 was not received as it was Hamed’s observation that the form was received. Interview with 3 of 3 staff revealed they are aware of providing requested documentation upon request. Staff reported a current resident roster is posted in the designated staff area for review. Based on record review, staff and witness interviews, the allegation that facility staff did not provide resident roster to Ombudsman is Unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided to facility representative.the state’s words, verbatim · CDSS document, Sep 12, 2025 · control 18-AS-20250729094957

Allegation investigated: Staff is locking the refrigirator at night time. Staff does not allow residents to keep their pets.

Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA Perez met with Caregiver, Fermin Cornista, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of interviews with staff and witnesses, observations, and file reviews. On July 17, 2025, Community Care Licensing received a complaint alleging facility staff is locking the refrigerator at night and staff do not allow residents to keep their pets. Throughout the investigation, LPA interviewed staff and residents and obtained supportive documentation to aid in determining the findings of the noted allegations. Multiple interview attempts were made with Additional Witness 1 (AW1) to gather further information, however, AW1 did not respond to the interview request. Continued on LIC 9099-C. Unfounded Regarding the allegation that facility staff lock refrigerators at night, it was alleged that residents were prevented from accessing or storing their personal food items due to staff locking the refrigerator at night. Interview with Administrator Najeh Hamed, confirmed that the facility maintains four refrigerators on site, in which three are designated for facility provided food and for resident use. Administrator added that one refrigerator located at the back of the garage is reserved exclusively for staff use. Administrator clarified that the staff refrigerator remains locked to secure employee food items and the refrigerator does not contain any allocated food for the residents. Interviews conducted with five out of five residents corroborated that the three resident refrigerators are accessible at all times and have not been seen locked, including at night. Residents also confirmed their awareness that the locked refrigerator in the garage is designated for staff use only. Residents did not have any concerns with refrigerators being locked or storing their items in the allocated resident refrigerators. Additional interviews with multiple staff members further supported that refrigerators intended for residents are never locked and remain accessible to those in care. LPA Perez documented observations made and verified that three refrigerators were designated for resident use, while a separate and secured refrigerator located at the back of the garage, was reserved for staff. Regarding the allegation that staff do not allow residents to keep their pets, it was alleged that residents are not allowed to keep their pets despite the fact they moved into the facility with their pets. Interview with Administrator stated that a temporary exception was made for Resident 1 (R1) due to an urgent housing need. Administrator explained R1’s previous housing arrangement had ended and to prevent homelessness, Administrator permitted R1 to bring their pet into the facility under the condition that it would be relocated shortly after admission. Administrator confirmed that R1 requested the accommodation due to an urgent need. Administrator added that R1 acknowledged the situation and the pet remained at the facility for approximately three weeks before being rehomed as agreed. Administrator emphasized that all residents, including R1, are required to sign an Admissions Agreement and a House Rules policy, which clearly prohibits pets on the premises. Administrator also cited legal concerns, noting that pets could pose a liability risk if they were to injure another resident or guest. Continued on LIC 9099-C. A review of facility records confirmed that 12 out of 12 residents had signed both the Admissions Agreement and House Rules, with no exceptions. Interviews with four of five residents confirmed that they had signed and were familiar with the House Rules, including the facility’s no-pets policy. Interview with Resident 1 (R1), stated they were under the impression that their pet was permitted to remain at the facility permanently, based on a verbal assurance from an unidentified man. However, R1 was unable to name or describe the individual. Additionally, R1 acknowledged that they had signed the Admissions Agreement and the House Rules, which advise of the pet restriction. Based on observation, record review, client, and staff interviews, the allegations that facility staff is locking the refrigerator at night time and staff does not allow residents to keep their pets is unfounded. A finding that the allegation is unfounded meaning that the allegation was false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted where a copy of this report was provided to facility representative.the state’s words, verbatim · CDSS document, Aug 29, 2025 · control 18-AS-20250717143749

Allegation investigated: Staff did not prevent an altercation between residents resulting in resident's injury

Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA Perez met with Administrator, Ahmad Abdallatef, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff and witnesses and file reviews. On May 29, 2025, Community Care Licensing received a complaint alleging facility staff did not prevent an altercation between residents resulting in resident's injury. Throughout the investigation, LPA interviewed staff and residents and obtained supportive documentation to aid in determining the findings of the noted allegations.Through interview with Administrator Najeh Hamed, it was confirmed that the incident did occur, but staff was present and available to separate the residents and diminish any further acts. Additional interviews with multiple staff members corroborated that the incident on May 26, 2025, involving Residents R1 and R2 did occur. Continued on LIC 9099-C Unsubstantiated It was the first documented case of aggression between the residents and measures were promptly implemented to prevent a recurrence. Through interview with R1, it was discovered that they initiated the altercation with R2 due to discomfort caused by R2’s smile and loud outburst. R1 shared that the staff quickly intervened to de-escalate the situation and medical attention was provided after R1 reported experiencing pain. Interview with R2 stated that they acknowledged making a statement to R1 that led to the incident. Additionally, R2 described the incident with R1 as an accident and reported that staff quickly responded to de-escalate the situation. Through interview with Additional Witness 1 (AW1), it was revealed that they were made aware of the incident by R1 and subsequently discussed preventive strategies with the Administrator. AW1 stated that they followed up with R1 and no further altercations have occurred with R2. AW1 stated they had no further concerns regarding staff’s intervention or engagement with residents. Additional interviews with residents reported no concerns regarding staff not preventing altercations between residents. A record review confirmed that facility staff had completed training in incident reporting, as well as in de-escalation, and behavioral management techniques. Based on observation, record review, client, and staff interviews, the allegations that staff did not prevent an altercation between residents resulting in resident's injury is Unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided to facility representative.the state’s words, verbatim · CDSS document, Jul 11, 2025 · control 18-AS-20250529222455

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with caregiver, Fermin Carnista. LPA was informed that Fermin is authorized to assist and provide the required documents for todays visit. The inspection included the following: The facility consists of two buildings. Building 8536 and Building 8548. Both building have a layout consisting of four (4) resident bedrooms, one (1) staff room, two (2) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, a covered patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to staff, no weapons are stored in the home. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats present. LPA observed the flooring to be sticky in the hallway and living room of building 8536. A technical assistance will be documented. LPA began review of client records. seven (7) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be incomplete, a deficiency was cited. LPA began review of personnel records- three (3) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 10/01/2026. LPA observed personnel records to be incomplete and a deficiency was cited. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals and sharps in the kitchen. LPA observed two knives stored in an unlocked cabinet in the kitchen and chemicals stored under a bathroom sink. Staff immediately secured items to the correct location, a deficiency was cited. Medications are centrally stored. There is a locked closet allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications records reviewed was incomplete, a deficiency was cited. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested. Carbon Monoxide detector was missing in one building and inoperable in the other building. A deficiency was cited. Fire extinguishers was serviced on 10/25/2024. Fire drills are conducted quarterly at the facility with the last drill on 01/16/2025 . Based on the information received during this visit today in the areas reviewed, there are deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. Corrections will need to be submitted to be cleared This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 11, 2025

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Staff are not assisting resident to refill their medication

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to further investigate into the above identified complaint allegation. LPA arrived at facility and was greeted at the door by Fermin Cornista, caregiver and granted entry. Ahmad (Adam) Abdallatef, Administrator arrived shortly after and met with LPA and LPA explained the purpose of the visit. Findings are based upon this investigation which included records review, interviews with the following: 5 out of 5 residents, and 2 of 2 staff. It is alleged that staff are not assisting resident to refill their medication. Interview with 2 of 2 staff revealed that resident’s medication is ordered and dispensed through Innovage and they send refills 3-4 days prior to end of month for all residents. Medication comes in a box and is individually packaged for each resident for each dose and time. It makes it easier for staff to dispense medication to each resident. Records Continued on LIC9099-C Unsubstantiated review for residents MAR sheet for November 2024 observations do not reflect any missed doses for any resident. Interview with 5 of 5 residents revealed that they have always gotten their medication on time and never have missed any doses of the medication in the past. Resident indicated that their medication goes through Innovage and gets sent and filled through that company. They also indicated that they have never had any issues with their medication. LPA Martinez on today’s visit inspected the medication and observed residents’ medication individually boxed and packaged for each dose/time. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Nov 20, 2024 · control 18-AS-20220721164247

Allegation investigated: Facility staff is not providing food to the residents

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to further investigate into the above identified complaint allegation. LPA arrived at facility and was greeted at the door by Fermin Cornista, caregiver and granted entry. Ahmad (Adam) Abdallatef, Administrator arrived shortly after and met with LPA and LPA explained the purpose of the visit. Findings are based upon this investigation which included records review, interviews with the following: 4 out of 4 residents, and 2 of 2 staff. It is alleged that facility staff is not providing food to the residents. Tour of the physical plant conducted on September 01, 2023, by LPA Arreola and tour conducted on today’s visit by LPA Martinez observations reveled that facility has two refrigerators and 1 freezer as well as 2 pantries and additional food storage in the garage. Interview with 4 of 4 residents revealed that they have never had an issue with the food Continued on LIC9099-C Unsubstantiated service at the facility. Residents indicated that facility offers the ability to request food when they are hungry outside of the meals times and that if they request food that they can get it. Snacks are provided, but residents indicated that they like to purchase their own snack and keep a stock of their own snack because it is their right to have what they want at the facility. Residents also indicated that a while back can’t remember when there was a different cook, but facility hired a new person to cook for them and that staff makes way better food for the residents, and they like it much better than before. Interview with staff revealed that residents get their 3 meals every day and snacks in between meals. Residents can request food at any time, and we give accommodate to them as needed, as well as if they don’t like any of the meals being served, they can request an alternative meal and we will prepare for them. Snacks and fruit are available for residents for them to help themselves as well. Records reviewed for weight logs that were received on the visit of September 01, 2023, and today’s visit reveled that 8 out of the 12 residents had a fluctuation in weight gaining and loosing between 1-10 pounds in the span of a year. No resident records reflected a significant weight gain or weight loss in a short period of time or over a year span. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Nov 20, 2024 · control 18-AS-20230823135335

Allegation investigated: Staff did not prevent resident from taking another resident’s belongings Staff did not prevent resident from injuring another resident

Licensing Program Analysts (LPAs), Stephanie Martinez and Seo Jeon, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPAs met with Staff, Ahmad 'Adam' Abdallatef, and informed him of the purpose for the visit. An allegation was received by the Department alleging that on or around 05/30/2024 Resident Two (R2) went into the bedroom of Resident One (R1) and took a pair of shoes. During the initial visit the LPAs toured the home, conducted staff and client interviews, reviewed records, and obtained copies. R1 was interviewed and confirmed their shoes were stolen by R2. R1 reported they know R2 stole their shoes because R2 told them they had done so. R2 was interviewed and denied taking R1's shoes; rather R2 stated R1 gifted them the shoes, for which they later returned. R2 stated they returned the shoes after R1 began to accuse them of taking the item. Two (2) additional resident interviews were conducted; one resident reported they did not know whether R2 stole R1's shoes and the second resident reported R1 gave R2 the shoes. Staff interviews reported no knowledge of whether R2 stole the shoes. Therefore, due to conflicting information, this allegation is Unsubstantiated deemed UNSUBSTANTIATED at this time. A second allegation was received by the Department alleging that when R1 requested the shoes be returned then R2 became upset and threw the shoes at the resident. It was reported the shoes hit the right side of R1's head causing a bump. R1 was interviewed and confirmed the alleged incident did take place. R2 was interviewed and reported they did throw the shoes at R1; however, the shoes landed on R1's lap. The additional two (2) interviews conducted with residents who witnessed the alleged incident were inconsistent. Although both residents reported R2 threw the shoes; one resident stated the shoes hit the resident in the head while the other stated the shoes landed near the resident's side torso. Staff interviews could provide no information on whether R2 threw the shoes at R1 or not. According to Administrator Najeh Hamed, R1 was assessed for injuries of which none were found. All interviews reported no prior related incidences or history. Resident interviews confirmed staff do supervise residents in care. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with staff Abdallatef and signatures were received from staff, Formin "Chris" Cornista. NOTE: Due to difficulties with equipment a handwritten copy was created and left at the facility.the state’s words, verbatim · CDSS document, Jun 12, 2024 · control 18-AS-20240603134430

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of conducting the annual inspection. LPA Colvin met with staff Formin "Chris" Cornista and informed him of the purpose of today's inspection. Below is a summary of what was observed: Physical Plant: LPA Colvin toured the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. LPA Colvin observed the required furniture and linen to be present and in good condition in resident bedrooms. LPA Colvin measured the hot water in the bathroom faucets to be 121.8 degrees in building 8536 and 120.2 degrees in building 8548. Deficiency cited.. LPA Colvin tested the facility's carbon monoxide alarm and smoke detectors and found them to be operational. LPA Colvin observed that sharp objects like knives were locked away from residents' reach. LPA Colvin toured the backyard and confirmed that no exits or pathways were blocked. LPA Colvin observed sufficient supply of perishable and non-perishable food and utensils and dishes for the residents in care. LPA Colvin observed numerous areas of the facility's backyard which had discarded/unused furniture, including multiple mattress and box springs. Deficiency cited. Operational Requirements: LPA Colvin observed the facility to be operating within their licensed capacity of 12 ambulatory residents, two of which may be non-ambulatory. Staffing & Staff Records: LPA Colvin observed that upon arrival at the facility, there was no staff present in the 8548 building, though there were residents present in that building. Staff for that building did not arrive until 2:48pm, and even then they spent the majority of the inspection in the staffed 8536 building. Deficiency cited. Lack of supervision is considered a serious deficiency which results in an immediate civil penalty of $500, which LPA Colvin will be assessing today. LPA Colvin was unable to review the Administrator's file as staff could not locate it. Deficiency cited. LPA Colvin observed that both staff files reviewed (S1 & S2) did not have training included in the file. Deficiency cited. Additionally, S1's CPR/First Aid Certification was expired and there was no certification in S2's file. Deficiency cited. Resident Records: LPA Colvin reviewed the files for 5 residents to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. LPA Colvin observed that Resident One (R1) did not have an Admissions Agreement in their file, and R3's Admissions Agreement is for a different licensed facility at an entirely different location (owned by same Licensee). Deficiency cited. LPA Colvin observed that R2 & R4 both have Physician's Reports for other facilities and are over 1 year old from date of Admission. Deficiency cited. Incidental Medical Services: LPA Colvin observed that resident medication is locked in the kitchen and inaccessible to residents. LPA Colvin confirmed that the facility is not retaining any residents with prohibited health conditions. Due to time constraints, the annual will be continued on a later date. Observations were documented and will be addressed during the annual continuation. An exit interview was conducted with staff Formin "Chris" Cornista and a copy of this report, LIC809D, LIC421IM, LIC9098 Proof of Corrections, and appeal rights were providedthe state’s words, verbatim · CDSS document, Mar 18, 2024