Care Janella

Allegation investigated: Staff used profanity towards residents. Staff did not assist resident when requested.

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above. LPA met with Administrator (AD) Julie Cornejo and explained the purpose of the inspection. Regarding allegation, Staff used profanity toward residents the following was reviewed: Complaint alleges Staff 1 (S1) used profanity words towards residents. Interviews were conducted with three facility staff, and three facility residents. During interview, one of three residents corroborated the allegation and stated S1 does use profanity words towards residents, however, two of three residents denied the allegation and stated S1 does not use profanity words towards residents. During interview, S1 denied using profanity towards residents and denied having any knowledge of any other staff using profanity towards residents. During interview, one of three staff corroborated the allegation and stated S1 does use profanity words towards residents, however, one of three staff denied the allegation and stated S1 does not use profanity words towards residents. (Cont. LIC9099-C) Unsubstantiated Regarding allegation, Staff did not assist resident when requested, the following was reviewed: Complaint alleges S1 did not assist former Resident 1 (R1) when requested. Interviews were conducted with three facility staff, and three facility residents. LPA attempted to contact R1 by phone on three separate occasions, however, R1 could not be reached to confirm or deny allegation. During interview, one of three residents corroborated the allegation and stated S1 does not assist residents when requested, however, two of three residents denied the allegation and stated S1 does assist residents when requested. During interview, S1 denied not assisting residents, including R1 and stated they assist residents any time they need assistance. During interview, one of three staff corroborated the allegation and stated S1 does not assist residents as requested, however, one of three staff denied the allegation and stated S1 does assist residents as requested. Based on information gathered, the Department did not find sufficient evidence to support the allegations, “Staff used profanity towards residents and Staff did not assist resident when requested”. 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 above allegations are Unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jul 27, 2026 · control 22-AS-20260723102035

Type of visit: Required - 1 Year

On October 7, 2025, at 2:30 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Julie Cornejo and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden, and have a hospice waiver for four (4) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, attached 2-car garage utilized as a staff break room, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with Caregiver (CG) Alicia De Guzman. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 115.8 degrees F and 117.8 degrees F. A comfortable temperature of 80 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents.Evaluation Report Continues on LIC 809-C The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, water, and supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and was serviced on August 1, 2025. All smoke/carbon monoxide detectors were operable. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility conducts Fire/Safety Drill quarterly and was last conducted on September 22, 2025. A working telephone (714-646-9367) remains available. First Aid Kit contained all the necessary elements. Evidence of Liability Insurance was effective from August 15, 2025, to August 15, 2026. LPA conducted an audit of resident files (R1-R4), staff files (S1-S3) and medication and medication administration record that were all in order and complete. LPA Kim conducted 1 resident interview and 1 staff interview. No deficiencies were cited during the inspection visit. An exit interview was conducted, and a copy of this report was provided to Administrator Julie Cornejo.the state’s words, verbatim · CDSS document, Oct 7, 2025

Allegation investigated: Staff are not properly supervising residents resulting in elopements.

On May 1, 2025, at 8:00 AM Licensing Program Analyst (LPA) Edward Kim conducted an unannounced initial complaint visit at the above facility. LPA Kim met with Administrator (ADMIN) Julie Cornejo and explained the purpose of the visit. ADMIN Cornejo explained that they could not stay for the visit and Caregiver (CG) Alicia De Guzman will sign the report in behalf of the facility. During today's visit, LPA Kim conducted a tour of the inside and outside of physical plant with CG De Guzman, and no concerns were observed. LPA Kim reviewed and obtained copies of four (4) resident record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, and other pertinent records. LPA obtained residents roster, staff roster, and incident reports. LPA Kim conducted three (3) staff interviews and made an attempted interview with one (1) resident. Continued on LIC9099C Substantiated Regarding Allegation: Staff are not properly supervising residents resulting in elopements It is alleged that a resident has been reported missing four times within the last month and a half. RP was concerned of the facility’s security measures and its ability to provide adequate supervision and staffing for the residents. The investigation revealed the following: Based on record reviews, Resident I (R1) was admitted to the facility on March 4, 2025 and was discharged on April 21, 2025. R1 was diagnosed with Dementia and is not able to leave the facility unassisted according to their Physician’s Report dated March 4, 2025. The department received an Incident Reported dated April 20, 2025 indicating that R1 eloped from the facility. R1 was discovered missing again at 7:28 PM on the same day. It was not noted when R1 returned to the facility. Another Incident Report dated March 14, 2025 indicates R1 left the facility again at 12:40 pm. The caregiver (S2) noticed the window was left open. The resident was found at the local Dollar Tree and returned to the facility. Based on interviews conducted, three out of three staff corroborated to the allegation. One resident could not confirm or deny the allegation. All staff confirmed the resident eloped from the facility on April 20, 2025. All staff stated the resident left the facility in the morning around 11:00 AM and was found at a Ford Dealership near the facility by the police. A staff member arrived at the Ford Dealership where the police was with the resident. The police asked the resident if they wanted to be accompanied by the staff or by the police back to the facility. The resident wanted to return to the facility with staff. The resident and staff were heading towards Dollar tree, where the resident hit the staff in the head twice, then ran away from the staff. Staff called 911. S2 and S3 state police found the resident and returned to the facility around 7:00 PM. Then the resident left the facility again around 7:30 PM. S2 and S3 state the police were notified that the resident was missing again and from orders of hospice, when resident returned that the resident needed to go to the hospital to be evaluated. Resident returned to the facility on April 21, 2025, around 2:30 AM. The police were notified by staff that the resident returned. Per orders of hospice, the Police accompanied the resident to the hospital to be evaluated. Continued on LIC9099C Based on LPA’s observations, the facility has four exits from the inside: the main entrance, the garage, the living area, and the resident room #4. All exits have an auditory device, but only the main entrance was operable. The living area and the garage auditory device were turned off, while the auditory device in resident room #4 was not working. S1 and S2 stated they did not know why the auditory devices were not working. LPA observed in room #2 where resident was staying the auditory device was taken off the window. S1 stated the resident would take it off and they just didn’t put it back on the window. A review of Police Report #DR 25-014211 confirmed R1 eloped on April 20, 2025. No Police Report was obtained for the March 14, 2025 elopement incident. Therefore, based on LPA's observations, interviews, and the records reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Staff are not properly supervising residents resulting in elopements is deemed SUBSTANTIATED as per the California Code of Regulations, Title 22, Division 6, Chapter 8. One deficiency is being cited on the attached LIC9099D. Exit interview was conducted a copy of the report, appeal rights, LIC9099D, and LIC811 were provided to Caregiver Alicia De Guzman.the state’s words, verbatim · CDSS document, May 1, 2025 · control 22-AS-20250422094955

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(d) · Plan of correction due date: May 9, 2025

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement... This requirement is not met evidenced by: Based on observations and interviews, LPA observed four out of five auditory devices were not working: room #4 auditory device was not working, room #2 window auditory device was not in placed, and living area and garage auditory devices were turned off. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 1, 2025

Plan of correction: Licensee states they will fix bedroom #4 and remove bedroom #2 window auditory device from the room. Licensee states they will ensure all auditory devices are in operation. Proof of Correction evidence will be sent to CCLD via email to Edward.kim@dss.ca.gov by May 9, 2025.

Type of visit: Required - 1 Year

On October 15, 2024, at 1:15pm, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) John Pontillas and explained the purpose of the visit. Administrator (AD) Julie Cornejo arrived at the facility at 1:45pm. The facility is licensed to operate for six (6) nonambulatory residents of which one (1) may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, 3 outdoor covered seating areas, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Pontillas. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 107.4 degrees F to 108.6 degrees F. A comfortable temperature of 82 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage and kitchen pantry. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-646-9367) remains available. The facility has one (1) fire extinguisher that was charged, mounted in the kitchen, and serviced on August 1, 2024. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S5), and medication and medication administration review. LPA Kim conducted two (2) staff interviews. Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Julie Cornejo.the state’s words, verbatim · CDSS document, Oct 15, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to conduct a Case Management visit. LPA met with Administrator (Admin) Leonora Amorsolo and explained the reason for the visit. It was established during the staff interviews in connection to Complaint Control Number: 22-AS-20230714131828 that the live-in Staff #1 (S1) does not provide assistance to residents in their Activities of Daily Living (ADLs) in the evenings. During the course of today's visit, LPA verified on the Personnel Report and through three out of three staff interviews confirming the presence of an additional staff in addition to S1 during the nocturnal hours. Based on the observations and interviews made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 Chapter 8 of the California Code of Regulations. Due to the Administrator's time constraints, Admin authorized House Manager to sign the report on her behalf. An exit interview was conducted with House Manager Verigilio Galang, and a copy of this report was provided to the HM at exit.the state’s words, verbatim · CDSS document, Oct 10, 2023