Casa Del Sol Residential

Type of visit: Required - 1 Year

On 10/13/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required annual visit. LPA was greeted by care staff, Darlene Shepard, and was granted entry into the facility. LPA informed Darlene of the purpose of the visit. LPA conducted a tour of the facility and observed the following during the tour: The facility is a single-story building which consists of (3) three residents bedrooms, (1) one staff bedroom, (2) two bathrooms, living room, dining room, garage, kitchen, and backyard. There is no pool and/or bodies of water. LPA observed the kitchen area to be clean and free of debris. Knives and other sharp items are located in a locked pantry in the kitchen. Centrally stored medication was also observed in the locked pantry inaccessible to residents. The facility maintained (2) two refrigerators which held the required (2) two day supply of perishable foods. LPA observed a (7) seven-day supply of non-perishable foods. Facility maintain emergency food and water supplies in the garage. LPA observed resident bedrooms to have the required bedding, furniture, seating, and functional lighting. Bathrooms were equipped with grab bars and skid resistant mats in the shower area. Indoor/Outdoor passageways were free from obstruction. Emergency disaster drills are conducted quarterly and range from scenarios. The facility operates their own laundry services; washer and dryer were observed to be in good repair and operable. Additional linen and towels are available for residents and appear to be in good repair. LPA observed the hot water temperature to meet requirements at 109.8°F. Per Administrator, Musarrat Khan, there are no firearms or ammunition on the premises. (Continue to LIC809...) (Continuation from LIC809) Facility sketch, residents personal rights, LTCO, and complaint poster are visibly posted on the walls throughout the facility. Facility staff records review include but are not limited to criminal record clearance, health screenings, TB result, First-aid/CPR training, and relevant training's to provide Assistance with Activities of Daily Living (ADL's). Resident records included but not limited to signed admission agreements, pre-admission assessments, physician reports, property and valuables, and needs/service plans. LPA reviewed (3) three out of (5) five residents Medication Administration Records. LPA conducted observations and records review conducted of the medication and medication administrator records, LPA observed multiple discrepancies. Therefore, deficiencies will be cited during today's visit. An exit interview was conducted and a copy of this report along with LIC9099D, LIC811 and appeal rights will be provided to Administrator, Musarrat Khan.the state’s words, verbatim · CDSS document, Oct 13, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff do not ensure residents' care needs are met

On 6/16/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering findings of the above allegation. LPA met with Licensee, Massurat Khan, who was informed of the purpose of the visit. LPA was granted entry, and LPA conducted a tour of the interior/exterior areas of the facility. It was alleged that staff do not ensure residents’ care needs are being met. This was alleged due to facility advertising dementia care and did not supply adequate staffing to support Resident 1’s (R1) cognitive impairment. Through interviews conducted, it was alleged that R1 was experiencing wandering behaviors not identified during the pre-appraisal assessment and was not divulged in the physicians report obtained prior to R1s admission into the facility. Information obtained from a confidential witness revealed there were no concerns with the actual care being provided to R1 by the staff but there were concerns of staff complaining of the level of care staff had to provide to R1; such services were advertised by the facility. (Continue to LIC9099C) Substantiated Through file review and interviews, facility staff did not submit incident reports to the Department regarding R1’s behavioral changes, the staff did not document R1’s observed changes of behavior, and the Licensee did not develop a written care plan based on the observation of R1’s alleged new condition as advertised in the Admission Agreement signed by R1, R1’s responsible party, and Licensee. Information revealed the facility staff did not conduct a reappraisal of R1’s suspected new condition. Per Title 22, Section 87466, a licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. Furthermore, Licensee is required to conduct a reappraisal of the resident, if the residents are experiencing physical, mental, cognitive, behavioral and/or functional changes per section 87463. Based on file review and interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. California Code of Regulations Title 22 is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report LIC 9099D, and appeal rights were reviewed and provided. Based on interviews and files reviewed, the allegation of staff does not have appropriate training is unfounded. A finding of Unfounded means the allegation could not have happened, is false, and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee, Masurrat Khan.the state’s words, verbatim · CDSS document, Jun 16, 2025 · control 18-AS-20240226122805

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: Jun 27, 2025

The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement was not met as evidence by: Based on record review and interviews, licensee did not conduct a reappraisal for one (1) out of two (2) residents when there was a change of Resident #1 (R1) mental and behavioral condition which posed a potential Health and Safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 16, 2025

Plan of correction: Licensee will create a training of Title 22, 87211, reporting requirements, and will document any relative incidents that affect the health and safety of the residents in care. Proof of training will be forwarded to LPA via email. (This is an amended version of the original report.)

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(4) · Plan of correction due date: Jun 27, 2025

If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted ..., and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement was not met as evidence by: Bases on file review and interviews, Licensee issued an eviction notice to one (1) out of two (2) residents without conducting a reappraisal of the need not previously identified in the pre-admission assessment which poses a potential Health and Safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 16, 2025

Plan of correction: Licensee stated she will have all upper management read Title 22, section 87224, Evictions Procedures and submit a signed document to LPA verifying the procedures were read. This document will be delivered to LPA via email. (This is an amended version of the original report.)

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by the Caregivers Susana Valadez and Gabriela Ramirez, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 3 residents bedrooms, 1 staff bedroom and 2 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 12/31/2024. LPA observed the hot water temperature to meet requirements at 114.8°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of July 11th, 2026 and a CPR certification with the expiration date of 11-30-26 Record Review and Resident/Staff Files: LPA reviewed files for Four(4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five (5) residents' files were reviewed and contained all required documentation. LPA observed first aid kit, Staff and resident files to be stored in a locked cabinet in the kitchen. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPA reviewed medications for five residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 08-15-2024, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to administrator Maria Musarrat Khanthe state’s words, verbatim · CDSS document, Nov 26, 2024

Type of visit: Prelicensing

On October 25, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a pre-licensing inspection and met with Administrator, Musarrat Khan, introduced herself, and stated the purpose of the visit. LPA Mixson toured the home inside and outside, along with the Administrator. The location is a single-story home with four bedrooms, three full bathrooms, a living room, dining room, activity room, kitchen, and two car garage with backyard and front yard. On 09/19/2023, The Moreno Valley Fire Department approved this location for four non-ambulatory, and two bedridden residents, for a total of six residents. LPA Mixson observed where the medications will be stored, locked, and inaccessible to residents. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed, tested by the fire department, and are operable. The LPA observed one fire extinguisher it was charged and in the green. The LPA observed cleaning supplies locked and inaccessible to future residents. The sharp objects are locked in a kitchen drawer, plenty of pots, pans, and other kitchen accessories. All facility doors, and passageways are clear from obstruction. There were no bodies of water, and/or fireplaces observed at the location. The LPA observed beds have the required linen and supplies. There was enough extra clean linen and hygiene items. There was appropriate lighting in each room with nightstand, dresser, and chair. The facility has central heating and air conditioning systems, Internet and WFI for residents in place and are operable. The Administrator dialed the facility land line phone number (951)208-1886, and it was operable. Outside/Yards: No obstructions observed. Component III completed at the Riverside RO on 10/12/2023, at 9:00am. An exit interview was conducted, a copy of this report was provided to Administrator, Musarrat Khan.the state’s words, verbatim · CDSS document, Oct 25, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Musarrat Khan, Licensee/Administrator Interview Method: Teams Meeting On 10/5/2023, 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, Oct 5, 2023