Chateau Arden Hills

Allegation investigated: ) Neglect/lack of supervision resulting in resident being burned 2) Resident did not receive timely medical attention. 3) Neglect lack of supervision resulting in serious bodily injury. 4) Facility did not report incident to authorized representatives.

Licensing Program Analysts (LPAs) Kevin Gould and Mabel Cummings made an unannounced inspection to Chateau Arden HIlls RCFE on 9/2/26 at 1:30pm to conclude the investigation of the above allegations and to deliver the findings. LPAs Gould and Cummings met with staff, Sandra Mohrmann and together discussed the investigation details. Based on the interviews, observations and documentation obtained during the investigation process, the allegations are substantiated. The Department obtained records for R1 (See confidential names list, LIC 811 dated 9/2/26) including required documents for community care licensing in addition to medical records for R1. The department conducted interviews with a former resident (R1), R1’s authorized representative (A1), facility licensee (S1), former staff member (S2), and home health nurse for R1 (N1). Report Continued on LIC 9099-C. Substantiated Interviews with S2 and A1 both confirm that S2 had requested A1 to provide a space heater for R1 as R1 was often cold at the facility and additional blankets and clothing were not meeting resident’s current needs. A1 agreed to provide a space heater and ordered a unit from amazon which was delivered to the facility. Staff interviews and documented assessments indicate that R1 often sat for extended periods at their desk using a computer, where the heater had been placed to keep R1 warm. Based on R1’s records, R1 is diagnosed with diabetic neuropathy in lower extremities and has reduced sensation in both legs. Although, R1 was able to access and adjust the portable heater using a remote, staff did not provide adequate supervision. As a result, R1 sat at their desk with prolonged exposure to the heating element and sustained burns to their right leg and toes on the right foot between April 09,2026 and April 11,2026. R1 reported that they asked an unidentified staff member to move the heater closer because they still felt cold. This staff member moved the heater under the desk and turned it on. Based on the information gathered, the facility did not provide adequate supervision to prevent prolonged exposure to the heating element, which resulted in R1 being burned. Based on statements obtained from S2, R1’s injuries were first observed and documented on April 11, 2026, photographs were taken and per S2, the injuries were reported to the facility administrator. Per S2’s statements, S1 requested S2 to report the injuries to R1’s home health nurse whose next visit was scheduled for April 17, 2026. N1 reported first observing the injuries to R1 on the first home health visit on April 17, 2026. Per N1, the wounds appeared old and had already begun to scab over. N1 states they were not informed by any staff member or the administrator regarding any injuries to R1’s legs or toes. Per N1 they also informed facility licensee (S1) regarding the injuries. R1 was not seen by a physician until R1’s podiatry appointment on April 23, 2026, nearly two weeks after R1 sustained the injuries and were first observed by facility staff. Therefore, the facility staff did not ensure the resident did not receive timely medical attention. Report Continued on LIC 9099-C In addition, staff did not ensure R1’s socks were changed and did not conduct frequent skin assessments despite having knowledge that R1 had diabetic neuropathy. As a result of the burn injuries sustained to R1, medical records reveal that R1 was seen by their podiatrist on April 23, 2026. R1’s lower extremity exam revealed a full-thickness burn on their right great toe measuring 0.5 cm x 0.6 cm x 0.1 cm, and a full thickness on the right second toe measuring 1.1 cm x 1.2 cm x 0.2 cm. Surrounding erythema with the second toe erythema extended to the base of his toe into his foot. On May 09,2026, R1’s right second toe was amputated due to the extent of his injuries. On July 17, 2026, R1’s right great toe was partially amputated due to the extent of his injuries. The allegations of neglect due to lack of supervision resulting in serious bodily injury is substantiated. Futhermore, based on statements obtained from A1, and associated documentation obtained by the department including text messages, R1’s authorized representatives were not notified that R1 was injured while at the facility on or between April 09,2026 and April 11, 2026 and were not made aware of the extent of the injuries sustained to R1 until R1’s examination at a podiatry appointment on April 23, 2026. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegations of neglect/lack of supervision and reporting requirements are substantiated. Per the California Code of Regulations, TITLE 22, The following deficiency is cited. An immediate civil penalty of $500 for Section 87468.1(a)(2). This incident is currently under review, and a future civil penalty may apply pursuant to the H&S code Section 1569.49(f). Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 2, 2026 · control 27-AS-20260511103954

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(e)(1) · Plan of correction due date: Sep 3, 2026

Personal Accommodations and Services: The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (1)Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. This requirement was not met as evidenced by based on resident and staff statements obtained during the investigation, the facility staff left R1 at their desk for an extended period of time next to a space heater resulting resident sustaining burns to his leg and foot which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The facility has agreed to provide and updated plan for supervision and regular resident checks to ensure health and safety of residents regardless of use of heaters or other assistive devices.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Sep 3, 2026

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by documentation obtained during the investigation that staff and licensee were aware of an injury to R1’s leg and foot as a result of being burned on 4/11/26 and their injuries were not addressed by a physician until 4/23/26 which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Facility has agreed to provide an updated plan for notifying a resident's physician of an injury to a resident and describe how it would be determined if a resident requires immediate medical care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1) · Plan of correction due date: Sep 3, 2026

Reporting Requirements: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by statements and documentation obtained by the department that the facility did not notify R1’s authorized representatives of an injury sustained by R1 while in care at the facility which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Facility has agreed to review reporting requirements will all staff members and signatures for all staff recognizing they have received direction in reporting requirements and timelines.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 3, 2026

Personal Rights of Residents in all facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by resident and staff statements obtained during the investigation that facility staff left R1 at their desk for an extended periods of time next to a space heater resulting in resident sustaining burns to his leg and foot which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The facility has agreed to provide and updated plan for supervision and regular resident checks to ensure health and safety of residents regardless of use of heaters or other assistive devices.

Type of visit: Case Management - Deficiencies

On 9/2/26 at 1:30pm Licensing Program Analyst (LPAs) Kevin Gould and Mabel Cummings conducted an unannounced Case Management inspection to address deficiencies revealed while completing a complaint investigation. LPAs met with designated staff member, Sandra Mohrmann and together discussed department findings. Based on the documentation and statements obtained from the investigation the department has determined licensee did not provide accurate and truthful statements to department investigators during the investigation. Licensee provided statements to the department that they were unaware of R1 sustaining burns while in care at the facility until R1 was taken to a podiatry appointment on 4/23/26. The department obtained statements from Former staff member (S2) and Home Health Nurses (N1) that R1 injuries were reported to the licensee on 4/11/26 and 4/17/26 and that licensee inspected resident’s injuries on the dates described. Additional text messages obtained by the department support that the licensee had knowledge of the injuries prior to R1’s hospital visit on 4/23/26. The department has determined that licensee had provided false statements to the department. Report Continued on LIC 9099-C The department has also determined, based on the severity of the substantiated allegations and the actions taken by the licensee/administrator the department has determined the facility administrator did not demonstrate knowledge of and ability to conform with applicable laws, rules and regulations of operating a facility. The administrator failed to seek timely medical care for R1 after burns were observed on R1. The administrator did not report the incident to the department or authorized representatives within the time frames specified in regulations. Additionally, the administrator did not provide adequate training to facility staff to ensure they understood how to seek appropriate medical attention for residents in care. Based on the above findings the department has also determined the Licensee did not exercise general supervision over the affairs of the licensed facility. Furthermore, LPAs Gould and Cummings arrived at the facility and observed two staff members present. LPAs reviewed Guardian records and observed S2 has a criminal record clearance but was not associated to the facility. S2 confirmed working at this facility since July 2026. Per the California Code of Regulations, Title 22, the following deficiencies are cited during today’s inspection. Exit interview conducted and a copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Sep 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Sep 3, 2026

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. This requirement was not met as evidenced by statements and documentation obtained including text messages that support the facility administrator/Licensee had knowledge of R1’s injuries prior to their hospital appointment where family members were made aware of the extent of R1’s injuries which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The facility has agreed to provide a written report of understanding of the rules and regulations of providing truthful statements to the department, residents, investigators and authorized representatives.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(d)(2) · Plan of correction due date: Sep 3, 2026

Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by facility administrator did not seek timely medical treatment for R1 after they were made aware of severe burns sustained while in care at the facility and not reporting the incident to the department or authorized representatives within the time frame specified in regulations which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Facility has agreed to complete the Technical support program and provide a written statement they will accept TSP consultation and agree to complete the TSP program.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: Sep 3, 2026

Accountability of Licensee Governing Body: The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by substantiated allegations for complaint number 27-AS-20260511103954 along with substantial non-compliance with Title 22 regulations observed on 4/29/26 which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Facility has agreed to complete the Technical support program and provide a written statement they will accept TSP consultation and agree to complete the TSP program.

From the deficiency page — Deficiency type: Type A · Section cited: HSC87355(e)(3) · Plan of correction due date: Sep 3, 2026

Criminal Record Clearance: 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: Request a transfer of a criminal record clearance as specified in Section 87355(c) ... This requirement was not met as evidenced by Staff S2 was not associated to the facility despite having a completed criminal record clearance which poses an immediate health safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: Facility will associate staff member S2 by the POC due date prior to returning to work at the facility.

Type of visit: Office

On 8/13/26 at 3:00pm, Licensing Program Manger (LPM) Arielle Pascua and Licensing Program Analyst (LPA) Kevin Gould conducted an informal office meeting Via Microsoft Teams with Licensee Maggie Posadas, Stephanie Gonzales, HR compliance and AJ Sebastian, Operations Director to discuss previously identified non-compliance with title 22 regulations. During today's informal office meeting LPM Pascua discussed plans that have been put in place to ensure deficiencies that have been observed do not reoccur. Destruction of syringes/infection control: Facility has obtained appropriate container to dispose of used syringes and have arrange for regular delivery for containers by pharmacy to ensure there are always appropriate containers for used syringe disposal. Administrator presence: Administrator has increased presence at the facility and ensure regular oversight to ensure sharps are stored correctly. Admissions and evaluations: Admin states they play a role as ensuring on boarding of new staff and ensuring they meet all regulations. Admin now has full access to guardian and can associate new staff members and understands requirements for other items such as TB clearances. Admin also described the role administrator plays in the acceptance of new residents including pre-placement appraisals, and items required by regulations. Admin discussed process of pre-placement appraisals. Admin also described notifying residents and family members of personal rights and theft loss policy. Change of condition a reassessment is conducted within 24 hours. Report Continued on LIC 9099-C. Staff Training: facility is documenting training and placing in staff files. Per Admin staff is not to be present in the facility until all items in checklist are complete. Staff supervision and Elopements: all doors are alarmed with the exception of front gate. Additional supervision is in place and staff breaks are staggered to ensure there is supervision of residents. 1 to 3 staff to client ratio currently. Admin is present at the facility to ensure staff gets breaks. AWOL procedure - notify family, contact emergency services if there is an injury. Potential reassessments. if resident cannot be located they are instructed to call police. most recent AWOL training. Staff shift is 12 hours, live in staff member, 5 days a week. Total 3 caregivers currently employed by facility. Medication: Facility is no longer pre-pouring medications. Facility has been providing audits of medication administration for last 8 weeks. Cameras: camera has been removed. improved monitoring by staff. The department has requested Updated LIC 308, LIC 500, updated AWOL procedures, staff training for medications and personal rights. Personnel on boarding checklist and new resident admission checklist. Facility has agreed to: Provide a all documents requested by the department by 8/21/26. Facility has agreed to participate in Department's Technical Support Program. Exit interview conducted and a copy of this report was emailed to licensee for signature.the state’s words, verbatim · CDSS document, Aug 13, 2026

Allegation investigated: ) Staff do not ensure medications are dispensed as prescribed

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Chateau Arden Hills RCFE on 6/19/26 at 1:30pm to inform the licensee of the complaint allegations and conclude the investigation and to deliver the findings. LPA Gould met with Licensee, Maggie Posadas and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations are substantiated. LPA reviewed the medication administration records and observed errors in insulin administration for R1 and incorrect administration of another medication that was directed to be given once per day for one month and was being given two times per day at the onset of the medication being ordered by R1's physician. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of Medication is substantiated. Report Continued on LIC 9099-C. Substantiated The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home. R1 denied any issues with staff supervision and denies eloping from the facility and identified enjoying walks around the facility property without leaving the grounds. R1 provided statements of being treated well by staff and identified having all items to meets their needs. R1 states they are mostly independent with ADLs and needs only minor staff assistance. LPA observed R1 to be active in the facility conducting exercises on their own and interacting positively with staff present. Staff interviewed denied not having adequate staff to meet resident needs and denied having inadequate supplies to meet residents needs. LPAs walk through of the facility revealed ample supplies to meet residents needs including insulin supplies, appropriately stored. LPA reviewed resident and staff files and observed to be well organized and all required documentation was present. All medications for R1 were locked and secured. Insulin was stored in a medication fridge and secured. Per staff and resident statements and LPA observations, LPA observed appropriate staffing levels and supervision to meet the needs of resident in care. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Medication and neglect/lack of supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 19, 2026 · control 27-AS-20260611082237

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 22, 2026

Incidental Medical and Dental Care: The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by LPA review of resident Medication Administration records that did show incorrect doses of insulin were administered to R1 on several occasions and another medication was not given according to the physician's orders on the prescription. Resident received additional doses of medication which poses an immediate heath, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2026

Plan of correction: Licensee has agreed to conduct weekly audits of medication administration records for all residents in care. Copies of MARs will be emailed to LPA every Monday beginning 6/29/26 and ending on 9/28/26. any errors observed the licensee will submit an incident report documenting the Medication error.

Allegation investigated: Staff did not provide adequate supervision to prevent resident from eloping

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Chateau Arden Hills RCFE on 4/29/26 at 9:00am to inform the licensee of the above allegation and to deliver the findings. LPA Gould met with Licensee, Maggie Posadas and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations are substantiated. LPA obtained confirmation that R1 was freely roaming the grounds of the facility and was able to open the front gate and exit the facilit grounds without staff supervision. Per R1's physican report, they are unable to leave the facility unassisted. Staff knoticed that R1 had not been seen for several minutes and inspected the grounds before locating R1 across the street from the facility and returning them to the facility. Per staff statemens there was only one staff member present as another staff member went to the grocery store. Report Continued on LIC 9099-C. Substantiated The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of neglect/lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of (indicate the complaint allegation) are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 29, 2026 · control 27-AS-20260427081319

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 30, 2026

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by R1's elopement from the facility and staff did not provide the appropraite supervision to ensure R1 does not depart the facility unassisted wich poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: Facility will submit an updated staff schedule (LIC 500) that matches administrator statements to LPA that during awake hours there are two staff members on duty and present at all times. LIC 500 will also identify overnight staff who are awake and on duty.

Allegation investigated: Staff did not provide adequate supervision to prevent resident from eloping

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the Chateau Arden Hills RCFE on 4/29/26 at 9:00am to inform the licensee of the above allegation and to deliver the findings. LPA Gould met with Licensee, Maggie Posadas and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations are substantiated. LPA obtained confirmation that R1 was freely roaming the grounds of the facility and was able to open the front gate and exit the facilit grounds without staff supervision. Per R1's physican report, they are unable to leave the facility unassisted. Staff knoticed that R1 had not been seen for several minutes and inspected the grounds before locating R1 across the street from the facility and returning them to the facility. Per staff statemens there was only one staff member present as another staff member went to the grocery store. Report Continued on LIC 9099-C. Substantiated The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of neglect/lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of (indicate the complaint allegation) are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 29, 2026 · control 27-AS-20260427081319

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 30, 2026

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by R1's elopement from the facility and staff did not provide the appropraite supervision to ensure R1 does not depart the facility unassisted wich poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2026

Plan of correction: Facility will submit an updated staff schedule (LIC 500) that matches administrator statements to LPA that during awake hours there are two staff members on duty and present at all times. LIC 500 will also identify overnight staff who are awake and on duty.

Type of visit: Post Licensing

On 4/29/26 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Chateau Arden Hills for the purpose of conducting a required Post Licensing inspection. LPA met with Administrator, Maggie Posadas and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 115 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed medications stored in the fridge and unsecured from resident's in care. LPA also observed used syringes were not being disposed of in an appropriate container outlined in title 22 regulations. LPA observed several sharp knives that were stored in an unsecured drawer. LPA also observed 9 of the 11 staff members listed on the LIC 500 form have not had their criminal record clearances associated to the facility. LPA observed incomplete staff an resident files including incomplete admission agreements, physician reports and no documented pre-placement appraisals or needs and services plans for any residents. Report Continued on LIC 9099-C. LPA advised the facility to discontinue practice of pre-pouring medications as this practice was discontinued by the department in 2021. LPA observed a camera in the bedroom of R1 as she is an elopement risk and LPA had staff remove camera from bedroom as it violates resident's personal rights. LPA observed one staff present without TB clearance documentation. LPA observed all staff have insufficient initial training to meet regulations as they only have 20 hours of initial training. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An immediate civil penalty was issued during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Apr 29, 2026

The state marks this report as 11 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 02/10/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility on an announced visit to conduct a Pre-Licensing Inspection to ensure compliance with Title 22 regulations. LPA met with the applicant, Eloisa Posadas, who assisted with the inspection. The applicant is seeking licensure for a Residential Care Facility for the Elderly (RCFE) with a capacity to accept and retain up to five (5) non-ambulatory residents and one (1) ambulatory resident at any given time. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) ambulatory resident. Bedroom #4 is approved for bedridden residents; bedrooms #1, # 2, #3, and #6 are approved for non-ambulatory residents; and bedroom #5 is approved for staff or ambulatory residents only. The facility has a dementia care plan on file and will provide care and supervision to residents 24 hours per day. At the time of the inspection, there were no residents in care. A brief interview was conducted with applicant Posadas. Mary Mata will serve as the Administrator of the facility. Administrator Mata holds Administrator Certificate #6070656740, which expires on 11/06/2026. The facility has completed an infection control plan and an emergency disaster plan, both of which were provided to Licensing for review and approval. LPA toured the facility and reviewed the facility sketch. The physical plant was observed to be consistent with the approved fire clearance (STD 850). The facility was observed to be clean and in good repair. The kitchen area was inspected, including cabinets and drawers. Silverware, plates, and utensils were observed to be sufficient to meet the needs of residents. Knives were stored and inaccessible to residents. The facility refrigerator was observed to be functional and in good repair. CONTINUED LIC 9099-C Food supplies were reviewed and found to be sufficient, including a minimum of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. Cleaning and laundry supplies were also observed to be stored in a locked and inaccessible area within the staff room. The common and dining areas were furnished appropriately and provided sufficient seating to meet the needs of up to six residents. Smoke detectors and carbon monoxide detectors were observed to be in good working condition. A fire extinguisher was located in the kitchen and was last serviced on 11/19/2025. Resident bedrooms were toured and found to be adequately furnished to meet resident needs. Hot water temperature measured 108.2 degrees Fahrenheit at the resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. Resident bathrooms were observed to be equipped with non-slip mats; however, the main resident bathroom/shower did not have grab bars at the time of inspection. During the visit, the applicant’s maintenance staff went to Home Depot to purchase grab bars and installed two grab bars in the bathroom. The facility temperature was measured at 69 degrees Fahrenheit. Medication storage areas were observed to be centrally located and locked in the staff room. The first aid kit was inspected and found to be complete. The facility maintains designated, locked storage areas for resident and staff records within the staff office. Required postings and documents were observed to be properly displayed. Activity supplies were observed to be available to residents in the dining area. The courtyard was toured and observed to have sufficient furniture and shaded areas for resident use. The facility pool was observed to be surrounded by secure fencing. The applicant has successfully passed the pre-licensing component of the application process. LPA will notify the Central Application Bureau (CAB) that the pre-licensing inspection has been completed and approved. Component III was reviewed with the applicant. An exit interview was conducted, and a copy of this report was provided to the applicant.the state’s words, verbatim · CDSS document, Feb 10, 2026