Cielo Vista Senior Living

Type of visit: Case Management - Health Checks

On August 31, 2026, at 1:55 PM, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced Case Management visit at the facility. LPA met with administrator Virgilio Agas and manager Justin Lee . The purpose of the visit was to inspect the facility for health and safety. During the visit, the Licensing Program Analyst (LPA) Dabuet conducted a thorough tour of the facility. The building is two-story. The first floor includes resident rooms, an activity area, a dining area, a kitchen, a medication area, and a lobby. The second floor is all resident rooms. Residents were observed in their individual rooms, as well as in the common areas and dining area. The facility was clean and odor-free, with well-maintained interiors, clear walkways, and adequate lighting. All fire extinguishers, smoke detectors, and carbon monoxide detectors were operational. Additionally, both a working landline and internet service were available. Agas reported that four residents were admitted after August 17, 2026, having relocated from Hayworth Terrace. Additionally, two staff members from Hayworth Terrace were involved in the transition. However, Staff #2 and Staff #3 were separated from their positions at this facility, effective August 28, 2026. The LPA reviewed the service files for the four newly admitted residents and found them to be accurate and complete. According to Agas, there are currently 13 residents from Hayworth Terrace, and one more is expected to be admitted on September 1, 2026. No deficiencies were cited during this visit. An exit interview was conducted with Virgilio Agas , and a copy of the report was providedthe state’s words, verbatim · CDSS document, Aug 31, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct a plan of correction visit. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Virgilio Agas and Manager Justin Lee and discussed the purpose of the visit. On August 17, 2026, a deficiency under 87355(e)(2) was issued due to staff being present without a background clearance. The Plan of Correction stated that Licensee is to ensure that all staff prior to working in the facility obtain a Criminal Background Clearance and Criminal Background Transfer Request and provide POC to Community Care Licensing. On August 17, 2026, LPA Fuller received an email from the facility Administrator with the Criminal Background Transfer Request and ID for Staff #1 (S1). Upon LPAs arrival on August 20, 2026, LPA observed S1 working in the facility without being associated. LPA reiterated that the staff needs to be associated and cleared before starting to work at the facility. LPA informed AD that when sending in Criminal Background Transfer Requests, that staff still cannot come to the facility until the transfer has been confirmed and cleared. Due to the unclear POC and AD sending LPA the papers by the POC due date, S1 was associated and is clear to work in the facility, thus clearing the citation 87355(e)(2). LPA observed Staff #2 (S2) clearing out an office and stated they were going to start working at the facility on September 1, 2026, and assisting residents that had just moved in on the second floor. LPA did not observe a background clearance and association to the facility for S2. Based on today’s observation a deficiency and $400 civil penalty were noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC 809D, civil penalty and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Aug 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 21, 2026

87355(e)(2) Request a transfer of a criminal record clearance... This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above in LPA observing Staff #2 did... not have a criminal record clearance or association.This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 20, 2026

Plan of correction: Licensee to background clear and associate staff and send LPA the clearance transfer paperwork and have all staff in management send a statement of understanding on regulation cited by POC due date Licensee to confirm clearance prior to staff working in the facility. Civil Penalty was assessed at the time of the visit.

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Hanna Fuller and Ernand Dabuet made an unannounced visit to the facility to conduct a case management health and safety check on residents in care. LPA Dabuet arrived at the facility at 9:15AM and LPA Fuller arrived at 11AM to assist with the visit. LPAs met with Virgilio "Gil" Agas and Manager Justin Lee and discussed the purpose of the visit. LPAs observed the facility to be clean with adequate lighting. During the tour, the Department observed residents watching TV, resting in their rooms and spending time in the common areas. The facility has a sufficient supply of perishable foods of two days and non-perishable food for seven days. Mandated postings, including Personal Rights, were observed. The medication room is locked and made inaccessible to residents in care. LPAs observed an adequate supply of personal protective equipment (PPE) on hand. LPAs inspected rooms 120, 124, 208, 207, 204 and 202 regarding the residents that were transferred from Hayworth Terrace that had a reported scabies outbreak to this facility on Friday August 14, 2026. LPAs reviewed 5 of the 9 resident files to be complete with 4 of the 9 files not being present at the facility. LPAs observed Staff #1 (S1) to not have an association to the facility and a $400 immediate civil penalty was given. LPAs observed S1 leave the facility. Based on today's inspection deficiencies are being noted along with a civil penalty per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC809Ds, LIC811 and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Aug 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Aug 18, 2026

(a)(2) Personal Rights of Residents in All Facilities ... To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on record review, interviews and observation, the licensee did not comply with the section cited above. LPA identified resident #1-#9 were relocated at this facility with an active scabies outbreak from former Hayworth Terrace facility on 8/14/2026. This violation poses an immedeiate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee to ensure that all residents are accorded with a safe and healthful environment. The licensee will notify CCLD RO of the intake of these residents and contact the Department of Public Health to cross report. Proof of correction to CCLD by POC due date at ernand.dabuet@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Aug 18, 2026

87355(e)(2)Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidence by: Based on record review, the licensee did not comply with the section cited above. LPA identified Staff #1 did not have a criminal record clearance in the CDSS Guardian Background Clearance Ssytem. This violation poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee is to ensure that all staff prior to working in the facility obtain a Criminal Background Clearance and Criminal Background Transfer Request and provide POC to CCLD by POC due date to ernand.dabuet@dss.ca.gov A $400 civil penalty was assesed at the time of the inspection and LPAs observed S1 leaving the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Aug 25, 2026

87457(c) Pre-Admission Appraisal Prior to admission a determination of the prospective resdient's suitability for admission shall be completed and shall include an appraisal of their individual services needs in comparison with the admission criteria... This requirement was not met as evidence by: Based on record review, the licensee did not comply with the section cited above in 4 of 9 residents not having the proper intake admissions or service files when admitted on 8/14/26. This violation poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee is to ensure that all resdients prior to admission must conduct the proper intake according to Title 22 section 87457(c) before admission into the facility. POC due 8/25/26 with residents completed service files including resident appraisal at ernand.dabuet@dss.ca.gov.

Allegation investigated: Staff did not properly transport resident resulting in injury. Staff did not seek medical attention for resident.

Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gil Agas and discussed the purpose of the visit. The investigation into the facility allegations mentioned above revealed the following: it was alleged that the facility did not use a hoyer lift properly to transfer Resident #1(R1) and staff did not seek medical attention for R1 after a fall while using the hoyer lift. R1 was admitted to the facility on July 13, 2026. LPA reviewed a preplacement appraisal for R1stating that R1 is non-ambulatory, unable to walk, needs assistance with all activities of daily living and wears diapers. It also states that R1 needs assistance when transferring in and out of bed. This document was signed by facility staff on July 13, 2026. LPA reviewed a needs and services plan for R1 stating that R1 needs assistance on all ADL’s except feeding themselves with facility staff being the person responsible for implementation. Continue on LIC9099C Unsubstantiated This document was signed and dated by facility staff on July 15, 2026. LPA reviewed a physicians report stating that R1 required continuous bed care, is able to communicate their needs and is unable to bathe, dress or care for their toileting needs. R1 is marked as non ambulatory due to their physical condition. This report was signed by a medical professional on January 13, 2026. LPA reviewed an incident report for R1 stating that on July 18th, 2026, at 8:30PM R1 was complaining of severe back pain and requested to go to the hospital and staff called 911. The report states that the resident fell around 2PM but refused to be sent to the hospital. This report was signed by the facility AD on July 20th, 2026. LPA interviewed 8 residents in care. 5 of 8 residents informed LPA that staff assist with their individual care needs. 2 of 7 residents did not confirm or deny the allegations. 1 of 8 residents informed LPA that they witnessed R1 refusing to be sent out to the hospital after falling, but was sent out by facility staff a few hours later after requesting to go via ambulance. 1 of 8 residents informed LPA that they shared a room with R1 and did not witness a fall due to not being in the room much in the afternoons and evenings. LPA was unable to interview R1 due to not being at the facility. LPA interviewed 5 staff and 5 of 5 staff informed LPA that R1 sustained an unwitnessed fall. 4 of 5 staff informed LPA that R1 was transported to the hospital after staff called 911. 1 of 5 staff informed LPA that when they arrived to R1s room they were already on the floor and assisted. 2 of 5 staff informed LPA that after R1 fell, they refused to go to the hospital and a few hours later requested to go due to pain. 4 of 5 staff informed LPA that R1 needs a hoyer lift when transferring and that training had been conducted on how to use one properly. 3 of 5 staff informed LPA that R1 could communicate their needs when incontinent care was needed. LPA reviewed training conducted on how to use a hoyer lift for 4 of 5 staff with 1 of 5 staff conducting said training on April 10, 2026. LPA reviewed training conducted for 3 of 5 staff on 911 calls with topics such as unwitnessed falls and residents right on refusing to go to the hospital with 3 of 5 staff on January 16, 2026, with 1 of 5 staff conducting said training. Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegations 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, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility. LPA interviewed 5 staff and 5 of 5 staff informed LPA that the air conditioning has always worked. LPA interviewed 8 residents and 6 of 8 residents informed LPA that the air conditioning has always worked. 1 of 8 residents did not confirm or deny. 1 of 8 residents shares a room with R1 and stated that the air conditioning has always worked in their room and is always cool. LPA was unable to interview R1 due to not being at the facility. Based on the evidence gathered, the Department finds that the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Aug 12, 2026 · control 22-AS-20260720170601

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct the required annual inspection. LPA entered the facility and waited for staff at the front counter and observed the windows and doors to the reception office to be unlocked leaving the medication on the tables and in the fridges accessible. LPA met with Administrator (AD) Gil Agas and discussed the purpose of the visit. The facility is a two-story building that consists of 30 resident bedrooms on each floor with shared Jack and Jill bathrooms. There are communal shower rooms, an activity area, dining room, kitchen, staff office spaces, laundry room and outdoor courtyard patio in the middle of the building. LPA observed the resident rooms to have all the required components and furnishings. LPA observed the bathrooms to have toilet paper and paper towels. The water tested between 105 and 120 degrees Fahrenheit. LPA observed shower rooms with multiple showers for resident use. All were equipped with non slip mats. LPA observed the old medication room to be used as storage with medications on the back shelves. The room was found to be unlocked and accessible to residents. Staff promptly locked it after discovery. LPA observed a locked housekeeping room where toxins and chemicals are stored. LPA observed the kitchen to be clean and free of vermin. A two day perishable and seven day non perishable food supply was on hand. The emergency food and water supply was observed to be in the kitchen pantry. The knives are in a kitchen drawer in the middle island with the kitchen door and window being able to lock after kitchen staff leave making them inaccessible to residents. All appliances were found to be operational. LPA observed the dining room with lunch being served to residents during the inspection along with activities being conducted. The activities area takes up the back of the dining room. LPA observed the medication to be stored in the reception office with the medication carts being locked. Continue on LIC809C Facility staff closed and locked a metal gate across the front of the room and locked the glass door that is accessible behind the gate securing the medications and leaving access to the reception counter through the front door and window. A completed first aid kit was observed. LPA observed the elevator to be operational. The second floor of the facility is empty and is not in use by residents. LPA observed the stairwells to have evacuation chairs. Fire extinguishers were observed throughout the facility charged and with a service date of November 10, 2025. An outdoor shaded seating area was observed with no debris or obstructions. LPA reviewed staff files and no discrepancies were observed. LPA reviewed resident files and medications and no discrepancies were observed. LPA reviewed the last fire drill was conducted on July 6, 2026. LPA reviewed the fire alarms were last tested on December 5, 2025, by Mendez Electritech and passed. All staff present are background cleared and associated to the facility. LPA provided AD with facility PIN so that annual fees can be paid online. Based on today’s inspection a deficiency is being noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with LIC809D and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 28, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced Case Management visit to the facility. LPA met with Licensee (LE) Rona Lomeda and House Manager (HM) Justin Lee and explained the purpose of the visit. The purpose of today's visit was to address concerns regarding the facility's management structure and oversight responsibilities. During the Department's review, information was obtained indicating that the current Administrator was reporting to Justin Lee, an associate of Dr. Kang, rather than to the current Licensee, Rona Lomeda. The Department also obtained information from LE Lomeda that she was no longer exercising effective control over the day-to-day operation of the facility despite remaining the licensed individual responsible for the facility. LE Lomeda stated that the Administrator was not following her direction or instructions and instead reported to Justin Lee. The department discussed the matter with LE Lomeda and HM Lee and advised that, regardless of any ownership changes reflected in filings with the California Secretary of State, the Department recognizes the individual identified on the current facility license as the responsible Licensee until a new application has been approved and a new license has been issued. LPA reminded LE Lomeda that she must maintain control over the operation of the facility and that the Administrator is required to report directly to the current Licensee. Based on information obtained during the Department's investigation, the following deficiencies are being cited: · Title 22, Section 87405(b) – Administrator Qualifications and Duties, for the Administrator's failure to report to and keep the current Licensee informed regarding the operation of the facility. (Case Management Report continued on LIC809C) · Title 22, Section 87205(a) – Accountability of Licensee Governing Body, for the Licensee's failure to maintain responsibility for and provide adequate oversight of the operation of the licensed facility. The Department has advised LE Lomeda and HM Lee that if ownership of the facility has changed, a new application must be submitted to and approved by the Department before operational control may be transferred. Until such approval is granted, LE Lomeda remains the legally responsible Licensee and is responsible for ensuring the facility operates in compliance with applicable laws and regulations. An exit interview was conducted with Licensee Rona Lomeda and House Manager Justin Lee. A copy of this report LIC809 and LIC 809C, LIC 809D and Appeal Rights were provided during the visit.the state’s words, verbatim · CDSS document, Jul 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(b) · Plan of correction due date: Jul 24, 2026

Administrator Qualifications and Duties ...The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This requirement was not met as evidenced by: The Department determined that the Administrator was reporting to Justin Lee, an associate new prospective Licensee, rather than to the current Licensee, Rona Lomeda.This poses as a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 3, 2026

Plan of correction: Licensee shall submit a signed statement acknowledging an understanding of the cited regulation and provide a written organizational chart identifying the facility's chain of command, including reporting relationships and the responsibilities of each staff position by POC due date to LPA.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87205(a) · Plan of correction due date: Jul 24, 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: The current Licensee acknowledged that she was no longer exercising effective oversight of the facility's day-to-day operations and stated that the Administrator was reporting to Justin Lee rather than to her. This poses as a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 3, 2026

Plan of correction: Licensee shall submit a signed statement acknowledging an understanding of the cited regulation and conduct an in-service training with all current staff regarding the authority of the current Licensee and the facility's reporting structure. Documentation of the completed training, including staff signatures, shall be submitted to LPA by POC due date.

Allegation investigated: Staff did not administer medication as prescribed.

Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegation. LPA met with the Manager Justin Lee and explained the purpose of the visit. During the investigation, LPA inspected the facility, interviewed staff and residents, and collected pertinent documents including staff roster, resident roster, physician’s report, face sheets, unusual incident reports, medication administration records, death certificate, and admission agreement. The investigation revealed the following: It was alleged that Staff did not administer medication as prescribed. Resident #1 (R1) moved to the facility on May 18, 2025, and moved out of the facility on January 28, 2026. R1 passed away at the hospital on February 6, 2026, from acute cardiopulmonary arrest and pneumonia. Continued on LIC9099-C. Substantiated Per review of Physician’s Report dated May 13, 2025, R1 was diagnosed with Dementia, Atrial fibrillation (AFib), and Osteoarthritis of right knee. R1 was transported to the hospital for labored breathing on January 19, 2026, at 8:50am and returned on January 22, 2026. Hospital records show R1 was referred to cardiothoracic surgery clinic for further evaluation. LPA reviewed the Medication Administration Record (MAR) dated January 2026. R1 was not administered Levothyroxine 25mcg on January 19, 2026, for their 5am dose. LPA reviewed incident report dated January 23, 2026. Per report, R1 was transported to the hospital after 4:21pm on this day, per request of family member. Based on review of MAR, R1 was not administered Levothyroxine 25mcg on January 23, 2026 at 5am. LPA interviewed 4 staff. Staff #4 (S4) reported that they administered Levothyroxine 25mcg on January 19 and January 22, 2026, but they did not initial the MAR. Three out of four staff interviewed reported that they always complete the MAR right after medication is administered. R1’s MAR shows that R1 did not receive Levothyroxine 25mcg on January 19 and January 23, 2026. Based on evidence gathered, the preponderance of evidence has been met, therefore, the above allegation is found to be Substantiated. Violations are being cited per Title 22 of California Code of Regulations. See LIC9099-D for cited deficiencies. An exit interview was conducted with the Manager and a copy of this report, (LIC9099, LIC9099-D), and Appeal Rights was provided to the facility representative.the state’s words, verbatim · CDSS document, May 12, 2026 · control 22-AS-20260218172543

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 13, 2026

87465 Incidental Medical and Dental Care (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: A review of records shows R1 did not receive Levothyroxine 25mcg on January 19 and January 23, 2026, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 12, 2026

Plan of correction: Licensee agrees to train all staff who administer medication to residents on CCR 87465 and to provide proof of training to LPA by the POC due date. Licensee submitted proof of training request on 05/06/2026.

Allegation investigated: Staff did not ensure facility is free from rodents

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. The Department received a complaint on 02/24/2026, LPA Mendivil conducted interviews with resident and staff as well as toured the facility. Regarding the allegation staff did not ensure facility is free from rodents, the investigation revealed the following: LPA Mendivil interviewed 6 out of 6 employees they all deny the presence of rodents. Per interview with Facility Manager Justin Lee, the facility has a contract Cali One Pest Control for monthly and as needed service. Based on interviews with 8 residents denied seeing rodents present in the facility. LPA Mendivil toured the facility including the second floor and all outside areas, LPA did not observe the presence of rodents. Unfounded Therefore based on the preponderance of evidence through observations and interviews the allegation Staff did not ensure facility is free from rodents is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 26, 2026 · control 22-AS-20260224144428

Allegation investigated: Facility staff did not follow hospice care plan for resident

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged facility staff did not follow hospice care plan for resident. During the investigation, LPA conducted interviews with staff and residents in care. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility staff did not follow hospice care plan for resident, it was reported Resident 1 (R1) was not being turned every two hours as indicated in the hospice plan. LPA interviews with one out of four staff stated they help turn residents who need assistance every two hours or as needed. One out of the remaining three staff stated they help transfer residents in and out of bed.The remaining two staff did not add anything relevant to this allegation. Interviews with three out of four residents stated their needs are being met and get assistance from staff for transfers. Continued on LIC9099-C dated 02/03/2026 Substantiated Three out of the four residents stated they do not need assistance with turning in their beds. The remaining resident stated they do not need assistance with transfers or turning in their bed. Record review for R1 revealed three out of three care staff received hospice care training on December 4, 2025. A hospice plan of care created on July 1, 2022 indicating R1's mobility plan including "...the need to turn patient every 2 hours..." R1's turning schedule from July 1, 2022 to July 10, 2022 did not indicate R1 was turned every 2 hours on July 3, 2022; July 4, 2022 and July 5, 2022. July 3, 2022 indicated R1 was turned at 12:00am, 2:00am, 4:00am, and 6:00am. July 4, 2022 indicated R1 was turned at 8:00am, 10:00am, 9:30pm, and 11:30pm. July 5, 2022 indicated R1 was turned at 1:30am, 3:30am, and 5:30am. No other times were indicated for those three dates. On July 7, 2022, R1 was indicated as turned with a three hour gap between 5:00am and 8:00am. Based on interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights. Record review revealed a representative from hospice was present at the facility on July 11, 2022, the same day of R1's passing. Regulation 87466 Observation of the Resident states the resident's physician and responsible party must be notified of a change of condition. It does not indicate a time requirement on when that notification must take place. Regarding the allegation facility staff did not dispense medication as prescribed, it was reported facility did not assist in providing R1 with pain medication unless prompted by family. R1's physician report dated July 1, 2022 indicated R1 could not ingest by mouth "NPO". R1's appraisal and functional capabilities form indicated R1 was non-verbal. Hospice sign in sheet indicated hospice staff visited R1 on July 1, 2022; July 2, 2022; July 3, 2022, July 4, 2022; July 6, 2022; July 7, 2022, July 9,2022, July 10, 2022, and July 11, 2022. Progress notes for R1 dated July 7, 2022 indicated hospice nurse met with family and R1 at the facility regarding R1's condition. Since R1 was listed as NPO, hospice nurse requested a pain medication patch to be ordered through the hospice physician. Pain medication patch was delivered and administered later the same day. Pain medication patch was prescribed to provide 72 hours of pain relief. Progress note for July 10, 2022 indicated family wanted facility to provide morphine to R1. Facility staff contacted hospice for approval. Hospice approved and morphine was given to R1 on that day. LPA reviewed medication training for three current staff and was completed on December 1, 2025. Regarding the allegation resident room was not clean, it was reported R1's room was dirty. LPA interviews with four out of four staff stated rooms are cleaned regularly. One out of four staff added each room is deep cleaned twice a week with quick cleanings done throughout the week. Four out of four residents stated their rooms are cleaned throughout the week. LPA observed floors were being mopped in the morning and did not observed any dirty areas in the facility including four rooms visited. Regarding the allegation facility is malodorous, it was reported R1's room had a bad smell. LPA did not observe any bad odors at the facility. LPA interviews with four out of four staff stated there are no lingering bad odors at the facility. Interviews with three out of four residents stated there are no bad odors at the facility. The remaining resident did not add anything relevant to the allegation. Regarding the allegation staff did not provide personal assistance with bathing of resident, it was reported R1 was bathed once in ten days while living at the facility. LPA interviews with two out of four staff stated each resident is assisted with showers two to three times per week. The remaining staff did not add anything relevant to the allegation. LPA interviews with three out of four resident stated they receive assistance from staff with bathing. Two out of the three residents added they receive two showers per week. The remaining resident stated they returned to the facility two weeks ago and has not received assistance with a shower. LPA observed this resident to be well groomed and did not observed any odors. Based on interviews, record review, and observations, the allegations are therefore deemed unsubstantiated meaning 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 and a copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 22-AS-20220714122113

From the deficiency page — Deficiency type: Type B · Section cited: CCR 78633(d) · Plan of correction due date: Feb 17, 2026

78633(d) Hospice Care of Terminal Ill Residents The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement is not met as evidence by: R1's hospice plan for mobility was not followed accurately which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: AD stated specific training on repositioning resident and documenting times will be completed and submitted to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit for the purpose of conducting a health and safety check. LPA was greeted and allowed entrance into the facility by staff. Licensee (LE) Rona Lomeda arrived shortly to assist with the visit. LPA explained the reason for the visit. During the inspection, LPA and LE Lomeda toured and inspected the facility. LPA observed no health and safety issues. Currently the facility is transitioning into new management. LE Lomeda is still around to ensure the residents are well taken care of and trying really hard to ensure there is a smooth transition when the new management will be granted a new license. Based on the observations made during today’s inspection, no deficiencies are being cited at this time. An exit interview was conducted with Licensee Rona Lomeda and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Nov 14, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit for the purpose of conducting a health and safety check. LPA was greeted and allowed entrance into the facility by staff. Licensee (LE) Rona Lomeda and Administrator (AD) Rochel Malaca arrived shortly to assist with the visit. LPA explained the reason for the visit. During the inspection, LPA and LE Lomeda and AD Malaca toured and inspected the facility. LPA observed no health and safety issues. LPA Tea requested LE Lomeda and AD Malaca for a valid lease agreement for the property by close of business Friday, Oct 10, 2025. Based on the observations made during today’s inspection, no deficiencies are being cited at this time. An exit interview was conducted with Licensee Rona Lomeda and Administrator Rochel Malaca and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Oct 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 1:00 PM LPA Tea was greeted and granted entry into the facility by Licensee (LE) Rona Lomeda and Administrator (AD) Rochel Malaca and explained the reason for the visit. The facility is licensed for 122 non-ambulatory residents, with a hospice waiver for twenty five. Currently there are 27 residents, of which six are on hospice during today's visit. LPA Tea reviewed six resident files and four staff files. Resident files and staff files contained all the required documentation. Upon review of records, the facility is up to date with the required quarterly disaster drills, which was last conducted in August 6, 2025. LE Lomeda current certificate expires on October 06, 2025. LPA Tea along with LE Lomeda and AD Malaca toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story building that consists of 30 resident bedrooms on each floor with shared Jack and Jill bathrooms between each room. There are shower rooms, main activity area, dining room, kitchen, medication room, staff office spaces, small activities area for dementia residents and outdoor courtyard patio area in the middle of the building. The facility’s fire alarm system is monitored by a third-party service company and the fire department. LPA observed cameras in the common area with no sound. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured between 113. 3 to 114 Fahrenheit degrees. LPA pulled on the emergency pull cord in one of the resident rooms; staff came within two minutes to respond to the call. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, Annual continuation on LIC809-C thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at the time of visit. There is emergency food and water stored in the kitchen pantry storage closet. Fire extinguishers were fully charged throughout the facility. LPA toured the outside grounds and there is ample shaded seating in a courtyard style outdoor area. Staff hold special occasions outside in the courtyard patio area and have an outside grill for barbecuing. Facility provides several activities that are displayed on a giant calendar in the hallway that is updated often. Residents like to play bingo and sing karaoke every day. At the time of the visit, LPA observed residents lounging around the facility. LPA reviewed medication storage and administration. Medications are stored and secured in the medication room. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Licensee Rona Lomeda and Administrator Rochel Malaca and a copy of this report LIC809, along with the 809-C, LIC858, and LIC859 were read and provided to the facility.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Lydia Martinez, made an unannounced visit the facility to conduct a Required 1-Year evaluation. LPA was greeted by MedTech Reynard Malaca who stated LPA Michael Tea conducted an Annual visit on 8/19/2024. LPA confirmed Annual visit was conducted by LPA Tea. LPA completed visit. Exit interview conducted, LPA sent copy of this report to email on file.the state’s words, verbatim · CDSS document, Aug 28, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:15 PM LPA Tea was greeted and granted entry into the facility by a facility staff and explained the reason for the visit. Administrator (AD) Rona Lomeda arrived shortly to assist with the visit. The facility is licensed for 122 non-ambulatory residents, with a hospice waiver for twenty five. Currently there are 23 residents, of which five are on hospice during today's visit. At around 8:43 AM LPA Tea reviewed six resident files and five staff files. Resident files and staff files contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted in August 6, 2024. AD Lomeda current certificate expires on October 06, 2025. LPA Tea along with AD Lomeda toured the facility at 9:54 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story building that consists of 30 resident bedrooms on each floor with shared Jack and Jill bathrooms between each room. There are shower rooms, main activity area, dining room, kitchen, medication room, staff office spaces, small activities area for dementia residents and outdoor courtyard patio area in the middle of the building. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational monitored by a third party service company. LPA observed cameras in the common area with no sound. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured around 114. F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Annual continuation on LIC809-C Fire extinguishers were fully charged throughout the facility. LPA toured the outside grounds and there is ample seating underneath a shaded patio area in a courtyard style outdoor area. Staff hold special occasions outside in the courtyard patio area and have an outside grill for barbecuing. Also residents garden little plants in pots. There is emergency food and water stored in the kitchen pantry storage closet. Facility provides several activities that is displayed on a giant calendar in the hallway that is updated often. Residents like to play bingo everyday. At the time of the visit, LPA observed residents doing morning exercise and singing karaoke. LPA reviewed medication storage and administration. Medications are stored and secured in a medication room. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator Rona Lomeda and a copy of this report LIC809, along with the 809-C, LIC858, and LIC859 were read and provided to the facility.the state’s words, verbatim · CDSS document, Aug 19, 2024