Coast Senior Care, 1

Type of visit: Required - 1 Year

On December 12, 2025, at 12:45 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Caregiver (CG) Reynoldo Avena. LPA Kim spoke with Administrator (ADMIN) Kristen Viana over the phone and explained the purpose of the visit. ADMIN Viana stated that CG Avena could sign on behalf of the facility The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for three (3) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, attached 2-car garage, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with CG Avena. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 118.2 degrees F and 118.5 degrees F. A comfortable temperature of 67 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. LPA observed the following cleaning supplies were placed in an unlocked cabinet under the sink: a bottle of Great Value Ultra Dish Liquid detergent and Ortho Home Defense Indoor Insect Killer spray bottle. Facility immediately removed and placed the items in the garage that is locked. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, water, and supplies are stored in the garage. The facility has one (2) fire extinguishers that were charged and were serviced on February 1, 2025. All smoke/carbon monoxide detectors were operable. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility conducted a Fire/Safety Drill quarterly and was last conducted on October 16, 2025. A working telephone (714-378-1289) remains available. First Aid Kit contained all the necessary elements. LPA conducted an audit of resident files (R1-R5), staff files (S1-S3) and medication and medication administration record. During the tour of the facility, LPA observed facility had kept medication in an unlocked cabinet in the dining room. Facility immediately placed the unlocked medication in a locked medication cabinet. LPA Kim conducted interviews with 2 residents and 2 staff. Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA observed medication that was stored in an unlocked cabinet in the dining room. LPA observed a bottle of Great Value Dish Liquid detergent and Ortho Home Defense indoor insect killer spray bottle were placed in an unlocked cabinet under the sink. An exit interview was conducted, and a copy of this report and appeal rights were provided to Caregiver Reynoldo Avena.the state’s words, verbatim · CDSS document, Dec 12, 2025

Allegation investigated: • Facility did not inform the resident’s representative of the change of conditions. • Facility neglected to identify the resident’s change of condition. • Resident sustained a stage 4 pressure injury. • Facility did not seek medical attention in a timely manner.

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrived at facility and was greeted at the door by caregiver and granted entry. LPA spoke with mitzi Avena and explained the purpose of the visit. The complaint was investigated by the Department. Findings are based upon this investigation which included records review, interviews with the following: 3 staff, 5 witnesses, and 2 residents, medical records from Senior Care Mobile Doctor, and Mission Home Care. It is alleged facility did not inform the resident’s representative of the change of conditions. Interview with 2 of 2 staff revealed the only change of condition that resident (R1) had was in November of 2023 and it was due to behavior change. Staff indicated that the change was reported to the Administrator as per protocol and Administrator informed R1’s representative. Administrator stated when R1’s behavior changed at times, Continue on LIC9099-C Unsubstantiated resident’s authorized representative would have to be called multiple times to assist with R1’s behavior. It is alleged that facility neglected to identify the resident’s change of condition. Interview with 2 of 2 staff revealed that they observed R1 to have a change in behavior in November of 2023. Staff stated that they did not observe resident to have any other change of condition. Staff indicated that they did not observe a change in R1’s physical appearance to be able to identify a change of condition. Staff gave R1 a shower on a daily basis that included a visual body check, and no changes were noted as well. It is alleged that resident sustained a stage 4 pressure injury. Interview with 2 of 2 staff revealed that there was no skin tear or wound on R1. R1 was on a daily shower schedule where body checks were conducted by staff and no skin tear, no wound, no redness, or mal odor was observed. Records from Senior Care indicate that the physician’s assistant on February 6, 2024, first learned that R1 had a stage 4 ulcer. However, records indicate that a visit was done on January 4, 2024, and January 5, 2024, with no mention of an ulcer. R1 was moved out of the facility on December 31, 2023. Interview with Senior Care physician’s assistant revealed that R1 had been under their care since prior to December 31, 2023. A visit was done with R1 on March 4, 2024, in which it was observed R1’s health was declining and that was the first time it was learned that R1 had an ulcer. Physician’s assistant had two prior visits before February 6, 2024, and was not aware or informed of an ulcer. Interview with private caregiver revealed that they had cleaned R1 in their bed and changed their diaper the day R1 was removed from the facility and did not observe any redness or a wound and no odor. Based on the information gathered by the department during the investigation, there was not enough evidence to corroborate the following allegations: facility did not seek medical attention in a timely manner, facility did not inform the resident’s representative of the change of conditions, facility neglected to identify the resident’s change of condition and resident sustained a stage 4 pressure injury. Based on the information mentioned above, the Department is unable to ascertain if the 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, this allegation is deemed Unsubstantiated. An exit interview was conducted with the facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Mar 19, 2025 · control 22-AS-20240306093154

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility today in conjunction with a complaint investigation. LPA were greeted by caregiver and was granted entry. LPA met with Mitzi Avena and explained the nature of the visit. This visit is to issue a citation for violation observed during the investigation of complaint number 22-AS-20240306093154. Interviews conducted with facility staff indicated that resident (R1) in November 2023 became more agitated, bullied staff and other residents, punched staff and resident and complained of pain even when they did not have pain. LPA did not find any LIC624 incident submitted by the facility for the changes that were observed. Based on the information obtained there is a deficiency issued and are noted on the attached LIC809-D form. This report is being reviewed with facility representative and a copy of this LIC809, LIC809-C and LIC809-D was provided and left at facility. Appeals Rights reviewed and a copy left at facility.the state’s words, verbatim · CDSS document, Mar 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Apr 2, 2025

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: LPA did not find any LIC624 incident submitted by the facility for the changes that were observed for R1.This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2025

Plan of correction: Administrator to ensure to report to CCL all conditions specified in section cited. Administrator to provide in-service training to all staff on cited regualtion. Provide proof of scheduled in-service training and copies of attendance to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility to conduct a Required - 1 year inspection. LPA identified herself and was granted entry into the facility by Caregiver (CG) Reynaldo Avena. Upon entry, LPA noted residents having breakfast. Facility appears clean, safe and sanitary. Administrator (AD) Kristen Viana arrived shortly after. AD Viana's certificate expired and LPA confirmed AD has submitted Renewal application. Six Residents and 2 staff present during today's visit. LPA, along with AD Viana toured the physical plant. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each Resident comfortably. Bathrooms were checked, toilets/water faucets worked properly and showers are free of mold/mildew. Hot water temperature is within regulatory requirements. Bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen is clean and organized. Perishable and non-perishable food supply was checked and adequately stocked. LPA observed sharps and cleaning supplies are inaccessible to the residents. Smoke detectors and carbon monoxide detector tested operational. Fire extinguisher was fully charged and mounted. No bodies of water were observed outside. Walkways around the home were clear of hazards. Exit gates were locked with padlocks. Backyard has shade with patio furniture for outdoor activities and sufficient seating for Residents and visitors. Emergency/Fire Drills are conducted last one being 09/15/2024. LPA observed emergency supplies including food and water. LPA reviewed 6 Resident files and 2 staff file. Resident and staff files contained required documentation. Medication was observed to be in a centrally stored location and medication reviewed appeared to have been dispensed accurately. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of LIC809, LIC809D, LIC9102 and Appeal Rights were sent to email on file.the state’s words, verbatim · CDSS document, Nov 1, 2024

Type of visit: Collateral

On this day Licensing Program Analysts (LPAs) Jenifer Tirre and Jessica Cho made an unannounced visit for the purpose of conduct a collateral joint visit in connection to open complaint investigations at Coast Senior Care #306005260 related to the current licensee. Facility Coast Senior Care closed and changed location as of January 30, 2024. LPAs met with Caregivers Reynaldo and Mitzi Avena and explained the reason for the visit. Administrator Kristen Viana was unavailable to be physically present during the visit and spoke to LPA's via telephone designating staff to assist with the visit. During today’s visit, LPAs Tirre and Cho conducted interviews and gathered pertinent resident records housed at this facility related to Complaint Control Numbers: · 22-NP-20210803071759 · 22-AS-20211208162350 An exit interview was conducted with Administrator via telephone. A copy of report was left at facility.the state’s words, verbatim · CDSS document, May 29, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility was greeted and granted entry by Kristen Viana, Administrator. A change of location application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden resident was submitted to CCL on 08/17/2023. Structure: The facility is a one story house with an attached garage with 4 resident bedrooms, 1 staff bedroom, 3 full bathrooms, a living room, a dining room, and a kitchen. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with an exit walkway on both sides of the house with covered seating for the residents. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 2 private rooms and 2 shared room accommodating two residents. Bedrooms #1 has a full bathroom. Bedrooms Staff: Bedroom #5 designated for awake-staff. Bathrooms: All bathrooms have a working toilet, wash basin, walk in shower. Linens & Hygiene Supplies: Adequate supply of linen stored in bedroom hallway storage. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested and found operational. Appliances: Gas Continued on LIC809-C five-burner stove, single oven, refrigerator, microwave, washer, and dryer are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents locked and stored in garage. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 109.4 Fahrenheit degrees in facility bathrooms. Medications, First-Aid Kit & Book: Medication and first aid kit/book are stored and locked in a storage cabinet located between dinning room and living room. Resident & Staff Files: Records will be kept locked in a cabinet located in office space. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents use, commensurate with the plan of operation. Fire clearance: Was approved on 11/09/2023. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facility. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Nov 21, 2023