Cool Meadow Care

Type of visit: Required - 1 Year

On 06/04/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross arrived at the facility to conduct the required annual inspection. LPA was greeted at the door by caregiver Araceli Angel and the purpose of the visit was explained. LPA was allowed entry. LPA was advised the Licensee was not available. LPA called the Licensee and he stated he would attempt to arrive as soon as possible. Facility Overview: The facility is a single story building with 4 residents' bedrooms, 1 staff bedroom, 2 bathrooms, a dining room, a living room, a kitchen, an office, an outdoor area, and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. LPA observed that sharp knives were unlocked in a cabinet in the kitchen and and were accessible to residents. Citation will be issued. LPA observed that some of the smoke detectors and carbon monoxide detectors worked but not all could be tested due to being out of reach. The fire extinguishers were observe to be operable and fully charged. The water temperature was tested and did not fall within regulations and measured 148.5 F. Citation will be issued. Due to time constraints, LPA is not able to complete the inspection today and advised staff that LPA will return at a later date. A copy of this report was provided to Caregiver, Araceli Angel.the state’s words, verbatim · CDSS document, Jun 4, 2026

Allegation investigated: Staff restrained resident.

On 9/30/25, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations, and to deliver findings. The Department was met by Administrator Long Zhang and the purpose of the visit was explained. Investigation consisted of the following: On 7/26/22, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. It was determined that the complaint required further investigation. On 9/16/25, the Department made a subsequent visit and interviewed the Administrator(A1) and 2 staff (S1-S2) who were present at the time of visit. The Department also conducted 3 resident interviews (R2-R3). R1 no longer lives at the facility. R1 remained at facility until her passing on 12/30/23. R1’s date of admission was 5/15/2022. On 09/16/25 The Department obtained and reviewed the following documents: Staff roster (dated 3/19/24), resident roster (6/1/25), physician’s order for wheelchair safety seat restraints (date 7/14/22), Employee training record. The Department reviewed Residents (R2-R4) file. On 9/23/25, the Department obtained via email copy of R1’s incident/death report (dated 12/20/23). Page 1 of 3 Substantiated Investigation revealed the following: Allegation: Staff restrained resident. The detail of the complaint alleges that "Witness #1 (W1) made an unannounced visit to this facility on 2 different occasions and witnessed a resident restrained.” On 9/16/25 at 11:00am, the Department interviewed the Administrator (A1) regarding the above allegation. A1 denied the allegation, stating that he was not the Administrator during the time of incident but pointed out that there was a doctor’s order for a wheelchair restraint for R1. On 9/16/25, between 9:00am and 11:00am, the Department interviewed 2 staff regarding the above allegation, and of those interviewed 1 out of 2 were hired after the alleged incident occurred. 1 out of 2 stated that she was at the facility during that time and stated that there was a doctor’s order in place for a wheelchair restraint. However, 1 of the 2 staff interviewed admitted to using a “handmade” restraint to keep R1 from falling out of her wheelchair. Both staff stated that they are aware of the residents’ rights and know that a resident should not be restrained unless there is a doctor’s order such as a wheelchair restraint for safety. On 9/16/25, between 9:00 and 11:30am The Department interviewed 3 residents (R2-R4) regarding the above allegation. Of those interviewed 3 out of 3 stated that they have never been restrained at any time, stated that their rights are respected and they feel safe at the facility. Page 2 of 3 On 9/16/25, The Department obtained, reviewed and evaluated the following pertinent documents: Staff training: Resident Rights (dated 1/18/19) and Physician’s Order for R1’s wheelchair restraint (dated 7/13/22 and signed by doctor on 7/14/22, which indicates a request for wheelchair safety seat restraint to prevent from fall/injury was granted. On 9/23/25, the Department obtained via email and reviewed copy of R1’s incident/death report (dated 12/20/23). Based on LPAs interviews 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) and Chapter (8) is being cited on the attached LIC 9099D. Exit interview conducted and copy of report and appeals rights provided.the state’s words, verbatim · CDSS document, Sep 30, 2025 · control 18-AS-20220722113442

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(1-5) · Plan of correction due date: Oct 1, 2025

Postural Supports(a) Based on the individual's preadmission appraisal, and subsequent changes…the facility shall provide assistance and care for the resident in those activities… resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement is not met as evidence by: R1 was observed to be restrained on two different occasions (9/12/22 & 9/13/22) using a handmade restraint limiting the use of R1’s ability to move. S1 admitted during the interview conducted on 9/16/25 that she had used a homemade belt made from a bed fitted sheet on R1’s wheelchair.the state’s words, verbatim · CDSS document, Sep 30, 2025

Plan of correction: Residents will not be restrained unless all requirements of Section 87608 are met.

Allegation investigated: Staff restrained resident.

**This report is to amend document dated 9/16/25. The purpose of the amended document is to change findings from UNSUBSTANTIATED to SUBSTANTIATED and to remove confidential information. Substantiatedthe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 18-AS-20220722113442

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver Vivian De Peralta, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 4 residents' bedrooms, 1 staff bedroom, 2 bathrooms, a dinning room, a living room, a kitchen, an office, an outdoor area, and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a cabinet in the kitchen and inaccessible to residents. The smoke detector and carbon monoxide detector were operable. The fire extinguishers were not in compliance with the department's requirements and were last inspected 12-04-2023. The water temperature was tested and did not fall within regulations measuring 148.5 F. Citations will be issued Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The Administrator holds a current Administrator’s certificate with the expiration date of 08-01-2026 and a CPR certification with the expiration date of 01-09-2027. Record Review and Resident/Staff Files: LPA reviewed files for 2 staff members, confirming criminal clearance, updated training, and health screening. 2 residents' files were reviewed and contained all required documentation. LPA observed first kit to be available for the residents in care. The clients and staff files were kept locked in a cabinet in the kitchen area and inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in the kitchen area. LPA reviewed medications for 2 residents confirming that all medication were listed and accounted for. Disaster Preparedness: The facility did not have a copy of the emergency and disaster plan as well as copies of the required quarterly emergency drills. Citations will be issued An exit interview was conducted and a copy of this report, 809D, and the appeal rights were reviewed and provided to Caregiver Vivian De Peralta.the state’s words, verbatim · CDSS document, Jun 20, 2025

Allegation investigated: Staff do not answer the facility telephone

Licensing Program Analyst, (LPA) Armando Perez conducted an unannounced visit to the facility and met with House Manager Liz Baclagan . The purpose of the visit was to inform of the complaint allegation findings. During this investigation, LPA conducted interviews with Administration, staff, clients, and additional witnesses. LPA also obtained pertinent documentation in order to assist with determining the findings for the above noted allegation. On October 25, 2024, Community Care Licensing (CCL) received a complaint alleging that the facility staff does not answer the facility telephone. It was reported that additional witness has contacted the facility numerous times in order to find out the well being of Resident #1. It was stated that the facility does not answer nor return the calls. On October 31, 2024, LPA conducted a tour of the facility and observed an operable telephone that had a loud ring tone and is capable of recording messages. Information obtained from Administrator stated there have been no issues with the phone service or system. Administrator further stated that staff do answer all calls when able and return calls within a reasonable timeframe. Interviews with facility staff corroborated the information. Unsubstantiated Facility staff indicated that additional witness is verbally aggressive when they contact the facility, but denied not answering the phone calls due to their behaviors. LPA interviewed Client #1 (C1) and they denied that the facility does not answer the phone. C1 stated that additional witness is verbally aggressive and yells at them over the phone during conversations. C1 indicated they often have to terminate the call and prefers not to speak with additional witness. Based on interviews, observation, and record review, the allegation that facility staff does not answer the facility telephone is unsubstantiated. A finding that the complaint is unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, where a copy of this report was provided to House Manager Liz Baclagan.the state’s words, verbatim · CDSS document, Nov 27, 2024 · control 18-AS-20241025152608

Type of visit: Required - 1 Year

On April 03, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator, Sylvia Busby. The facility file review was conducted in the Regional Office and additional forms were reviewed and requested on site. The facility is licensed for six Elderly Adults and is currently operating at a capacity of four Elderly Adults. LPA Mixson toured the facility along with the Lead Caregiver, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home located at 29787 Cool Meadow Dr. Menifee, CA. 92587. Physical Plant: The facility phone number is (951) 246-0214 and it is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguisher. LPA Mixson observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit, and there were safety lights for night. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharps are locked. Care & Supervision: Facility has sufficient staff, two staff on site at the time of this visit. Records Review: The LPA reviewed resident and staff files, conducted staff interviews. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Lead Caregiver, Liz Balagan.the state’s words, verbatim · CDSS document, Jun 4, 2024

Allegation investigated: Staff refused to accept resident back to the facility

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Long Zhang, who was informed of the purpose of the visit. During the visit, LPA conducted interviews and conducted records reviews. It was alleged that “Staff refused to accept resident back to the facility”. It was alleged that Resident #1 (R1) was not accepted back to the facility due to Staff #1 (S1) citing nonpayment and inability to care for R1’s condition. LPA reviewed the regional office accountability log for received eviction notices. None were found for R1. Substantiated Staff interviews revealed that R1 was placed by a hospital which transported R1 to the facility (2) hours after S1 verbally accepted R1. The resident was placed on 5/7/2024. No medical records or rental agreements were signed as evidenced by staff interview and records review. Staff interviews revealed that R1 had behaviors such as becoming physical with staff, destruction of property, and wandering. Staff interviews revealed that R1 required 1:1 supervision to ensure safety and could not be cared for at the facility. Within (5) days, on 5/12/2024 Staff revealed R1 was transported to the hospital due to an unwitnessed fall and was not accepted back to the facility by S1. Therefore, based on the records review and interviews conducted, it is found that the allegation is substantiated. Findings that are substantiated mean that the preponderance of the evidence standard has been met. Deficiencies were cited under California Code of Regulations Title 22. An exit interview was conducted with Licensee, John Zhang where this report, deficiency page and appeal rights were reviewed and provided to them.the state’s words, verbatim · CDSS document, May 22, 2024 · control 18-AS-20240516110321

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: May 23, 2024

Additional Personal Rights of Residents…(a) In addition to the rights listed ... residents...shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions.... This requirement was not met as evidenced by: Based on interviews and records review it was found that the facility did not accept R1 back from the hospital. This poses an immediate health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 22, 2024

Plan of correction: The licensee agreed to send the LPA a written step by step plan on how they will screen resident before admission to evaluate compatibility and avoid unecessary transfers. This is due by the POC due date to the LPA.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit for an unrelated matter. LPA met with Licensee, Long Zhang, who was informed of the purpose of the visit. During the visit information was revealed on past residents and employee. LPA conducted interviews and gathered records. LPA informed the licensee this investigation will remain open at this time. An exit interview was conducted with Licensee, Long Zhang where this report, deficiency page and appeal rights were reviewed and provided to them.the state’s words, verbatim · CDSS document, May 22, 2024