Country Club Guest Home

Type of visit: Required - 1 Year

On 8/26/26, Licensing Program Analyst (LPA) Kyle Wellington arrived unannounced to conduct an annual inspection. LPA met with Licensee, Julita "Julie" Ramirez, who was informed of the purpose of the visit. The census at the facility is 25 residents. LPA received a resident and staff roster from Licensee. LPA toured the inside and outside of the facility with Manager, Kevin Ramirez. LPA conducted an observation and record review for the inspection. Facility Overview: Facility is a two story building with 20 resident bedrooms, 13 resident bathrooms, office, kitchen, dining room, laundry room, two (2) commons areas and storage room. There are no pools, bodies of water or firearms at the facility. Facility has a fire clearance for eighteen (18) non-ambulatory elderly adults and twelve (12) ambulatory elderly adults. Hospice waiver was granted to the facility for one (1) resident. Infection Control: LPA observed hand sanitizers and soap dispensers throughout the facility. Cleaning equipment and supplies were kept in the locked laundry room and available for regular facility maintenance. Extra laundry and cleaning supplies were located in the storage room. LPA reviewed the facility’s infection control plan which met the department’s requirements. Physical Plant: LPA observed the inside and outside of the facility to be clean, safe and well kept. The commons areas and dining room furniture was in good repair. The residents' bedrooms and bathrooms were well maintained. The residents’ bedrooms contained the required bedding, lighting and furniture. Bathrooms had soap, automatic hand dryers, grab bars and non-slip mats in the showers. Extra linen and towels were kept in a closet in the hall. Laundry equipment appeared to be in good working condition. Laundry supplies were kept in the locked laundry room. Fire extinguishers were charged and last inspected on 2/19/26. Facility has smoke and carbon monoxide detectors and a pull system fire alarm. The wrap around deck and backyard area was free of hazards and contained outdoor furniture and shaded area for residents. Kitchen/Food Service: LPA observed the kitchen to be clean, organized, and well maintained. The kitchen had the ability to prepare and store food in a safe and clean environment. Kitchen appliances appeared to be in good working condition. All sharp objects were kept in a locked cabinet under a kitchen sink inaccessible to residents. Cleaning supplies were kept in a locked cabinet under a kitchen sink inaccessible to residents. Facility has over a two day supply of perishable foods and over a seven day supply of non-perishable foods. Care and Supervision: LPA observed four (4) staff and 24 residents at the facility. One (1) resident was away from the facility at the time of the visit. Facility has sufficient staff to supervise the residents. Administration: LPA observed facility sketch, personal rights, emergency disaster plan, emergency phone numbers, complaint procedures, long-term care ombudsman information, and facility license posted in the dining room. Licensee holds a current Administrator Certificate, CPR/First Aid Certificate and a Criminal Record Clearance. Resident & Staff Records: LPA reviewed the records of five (5) resident files and three (3) staff files. Staff present have CPR/First Aid Certificate, criminal record clearance and are associated with the facility. The files contained all the required documentation and paperwork. The staff and resident files were kept in a cabinet in the locked office inaccessible to unauthorized individuals. Health Related Services/Incidental Medical Services: LPA observed clients' medications were centrally stored in a locked cabinet in the kitchen inaccessible to residents. First aid kit was kept in a locked cabinet in the kitchen and it contained all the required items. LPA reviewed five (5) residents' medications to the facility’s medication log to make sure all medication was accounted for and dispensed correctly. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. It is current and up to date. Fire drills are done quarterly and was last completed on 8/4/26. Facility's property and liability insurance is current and expires on 8/17/27. All facility exits had signage and were clear of obstructions. No deficiencies were cited during this visit. An exit interview was conducted with the Licensee, Julita Ramirez, and a copy of this report was given to Licensee, Julita Ramirez.the state’s words, verbatim · CDSS document, Aug 26, 2026

Allegation investigated: Resident is being financially abused by licensee.

On 02/11/2026, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit regarding the above allegation. LPA Richard met with the Administrator Julie Ramirez, and the purpose of this visit was explained. LPA toured the facility. The investigation included the following: On 12/14/2023, Licensing Program Analyst (LPA) Kathleen Banrasavong visited the facility to begin the investigation into the allegations listed above. The LPA met with the Administrator (A1), Julie Ramirez. The LPA also interviewed the caseworker (CW) regarding the Assisted Living Waiver Program. On 02/11/2026, LPA reviewed and requested the following documents: the residents roster and the staff roster. LPA reviewed and requested Residents #1-5, Admissions Agreement, and Physicians' Reports. LPA also requested and obtained the following documents for Resident #1 (R1): Residents' Appraisals, Needs & Services, and copies of 7 Social Security checks, a handwritten note, and the signature of R1. LPA interviewed five residents (R1-R5), four Staff members (S1-S4), and the Administrator (A1). Unsubstantiated Allegation: Resident is being financially abused by the licensee. The complaint alleged that the Administrator brought Social Security checks to the resident at a skilled nursing facility for signature and did not return to deliver the funds to R1. On February 11, 2026, at 11:00 AM, LPA Richard interviewed the administrator (A1), who denied the allegation. A1 stated R1 moved into the facility on 12/08/2022 and that R1's Social Security benefits did not start until 05/1/2023. R1 moved out of the facility on 07/31/2023. R1 still owed the facility back payments for the five months preceding the move-in date. On 12/16/2023, A1 visited R1's residence, had R1 sign the checks for the back rent, and gave R1 the remaining funds after all rent was paid. On February 11, 2026, at 11:55 AM, LPA Richard interviewed four staff members #1-4, (S1-S4). All four denied the allegation, stating they are not involved in managing residents' personal funds and P&I; they only assist residents with shopping, and residents control their own money. Later, at 12:15 PM the same day, LPA interviewed five residents (R2-R6). All five denied any issues with their money. Residents R2, R3, and R4 stated that the payee deposited the funds into their respective bank accounts. On 12/16/2023, LPA interviewed the Case Worker (CW), who denied the allegation and explained that the resident stayed at the facility and was not paying full rent due to SSI being in limbo. CW also stated that R1 owes the facility back pay. CW added that this ALW has ceased because R1 has not been residing at the Country Club Guest Home since June 2023. Report Continued on LIC9099C On February 11, 2026, LPA Richard examined R1’s records, which showed seven copies of Social Security checks and a letter explaining the breakdown of the start of benefits. LPA also reviewed a handwritten note and signature of R1 receiving extra money from A1 for 2022 and 2023. Additionally, copies of the returned checks were sent to the Department of the Treasury because R1 no longer lives at the facility. LPA was unable to interview R1 because R1 moved out of the facility on 07/31/2023. Based on interviews, observations, and records reviewed, there is insufficient evidence to support the allegation: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator, Julie Ramirez.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 18-AS-20231208140426

Allegation investigated: Resident is being financially abused by licensee.

On 02/11/2026, Licensing Program Analyst (LPA) Antonine Richard investigated the above allegation. LPA Richard met with the Administrator Julie Ramirez, and the purpose of this visit was explained. The investigation consisted of the following: During today’s visits, LPA toured the entire facility. On 02/11/2026, LPA reviewed and requested the following documents: residents roster and staff roster. LPA reviewed five Residents #1-5 (R1-R5) Admissions Agreement, Physicians' Reports, and Medication records. LPA also requested and obtained the following documents for Resident #1 (R1): Residents' Appraisals, Needs & Services, and two checks from DBA Senior Impact. LPA interviewed five residents (R1-R5), four staff members (S1-S4), and the Administrator (A1). Report continued on LIC9099-C. Unsubstantiated Allegation: Resident is being financially abused by the licensee. The complaint alleged that the residents (R1) had not received a check from the licensee for a couple of years. On February 11, 2026, at 11:00 AM, LPA Richard interviewed the Administrator (A1), who denied the allegation. A1 stated that DBA Senior Impact sends two $15 checks to the facility address in R1's name. A1 assisted R1 in going to the check-cashing location on Fig Street in Escondido to cash the check. After R1 cashed the check, the facility is not responsible for how R1 uses that money. A1 also mentioned that after the complaint was filed, A1 contacted the payee, who subsequently helped R1 with the supplemental check. On February 11, 2026, at 11:55 AM, LPA Richard interviewed four staff members #1-4 (S1-S4). All four denied the allegation and stated that they are not involved in managing residents' personal funds and P&I; they only assist residents with shopping, and residents control their own money. Later, at 12:15 PM the same day, LPA Richard interviewed five residents (R1-R5). All five denied experiencing any issues with their money. Residents R2, R3, and R4 stated that the payee deposited the money into their bank accounts. R1 also mentioned that their social workers are currently assisting them with cashing their checks. On February 11, 2026, LPA Richard examined R1’s records, which showed two checks from Senior Impact for $15 each, dated February 1, 2022, and August 1, 2023. The facility has stopped receiving the R1 supplement check from Senior Impact. Report Continued on LIC9099C Based on interviews, observations, and records reviewed, there is insufficient evidence to support the allegation: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Julie Ramirez.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 18-AS-20230710110439

Type of visit: Required - 1 Year

On 8/25/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Licensee, Julita "Julie" Ramirez who was informed of the purpose of the visit. The facility has a fire clearance to serve 12 ambulatory and 18 non-ambulatory elderly residents. The facility also has an approved hospice waiver for one (1) and LPA was informed none of the current residents residing in the facility are on hospice. LPA toured the facility with Administrative Assistant (AA), Kevin Ramirez. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility had a two-day supply of perishable foods and seven-day supply of non-perishable food items. Medications are secured in locked kitchen cabinets. AA Ramirez tested one (1) of the smoke alarms/carbon monoxide detectors and LPA heard it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility that were last serviced on 2/26/2025. The facility's certificate of liability insurance expires on 8/17/2026. Staff present have a criminal record clearance and are associated with the facility. Resident files reviewed had the required records. LPA reviewed the facility's Fire Drill Log noting their last fire drill was conducted on 6/6/2025. Long Term Care Ombudsman's contact information, residents' personal rights, grievance procedures, facility sketch, and emergency names and phone numbers are visibly posted in the dining room. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Ramirez.the state’s words, verbatim · CDSS document, Aug 25, 2025

Allegation investigated: Facility staff are financially abusing resident

On 12/16/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to deliver investigative findings regarding the allegation listed above. LPA met with Caregiver, Victoria Matthews who was informed of the purpose of the visit. Licensee, Julie Ramirez was contacted over the phone and also informed of the purpose of the visit. It was alleged Staff 1 (S1) accompanied Resident 1 (R1) to the bank to withdraw $5,000.00 in July 2024 to pay their rent balance and R1 may be getting financially abused by the facility. LPA reviewed R1's Physician Report (LIC602A) dated 8/17/2023, which indicates R1 does not have the capacity to manage their own cash resources. LPA reviewed R1's admission agreement dated 3/1/2015 noting R1 is responsible for themselves, and the facility will maintain and supervise R1's cash resources. Unsubstantiated The admission agreement also notes R1 pays the standard Supplemental Security Income monthly rate for basic services which is currently $1,398.07. S1 was interviewed and reported they safeguard R1’s checkbook in the staff office and R1 writes their own checks. S1 explained R1 pays their monthly rent using paper checks and ran out of checks in May 2024, which resulted in R1 not paying their rent for three (3) months. S1 explained the facility did not realize R1 had not paid their rent until July 2024. S1 reported they informed R1 and R1 requested S1 accompany them to the bank to withdraw money to pay the rent in cash. S1 reported R1 withdrew money and paid the rent balance in cash. R1 was interviewed and corroborated the information provided by S1 and reported they withdrew more than the rent owed, paid the rent balance to the facility in cash, and kept the remaining money on their person, which they recall was approximately $240.00. R1 reported they do not have a reason to suspect S1 or any other facility staff are financially abusing them and did not express any concerns with the care and supervision they currently receive at the facility. LPA reviewed R1’s bank statements noting $4,420.00 was withdrawn on 7/3/2024. LPA conducted a record review and noted the facility documented R1 withdrew cash and paid the rent balance on 7/3/2024. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. An exit interview was conducted and this report was reviewed with Licensee Ramirez over the phone and a copy of this report was provided to Caregiver Matthews along wiht a Confidential Names list (LIC 811).the state’s words, verbatim · CDSS document, Dec 16, 2024 · control 18-AS-20240814162626

Allegation investigated: Staff physically and emotionally abused resident

On 12/16/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to deliver amended investigative findings regarding the allegation listed above. LPA met with Caregiver, Victoria Matthews who was informed of the purpose of the visit. Licensee, Julie Ramirez was contacted over the phone and also informed of the purpose of the visit. It was alleged Resident 1 (R1) was being physically and emotionally abused by Staff 1 (S1) and R1 sustained multiple bruises on their forearm and back of leg. It was not described how R1 is allegedly emotionally abused. LPA toured the facility, made a collateral visit, conducted resident, staff, and witness interviews and obtained copies of pertinent documentation. LPA made a collateral visit to R1's day program and observed R1 with multiple bruises on their forearms and back of leg. A witness interview conducted revealed R1 has been observed at day program with bruises on their forearms since 2023 but the day program did not suspect abuse from facility staff. Information gathered during an interview with R1 did not refute nor corroborate the allegation. LPA attempted to conduct an interview with R1's roommate, however they refused to be interviewed. *This is an amended version of the original report. Unsubstantiated Two (2) facility staff were interviewed and reported they have never observed S1 abuse R1 or any other resident. S1 was interviewed and reported they have never hit or abused R1. Licensee Ramirez was interviewed and reported R1 receives home health services at the facility twice per week. LPA contacted the home health agency who reported due to R1's diagnosis, R1 sustains substantial bruises with minor contact, including when receiving transfer assistance. The home health agency added they do not suspect R1 is being abused by facility staff and there are no concerns with the type of care and supervision R1 is receiving at the facility. This agency has investigated the complaint alleging "Staff physically and emotionally abused resident". Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and this report was reviewed with Licensee Ramirez over the phone and a copy of this report was provided to Caregiver Matthews along with a Confidential Names list (LIC 811). *This is an amended version of the original report.the state’s words, verbatim · CDSS document, Nov 18, 2024 · control 18-AS-20241113162414

Type of visit: Case Management - Deficiencies

On 11/18/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to address a deficiency discovered during investigation of complaint control number 18-AS-20241113162414. LPA met with Licensee, Julie Ramirez who was informed of the purpose of the visit. During the investigation, Staff 1 (S1) was interviewed and reported on several occasions, they have physically showered Resident 1 (R1) after R1 verbalized their refusal to shower. S1 reported R1 attends day program and they believed R1 was required to shower on their scheduled shower days. Licensee Ramirez reported the facility does not currently document resident shower refusals. S1 also reported they gave R1 the option to shower or stay home from day program. The facility will be cited. An exit interview was conducted where a copy of this report was reviewed and provided to Licensee Ramirez along with Confidential Names list (LIC 811) and Appeal Rights.the state’s words, verbatim · CDSS document, Nov 18, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Nov 22, 2024

(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. Based on interviews conducted, S1 showered R1 on several ocassions despite R1 verbalizing their refusal to shower. This poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 18, 2024

Plan of correction: Licensee reported they will conduct an in-service staff training regarding residents' personal rights and develop a log to document residents' shower refusals. Proof of correction to be submitted to LPA by POC due date.

Allegation investigated: Staff did not provide resident a statement of fees or payments

On 12/27/2024, Licensing Program Analyst (LPA), Janette Romero made an unannounced visit to the facility to deliver amended findings regarding the allegation listed above. LPA met with Caregiver, Claras Aguas who was informed of the of the purpose of the visit. LPA communicated with Licensee, Julie Ramirez over the phone who was also informed of the purpose of the visit. It was alleged the facility is managing Resident 1's (R1's) finances and did not provide them with receipts or statements of fees. LPA toured the facility, conducted interviews and obtained copies of pertinent records. LPA reviewed R1's Physician's Report (LIC602A) dated 8/17/2023, which indicates R1 does not have the capacity to manage their own cash resources. LPA also reviewed two (2) Resident Appraisals (LIC603s) for R1 dated 3/1/2015 and 6/14/2019, which list assistance with managing cash resources as a service needed. LPA reviewed R1's admission agreement dated 3/1/2015, which also indicates the facility will maintain and supervise R1's cash resources. R1's checkbook is safeguarded by Administrator, Kevin Ramirez in the staff office. Administrator, Melanie Cuaresma corroborated this information. *This is an amended version of the original report Substantiated Administrator Cuaresma was interviewed and reported the facility manages R1's finances and has never provided R1 with receipts for cash resources or monthly rent paid to the facility. Administrator Cuaresma reported the facility keeps a record of R1's safeguarded cash resources and was unaware they had to provide R1 with receipts. R1 was interviewed and reported their finances are managed by the facility and they have not received receipts for rent paid or statements of fees. Based on LPA’s interviews conducted and records reviewed, 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, Chapter 8), is being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided to Administrator Cuaresma along with a Confidential Names List (LIC811) and Appeal Rights.the state’s words, verbatim · CDSS document, Aug 21, 2024 · control 18-AS-20240814162626

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Aug 21, 2024

87217(b) The licensee shall give the residents receipts for all such articles or cash resources. This requirement was not met as evidenced by: A complaint investigation revealed the facility was managing R1's finances and providing them with receipts for monthly rent or cash resources. This poses a potential health/safety/personal rights to residents in care.the state’s words, verbatim · CDSS document, Aug 21, 2024

Plan of correction: During LPA's visit, Administrator Cuaresma had a physical receipt book, featuring a white originals and canary duplicates, delivered to the facility. Administrator stated the facility will provide R1 with the original white receipt and keep the canary duplicate for their records. Administrator also stated the facility will use the Department's LIC405 form in place of their log. POC met.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 08/08/24 at 8:45am Licensing Program Analyst (LPA) Javina George made an unannounced visit for the purpose of conducting a 1 year required visit/annual inspection. LPA George met with Licensee/Administrator Julie Razmirez and informed her of the purpose of today's visit. The facility is licensed to serve (30) Elderly clients age 60 years and above (18) non ambulatory and (12) ambulatory. The facility has an approved hospice waiver for (1), with (0) resident's receiving hospice services. Below is a summary of what was observed during today’s inspection: Infection Control: LPA George observed that the facility has an updated Infection Control Plan on file and is demonstrating best practices in the facility to maintain a healthy environment for staff and residents. The facility was observed to have an adequate supply of Personal Protective Equipment (PPE) supplies. Physical Plant: LPA toured the interior and exterior of the facility and observed that there a sufficient bedrooms (24) and bathrooms (12) for client use. The facility was observed to have the required furniture and linen to be present and in good condition in resident bedrooms. The exits are not obstructed and that there is plenty of space for activities. There is an activities calendar posted on the white board. There are no pools or bodies of water on the premises. Staff Records: LPA observed that there are sufficient staff present to meet the needs of clients. LPA George additionally confirmed that there is an Administrator present with a valid certificate that expires April 2025. LPA observed for staff present to have criminal record clearance and were associated to the facility and have training to perform their required duties. Staff present at have current CPR/First Aid Certification. In addition LPA verified facility contact information was up to date. Resident Records: A review of (3) client files including Physician's Report, Admissions Agreement, and current Needs & Services Plan. The client's are assisted with cashing their checks, and are responsible for there money thereafter therefore no Personal and Incidental funds were reviewed during today's inspection. Food Services: The kitchen and dining area to be maintained in a clean and healthful manner. The facility was observed to have sufficient dishware and silverware were present for resident’s use. There were graham crackers, cereal, fruit cups and 2 bottles of salad dressing, that were observed to have expired. The items were discarded at the time of LPAs visit, therefore no citations were issued. LPA observed the facility to have the required amount of 7 day supply non-perishable and a two supply perishable food items. Medication: Resident medication was observed to be locked in the medication storage and inaccessible to residents. A review of medication revealed that the medication is being given as prescribed as evidenced by the Medication Authorization Record (MAR) and medication (bubble packs). Emergency Disaster Preparedness: The facility has an Emergency Disaster Plan on file and conducts regular disaster drills on a quarterly basis. The last drill was conducted on 06/12/24, the next drill is due this month. The smoke and carbon monoxide detectors were tested and were found to be operable. The facility has (4) fully charged fire extinguishers. There are no known guns or ammunition on the premises. The hot water was tested and was found to be within regulatory limit measuring at 108-111 degrees Fahrenheit. The facility has emergency food and water supply. The sharps and hazardous chemicals were observed to be locked and inaccessible to clients in care. Based on today's inspection no deficiencies/citations were issued. An exit interview was conducted and a copy of this report, were provided to Licensee/Administrator Julie Ramirez.the state’s words, verbatim · CDSS document, Aug 8, 2024