Country House

Allegation investigated: Uncleared adult is supervising residents

On December 11, 2025, Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility for the purpose of delivering findings for a complaint that was received December 1, 2025. LPA was greeted by Administrator Michael Foz and explained the purpose of the visit. During the course of the investigation, LPA reviewed pertinent documents and conducted interviews with staff. Continued on LIC 9099-C. Substantiated Allegation: Uncleared adult is supervising residents It was alleged that a staff member (S1) was providing care and supervision to the residents of the facility without a criminal record clearance. Only S1’s first name, approximate age, and physical features were provided in the complaint summary. On December 1, 2025, LPA reviewed the California Department of Social Services Guardian Background Check System and observed a staff with the same first name and approximate birth date who had been associated to the facility on December 1, 2025. LPA noted this staff had received a criminal record exemption on November 7, 2025. LPA contacted the facility Administrator via email and requested a current LIC 500 – Staff Roster. LPA reviewed the current LIC 500 and observed a staff member with the same first name whose start date was listed as December 1, 2025. LPA interviewed Administrator who stated S1 was the only staff member in the facility with the same first name listed in the complaint. Administrator stated S1 had been employed by the facility on and off for several years and was most recently working in October and November 2025 before going on a temporary leave of absence. LPA interviewed Licensee, Rico Foz, who admitted he hired S1 knowing they had not yet received a criminal record clearance/exemption to be able to work in the facility. Licensee stated he was trying to help S1 when they were in need. Administrator stated S1 is still currently employed by the facility, however, is not on the schedule at this time. On December 7, 2025, LPA reviewed the staff schedule for the months of October and November and noted S1 was listed as working for 19 days between October 3, 2025, and November 7, 2025, when S1’s criminal record exemption was approved. Based on observations, document review, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is cited on the attached LIC 9099-D. Civil Penalties have been assessed on the attached LIC421BG. Exit Interview conducted. A copy of this report, and Appeal Rights were provided to Michael Foz, Administrator, via email.the state’s words, verbatim · CDSS document, Dec 11, 2025 · control 59-AS-20251201110236

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(1) · Plan of correction due date: Dec 12, 2025

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations. This is evidenced by: Based on interviews conducted, observation, and documentation reviewed, the Licensee did not ensure that S1 had a valid criminal record clearance before working in the facility, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: Administrator agrees to fill out a LIC 9098 Proof of Correction Form indicating the regulation is understood for the future. Further, civil penalties have been assesed. Adminsistrator shall provide LIC 9098 to LPA by end of business on December 12, 2025.

Allegation investigated: Staff are financially abusing a resident.

On October 23, 2025, Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility unannounced for the purpose of opening up a complaint investigation. LPA was greeted by Administrator, Michael Foz, and explained the purpose of the investigation. During the visit, 16 residents were in facilty and 2 staff were providing direct care. LPA and Administrator toured the facility and made observations. Allegation: Staff are financially abusing a resident. During the course of the investigation, LPA interviewed one (1) resident (R1), R1's responsible party and two (2) staff. LPA requested the following documents: R1's current LIC 602 and R1's emergency identification sheet. It was alleged that a staff had accepted monetary gifts from R1. All parties interviewed denied this allegation ever occured. R1's LIC 602 did not indicate a dementia diagnosis and the R1's responsible party (RP) indicated this allegation was not a possibility as RP is responsible for managing the resident's finances. The administrator noted that an All-Staff meeting is already scheduled for October 30, 2025, where this topic will be discussed and staff will be reminded that they are not to take any monetary gifts from residents regardless of their mental diagnosis. The adminstrator indicated they will reach out to R1's responsible party regarding any changes in the resident's mental condition in regards to their finances. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided to Administrator , Michael Foz, via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 23, 2025 · control 59-AS-20251013140255

Type of visit: Required - 1 Year

On October 23, 2025, Licensing Program Analyst (LPA) Kayla Adkison, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Michael Foz, Administrator, and explained the purpose of the visit. 16 residents and 2 (two) care staff were present in the facility during the inspection. LPA and Administrator toured the facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, kitchen, backyard, and (2) two common restrooms. All areas observed were found to be clean and in good repair. LPA observed each bedroom to have the required furnishings, working lights, and windows with screens. Facility has a 2-day perishable and a 7-day non-perishable amount of food. LPA observed all sharps to be kept locked in a kitchen drawer and inaccessible to residents. LPA observed medications to be locked in a med cart and inaccessible to residents in care. Overstock medications are in the process of being moved to the administrators locked office. The facility is in the process of implementing a new system for tracking medications for clients LPA observed all toxins and cleaning supplies to be locked in cabinets and inaccessible to clients. The facility has variety of games, cards, and activities available for client use. LPA observed a calendar of events for residents to view. During the inspection, residents were in the common areas watching television, having lunch, doing puzzles, and participating in a flower bouquet class. LPA observed two (2) fire extinguishers which were last inspected in August 2025. LPA observed a disaster drill log with the last drill recorded in September 2025. The facility is conducting drills monthly. LPA observed a complete first aid kit ready for emergency use. LPA observed smoke detectors and carbon monoxide in working condition. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA reviewed a total of four (4) residents' files and four (4) staff files which contained all required documentation. All staff are fingerprint cleared and associated to the facility. No deficiencies are being cited as result of this inspection. Exit interview conducted. A copy of this report and Appeal Rights were provided, via email, to Administrator, Michael Foz, via email.the state’s words, verbatim · CDSS document, Oct 23, 2025

Type of visit: Required - 1 Year

On 09/10/2024, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Assistant Administrator, Michael Foz and explained the purpose of the visit. LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, backyard, shed, and common restrooms. LPA observed the resident bedrooms to have all the required furnishings, working lights/fans with windows with screens. All resident bathrooms observed to be in working order and have the required supplies. LPA observed the resident showers to have bathroom the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. Hot water was measured throughout the facility, the temperature was above the required temperature (122 F) on one side of the building and below the required temperature(101 F) on the other side of the building. The thermostat was within range in the facility but inconsistent throughout the facility, some rooms and halls were warmer on one side. Facility has a 2-day perishable and a 7-day non-perishable amount of food. LPA observed medications sharps to be locked inaccessible to residents. LPA observed posted weekly menu and activities for the residents. LPA observed a plethora of supplies for the residents to use. LPA observed fire extinguishers, fire detectors, and carbon monoxide detectors. LPA observed a complete first aid kit ready for emergency use. LPA observed a completed emergency disaster plan, and the required emergency disaster drills conducted within the last 12 months. LPA observed the facility to be clean, in good repair and odor-free. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA reviewed a total of five (5) residents' files and five (5 ) staff files. Two of the five resident files reviewed had outdated physician reports for residents who have dementia. Employee files contained all of the required documentation. The following deficiencies were cited per Title 22 of the California Code of Regulation (See LIC 809D). Appeal Rights were explained and provided to the facility representative listed above Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Prelicensing

On 10/25/2023, Licensing Program Analyst (LPA) Jaynae Boyles and Ivan Avila arrived at the facility unannounced to conduct a Pre Licensing Inspection. LPA's met with Facility Administrator, Meryl Foz and explained the purpose of the visit. LPA's and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, garage, backyard, and common restrooms. LPA's observed the facility to be clean, in good repair and odor-free. LPA's observed each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids. The water in the bathrooms, resident restrooms and bathers measured above the required range. LPA's checked the kitchen area for the ability to prepare and store food. Facility has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA's observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA's observed three (3) fire extinguishers, fire detectors, and carbon monoxide detectors. In the areas toured no immediate health, safety, or personal rights violations were observed. Several topics were discussed. COMP 3 will be waived as the Administrator has sufficient experience. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given This facility is ready to be licensed.the state’s words, verbatim · CDSS document, Oct 25, 2023

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Change of ownership Capacity: 20 Census (if any clients in care): 13 COMP II Participants: Meryl Foz, Romerico Foz Interview Method: Telephone interview On October 02, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 2, 2023