Del Cerro Elder Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers were granted entry into the facility by Co-Administrator Jenny Sequeira. LPA identified herself and stating the purpose of the inspection. The facility serves 6 elderly residents, age 60 and above, all whom may be non-ambulatory, of which one (1) may be bedridden. LPA was accompanied by Co-Administrator Sequeira for a tour of the facility, which was conducted inside and out and included a all of resident rooms and common areas. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Exterior and interior passageways were free from obstructions. Resident and common room temperatures were within a comfortable range. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food was observed to be properly stored and labeled. Special Food diet orders are present. Activity supplies are present. Chemicals and cleaning supplies were stored in a locked room. The medication closet was locked and medications were labeled and kept in compliance with label instructions. LPA reviewed staff and resident records/files. LPA interviewed multiple staff and clients. LPA conducted a review of In-service training procedures. The staff and client files which LPA reviewed contained required documents. Confidential records were stored in locked areas. There is a pool on premises secured and made inaccessible through fencing to residents. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Co-Administrator Sequeira, to whom a copy of this report was provided during the visit.the state’s words, verbatim · CDSS document, Aug 21, 2026

Allegation investigated: Staff physically abused clients Staff unable to communicate with clients

Licensing Program Analyst (LPA), Amy Rodgers, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Co-Administrator, Abhinav Singh, who identified herself and disclosed the purpose of the visit. On August 21, 2025, Community Care Licensing (CCL) received a complaint alleging the above- mentioned allegations. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of a records review, interviews with facility staff, residents, outside sources. (continued on LIC9099) Unsubstantiated (continued from LIC9099) The resident involved in the allegation has a documented history of making statements that have been determined to be exaggerated or unsubstantiated. Interviews conducted with facility staff, outside sources, and family members, along with a review of facility records, indicate a pattern of the resident making claims of verbal, physical, or personal rights violations, often during times of redirection, denial of preferred items, or emotional distress. While each allegation is taken seriously and investigated thoroughly, this behavioral history and corroborating information are considered as part of the overall assessment. The facility continues to monitor the resident and provide appropriate support to ensure their safety and well-being. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Co-Administrator Abhinav Singh whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]the state’s words, verbatim · CDSS document, Aug 28, 2025 · control 08-AS-20250821152355

Allegation investigated: Facility staff verbally abused client. Facility staff is withholding food from resident. Facility staff does not afford privacy to resident.

***This is an amended document*** Licensing Program Analyst (LPA), Amy Rodgers, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Co-Administrator Abhinav Singh. LPA Rodgers identified herself and disclosed the purpose of the visit. On June 23, 2025, Community Care Licensing (CCL) received a complaint alleging the above- mentioned allegations. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of a records review, interviews with facility staff, residents, and outside sources. (Continued on LIC9099) Unsubstantiated (continued from LIC9099) The resident involved in the allegation has a documented history of making statements that have been determined to be exaggerated. Interviews conducted with facility staff, outside sources, and family members, along with a review of facility records, indicate a pattern of the resident making claims of verbal, physical, or personal rights violations, often during times of redirection, denial of preferred items, or emotional distress. While each allegation is taken seriously and investigated thoroughly, this behavioral history and corroborating information are considered as part of the overall assessment. The facility continues to monitor the resident and provide appropriate support to ensure their safety and well-being. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Co-Administrator Abhinav Singh whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]the state’s words, verbatim · CDSS document, Aug 28, 2025 · control 08-AS-20250623141124

Allegation investigated: Neglect resulting in injury Facility did not afford resident dignity Facility did not meet resident's incontinence needs Inappropriate space used for resident's sleep Inappropriate use of video surveillance

Licensing Program Analyst (LPA), Amy Rodgers, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Co-Administrator, Jenny Sequeira , who identified herself and disclosed the purpose of the visit. On January 23, 2025, Community Care Licensing (CCL) received a complaint alleging the above- mentioned allegations. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of records review, interviews with facility staff, residents, and family members. (Continued on LIC 9099) Unsubstantiated (Continued from LIC9099) (Page 2 of 3) Regarding the allegations, neglect resulting in injury and facility did not afford dignity. More specifically, Reporting party (RP) states that R1 has a wound on the right knee for months that reopens because R1 crawls on the floor and R1 complained of pain in her hip. RP further stated they did not observe any injuries. Physician’s Report dated January 20, 2025, states Resident #1 (R1) is non-ambulatory and diagnosed with Parkinson's disease and dementia, and with a history of ataxic gait, dysphonia, cerebrovascular accident. R1 struggles with speech and movement. Interviews were conducted with facility staff, the administrator as well as responsible party. Staff interviews and R1's responsible party confirmed that R1 had a skin condition which was monitored and that appropriate wound care was provided. R1 was observed during the visit and appeared clean alert and responsive. R1 responsible party confirmed R1 occasionally crawled on the floor, and both the staff and the responsible party encourage the use of a wheelchair. They also state that R1 was new to the facility, and the staff were working as a team to address R1's needs, including care related to an undiagnosed brain condition. There is not a preponderance of evidence the facility failed to provide adequate care and uphold our one's personal dignity Regarding the allegation, facility did not meet resident's incontinence needs and Inappropriate space used for resident's sleep. More specially, R1 incontinence brief was removed and wet and that R1 may have been not been sleeping on their bed.. Interview with administrator reveal staff regularly attempt toileting routines with R1, though these are often unsuccessful. Responsibly party as well as staff interviews reveal R1 often removes incontinence brief due to behavior tendencies. Interviews further reveal R1 has a pattern of crawling off the bed and around their room. LPA observed R1's bed to be positioned as low to the ground as possible, with and additional mat placed on the floor to protect R1 should they leave the bed. Staff explained the mat is to support R1's safety and preference for tight spaces due to behavior factors. A review of records as well as LPA observations reveal that's sufficient staffing is in place to meet residents needs including incontinence care. (Continued on LIC999C) (Continued from LIC9099C) ( page 3 of 3) Regarding the allegation, Inappropriate use of video surveillance. More specifically, there was a surveillance camera in R1's bedroom. According to an interview with R1's responsible party, they confirmed they provided a camera in R1's room. LPA observations of R1's room revealed no camera in the room during a tour. The administrator confirmed there was a camera temporarily placed in R1's room with R1's responsible person's knowledge and consent. The administrator further reported that they took the camera out of R1's room after discussing it with R1's responsible party. Interviews and documentation indicated the camera did not record audio. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed UNSUBSTANTIATED. A copy of this report along with licensee rights was given to Co-Administrator Jenny Sequeira whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 08-AS-20250123135957

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers were granted entry into the facility by Co-Administrator Jenny Sequeira. LPA identified herself and stating the purpose of the inspection. The facility serves 6 elderly residents, age 60 and above, all whom may be non-ambulatory, of which one (1) may be bedridden. LPA was accompanied by Co-Administrator Sequeira for a tour of the facility, which was conducted inside and out and included a all of resident rooms and common areas. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Exterior and interior passageways were free from obstructions. Resident and common room temperatures were within a comfortable range. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked room. The medication closet was locked and medications were labeled and kept in compliance with label instructions. LPA reviewed staff and resident records/files. LPA interviewed multiple staff and clients. LPA conducted a review of In-service training procedures. The staff and client files which LPA reviewed contained required documents. Confidential records were stored in locked areas. There is a pool on premises secured and made inaccessible through fencing to residents. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Co-Administrator Sequeira, to whom a copy of this report was provided during the visit.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Amy Rodgers conducted and unannounced visit to issue a deficiency for a post-licensing visit that was conducted on November 25, 2024. LPA was greeted by and granted entry by CO-Administrator Jenny Sequeira arrived during the visit. On November 25, 2024 LPA's Rodgers and Boyle toured the facility with Co-Administrator in addition to conducting a general overall inspection, which included, but was not limited to the following: facility physical plant, food service, medication management, records review, and facility administration. There is a pool on the premise, made inaccessible to clients in care. Carbon monoxide detector, fire extinguisher, and facility telephone were present. On November 25, 2024 LPAs observed a front door lock which utilized a keypad and locks on exterior fence gates. Records review and interviews indicated that a locked perimeter for this facility is not approved by fire clearance. A deficiency is being cited today due to the facility having a locked perimeter without fire clearance. The deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 809-D. An immediate civil penalty in the amount of $500 issued at today's visit. LPAs spoke to Co-Admin Jenny Sequeira and reviewed report, civil penalties and POC. An exit interview was conducted with Co-Administrator Jenny Sequeira whom a copy of this report and the Licensee/Appeal Rights (LIC809-D 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(1)(2) · Plan of correction due date: Jul 23, 2025

(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2) The licensee.fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement is not met as evidenced by: Licensee removed the outside padlocks and agreed to replace the keypad operated front door lock. LPA cleared the citation during the visit on 11/26//24 to ensure front door lock is replaced to allow it to be opened from the inside.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Based on observation and interview, the licensee did not comply with the section cited above in 6 out of 6 residents (R1-R6) which poses an immediate safety or personal rights risk to persons in care. This is an amended version of the original report delivered on 11/25/2026.

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Arian Golbakhsh and Amy Rodgers conducted an unannounced Case Management visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Co-Administrator Jenny Sequeira. LPA briefly toured the facility, performed a health and safety welfare check. There are six (6) residents at the facility at this time. LPAs Rodgers and Golbakhsh spoke with staff. No deficiencies were observed or cited on this date. An exit interview was conducted with Co-Administrator Sequeira to whom a copy of this report was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Mar 11, 2025

Allegation investigated: Facility staff restrain residents to their wheelchairs

During a Regional Office Meeting, Licensing Program Manager (LPM) Robyn ClarkLicensing Program Analyst (LPA) Sabel Martinez delivered a revised Substantiated Complaint report. The LPA discussed this with Administrator Gaurav Rathi. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of records review, interviews with facility staff, residents and outside sources which included medical professionals and family members. It was reported to CCL that facility staff restrain residents to their wheelchairs. It was specifically reported that a witness observed a staff member place a belt around a Resident (R1) and their wheelchair which restricted their ability to move. (See LIC 9099C for continuation of report.) Substantiated On 10/14/24 the Department visited the facility and observed R1, who was present watching TV. R1 was well groomed and not exhibiting any signs of distress or discomfort. LPA Ramirez made multiple attempts to speak with R1, however they were unable to effectively communicate with LPA. The Department was able to inspect R1’s records which revealed that there were no relevant diagnosis or medical need for the use of restraints or postural supports. Records also revealed contact information for R1’s family member and responsible party (OS4). The Department attempted to contact OS4 several times however voicemails were not returned. On 10/14/2024, LPA toured the facility which included an inspection of wheelchairs, bedrooms, and common areas. There was no evidence of restraints, however one beige gait belt was observed sitting on the seat of a wheelchair in the living room, loose and unattached. Shortly after, LPA observed a staff member use the belt to assist a Resident (R3) in transferring from the couch to their wheelchair, and then to their room. At no point during the transfer was the belt fastened or secured to R3 or their wheelchair. LPA later inspected R3’s room, where a medical professional (OS6) was inside tending to R3. OS6 reported that they visited the facility frequently and never observed the use of restraints, or did they observe improper use of Gait belts, which they reported are commonly used in care facilities to safely assist Residents who need help with mobility and transfers. Of the four remaining Residents (R2, R3, R4, R5), LPA was only able to successfully communicate with R2, who used body gestures and limited language to respond. According to R2, no Residents had straps or belts on them when seated in wheelchairs. Additionally, LPA spoke to the facility administrator and one staff member (S1, S2), and both denied the allegation. On 11/18/24, LPA conducted additional interviews with outside sources (OS1, OS2). OS1 was a responsible party for a resident. OS1 stated that they were present in the facility several times during the period of the allegation, had no concerns and denied ever witnessing residents strapped to wheelchairs at the facility. OS2 was a family member of an additional Resident and stated that they were present in the facility weekly during the time of the allegation. According to OS2, residents had never been strapped to their wheelchair and they had no concerns about care & supervision. (See LIC 9099C for continuation of report.) While two staff members (S1, S2), one resident (R2), two family members (OS1, OS2) and one medical professional (OS6) denied the allegation, an outside source (OS5) was able to corroborate the allegation on 11/18/24 by providing photographic evidence. Photographic evidence showed R1 seated in a wheelchair with a belt strapped across their abdomen and around their wheelchair seat. The belt was identical to the belt previously observed by the LPA in the facility on 10/14/24. In the photo, the belt was latched behind the wheelchair and out of reach of R1, which prevented them from releasing the clasp. On 12/6/24, LPA visited the facility and confirmed the person in photograph’s provided by OS5, was R1. LPA asked permission to take resident/victim’s photo, after which the resident nodded their head yes in approval. LPA inspected the environment and further noted that flooring and walls from photographs provided by OS5, matched those of facility. A further review of the facility file confirmed that there were no documented exceptions on file for the use of postural supports, which when approved, may only be fastened or tied in a manner that permits quick release by the resident. The departments review of the available evidence revealed that the preponderance of evidence standard was met and the allegation was SUBSTANTIATED. A deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of corrections was developed with Administrator. An exit interview was conducted with Administrator to whom a copy of this report and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 22, 2025 · control 08-AS-20241007104853

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Jan 22, 2025

87468.2 (a)(8) – Additional Personal Rights of Residents in Privately Operated Facilities 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(8) In addition… residents… shall… be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse This requirement was not met as evidenced by: Based on observations, records review and interviews, a postural support was used to restrain a resident (R1) to their wheelchair. This posed a potential personal rights and safety risk to 1 of 6 residents in care.the state’s words, verbatim · CDSS document, Jan 22, 2025

Plan of correction: Administrator agreed to obtain outside source training for all staff on personal rights and submit proof of training by 2/22/25.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management Visit to correct/amend a report. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Abhinav Singh. During today's visit, LPA amended one (1) prior-delivered LIC9099-D Complaint Investigation Report. LPA discussed the changes that were made with Licensee. Licensee was advised to remove any copies of these prior reports they have, substituting/replacing them with the amended reports. No deficiencies were observed or cited during today’s visit. An exit interview was conducted with Singh, to whom a copy of the amended report, this visit report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 13, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to Licensee Gaurav Rathi and Administrator Abhinav Singh. The facility fire clearance was granted on 08/6/2024 and reflected that the facility was approved for 6 non-ambulatory residents aged 60 and above. One of which can be bedridden. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter. The submitted facility sketch was consistent with the current layout of the facility. LPA Rodgers toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. During today’s visit, LPA, accompanied by Licensee Gaurav Rathi and Administrator Abhinav Singh, checked Hot water temperature at taps accessible to residents were also compliant: Bathroom #1 sink was 110 F, Bathroom #2 sink was 110.0 F The facility’s ambient internal temperature was complaint at 75 degrees.. The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records. (CONTINUED ON LIC 809-C, NEXT PAGE) (CONTINUED FROM LIC 809) There is a pool at the facility, made inaccessible to residents.There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per Licensee Gaurav Rathi and Administrator Abhinav Singh no firearms or ammunition are or will be stored at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguisher(s) were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection. LPA also reviewed the Component III Training with Rathi and Singh on 08/23/24. They were advised that the facility’s application is pending management final review and approval. An exit interview was conducted with Licensee Gaurav Rathi, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 23, 2024

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: GAURAV RATHI Interview Method: Telephone interview On August 15, 2024, 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, Aug 15, 2024