El Descanso Retirement Home

Allegation investigated: Staff took videos of residents without consent Staff did not intervene when outside vendor took videos and pictures of residents without consent

***This licensing report supersedes the report delivered on 08/20/2026, the reason for the superseded report is to clarify information listed on the initial report. The findings will remain unsubstantiated. *** On today’s visit LPA Vaid met with Administrator Clemencia Bousheri and discussed purpose of visit. LPA Vaid and Bousheri toured the facility and did not observe any health and safety concerns. On 08/20/26, Licensing Program Analyst (LPA) Vaid conducted a subsequential visit for the above-mentioned allegations and was allowed entry by Caregiver, Norma Salazar. Facility Manager, Escarling Godoy, arrived shortly after, and the reason for the visit was discussed. LPA obtained staff and residents' rosters. LPA Vaid and Manager Godoy toured the facility and did not observe any health and safety concerns. Administrator Bousheri arrived shortly after. On 05/26/2026, LPA Vaid conducted initial visit and obtained the following documents: staff roster, resident roster, Resident #1 (R1) Face-Sheet, Admissions Agreement, photo release and confidentiality agreement. Interviewed staff, residents and witnesses. Continued on 9099C........ Unsubstantiated ***This licensing report supersedes the report delivered on 08/20/2026, the reason for the superseded report is to clarify information listed on the initial report. The findings will remain unsubstantiated. *** Regarding the allegation: Staff took videos of residents without consent. It is alleged that the staff took videos of residents without their consent. Interviews with three (3) of three (3) staff deny the allegation, staff state that the facility does not consent to the residents or resident's representatives use of recording equipment in the facility, the only exception is when informed consent and full knowledge is applied. Residents' Representatives can utilize the facility patio areas for private parties. In November of 2025, R1’s family held a party for R1 in the facility’s patio area. R1’s family hired the Entertainer/Videographer (EV) for R1's party and the EV also recorded the event using video/audio. In the video recordings, the individuals identified by staff and witnesses are not facility residents, and were identified as R1's family members who agreed to be video recorded and agreed to participate with holding the recording device. The investigation revealed that the facility staff did not take photos/videos of R1 or any facility residents. Additionally, the facility staff did not hire the entertainer for R1’s party. Interviews with R1’s family members acknowledge that R1’s family hired the entertainer, however, R1’s family members were not aware of the content of the videos posted on social media. Fifteen (15) of fifteen (15) residents interviewed could not corroborate the allegation, residents stated they were not aware of staff video recording residents without consent. Based on interviews with residents, staff and witnesses, review of videos and pictures, 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. Regarding the allegation: Staff did not intervene when an outside vendor took videos and pictures of residents without consent. It is alleged that the facility staff did not prevent an outside vendor from taking pictures and videos of residents without their consent and posting the videos on social media. Three (3) of three (3) staff deny the allegation, according to interviews with staff #1 (S1), the entertainment company was not hired by the facility. S1 reported the entertainment company was hired by R1’s family and R1’s family sought facility permission to hold the party in the patio area of the facility. According to R1’s family members, all the individuals shown in the videos were R1 and R1’s family members, and no residents or staff were shown in the videos. R1’s family members stated having hired the entertainer for R1’s party and R1s family members were not aware of the content posted on social media. Fifteen (15) of fifteen (15) residents interviewed could not corroborate the allegation, residents stated they were not aware of an outside vendor video recording residents without consent. Therefore, the investigation revealed that staff did not hire the outside vendor and staff did not organize or participate in R1’s party. Based on interviews with residents, staff and witnesses, review of videos and pictures, 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. An exit interview was conducted and copy of this report was provided to Administrator Clemencia Bousheri.the state’s words, verbatim · CDSS document, Aug 25, 2026 · control 28-AS-20260518121219

Allegation investigated: Staff took videos of residents without consent Staff did not intervene when outside vendor took videos and pictures of residents without consent

Licensing Program Analyst (LPA) Vaid conducted a subsequential visit for the above-mentioned allegations and was allowed entry by Caregiver, Norma Salazar. Facility manager, Escarling Godoy arrived shortly after, and the reason for the visit was discussed. Obtained staff and residents' rosters. LPA Vaid and Manager Godoy toured the facility and did not observe any health and safety concerns. On 05/26/2026, LPA Vaid conducted initial visit and requested, obtained and reviewed the following documents: staff roster, resident roster, R1-face-sheet, admissions agreement, photo release and confidentiality agreement. Interviewed staff, residents and witnesses. Regarding the allegation: Staff took videos of residents without consent. It is alleged that the staff took videos of residents without their consent. Three of three staff deny this, facility does not consent to the residents or resident's representatives use of recording equipment in the facility, the only exception is when informed consent and full knowledge is applied, residents' representatives can utilize the facility patio areas to record private parties. CONTINUED ON 9099C....... Unsubstantiated In November of 2025, R1's family held a party for R1 and hired Entertainer/Videographer Polly Wolly for R1's birthday celebration and to video record the event. In the video recordings, the people identified by staff and witnesses are not residents of the facility, they are R1's family members who agreed to be video recorded and participated with holding the recording device. The facility staff did not take videos of R1. The facility staff did not hire the entertainer, the family of R1 hired the videographer. Fifteen of fifteen residents interviewed could not corroborate this, residents are not aware of this incident happening. W2 family of R1 acknowledge hiring the entertainer but were not aware of the content of the videos posted. Based on records reviewed and interviews conducted, 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. Regarding the allegation: Staff did not intervene when outside vendor took videos and pictures of residents without consent. It is alleged that the facility staff did not stop outsider vendor from taking pictures and videos of the residents without their consent. Three of three staff deny this, according to S1 the entertainment company was not hired by the facility. The entertainment company was hired by R1’s family and R1’s family sought facility permission to hold the party in the patio area of the facility. According to W2 and W3, all the people shown in the videos were R1 and R1’s family and no other resident or staff. W2 stated having hired the entertainer for R1’s birthday party and was not aware of the content posted on internet platforms. Therefore, the facility staff are not responsible for video and pictures taken of R1 and R1’s family by an outside vendor approved by R1 and their family. Therefore, based on interviews, review of videos and pictures with staff and witnesses, 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. An exit interview was conducted and copy of this report was provided to Administrator Clemencia Bousheri.the state’s words, verbatim · CDSS document, Aug 20, 2026 · control 28-AS-20260518121219

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual visit to the facility. LPA met with Andrea Mazariego,caregiver and explained the reason for the visit. Administrator Clemencia Bousheri was notified and arrived at the facility shortly after. The facility is licensed to serve fifteen (15) non-ambulatory residents, ages 60 and above, and had six (6) Hospice Waiver approved. Current census is 15 residents, and 4 hospice residents. LPA reviewed the following CARE inspection tool domains during this visit: 1.Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation were observed during the visit. There is a responsible person and emergency training was provided for staff. Personal protective equipment was observed. 2.Operational Requirements: Facility maintains a plan of operation. Facility is operating within the license. Facility has current liability insurance, expiration 03/26/2027. 3.Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Andrea Mazariego and observed the following: Facility is a single home located in a residential neighborhood. The home consists of a lobby area/ office, a kitchen, a family room, a dining room, 10 resident rooms (5 private and 5 shared rooms), 5 resident bathrooms, 1 staff bathroom, a laundry area, a front porch, a back yard consisting of the patio and garden. Facility was observed in good repair indoors and outdoors. All common areas are clean, and provide sufficient sitting area, and lighting. Kitchen area is clean; sharps were observed locked in a box. Medications were observed locked in the office. Cleaning supplies were observed to be inaccessible to residents in the laundry room. Laundry area was observed in good repair. LPA observed 6 random resident rooms, each in good repair, with all bedding supplies, and sufficient lighting. Five bathrooms were observed all in good repair, with grab bars, and non-slip shower floors. (CONTINUED ON LIC 809C) Water temperature was tested in the resident bathrooms between 107.2 to 112.8 degrees F., which is within the required temperature. Carbon Monoxide/Smoke detectors were tested and are in working condition. Fire extinguishers were observed and last checked on 09/23/2025. The backyard has a shaded covered area. 4.Staffing: Staff have current CPR/First Aid training on file. Night staff have been provided with emergency training. Sufficient staff were observed. 5.Personnel Records/Staff Training: Administrator certificate was observed for Clemencia Bousheri exp. date: 4/5/25. Renewal documents have been submitted to the department. All staff records were available for review. LPA reviewed a total of 5 staff files which included medical assessment, TB clearance, background clearance, and initial and yearly training. 6.Resident Rights/Information: Personal Rights, Let Us No, and Local Ombudsman posters were observed throughout the home. 7.Planned Activities: Activity materials were observed. Outdoor area has a seating area and activity supplies to promote outdoor activities. 8.Food Service: Sufficient food supplies were observed for perishables for at least 2 days and 7-days non-perishables. There are residents with special diets, and staff prepare meals accordingly. No pests were observed within the interior and exterior of the facility building. 9.Incidental Medical and Dental: Medications are centrally stored in the office. Medications are labeled and in their original containers. LPA reviewed medication for 6 residents. 10.Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 6 resident files which contained medical assessment, TB clearance, admission agreement, appraisal, needs and care plan. 11.Disaster Preparedness: Emergency Disaster plan (LIC 610E) was last reviewed on 01/01/2026 and an emergency disaster plan was reviewed. Emergency drills are conducted monthly, last drill was on 03/05/26. 12.Residents with Special Health Needs: There are no residents with restricted health conditions under care. Facility follows dementia regulations. Medical assessments for residents with dementia were observed within the last 12 months. Auditory devices were observed at each exit door. Facility currently has four residents on hospice and keeps hospice plan on file. No deficiency were observed on todays’ visit. Exit interview was conducted with Administrator and a copy of this licensing report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2026

Allegation investigated: Facility is operating beyond the limits of the licensed capacity Facility is operating with insufficient staffing

Licensing Program Analyst (LPA) Vaid conducted an initial visit and was met by facility manager-Escarling Godoyvega, LPA Vaid and manager Godoyvega toured the facility and did not observe any health and safety concerns. Administrator Clemencia Bousheri was notified and arrived shortly after, and the reason for the visit was discussed. LPA Vaid collect the following document: Staff roster dated 02/05/2026 and resident roster dated 02/10/2026. LPA took head count of residents in care, LPA Vaid counted number of beds in the facility. LPA interviewed residents and staff. Regarding the allegation: Facility is operating beyond the limits of the licensed capacity. It is alleged that the El Descanso Retirement Home is operating beyond its’ 15 persons’ capacity by allowing more residents into the facility than the capacity allows. CONTINUED ON 9099C............ Unsubstantiated Six of six staff deny this allegation, the facility capacity is fifteen residents, and (15) residents currently reside in the facility. Five of five residents could not corroborate this allegation; residents’ do not know the business operations of the facility. Residents stated not knowing the number of residents in care and that the is staff adequately able to provide assistance to all the residents with their physical needs. Based on LPA observations; residents physical count and number of beds, record review and interviews. 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. Regarding the allegation: Facility is operating with insufficient staffing. It is alleged that the facility is improperly staffed, particularly during the evening and the nighttime. Six of six staff deny this allegation, according to the staff roster facility has sufficient staff to assist residents and to meet the residents needs and services. Four to five (4-5) staff are scheduled in the AM shift: 5AM- 1PM, four (4) staff are scheduled for PM shift 1pm to 9PM and one (1) staff during NOC shift (9pm- 5am). According to Administrator staff will work past regular scheduled shifts to assist with residents when required. Four of five residents stated the facility has adequate staff and residents are assisted with their daily needs and services. One of five residents stated facility could hire more staff, but is happy with the current staff persons. Based on LPA observations of residents’ rooms and residents’ bedding, and records review. 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. A copy of this investigation complaint report was provided to Administrator Clememcia Bousheri.the state’s words, verbatim · CDSS document, Mar 23, 2026 · control 28-AS-20260317095152

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Escarling Godoy Manager and explained the reason for the visit. The facility is licensed to serve fifteen (15) non-ambulatory residents, ages 60 and above, and had six (6) Hospice Waiver approved. Facility is a single home located in a residential neighborhood. It consist of a lobby area, office, a kitchen, a family room, a dining room, 10 resident rooms, 5 resident bathrooms, 1 staff bathroom, a garage, a laundry area, a front porch, a back yard. LPA reviewed the following CARE inspection tool domains during this visit: Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Escarling Godoy and observed the following: Facility was observed in good repair indoors and outdoors. All common areas are clean, and providing sufficient sitting area, and lighting. Kitchen area is clean, sharps were observed locked in a box. Medications were observed locked in the office. Cleaning supplies were observed inaccessible to residents in the garage. Laundry area was observed in good repair. LPA observed 5 random resident rooms, each in good repair, with all bedding supplies, and sufficient lighting. Five bathrooms were observed all in good repair, with grab bars, and non-slip shower floors. (CONTINUED ON LIC 809C) Water temperature was tested in the resident bathrooms between 115.5 - 127.5 degrees F., which is not within 105-120 degrees F. Carbon Monoxide/Smoke detectors were tested and are in working condition. Fire extinguishers were observed and last checked on 9/25/24. The backyard has a cover shaded area. Staffing: Administrator Clemencia Bousheri arrived at the facility shortly after. Staff have current CPR/First Aid training on file. Night staff have been provided emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate was observed for Clemencia Bousheri #6004291740 exp. date: 4/5/25. Renewal documents have been submitted to the department. All staff records were available for review. LPA reviewed a total of 5 staff files which included medical assessment, TB clearance, background clearance, and initial and yearly training. Resident Rights/Information: Personal Rights, Let Us No poster (PUB 345), and Local Ombudsman posters were observed throughout the home. Planned Activities: Activity materials were observed. Outdoor area has a seating area and activity supplies to promote outdoor activities. Food Service: Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. There are residents with special diets, staff prepare meals accordingly. No pest was observed. Incidental Medical and Dental: There is an area designated to centrally stored medication in the office. Medications are label and in their original containers. LPA reviewed medication for 5 residents. Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 5 resident files which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610E 10/03) was last reviewed on 1/1/25 and an emergency disaster plan was reviewed. Last Emergency drill was conducted on 3/125 and they conduct monthly emergency drills. Residents with Special Health Needs: There are no residents with restricted health conditions under care. Facility is following dementia regulations. Medical assessments for residents with dementia were observed within the last 12 months. Auditory devices were observed in each exit door. Facility currently has three residents on hospice and keeps hospice plan on file. LPA interviewed 3 residents and 3 staff. Deficiency was noted per Title 22 Regulations. Exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with staff#1, who assisted with the visit. Facility capacity is fifteen (15) residents. The facility is licensed to serve fifteen (15) non-ambulatory residents, ages 60 and above, and had six (6) Hospice Waiver approved. Annual licensing fees are current. Administrator certificate is current with expiration date on 4/5/25. LPA discussed the purpose of today's visit with staff#1. During the visit, the inspection tool was used, staff and resident interviews were conducted, food supply/medications/ staff and residents records were reviewed,and physical plant was conducted. The facility is a single story home located in a residential neighborhood, consisted of ten (10) resident bedrooms, six (6) bathrooms, reception area, Administrative office, living room, dining room, kitchen, TV room, sitting room, music/garden room, linen closet, laundry room, garage utilized as storage room and an indoor/outdoor activity area. Medications were centrally stored, locked and inaccessible to residents in care. All the rooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Hot water temperature was measured at 114.0 degrees Fahrenheit which was within Title 22 Regulation guidelines. Sufficient of linen supplies and personal hygiene supplies were observed. Auditory device alarms were operational. Last fire drill was conducted on 4/4/24. Sufficient supply of perishable and non-perishable foods was observed. Smoke detectors and carbon monoxide detectors were tested and operable. Side and front yards are well maintained and free of debris. A shaded outdoor area with ample seating was observed. No bodies of water observed. No deficiency was cited per California Code of Regulations, Title 22. An exit was conducted. This report was discussed and provided to staff#1.the state’s words, verbatim · CDSS document, Apr 23, 2024

Allegation investigated: Staff sexually assaulted resident while in care. Staff inappropriately handled resident while in care.

Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced visit to continue the investigation and deliver the complaint finding of the allegations at the facility today. LPA explained the purpose of today's visit to Alberto Galvan, administrator assistant, who assisted with this visit. On 09/29/22, LPA Tao conducted the initial unannounced investigation at the facility. LPA met with Clemencia Bousheri, Administrator during the visit. LPA conducted a Health and Safety check at the facility and obtained resident#1’ records. On 10/13/22, a subsequent visit was conducted by Investigator Brian Slatic for an investigation. Investigator interviewed administrator, resident#1 (R1), resident#1’s responsible party, and Ombudsman. IB reviewed R1’s facility file and related documentation. (- continued in LIC 9099 C-) Unsubstantiated In regard of allegation of staff sexually assaulted resident while in care, it was alleged that facility staff put their finger in R1’s vagina while they bathed R1 at the facility. The investigation revealed the following. On 10/13/22, IB investigator conducted interviews with R1, R1’s responsible party, administrator, staff, and ombudsman. Per resident interview, it revealed the R1 was inconsistence with resident’s statements and the allegation. Thus, the resident could not corroborate the allegation. Per the interviews of staff and responsible party, all of them denied the allegation. Per record review, R1 had a history of not aligning R1’s understanding with the reality and misunderstanding of what was happening to the resident. On today’s visit, LPA Tao interviewed staff from staff#2 (S2) to staff#4 (S4). All staff denied the allegation. Per resident interviews from resident #2 (R2) to resident#4 (R4), all residents could not corroborate the allegation. Thus, there was not preponderance of evidence to prove staff sexually assaulted resident while in care. In regard of allegation of staff inappropriately handled resident while in care, it was alleged that staff grabbed, pushed and hit the resident a few times over the past few months. The investigation revealed the following. The department conducted investigation visits on 10/13/22 and 1/19/24 (today). Per resident interviews, four (4) out of four (4) residents interviewed could not corroborate the allegation. It revealed staff did not mishandle residents while providing care. Per the interviews of staff, ombudsman and responsible party, all six (6) of them denied the allegation. Per record review, R1 had a history of not aligning R1's understanding with the reality and misunderstanding of what was happening to the resident. Per staff interviews, all staff denied the allegation. Per resident interviews from resident #2 (R2) to resident#4 (R4). All residents interviewed could not corroborate the allegation. Per record review, R1 had a history of having R1’s own interpretation of incidents but not aligned with the reality. Thus, there was not preponderance of evidence to prove staff inappropriately handled resident while in care. Although the allegations may have happened or is valid, there’s not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted with Alberto Galvan, administrator assistant. Findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Jan 19, 2024 · control 28-AS-20220928154009

Allegation investigated: Resident sustained an injury due to staff neglect.

Licensing Program Analyst (LPA) Tao conducted an initial unannounced investigation regarding the above-mentioned allegations at the facility today. LPA explained the purpose of today's visit to Alberto Galvan, administrator assistant, who assisted with this visit. Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of resident from resident#1 (R1) through resident#4 (R4); reviewed resident#1’s record reviews, and a facility tour. LPA obtained copies of the staff /resident rosters and R1’s resident records with relevant information. In regard of the allegation resident sustained an injury due to staff neglect, it was alleged that a resident had a bruise on resident’s right eye. The investigation revealed the following: Per resident interviews, all residents from R1 to R4 could not corroborate the allegation. (-continued in LIC 9099 C-) Unsubstantiated Residents’ interviews revealed that staff provided appropriate care to residents. Per staff interviews, all four (4) staff, including the administrator, denied the allegation. File review revealed resident#1 (R1) got agitated in R1's room trying to get up. R1 fell on the floor as a result. As soon as the administrator aware of the incident, administrator checked on R1 and observed R1’s bruise on R1’s right eye. Administrator took immediate action to notify R1’s responsible party and R1’s physician. Administrator conducted an internal investigation on this incident. It was a single incident which resident fell and got bruise on the resident's eye. Ice pack immediately applied to the resident. Per R1’s physician visit, it stated R1’s bruise was all gone and no medical concern after the fall. An in-service training on resident’s fall risk was provided to staff. Per LPA's observation, R1 was doing fine and bruise was all gone. Therefore, the resident was injured due to staff neglect was not observed. Although the allegation may have happened or is valid, there’s not preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with Alberto Galvan, administrator assistant. Findings were discussed. A copy this report was provided at the time of visit.the state’s words, verbatim · CDSS document, Jan 19, 2024 · control 28-AS-20240118114620