Emerald Court

Allegation investigated: Facility is understaffed Staff does not have the proper training.

On 06/20/2026, Licensing Program Analyst (LPA) Arielle Pascua delivered complaint findings via email. Current census was 230. It was alleged that the facility was understaffed and did not have proper training. LPA Pascua attempted to contact former staff and residents to obtain additional information however all staff and residents were not available for interview or have not been present at the facility since 2023. In addition, a review of facility records did not indicate that the facility was understaffed or did not proper training. Based on the information gathered, the LPA could not corroborate that the facility was understaffed or did not have proper training. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interview, a copy of this report will be mailed to the facility licensee address as well as via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 20, 2026 · control 22-AS-20230515104727

Allegation investigated: Staff did not properly address resident's multiple falls at facility. Staff does not put resident’s meal in reaching distance for resident. Staff left resident in soiled diapers.

On 06/20/2026, Licensing Program Analyst (LPA) Arielle Pascua delivered complaint findings via email. Current census was 230. It was alleged that the facility staff did not properly address resident's multiple falls, did not put resident's meal in distance of the resident, and left them in soiled diapers. LPA Pascua attempted to contact former staff and residents to obtain additional information however all staff and residents were not available for interview or have not been present at the facility since 2024. In addition, a review of facility records did not indicate that the facility was understaffed or did not proper training. Based on the information gathered, the LPA could not corroborate the allegations. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interview, a copy of this report will be mailed to the facility licensee address as well as via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 20, 2026 · control 22-AS-20240523150728

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility. Upon arrival, LPA was greeted by Ruby Vasquez, Assisted Living Director, who granted entry. LPA explained the purpose of the visit. The purpose of today’s visit was to follow up on an incident report received by the Department on May 11, 2026, regarding the death of Resident 1 (R1). According to the death report received, R1 passed away on May 6, 2026, in her room at the facility. The report indicated that a housekeeper found R1 lying in bed and not moving. Facility staff initiated CPR and called 911. Upon arrival, paramedics assessed R1 and determined that R1 had expired. During the visit, LPA contacted the Coroner’s Office, who advised that R1 passed away from natural causes. LPA also toured the interior and exterior of the facility and reviewed R1’s facility file. LPA did not observe any immediate health and safety concerns during today’s visit. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on a death report received by the department on 04/10/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. Death report dated 04/09/2026 indicated care staff had conducted a safety check on Resident 1 (R1) and the resident was observed unresponsive. CPR was initiated by staff while waiting for paramedics to respond. Once paramedics responded, the resident was pronounced deceased at 4:47 AM. Facility noted case #1132 and 26-011632. Per facility notes, R1 was last checked by staff at 2:00 AM. Per physician report dated 02/03/2026, R1 is diagnosed with Parkinson's Disease. Per incident reports submitted to the department, R1 was observed with a loss of consciousness on 04/06/2026 but refused transport to hospital. On 04/07/2026, R1 was transported to hospital for dizziness. Facility indicated resident had an un-witnessed fall but R1 denied hitting their head. R1 left the hospital "Against medical advice" and was returned to the facility by a friend. The resident was referred for hospice care on 04/08/2026 but passed before admitted to hospice care. LPA toured the facility during the visit and observed the following: Facility is a three story building and appears clean, safe and sanitary. LPA observed residents dining in the dining room and walking about the facility. Residents appeared clean and well taken care of. LPA observed ample emergency food and water. LPA observed no health or safety concerns during the visit. Facility to forward death certificate once receipt. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 16, 2026

Allegation investigated: Staff interfered with resident's visits

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on January 18, 2024. LPA was greeted and granted entry into the facility and met with Hospitality Services Director Kelsey Repik Chavez. LPA explained the reason for the visit. This Department has investigated the complaint alleging that staff interfered with resident's visits. Regarding the allegation the following was revealed: During the course of the interviews with individuals seven of nine individuals interviewed denied the allegation. During the course of the investigation LPA reviewed documents including the Emerald Court Admission Agreement dated October 29, 2021, for Resident 1 (R1). Per Admission Agreement under Guest Visits and Communication it states your guests are welcome to visit, provide they respect the rights of other residents and staff and abide by our visitor and guest policies. During the course of the interviews with witnesses, Witness 1 (W1) reported that facility denied him to visit his mother in her bedroom and stated that when visiting her mother that they would meet in the common area or dining room. CONTINUED ON LIC9099-C Unsubstantiated During the course of the interviews with residents, R2 reported that staff have never interfere when he has visitors. R3 stated that her family visits often and reported that she has never had issues with visitations. Per R4, staff do not interfere with visits and stated that he has not had visitations denied. R5 stated that staff do not interfere with visitations. Per R6, visitors have never been denied entrance to see her and reported that staff do not interfere with visitations. During the course of the interviews with staff, Staff 2 (S2) reported that staff did no interfere with the resident visits. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with facility representative, and a copy of this report was provided to the facility. R6 stated that the facility provided her daughter with a copy of her Admission Agreement. During the course of the interviews with staff, S1 reported that R1's son was notified that he was not the Responsible Party (RP) for R1; therefore, he could not get a copy of the Admission Agreement. S2 stated that R1's son was not provided with a copy of R1's Admission Agreement because R1 is self responsible. Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. LPA Ramirez conducted an exit interview with facility representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 19, 2025 · control 22-AS-20240118165523

Allegation investigated: Staff did not ensure that resident was adequately fed Resident was not provided services in the resident's Admission Agreement Staff provided resident with THC

On October 27, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings for the allegations listed above. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Executive Director (ED) Dillon Cagulada was present and assisted on today's visit. Regarding the allegation that, staff did not ensure that resident was adequately fed, the following has been concluded: It was alleged that Resident #1 (R1) was not fed at times. The Department reviewed R1's Physician's Report dated, April 4, 2021. which stated that R1 was able to feed herself. The Department also reviewed R1's Care Plan dated July 12, 2021, which stated that two meals would be delivered to R1's apartment daily due to her physical limitations. The Deparment was unable to interview R1 for this complaint. The Department conducted eight staff interviews. Eight out of eight staff interviewed denied the allegation and confirmed that R1 always received food to her apartment. The Department also conducted six resident interviews. CONTINUED ON LIC9099-C Unsubstantiated Six out of six residents interviewed denied any issues with accessing food. The residents interviewed also expressed that they were satisfied with the quality, the portions, and the variety of food provided to them. Regarding the allegation that, resident was not provided services in the resident's Admission Agreement, the following has been concluded: It was alleged that R1 paid extra to have caregiver support four times per week which has not been provided. The Department reviewed R1's Admission Agreement dated April 12, 2021. Per R1's Admission Agreement, R1 required, and agreed to pay for a level three care which remained the same until she moved out of the facility on September 30, 2025. The Department reviewed R1's Care Plan dated July 12, 2021. Per R1's Care Plan, R1 received assistance in bathing twice a week, assistance with transferring, assistance with toileting, assistance with escorts as needed, and received housekeeping services on a daily basis. The Department was unable to interview R1 for this complaint. The Department conducted eight staff interviews. Eight out of the eight staff interviewed confirmed that R1 was receiving the services agreed upon and that R1 was receiving appropriate care. The Department also interviewed six residents. Six out of the six residents interviewed confirmed that they are receiving the services and level of care they agreed upon with the facility. The residents interviewed also expressed that they all enjoy living at the facility and that the staffing is appropriate. Regarding the allegation that, staff provided resident with THC, the following has been concluded: It was alleged that a unknown staff provided R1 with THC gummies. The Department reviewed R1's list of prescribed medications dated September 28, 2025. The Department confirmed that THC gummies were not a medication that was prescribed to R1. The Department conducted six resident interviews. Six out of six resident interviews denied staff ever trying to provide them with THC gummies, or any medication that was not prescribed to them. The Department also conducted eight staff interviews. Eight out of the eight staff interview denied observing or witnessing a staff trying to provide THC gummies to R1, or any other residents'. The staff interviewed also stated that providing unprescribed medications to residents would be against the facility's policy. Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the three allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Dillon Cagulada and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 27, 2025 · control 22-AS-20211123123942

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to conduct the required annual inspection. Upon arrival, LPA was greeted and granted entry by staff and subsequently met with Executive Director Dillon Cagulada, who accompanied LPA throughout the inspection. LPA explained the purpose of the visit. The facility consists of two separate buildings. The main building, known as Emerald, is a three-story structure that houses the administrative offices. The second building, called Sapphire, is a two-story structure. The memory care unit is located on the first floor, and LPA observed that the delayed egress exit doors were functional and in compliance with safety requirements. The facility maintained at least a two-day supply of perishable food and a seven-day supply of non-perishable food. Emergency food and water supplies were observed stored in a closet adjacent to the kitchen. LPA and the Executive Director toured Building 1. All stairwells were equipped with emergency evacuation chairs. Hallways and stairwells were free from obstacles and tripping hazards. Medications were observed to be stored securely within the medication room inside locked medication carts. All fire extinguishers were fully charged and had a last inspection date of July 2025. In Building 2, LPA observed that hallways and stairwells were also free of obstacles or hazards, and emergency evacuation chairs were available in the stairwells. All residents’ rooms were equipped with required furnishings and safety components. LPA measured the hot water temperature at 117 degrees Fahrenheit, which is within the regulatory range. LPA toured the exterior of the facility and observed that no bodies of water were present. Outdoor pathways and common areas were free of hazards or obstructions. The smoke detectors and fire alarm system were tested in November 2025 by a third-party company, Cal Building System. The report provided by Cal Building System indicated no discrepancies or issues with the system’s operation.Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. An exit interview with conducted and a copy of this report was provided tthe state’s words, verbatim · CDSS document, Oct 21, 2025

Type of visit: Case Management - Other

LPA Samer Haddadin conducted a case management visit on this date in response to a Special Incident Report (SIR) received on September 27, 2025. Upon arrival, LPA was greeted by Administrator Dillon Cagulada, who granted entry. The purpose of the visit was explained. The report indicated that Resident 1 (R1) experienced a change of condition and was transferred to the hospital. LPA reviewed R1’s physician’s report and hospital discharge paperwork. Documentation confirmed that the facility did not neglect R1 and that medical services were provided on the same day the change of condition occurred. Based on the information obtained, no deficiencies are being cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to complete a case management visit. Upon arrival, LPA was met by Executive Director (ED) and was granted entry into the facility. LPA explained the purpose of the visit. On September 25, 2025, Community Care Licensing received an incident report from the facility regarding a concern that staff member (S1) overheard another staff member (S2) state, “we need to force her to bed,” in reference to a resident (R1). The facility’s Human Resources department conducted an internal investigation and determined that no abuse occurred. The incident was attributed to a language barrier between two staff members. During today’s visit, LPA conducted an interview with R1. R1 denied the allegations, and LPA did not observe any signs of physical abuse or negligence. Facility staff interviews and observations further supported that no abuse had taken place. Based on the information obtained during this visit, no deficiencies are being cited at this time. An exit interview was conducted, and a copy of this report was provided to the Executive Director.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: Facility staff did not respond to resident in a timely manner

On May 25, 2025, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint visit to present findings regarding the reported allegation cited above. Upon arrival, LPA Haddadin was greeted by Service Manager Kelsy Chavez, who granted access to the facility. Executive Director Dillon Cagulada later joined the visit. During the investigation, LPA Haddadin toured the facility, interviewed one resident and four staff members, and reviewed all relevant facility records pertaining to pendent device activations. The allegation under review was that “Facility staff did not respond to resident in a timely manner- pendent call.” (The pendent is a device that residents wear and press when they require assistance.) Four staff interviews and four residents interviews were conducted. Per staff interviews, all four employees confirmed that their response times intervals range from ten to twelve minutes and that they summon additional staff if a delay is anticipated. Four residents interviewed also indicated that staff respond to pendent calls but were unable to recall exact response times. ****CONTINUE*** Unsubstantiated Record review of the Device Activity Report for May 25, 2025, revealed that every pendent call that day was acknowledged in under ten minutes, with the longest recorded response time being ten minutes and the shortest six minutes. Therefore, based on the preponderance of evidence gathered through interviews, record review, and analysis of the facility’s response logs, the allegation that staff “did not respond to a resident’s pendent call in a timely manner” is UNSUBSTANTIATED. Although timely responses are essential to resident safety, the evidence does not support a finding that the facility failed to meet its standard of care. No deficiencies were cited during today’s visit. An exit interview was conducted with the Executive Director, and a copy of this report was provided to facility administration.the state’s words, verbatim · CDSS document, Jul 18, 2025 · control 22-AS-20250528130635

Allegation investigated: Food service is inadequate. Staff are not able to communicate with the residents. Staff are not trained.

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Executive Director Dillion Cagulada and explained the reason for the visit. The investigation into the allegation revealed the following. It was alleged that food is not properly prepared and served cold. No details were provided as to when the meals were served cold. LPA interviewed 7 residents who reported that they had no issues with the temperature of the food being served. LPA interviewed 5 staff members that reported that all food is served after it is prepared and is served hot. LPA interviewed the Dining Services Director that all food is prepared using normal restaurant practices and cooked safely in compliance with all applicable rules and regulations. It was reported that the facility did not fully cook the baked potatoes. 7 out of 7 residents interviewed reported the baked potatoes were fully cooked. 5 kitchen staff members reported that the baked potatoes are fully cooked for at least 45 minutes. LPA observed dinner service during the visit. LPA did not observe any deficiencies during the visit. Unsubstantiated There is no evidence to support the allegation, therefore the allegation is unsubstantiated. 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. The investigation into the allegation, staff are not able to communicate with the residents, revealed the following. It was alleged that facility kitchen staff and servers could not communicate with residents because of a language barrier. No details were provided. LPA interviewed 7 staff members who reported they have no issues communicating with residents. LPA interviewed 7 residents. 5 out of 7 residents reported they had no issues communicating with staff members. 2 out of 7 residents reported they have issues communicating with staff because of hearing impairment issues. There is no evidence to support the allegation, therefore the allegation is unsubstantiated. 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. The investigation into the allegation, staff are not trained, revealed the following. It was alleged that kitchen staff are not trained. California Code of Regulations (CCR) Tile 22, Division 6, 87411(c) states, "All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69.". Kitchen staff and servers do not assist residents with their activities of daily living. There is no regulatory requirement for Kitchen staff or servers to be trained. A review of facility records shows all kitchen staff and servers are trained in topics relevant to food preparation and safety. LPA reviewed 2 server training records, each server completed at least 10 hours of training after being hired. The Dining Services Director reported that all kitchen staff receive at least 10 hours of training when they are hired. Based on the evidence gathered the allegation is unsubstantiated. 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. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 22-AS-20211216130921

Allegation investigated: Facility kitchen equipment is broken. Facility staff does not keep facility free from pests.

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entering the facility. At the beginning of the visit, LPA Haley was led on a brief tour of the facility by Executive Director Dillon Cagulada. Regarding the complaint allegation: Facility kitchen equipment is broken. During the investigation, 6 of 10 individuals interviewed confirmed there are several pieces of equipment in the kitchen that are broken or are not properly working. During interviews, it was discovered the following items are broken or not properly working: a commercial toaster, multiple freezers, the steamer, two stove ovens, a flat top stove, griddle, soup warmer, plate warmer, and a food warmer. During the visit, areas of the kitchen were closely observed and items that needed repair or replacement were photographed. Continued on LIC9099C Substantiated According to Staff 1 (S1), after discovering kitchen equipment was not working at all or not properly working, a request was made to approve capital expenses. S1 also explained that another member of the management team has been trying to repair some of the equipment in the kitchen that’s broken or not properly working by having parts replaced/repaired. Regarding the complaint allegation: Facility staff does not keep facility free from pests. During the investigation, 4 of 10 individuals confirmed they have seen a bug in the facility. While walking around the kitchen to make observations, bugs were observed and photographed. A brown color bug was running across the commercial dishwasher, a couple black bug were observed crawling on the floor behind the kitchen area, and flies were observed in one of the dining rooms on some of the utensils and on some fruit that was nearby. Photos were taken and a video of some of the flies was captured. Based on the evidence gathered through interviews, and observations the preponderance of evidence standard has been met, therefore, the above allegations are SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20250625105327

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 8, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not being met as evidenced by: Equipment in the kitchen that is not working or not properly working were confirmed by multiple individuals and photos were taken. Further, a request was made to approve expenses that will be used to purchase new equipment or repair the existing equipment.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: Executive Director states, receipts, and invoices, will be provided for all kitchen equipment that needs repair or replacement by Tuesday, July 8, 2025. Executive Director will provide dates of delivery and installation of the new equipment. For equipment that need repairs, Executive Director will provide receipts for all repairs made for all kitchen equipment including: both ovens, steamer, flat top, griddle, commercial toaster, plate warmer, food warmer, soup warmer, and freezers.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Jul 8, 2025

87555 General Food Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by: During the visit, LPA Haley observed bugs on the ground in an area behind the kitchen, a bug crawling across the commercial dishwasher, and flies flying over some fruit and utensils in one of the dining rooms. Photos were taken and a video was captured.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: Executive Director states the regulation section will be reviewed. After reviewing the regulation section a statement of acknowledgement and understanding will be provide that includes a plan that will be implemented to prevent the presence of bugs and flies in the future.

Allegation investigated: Eating utensils and dishes are not properly cleaned and sanitized. Facility is serving food that is unsafe.

Regarding the complaint allegation: Eating utensils and dishes are not properly cleaned and sanitized. During the initial visit, interviews were conducted with 10 individuals including facility residents and staff. 0 of 10 of the individuals interviewed could provide any evidence to corroborate the allegations above. During the visit, LPA Haley walked around the kitchen several times accompanied by three different facility staff members to make observations. During the final walk around of the kitchen with one of the staff members, the commercial dishwasher was observed and photographed. The dishwasher was just finished being used, and a container full of clean utensils was sitting on the other end of the dishwasher where dishes come out after being cleaned. Photos were taken of the container full of clean utensils. Regarding the complaint allegation: Facility is serving food that is unsafe. Continued on LIC9099C Unfounded During the investigation, all the residents that were interviewed provided information that contradicts the complaint allegation. One of the residents gestured with the hands that the food was so so. When asked to explain, the resident said maybe because I’m vegetarian. Another resident stated they like the food but wishes there were more variety. The resident said they like Mexican food and listed several Mexican dishes they like to eat. The same resident talked about how they order additional items off the menu in case something doesn’t taste right or isn’t cooked right they can eat the other item they ordered. Further, during the facility walk through, breakfast and lunch was observed. The food looked and smelled appropriate and food and drinks were both being handled with care. Food that was prepared was covered in plastic and placed on a cart, and the drinks that were sitting on the table were covered with a tablecloth. Photos were taken. Based on the information gathered during through interview, and observation, and the following allegations: Eating utensils and dishes are not properly cleaned and sanitized, and Facility is serving food that is unsafe, are deemed Unfounded, meaning the allegations are false, could not have happened and/or are without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20250625105327

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to follow up on a death report received by the department on 06/20/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. Death report dated 06/18/2025 indicated that while Resident 1 (R1) was taking evening medications, the resident started to shake and became unresponsive. 911 was called and staff started CPR. Once the paramedics responded, resident death was called. Resident was a "Do not resuscitate." Resident had been hospitalized from 05/31-06/03/2025 for Acute Metabolic Encephalopathy. While hospitalized, R1's family had consulted regarding hospice care but requested to put off admission until a family trip was concluded. Per physician report dated 12/24/2024, R1 is diagnosed with Osteoporosis, Hypertension, Hypothyroidism and Osteoarthritis. Facility to forward a copy of the death certificate to LPA once obtained. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 25, 2025

Allegation investigated: Facility has foul smelling odor Staff not addressing residents needs

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. Executive Director Dillon Cagulada arrived during the visit. During the course of the visit, LPA toured the facility and interviewed residents and staff. Regarding the allegations that staff not addressing residents needs and facility has a foul smelling odor, the investigation revealed the following: Facility appears clean, safe and sanitary without any odors present. LPA toured Resident 1's (R1) room and observed it was clean and without odor. Six out of six residents interviewed stated facility is clean and odor free. R1 resides in independent living in the community and was receiving no assistance with activities of daily living and does not have a care plan in place. Resident was provided an eviction notice on 04/11/2025 for violation of admission agreement and violation of resident handbook for aggressive behaviors. Per facility documentation, R1 was put on a 5150 hold on 02/19/2025 resulting in a diagnosis of schizo-affective disorder. CONTINUED ON LIC 9099C DATED 04/30/2025 Unfounded Based on interviews conducted and records reviewed, the above allegations are deemed UNFOUNDED meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 22-AS-20250423090249

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff and later met with Assistant Executive Director (AED) Kathleen Panganiban and explained the reason for the visit. LPA, along with AED toured the facility and observed the following: Facility consists of two separate buildings: the main building with the administrative offices is called Emerald and has three stories, building 2 is called Sapphire and has 2 stories. Facility has a memory care unit which is in building 1 on the first floor. LPA tested the memory care in-room trigger alarm and it was operational with response time of .40 seconds. LPA observed the delayed egress exit doors are operational. LPA observed the kitchen was clean and organized, no mold or mildew seen. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand. LPA observed emergency food and water stored in a closet next to the kitchen. LPA and AED toured building 1. LPA observed all stairwells had emergency evacuation chairs. LPA observed all the hallways and stairwells were free of obstacles and or tripping hazards. LPA observed medications were kept secured in the med room inside of medication carts. LPA observed all fire extinguishers are fully charged with last inspection date of July 2024. LPA toured building 2. LPA observed all hallways and stairwells were free of obstacles and hazards. LPA observed emergency evacuation chairs in the stairwells. All resident rooms observed to have all required components. LPA observed the common restrooms are clean and operational with hygiene supplies. LPA tested water temperature which was 117.- degree Fahrenheit and was within regulatory requirement. LPA, toured the outside of the facility. No bodies of water observed outside of the facility. LPA did not observe any obstacles or hazards outside of the facility. Smoke detectors and fire alarm system were tested on November 11th, 2024 by third-party company (Cal Building System) and no discrepancies on the report provided by Cal Building. (...CONTINUE 809D...) LPA observed required department postings throughout the facility, however, LPA did not see pub-475 department poster. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. An exit interview with conducted and a copy of this report was provided to the AED.the state’s words, verbatim · CDSS document, Dec 6, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst LPA Samer Haddadin conducted an unannounced visit for the purpose of completing a case management deficiency visit. LPA was met by Executive Director, Dillon (ED). LPA was granted entry to the building and then explained the reason for the visit. On November 21, 2024, Community Care Licensing received an incident report from this facility regarding resident (R1) who eloped the building and was found by few good Samaritans. Today, LPA Haddadin visited the facility to review (R1) physician report in which it was determined that the resident was unable to leave the facility unassisted per medical record. Based on the observation made today, deficiencies are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Dec 2, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 2, 2024

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by Resident 1 was able to elope from the facility Which poses an immediate safety and health risk to persons in care.the state’s words, verbatim · CDSS document, Dec 2, 2024

Plan of correction: Facility has implemented monthly elopement drills, contracted a company to assess the facility and provide suggestions to deter elopements. Facility to send LPA Haddadin elopement in services by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct a case management visit in conjunction with an unusual incident/Injury Report (LIC 624) received in our office on May 3,2024. LPA was greeted and granted entry by Karollyne Saveestasi, Customer Service Representative (CSR). During today’s visit, LPA met with Kathleen Panganiban, Assistant Executive Director (AED) and Dillon Cagulada, Executive Director (ED). The facility is a large Residential Care Facility for the Elderly (RCFE). It is a triple story building attached with a two story building with an approved fire clearance for total capacity of 299; 259 non-ambulatory residents of which 40 may be bedridden. The three story building has Independent Living (IL), Assisted Living (AL) and Memory Care and the newer two story building is strictly for AL. The facility has an approved hospice waiver for 40 residents. The facility currently has a census of 263 residents in care. During the visit LPA Ruppert requested the following documents: File for Resident #1 (R1) (LIC 858), file for Staff #1 (S1) (LIC 859), associate roster, insurance automobile claim form submitted after incident and a copy of the physician's report. Per Physician's Report dated March 14, 2024 resident is non-ambulatory with a primary diagnosis of altered mental status and MCI. LPA Ruppert interviewed the driver and resident regarding the incident. Driver showed LPA where the incident occurred. Administrator has since installed an additional surveillance camera and provided receipt for the installation of audio back up chimes on the Ford Flex and Ford Transit Connect vehicles. A training was conducted on May 1, 2024 on "Procedure of Situational Awareness when Backing/Reversing" and a copy was provided. Facility self reported incident and cross reported to Community Care Licensing, the Long Term Care Ombudsman, Responsible Party and Physician. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiency cited on this date. An exit interview was conducted with AED Kathleen Panganiban and a copy of the report was given at the time of the visit.the state’s words, verbatim · CDSS document, May 16, 2024

Allegation investigated: Facility failed to provide care and supervision to resident

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings for the complaint investigation into the allegation listed above. LPA met with Assistant Executive Director Kathleen Panganiban and explained the reason for the visit. The investigation into the allegation, facility failed to provide care and supervision to resident revealed the following. Resident 1 (R1) has been diagnosed with Dementia. The care plan states R1 has an increased risk for fall. R1's care plan dated 6/13/2021 states the staff will check on the resident every 2 hours and provide assistance when required. R1 can ambulate and according to the care plan they will escort the resident when needed and R1 can complete all transfers independently. According to R1’s care plan they are not provided a one-on-one caregiver. On July 4, 2021, R1 fell and was found by Staff 1 just outside the entrance of the facility. Staff 1 assessed R1 and called 911. Facility staff reported the resident was treated and returned the same day with no new orders. Staff 1 reported they did not see R1 fall and they don’t know how long they were there before they were discovered. Unsubstantiated After R1 fell and Staff 1 saw them, 911 was contacted and R1 was transported to the hospital and treated. Facility staff notified R1’s family and primary care physician. The Agency received an Unusual Incident Report (LIC 624) reporting the incident on 7/08/2021. LPA interviewed R1 who did not recall the incident and there were no visible injuries on R1. 5 out of 5 staff interviewed reported that all residents are checked on regularly and properly cared for. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of the report provided.the state’s words, verbatim · CDSS document, Jan 25, 2024 · control 22-AS-20210707111504

Allegation investigated: Resident is being hit while in care.

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings for the complaint investigation into the allegation listed above. The investigation into the allegation, resident is being hit while in care, revealed the following. It was alleged that Resident 1 (R1) was hit by someone at the facility sometime on or before 2/5/2022. On 2/4/2022 R1 was sent to the hospital due to displaying symptoms of a stroke. R1 was treated at the hospital and returned to the facility at 4:00 am on 2/5/2022. On 2/5/2022 at 8:00 am R1 was displaying symptoms of a stroke. R1 was sent to the hospital and admitted for treatment. R1 returned to the facility on 2/07/2022. R1’s responsible party reported that they visited R1 daily from 2/07/2022 until their passing on 7/09/2022. R1 passed away on 7/9/2022 and was never interviewed. R1’s responsible party reported they never witnessed any abuse and never saw any signs of abuse on R1. 5 out of 5 staff members interviewed reported they never abused R1 and never saw any abuse. LPA could only make contact with one hospice nurse who reported they never witnessed any abuse and never saw any signs of abuse. Unsubstantiated The Administrator reported that none of the staff reported any incidents concerning R1 and have not reported any signs of abuse. No evidence was gathered that supports the allegation, therefore the allegation is deemed unsubstantiated. 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. An exit interview was conducted, and a copy of the report provided.the state’s words, verbatim · CDSS document, Jan 25, 2024 · control 22-AS-20220208165528

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Claudia Gutierrez made a unannounced case management visit for the purpose of following-up regarding facility's new fire clearance. LPA met with Assistant Executive Director (AED) Kathleen Panganiban and Environmental Services Director (ESD) Pablo Gonzales, and explained the purpose of the inspection. Fire clearance was updated to include a memory care unit with delayed egress and a capacity increase. New fire clearance was approved by a fire inspector of Anaheim Fire & Safety on 01/18/2024. Capacity was increased to 299, of which 259 may be non-ambulatory, and 40 bedridden. Special conditions noted, “Bedridden on first floor only.” Facility currently has a hospice waiver for 40 residents. LPA, AED, and ESD conducted a tour of the premises and memory care. The memory care unit is located on the first floor of the main building and consists of 16 resident bedrooms, one dining room, one living room, and an outdoor garden. LPA observed residents in memory care engaging in an arts and crafts activity. Delayed egress was tested and observed to be operable. Based on observation made during today's inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 25, 2024