Family Feels Residential Care

Type of visit: POC

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced POC case management visit to clear deficiencies cited on 04/22/2026 during an annual inspection visit. The following deficiencies were cited: 87705 Care of Persons with Dementia (b) Licensees shall be responsible for the following: (1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation. §1569.695 Emergency Plans (b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. §1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation...it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. During todays visit, LPA verified training record, and toured the facility. The facility has no resident at the time of the visit. LPA had a conversation with Licensee Juliet Pacaldo while at the facility. Licensee stated they were recently vendorized by the San Andreas Regional Center (SARC) and will accept adults 60 and over with developmental and intellectual challenges and will be providing an updated Program Design to Community Care Licensing (CCL). No deficiencies were cited during today's visit and a copy of the report was provided to Designated Administrator (DADM) Philipp Perez.the state’s words, verbatim · CDSS document, Jul 16, 2026

Allegation investigated: Staff did not ensure that facility was free of illegal drugs.

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit to deliver the findings of the complaint investigation with the above allegation and met with administrator Philipp Perez. On 12/18/2025, the Department received the complaint that staff did not ensure the facility was free of illegal drugs. The Department conducted an investigation on 12/23/2025 and interviewed reporting party (RP), 3 staff (S1, S2, and S3), and 4 residents (R1, R2, R3, and R4) on 01/07/26 and 02/02/26 and requested for documents during the course of the investigation. page 1 of 2 continued to LIC 9099 C Unsubstantiated Based on document review and interviews, R1 was hospitalized on 12/16/25 for respiratory distress. S1 and S3 proceeded to change R1's beddings and prepare the room for R1s return after hospitalization. During this time a bag fell and items believed to be drug paraphernalia (glass pipe, bag with white powder) fell out of the bag. S1 contacted the reporting party (RP) and then called law enforcement and confirmed a brief computer aided dispatch (CAD) response, but no report was taken; staff were instructed on the disposal procedures. Based on records review R1 had a long history of substance use, including methamphetamine, cocaine, and marijuana. Records from 12/04–12/06/25 confirm R1 self reported use of methamphetamine and cocaine the night prior to hospitalization. Records from 12/16/25–12/19/25 do not identify illicit drug use within the facility. S1 to S3 stated that the facility had no policy for searching client’s room and belongings. No policy requiring confiscation of illegal drugs and stated they tell residents to use substances off property if visually observed. No staff had visually seen R1 use methamphetamine or cocaine on-site. Staff stated that they observed or suspected marijuana use by residents, including R1, occurring primarily on the backyard patio. R2, R3 and R4 stated that marijuana odor was common, that R1 smoked marijuana frequently, and that staff generally did not intervene. However, R2, R3 and R4 did not observe methamphetamine or cocaine use. R2 reported smoking marijuana with R1 when offered. R3 reported that when R1’s friend would visit and they would smoke marijuana on the patio. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with current administrator Philipp Perez and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 26-AS-20251218135439

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced annual required inspection and met with Administrator (ADM) Philipp Perez and stated the purpose of the visit. The facility is licensed to serve adults age 60 and over and approved for capacity of 6, 5 may be non-ambulatory and 1 ambulatory and approved for 2 hospice waiver. LPA toured the facility, including common areas, resident rooms, kitchen, bathrooms, driveway, and outdoor spaces and storage areas. The kitchen was sanitary and organized; knives and chemicals were locked. Food supply met requirements (2 days perishable, 7 days non-perishable). Bathrooms had grab bars and non-skid mats. Resident rooms had adequate storage for personal belongings. Medications were locked and inaccessible to residents; first aid kit was complete. Outdoor areas were free of hazards; laundry appliances were functional, and cleaning supplies were secured. LPA observed fire, smoke, and carbon monoxide alarm systems were operational; indoor hallways were clear and well-lit. The facility's ramp at the back is sturdy and in good condition. The exit doors are free from tripping hazard and free from obstruction. Indoor temperature was within acceptable range of 65°F. Kitchen water temperature measured at 111.9 up to 112.1°F. 2 out of 2 bathroom hot water temperature was measured and range from 113.1°F to 114.9°F. Refrigerator temperature is at 32°F and freezer temperature is at 0°F. page 1 of 2 LPA reviewed resident and staff records, including medication logs, admission agreements, care plans, health screenings, and training. All staff have required fingerprint and background clearances and 1st Aid/CPR certifications. Based on record review that the facility last conducted the fire and earthquake drill April 16, 2025. The facility Emergency Disaster plan last update was done on 08/24/2024. S2s has no dementia training. Based on record review 2 out of 4 residents have dementia and 1 out of 4 has mild cognitive impairment (MCI) and 1 out of 4 is conserved and 1 out of 4 is under hospice care. Deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. See LIC 809D. An exit interview was conducted with Administrator Philipp Perez and a copy of the report was provided. page 2 of 2 end of reportthe state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter conducted an unannounced case management other visit, and met with Staff Phillip Perez. LPA explained the purpose of the visit was to conduct follow up interviews with 3 staff members, regarding the complaint 26-AS-20250609082231. During todays visit LPA toured the facility inside and out, including resident bedrooms, bathrooms, living room and backyard. LPA re-interviewed Staff S1-S3. No deficiencies cited during todays visit. A copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Allegation investigated: Facility has staff shortages resulting in delay in providing necessary services to meet the residents' needs.

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced complaint visit to deliver the findings for the above allegation and met with designated administrator (DADM) Philipp Perez. Administrator/Licensee Yiwen Shih and Juliet Pacaldo were not available during the time of the visit due to prior commitment. On 02/10/2026, the Department received a complaint with the above allegations. On 02/12/2026, LPA conducted an initial investigation and conducted an interview with 5 residents and 2 staff, requested copies of 3 out 5 resident medical assessment, appraisal needs and services plan and conducted an inspection of the facility. 5 resident bedroom, kitchen, dining, bathroom laundry room and exterior perimeter. See LIC9099C page 1 of 3 Unfounded On 02/12/2026, LPA interviewed witness 1 (W1). W1 stated that he/she called because of a staffing concern. The complaint is that the staff are not getting their days off. W1 stated the staff are overworked and not had a day off since the beginning of January 2026. W1 stated that the licensee is not hiring people. W1 stated no resident has been left with a dirty diaper for 14 hours and stated that's is not what W1 said when he/she called the 1-800 number. W1 stated that the staff are working and helping the other facilities (Family Feels 2 and Family Feels 3) and stated that staff are working non-stop for more than 8 hours a day and never had a day off. W1 stated that he/she is worried that the caregivers will get sick if they do not have a day off. On 02/12/2026, LPA conducted an interview with 5 residents (R1 to R5) R1 stated that staff are there everyday Sunday to Saturday, 7 days a week and when R1 needs help staff responds to R1s needs within 2 to 5 minutes. R1 has no problem with the staff. R5 stated "they are here and can see them here all the time." R2 was asleep and did not want to be bothered. LPA attempted to speak with R3. Staff 1 and 2 (S1 & S2), introduced LPA to R3, but R3 refused to speak with LPA. R3 just stared at LPA. S1 and S2 stated that R3 will only speak to people he/she knows. R3 has very specific and select few that he/she wants to talk and engage in conversation. R4 stated that he/she is ambulatory with assisted device (walker) but pretty much can go to the bathroom and needs minimal assistance with his/her ADLs, he/she gets assistance with his/her laundry, showering, and changing clothes, cleaning and changing beddings and cooking food. R4 stated he/she has not experienced any delay from staff assisting him/her with ADLs. R4 stated he/she is not incontinent and can go to the bathroom by himself/herself. R4 stated that staff did not leave a resident for 14 hours in a dirty diaper. R4 stated "that's a bit excessive I would have complained I smell pee. Staff come as soon as a resident call and respond within 2 to 5 minutes." See LIC9099C page 2 of 3 R5 stated that he/she calls the staff on their phone whenever he/she need assistance and staff would come within 2 to 5 minutes. R5 can transfer to and from bed to wheelchair with assistance. R5 stated he/she is not bed bound. He/she has paralysis on his/her lower extremities, but is able to ambulate with a walker with assistance from staff. R5 stated that staff are taking care of him/her well. Has no complaints with the staff. There was no incident that a resident was left on his/her diaper for 14 hours. 02/12/2026 - Interview with Staff 1 and 2 (S1 and S2) S1 stated that staff checks on the residents as often as they can. Staff stated "as you can see, the facility is small and we are here all the time." If one of the adjoining facility (Family feels 2 and 3) needs help, one of the staff from that facility will come here to cover. Residents can call us on our cell phone and we respond to them right away. We do not leave them here by themselves. We do our checks every hour or sometimes if it's busy we check on them every two hours. No more than 2 hours will pass, because it is a small facility." S2 stated that they check on the residents every hour. S2 stated "this is a really small facility and I can hear the resident if they call me." S2 stated, that R2, R3 and R5 prefers to be given a bed bath. R4 and R1 can shower by themselves but watches over them while in the shower to ensure their safety. S2 stated they have showering and bathing schedules for each resident. S2 stated that residents are able to call them on their cellphones if they need assistance and staff will always show up within 2 to 5 minutes. If it will take them longer than 5 minutes because they are attending to another resident, they notify the resident. On 02/12/2026, LPA Partoza, conducted an inspection of 5 resident room, Rooms 1, 2. 3 and 4 are single occupancy, and Room 5 is shared with its own bathroom. Room 4 is currently vacant. LPA observed that each room is kept organized and did not smell any malodorous odor inside and outside of the facility. LPA conducted an inspection of the bathrooms and observed the area to be sanitary and organized. This agency has investigated the complaint that the "facility has staff shortages resulting in delay in providing necessary services to meet the residents' needs." The Department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies are cited during today's visit base on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with designated Administrator Philipp Perez. A copy of the report was provided. page 3 of 3 end of reportthe state’s words, verbatim · CDSS document, Feb 20, 2026 · control 26-AS-20260210113828

Allegation investigated: Unlawful Eviction

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to deliver the findings for a 2 Out of 3 complaint investigation. On 12/18/2025, the Department received a complaint regarding the above allegations. On 12/22/2025, the Department conducted an initial 10-day investigation visit, during which requested documents were obtained and interviews were conducted with four staff members (S1–S4) and three residents (R2–R4) out of the six residing at the facility. Two residents (R5 and R6) were not interviewed; R5 declined to participate, and R6 was resting at the time of the visit. Resident 1 (R1) was not present during the visit, as R1 had been hospitalized due to pain. After discharge, R1’s case manager (CM) placed R1 in a temporary shelter (motel) due to the fact that the licensee did not want R1 back at the facility. 1 of 3 Substantiated S2 stated that S3 assisted during the cleanup. S3 stated that while cleaning the room and replacing the mattress, they hit the bag hanging on the bed, causing its contents to fall. S3 observed a white substance and a pipe among the items. S2 and S3 stated that staff did not search through R1’s belongings. Residents R2 through R4 stated that staff request permission before entering their rooms for cleaning and do not go through personal belongings. Based on review of the complaint narrative, R1 alleges that staff were interested in his/her food stamp and had recently purchased a box of waffles and later discovered that S2 had given the waffles to another resident. Staff members S1 through S4 stated that food belonging to residents is labeled with the resident’s name to ensure proper identification. Three out of five residents (R2–R4) stated that they write their names on boxes or containers to prevent others from taking their food from the refrigerator. R2 to R4 stated they have not experienced staff giving away their food. The remaining two residents (R5 and R6) do not store food in the refrigerator, as their meals are prepared according to their specific dietary requirements. Based on interviews, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No citations are issued based on California Code of Regulation (CCR) Title 22. A copy of the report was provided to designated administrator Philipp Perez. An exit interview and a copy of the report was provided. page 2 of 2 Based on interviews with staff members S2 through S4, they stated that they were not aware of any eviction notice for R1. S2 reported that R1’s case manager (CM) visited the facility and informed staff that R1 would be returning. S1 stated that R1 violated the facility’s house rules and could no longer reside at the facility. S1 confirmed that no formal eviction notice was issued to R1 and no notification was sent to the Community Care Licensing Division (CCLD). S1 stated that he/she communicated with CM regarding R1’s noncompliance with house rules that is related to drug use and allowing individuals into R1’s room without prior notification to staff or the licensee. S1 stated to CM that he/she feels that R1s behavior poses a safety concern for other residents. On 02/05/2026, LPA Partoza conducted an interview with R1’s case manager (CM). CM stated that S1 reached out to him/her to inform him/her that S1 will not admit R1 back at the facility, when staff discovered drug paraphernalia in R1’s room. CM stated that he/she could not dissuade S1 not to make a rushed decision in not re-admitting R1 back to the facility, which compromised R1s safety. The rush decision prompted CM to place R1 in a motel after being discharge from the hospital. CM stated that they were not given a 30-day eviction notice by S1 to give them time to find a new placement for R1. CM stated that S1 was firm with the decision and said that he/she will take full citations from CCLD for the unlawful eviction. CM stated that S1 expressed his/her concern regarding R1s behavior. S1 told CM that he/she was not willing to readmit R1 to the facility because S1 would be prioritizing the safety of the current residents in place and staff over compliance with licensing requirements. S4 stated that he/she observed R1 smoke Marijuana when he/she and S2 first got hired in 2024. then in June of 2025 R1 no longer smokes weed at the property. S4 stated he/she has not seen R1 use any other drugs. Based on document review from the time that R1 was admitted to the facility on 08/01/2023, no incident report was submitted to CCLD by the facility that R1 was observed using drugs inside the facility that would require law enforcement intervention. R1s medical assessment states that R1 has a substance abuse, hypertension, diabetes type 2, COPD and HIV. R1 is highly cognitive, and is able to leave the facility without assistance. R1s appraisal needs and services plan, states that R1 is alert and oriented, and will maintain current level of functioning and "very independent with his/her ADLS and likes to go out with his/her friends." page 2 of 3 Based on review of the admission agreement, stipulated on page 10 under the condition for eviction, are as follows: “the licensee to provide a 30-day written notice to the resident for, 3. Failure of the resident to comply with written general policies of the facility (house rules).” The written general policies was updated in June of 2025 as part of the admission agreement. Based on document reviews and interviews the preponderance of evidence standard has been met; therefore, the allegation of unlawful eviction is found to be SUBSTANTIATED. Deficiencies were cited during today's visit based on the California Code of Regulation (CCR) Title 22. An exit interview was conducted with designated Administrator Philipp Perez and a copy of the report was provided. This report is continued for the other 2 allegations for this complaint. (See LIC 9099A) page 3 of 3the state’s words, verbatim · CDSS document, Feb 20, 2026 · control 26-AS-20251218135439

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Feb 21, 2026

87224 Eviction Procedures(a)...Thirty (30) days written notice to the resident is required...This requirement is not met as evidenced by: Based on interviews and record review, Licensee did not follow eviction procedure as stipulated on the admission agreement by not issuing a 30-day eviction notice to R1s and CM and provide CM & R1 time to relocate on 12/16/25, which pose/s an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: DADM, stated that licensee will be notified that a plan of correction needs to be submitted to LPA within 24 hours (02/21/2026).

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(f) · Plan of correction due date: Mar 2, 2026

87224(f) Eviction procedure (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement is not met as evidenced by: Based on interview and record review, the Licensee did not submit a written report within 5 days to CCLD and R1s CM commencing on 12/17/25, which pose/s a potential health, safety and personal right risk to persons on care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: DADM stated that he/she will notify Licensee/administrator that a plan of correction is required to handle notification regarding eviction procedures by 03/02/2026.

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter conducted an unannounced case management other visit, and met with Staff Phillip Perez. LPA explained the purpose of the visit was to ensure plan of corrections that were submitted regarding previously addressed deficiencies are being followed. During todays visit, LPA re-interviewed Staff S2. LPA requested a copy of R1's Emergency Contact Information. No deficiencies cited during todays visit. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mita Partoza conducted a case management - deficiencies during a complaint investigation and met with Philipp Perez and Mary Jane Acosta who are the designated administrators in the absence of administartor Juliet Pacaldo. LPA conducted a facility check while doing the investigation, LPA encountered one of the facility staff (S3) who was directly caring for a resident in room 3. Based on research the Staff 3 (S3) was not listed on the list of staff that were cleared to directly care for residents at the facility on Guardian. LPA requested to review S3's file and found that the S3 submitted a fingerprint scan and was cleared by DOJ on 04/11/2025 and received a response from CA Department of Social Services (CDSS), Care Provider Management Branch (CPMB) on 4/12/2025. Based on document review, a letter from (CPMB) was sent to the applicant on 08/06/2025, stating that the S3's application was incomplete and if information is not received by 09/22/2025, the background application will be closed. There was no submission from applicant of the required information by CPMB, and the application was closed. S3 status on the Guardian is separated from the facility since 08/14/2025. Deficiency is cited for not complying with California Code of Regulations (CCR) Title 22 87355 (e)(3). 87761 Penalties(b)Notwithstanding Section 87761(a)... an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed if any individual required to be fingerprinted under Health and Safety Code Section 1569.17(b) has not obtained a California clearance or a criminal record exemption, requested a transfer of a criminal record clearance or requested and be approved for a transfer of an exemption as specified in Section 87355(e) prior to working, residing or volunteering in the facility. An exit interview was conducted with designated administrator Philipp Perez and Mary Jane Acosta. A copy of the report and appeals rights were provided.the state’s words, verbatim · CDSS document, Dec 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Dec 23, 2025

87355 Criminal Record Clearance (e) All individuals...pursuant toHealth and Safety Code Section 1569.17(b) shall prior to working...(3) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by: Based on document review, S3 has a clear FP scan on 4/11/25, but was not received by CPMB. CPMB, notified applicant (S3)regarding incomplete app on 8/14/25. Application was closed by CPMB due to no response received from S3. S3 is separated from the facility. Whichthe state’s words, verbatim · CDSS document, Dec 22, 2025

Plan of correction: con't - pose, poses a immediate health safety and personal rights risk for persons in care. Plan of correction: LIC/ADM stated that a written plan of correction will be submitted to LPA by POC due date 12/23/25 stating that the LIC/ADM will call CPMB, to complete S3s requirement for the BG clearance prior to working at the facility.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Manuel Monter conducted a case management deficiencies visit was conducted due to violations discovered during the investigation process and safety check for residents in care. LPA met with Administrator Rita Garcia (ADM2). LPA explained the purpose of the visit. Due to comments made by staff during the complaint investigation, regarding delayed payments to staff, LPA also followed up regarding the facility's finances. LPA spoke with ADM Yiwen. ADM Yiwen stated the facility is not in financial distress. ADM Yiwen stated there was a time in May when staff's paychecks were delayed due to an issue with the bank. ADM Yiwen stated that issue was resolved with in 3 days. During visit, LPA toured the facility kitchen. LPA observed Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA also observed toiletry supplies. LPA also observed 3 staff in the facility and 5 residents. Wile investigating the complaint 26-AS-20250609082231, regarding R1, LPA noted issues in resident R1's appraisal needs and services plan, dated August 1, 2023. LPA asked ADM2 if she has an updated Needs and services plan for R1. ADM2 stated the appraisal needs and service plan dated August 1, 2023 is the only needs and services plan they have on file. The Department reviewed resident R1’s Physician's Report dated August 18, 2023. R1's physician's report is not signed by the physician. LPA asked ADM2 if she had a signed copy. ADM2 stated the physicians report on file was the only one the facility had. Page 1 Out of 2. LPA provided the Licensees information regarding the Department’s technical support program (TSP) and provided TSP Brochure and Community Care Licensing Division (CCLD) website www.cdss.ca.gov Deficiencies was cited during todays visit. This report was reviewed with Administrator Rita Garcia. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Nov 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Nov 13, 2025

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional... This requirement was not met as evidenced by; Based on record review and interview; R1’s Physician's Report dated 8/18/23. R1's physician's report is not signed by the physician. ADM2 stated that physicians report on file was the only one the facility had. This poses a potential threat to residents health, safety and personal rights.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: ADM2 stated she will send a letter of understanding regarding the regulation. ADM2 stated she shall obtain a new physician's report for R1 and send CCL a copy of the physician's report by POC due date, November 13, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a) · Plan of correction due date: Nov 6, 2025

87463 Reappraisals (a)The pre-Admission appraisal... shall be updated in writing as frequently as necessary or once every 12 months ... to keep the appraisal accurate... This requirement was not met as evidenced by; Based on record review and interview, ADM2 stated the appraisal needs and service plan dated August 1, 2023 is the only needs and services plan they have on file. This poses a potential threat to residents health, safety and personal rights.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: ADM2 stated she will send a letter of understanding regarding the regulation. ADM2 stated she will send LPA an updated appraisal needs and service plan for R1 by November 13, 2025.

Type of visit: POC

Licensing Program Analyst Manuel Monter conducted a POC case management visit to clear deficiencies cited on October 28, 2025 during the conclusion of a complaint investigation. LPA met with Staff Mary Jane Acosta. LPA explained the purpose of the visit. The facility cited the following Type A deficiencies on October 28, 2025 • 1569.50 Denial, suspension or revocation of license(a)(3), POC due date October 29, 2025 LPA received plan of corrections by POC date. Deficiencies cleared during todays visit. POC cleared letter provided to Staff Mary Jane Acosta No deficiency was cited during todays visit. This report was reviewed with Staff Mary Jane Acostathe state’s words, verbatim · CDSS document, Nov 4, 2025

Allegation investigated: Facility staff is financially abusing resident in care

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the finding for this complaint investigation. LPA met with Administrator designee Rita Garcia On 06/09/2025, the Department received the complaint alleging that the staff is financially abusing resident (R1) by asking R1 to lend them money. It was alleged that a staff asked R1 for $100.00 then paid it back, and another staff asked to loan $200.00 from R1. The reporting party (RP) stated that R1 could not say no and loaned staff the money and staff had not paid back R1 as of 06/09/2025. On 06/18/2025, the initial complaint investigation was conducted. Documents were obtained to include 6 residents physician's report, identification and emergency contact information, resident roster, LIC500, and 1 resident's admission agreement and appraisal/needs and services plan. Page 1 Out of 3. Substantiated On 06/18/2025, 3 staff members (S1 – S3) and the Administrator were interviewed. S1 states that there was one time around May 2025 when the staff’s paycheck was running late. S1 stated that he/she desperately needed to send money to his/her family member for school. S1 stated that the staff were talking about their paycheck being late in the dining room when R1 overheard and offered to loan S1 $200. S1 admitted to taking the money that R1 offered and paid R1 pack with a $50 interest about 3 days after. S1 denied asking R1 for money. S1 states that it only happened once and denied borrowing money from R1 on other occasions. S1 states that R1 likes to go shopping and if R1 doesn’t like the clothing, R1 sells them to the staff. S1 states that he/she has bought clothes from R1. S1 states that he/she bought a clothing item from R1 amounting to $25. S1 stated to have paid R1 $15 but still owed R1 $10. S1 states that R1 was okay with it and stated that S1 can pay R1 back later. S1 states that R1 likes to make money in the facility and the staff support it. S2 denied ever taking or asking for money from any resident and denied R1 loaning him/her any money. S3 stated that R1 buys him/her a vape at least once a month or when he/she runs out and pays R1 back whenever he/she receives a paycheck. S3 stated that he/she would pay R1 extra money on top of the price of the vape to pay for R1’s gas. S3 denied owning any money to R1. S3 also stated that about 2-3 months ago, S3 asked R1 for money because his/her paycheck was late. S3 stated that R1 loaned him/her $100 and when S3 received his/her paycheck about 6-7 days after, S3 gave R1 the money owed plus interest of $50 totaling $150. On 06/18/2025, resident (R1) was interviewed. Based on interview, R1 denied any staff asking R1 for money and denied any staff taking money from R1 without his/her consent. R1 stated that he/she voluntarily loaned his/her money to 3 staff members (S1 – S3) because R1 felt bad that their paycheck was late. R1 denied staff asking him/her to loan money and stated to have voluntarily offered his/her money on his/her own doing. R1 states that the 3 staff members that he/she loaned money to paid R1 back, and denied any staff currently owing R1 money. R1 denied receiving more money than what was initially loaned. R1 stated to voluntarily buy a staff (S3) a vape from the smoke shop because they have a good friendship. R1 stated that S3 has also given him/her money to buy a vape when R1 goes to the smoke shop. Page 2 Out of 3. On 06/18/2025, the Administrator was interviewed who denied knowledge of any staff borrowing money from R1. The Administrator stated that R1 takes care of his/her own cash resources. Administrator states that the staff do not have any policy or rules regarding do and don’t while working in the facility. Administrator states that the staff should not be accepting money from the residents. On 10/07/2025, the Administrator states they have created a house rule and policy for the residents and staff to sign. The review of the house rules and policy states that the residents and staff are not allowed to sell or buy anything from each other, and no borrowing or lending money to residents and vice vera. This was signed by the residents on 06/21/2025 and the staff members (including S1 – S3) on 07/15/2025. On October 22, 2025, LPA Monter interviewed Staff S4. S4 confirmed there is no written agreement regarding handling R1's finances and/or loaning money from residents. Based on record review, R1 does not have a neurocognitive disorder and is able to manage his/her cash resources. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies were cited during todays visit. Please see LIC9099-D. This report was reviewed with Administrator designee Rita Garcia, Appeal rights were provided. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Oct 28, 2025 · control 26-AS-20250609082231

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.50(a)(3) · Plan of correction due date: Oct 29, 2025

1569.50 Denial, suspension or revocation of license; ...exclusion from licensee without right to petition for reinstatement (a)(3) Conduct that is inimical to the health, morals, welfare, or safety ... from the facility or the people of the State of California. This requirement was not met as evidenced by; Based on interviews conducted, and evidenced reviewed, staff S1 and S3 admitted to loaning money from R1. This action is a violation of resident R1’s personal rights. This poses an immediate threat to residents health, safety and personal rights.the state’s words, verbatim · CDSS document, Oct 28, 2025

Plan of correction: ADM stated she will conduct a personal rights training with her staff. ADM stated she will send documentation of the training with the following information: who participated, who conducted the training, duration of the training, what materials were used. ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send the plan of corrections to LPA by POC date, October 29, 2025.

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter conducted an unannounced case management to amend a Complaint investigation, LIC9099, LIC9099-C issued on October 07, 2025. LPA met with Administrator Rita Garcia explained the purpose of the visit. The complaint investigation closed on October 07, 2025 is being amended and re-opened due to new information provided to the Department. No deficiencies cited during todays visit. This Report was reviewed with Administrator Rita Garcia. A signed copy was provided.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Required - 1 Year

On 06/24/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection. LPA met with administrator Noralee Reyes and explained the purpose of today's visit. There is 3 staff present and 5 residents present. This facility is licensed for ages 60 years and over. 5 may be non-ambulatory and 1 ambulatory. Hospice wavier approved for 2 residents. There are currently no residents on hospice at time of this inspection. LPA was allowed entry into the facility. This is a single level facility. Annual fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. The backyard is shared with their sister facility Family Feels 2 located at 777 Terrazo Drive. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the stove. Cleaning supplies are observed as locked beneath the kitchen sink. Medications are locked in a file cabinet in the main dining room area. Perishable and non-perishable food items are observed as in place. There is an additional freezer and canned food supplies stored near the office and staff rooms. This facility does not have a garage as it was converted into the office area and staff room are. First aid kits are observed as complete with required items. LPA observed fire extinguisher in the dining room with an inspection tag dated 08/09/24. The fire extinguisher is charged and within operable range, smoke detector/carbon monoxide detectors are observed in place through out the facility, and central heating/cooling system. PPE and additional food supplies are observed as in place. Continued on next page. Page 2 Laundry area is also observed as fully operational located beneath the facility. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted in January 2025. Water temperature was measured at 110F in a common bathroom in the main hallway. Shower floor is observed to have non-skid flooring. LPA observed rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place. Rooms 4 and 5 have residents using oxygen but there is no sign in place during time of inspection. Signs were printed and affixed to the outside of those rooms. Rooms 2, 3, and 5 have residents that have 1/2 bed rails in place but do not have orders on file for the rails. LPA reviewed 6 resident files and also reviewed 3 staff files on this day. Per resident files reviewed they are current with the exception of the bed rail orders. Per staff files reviewed all files. Staff have current first aid but no training records within the last year on file. Client medications are inspected and are current including facility medication administration records. Administrator certificates are observed as current expiring on 01/05/2026. The following updated forms are requested to be submitted to CCLD by 07/01/2025: • Copy of updated Administrator Certificates • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule Technical violations are given on this day on the attached LIC9102TV pages. Report is reviewed with Rita Garcia and a copy is provided.the state’s words, verbatim · CDSS document, Jun 24, 2025

Type of visit: Case Management - Annual Continuation

On 6/07/2024 at 1:00 p.m. Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced case management for Annual continuation and was met by Designated Administrator (DADM) Rita Garcia. The Administrator(ADM) Yiweh (NIcole) Shih was not present at the time of the visit. DADM called ADM and asked if ADM can come to the facility. ADM stated he/she is not available due to prior commitment. During today's visit LPA observed that 6 out of 6 residents are resting and are currently in their respective bedrooms. 4 out of 6 residents have neurocognitive impairment, 2 out of 6 has mental impairment. On 6/4/2024, LPA with DADM toured the facility inside and out, such as kitchen, dining, living area, backyard, resident's room, bathrooms, entry way, staff room and office. The facility has 5 resident bedroom, 1 of the 5 bedroom is shared and 4 are private. LPA observed a sign on the entry way that oxygen is in use. DADM stated that the oxygen is used by 1 Out of 6 resident (R1) on as needed basis. LPA observed a sign on the entry way that oxygen is in use. DADM stated that the oxygen is used by 1 Out of 6 resident (R1) on as needed basis. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident and staff. The temperature inside the home was at 68 to 70.1 degrees F. LPA observed the kitchen to be organized, and sanitary with working appliances. Knives were kept in a secure locked area and not easily accessible to residents. The laundry room has a lock, and staff room is The facility has 2 days of perishable food and 7 days of non-perishable food. page 1 of 3 LPA inspected the residents' bedrooms and found that 5 out of 5 rooms have furniture and closet space for resident's personal belongings, bed frames with mattress and bed linens. 5 Out of 5 resident room is sanitary, organized and are free from debris. LPA observed that the 3 Out of 3 bathrooms have dark stains on the wall tile inside the shower area, water stains, rust on the shower floor, stains on the toilet bowls, sink, faucet, trash bins and floor. LPA with ADM tested the water temperature for kitchen and bathrooms, water temperature was measured at 107.6 degrees F to 116.2 degree F. LPA with DADM inspected the laundry area and observed washer and dryer are in good working condition. LPA observed that the medication is in a locked cabinet. The facility has a first aid cabinet with first aid supplies and accessible to staff. The side door and sliding door to access the backyard opens easily and are free from obstruction. LPA observed ramps and walkways are free from obstruction. LPA observed the backyard area to be free from debris and is maintained. The facility is in a compound with two other facility under the same ownership. LPA reviewed facility record and 1 out of 2 staff were found to have no criminal clearance exemption and was cited on the initial visit on 6/4/2024. During today's visit LPA reviewed 2 out of 2 staff record 3 out of 6 resident record and facility records. LPA reviewed the facility record, the disaster training has not been conducted since the facility got licensed on 6/16/2023. Staff training records were up to date, Staff records were reviewed with current first aid certifications, 1 out of 2 have a valid CPR, first aid training. Residents files were reviewed to be complete. Residents' medications are labeled and current. LPA reminded LPA requested updated documents, LIC 500, lease agreement, updated liability insurance and LIC 308 and the Summer Wellness Preparedness readiness that is available online for the DADM and ADM to discuss and train staff. page 2 of 3 at 5:00 p..m. LPA with DADM Rita Garcia spoke with LIcensee/ Administrator(LIC/ADM) Yiwen (Nicole) Shih by phone and discussed the deficiencies cited during today's visit. LIC/ADM stated understanding and will have a plan to correct the deficiencies by the due date. Deficiencies are cited during today's visit based on the California Code of Regulations (CCR) Title 22, see LIC 809D. An exit interview was conducted with designated administrator (DADM) Rita A Garcia. A copy of the report and appeals rights were provided. page 3 of 3 end of reportthe state’s words, verbatim · CDSS document, Jun 7, 2024

Type of visit: Required - 1 Year

On 6/4/2024, Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted a required annual inspection and was greeted by 2 staff. License/Administrator (LIC/ADM) Yiwen (Nicole) Shih was not present and designated Administrator (DADM) Rita Garcia was not in the facility. A staff called the DADM and DADM arrived within 5 minutes. LPA stated the purpose of the visit to DADM. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over, capacity of 6, 5 non-ambulatory and 1 ambulatory. The facility has a waiver for 2 hospice care. The facility's has 6 residents (R1 to R6) that have neurocognitive impairment. 2 staff were present at the time of the visit. 6 residents were present at the facility. 1 out of 6 were in the dining area. 1 out of 6 residents are in the backyard, 3 out of 6 were in the bedroom 2 out of 6 are non-ambulatory and 4 of 6 are ambulatory. LPA and ADM toured the facility inside and outside, including but not limited to the following: Kitchen, dining, laundry, garage, 5 resident room, 1 staff room, 2 bathrooms, backyard and the exterior walkways. The facility has access to two facilities under the same ownership. LPA checked Guardian and found that on 12/18/2023 a notice from the California Department of Social Services(CDSS), Care Provider Management Bureau (CPMB) was sent to licensee/administrator (LIC/ADM) informing the LIC/ADM that a criminal record exemption is required for S1. LIC/ADM did not submit the requirement as requested by CPMB within the given time frame. S1 stated that he/she started working at the facility 12/5/2023 and was aware of the exemption letter and requirement. S1 stated he/she passed on the letter to LIC/ADM when S1 received the letter in December of 2023. LPA discussed the importance of responding to CPMB to LIC/ADM, DADM and to S1. page 1 of 2 At the time of record review for the facility, LIC 308 Designation of Facility Responsibility was not completed. LPA requested the following documents: LIC 500, LIC 308, Lease Agreement, Liability Insurance, resident roster and staff background clearance record. Deficiencies is being cited during today's visit based on California Code of Regulation, Title 22, please see LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days) for staff (S1) working at the facility without criminal record clearance or exemption. See LIC 421BG. Due to time constraint the annual inspection will be continued at a later date. An exit interview was conducted with Designated Administrator Rita Garcia. A copy of the report and appeals rights were provided. page 2 of 2the state’s words, verbatim · CDSS document, Jun 4, 2024