Golden Age Senior Homes

Allegation investigated: Staff yell at residents Staff mismanaged resident’s medication Staff left residents unattended Staff did not meet resident’s diapering needs Staff did not provide adequate food service Facility is unsanitary

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the six allegations listed above. LPA was greeted and granted entry by facility administrator Rico Mico after explaining the purpose of the visit. The initial complaint investigation visit was conducted on February 9, 2024. During this first visit, LPA accompanied by administrator conducted a tour of the physical plant. Resident and staff records were requested and obtained during the visit. LPA conducted a follow-up investigation visit on April 19, 2024. During this second visit, LPA conducted or attempted to conduct interviews with all three residents at the time and toured the physical plant. Additional witness interviews were also conducted via telephone over the course of the investigation. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff yell at residents, the following has been concluded: Based on observations conducted during three facility visits, LPA failed to observe any instance of staff members yelling at residents. Eleven out of twelve interviews conducted provided no evidence of yelling or inappropriate verbal interactions occurring on behalf of staff either. Regarding the allegation that Staff mismanaged resident’s medication, the following has been concluded. Interviews with residents, observation of the medication central storage and a review of resident records kept on the premises including medication records was conducted during multiple visits. No firm evidence of improper handling or inadequate assistance with self-administration was found in order to corroborate the allegation. All medication dispensed appears accounted for at the time of the visits. Regarding the allegation that Staff left residents unattended, interviews and observation conducted on the premises failed to provide any evidence of specific circumstances or date when staff was not present on the premises to provide care and supervision as required. Adequate staffing was present on the premises during each of the three visits conducted. Regarding the allegation that Staff did not meet resident’s diapering needs, multiple residents diagnosed with incontinence were observed to be admitted and present per a review of resident assessments conducted. No indication of inadequate toileting care or insufficient management of bladder or bowel incontinence were evidenced during the investigation. Interviews conducted also failed to provide evidence or instances of inadequate replacement of diapers as needed. Regarding the allegation that Staff did not provide adequate food service, the following has been concluded: the food supply on hand was verified on three separate occasions. Additionally staff was observed to be cooking in preparation for upcoming meals and/or cleaning the kitchen after the meals in question. Meal service was confirmed to take place after 5pm on the day of the present visit. No concerns related to food or nutrition were made during the witness interviews conducted. CONTINUED ON FORM LIC9099-C CONTINUED FROM LIC9099-C Regarding the allegation that Facility is unsanitary, the following has been concluded: During the present visit, staff members on duty were observed to be performing cleaning duties in the kitchen and common areas. Bathrooms and bedrooms were free of odors that could be associated with lack of cleanliness or insufficient sanitary measures. As a result, all six allegations are found to be Unsubstantiated, meaning that although the six allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 22-AS-20240205155235

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced site visit to the facility on this date for the purpose of delivering an amended report originally issued on October 08, 2025. LPA arrived at the facility was greeted and granted entry by care staff. LPA met with Rico Mico, Administrator and explained the reason for the visit. Upon entry LPA observed three residents in the living room relaxing and watching television. LPA toured the physical plant of the facility. LPA delivered a complaint findings report, that needed to be amended and re-delivered. On today visit LPA delivered the amended report as well as this case management report to the facility. Based on the observations made during today's visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code if Regulations. An exit interview was conducted with Administrator and a copy of this LIC809 report was left at the facility along with copies of the amended report.the state’s words, verbatim · CDSS document, Oct 21, 2025

Allegation investigated: Licensee does not ensure that facility is clean. Licensee did not provide resident with linens. Resident left in soiled diapers for an extended period. Licensee allows minors to provide care and supervision to the residents Residents are not provided with activities. Residents are left unattended. Licensee does not provide adequate care to residents.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation to the above identified complaint allegations. LPA arrived at the facility and was greeted at the door and granted entry. LPA spoke with Rico Mico, Administrator and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review and interviews conducted. It is alleged that licensee does not ensure that facility is clean. LPA conducted a facility visit on September 30, 2025, and observed facility to be clean and sanitized. Staff were observed to be cleaning kitchen and resident bedrooms. LPA toured resident’s bedroom and did not observe there to be any urine on the Continued on LIC9099-C Unsubstantiated floors. Interview with staff stated that facility is cleaned every day throughout the day, and the facility is moped in the evenings once residents go to sleep. The interview with 3 of 3 residents stated that their room gets cleaned all the time. It is alleged that licensee did to provide a resident (R1) with linens, specifically to pillowcases. LPA conducted a facility visit on September 30, 2025, toured the physical plant of the facility and observed linens stored in cabinet located in hallways leading to resident bedrooms and in large closet storage to the right of facility restroom. LPA toured the resident bedrooms and observed all bedrooms to have pillows with pillowcases in each of the residents’ beds. Interview with staff stated that facility has plenty of linens and is sufficient amount for all residents use. It is alleged that resident left in soiled diapers for an extended period. Interview with witness stated that they have never seen residents in soiled diapers or soiled at all. Interview with staff stated that residents with diapers are checked often for diapers if they are soiled. Diapers get changed often as needed. Interview with 3 of 3 residents stated that they get help from staff and check on often as needed. It is alleged that licensee allows minors to provide care and supervision to the residents, specifically in reference to licensees two daughters. LPA Martinez obtained copies of licensee’s daughters in question and revealed that daughters are of the age of 20 and 24. Both daughters are fingerprint cleared and associated with the facility. Interview with licensee/administrator stated that they only have 2 daughters and neither are minors. No minors ever help at the facility with the care of the residents. It is alleged that residents are not provided with activities. LPA conducted a tour of the facility on September 30, 2025, and observed the facility has board games, books, and other recreational materials for the residents’ use. Interview with staff stated that they have exercise sessions for residents, puzzles, crafts and take them out of the facility. Interview with 3 of 3 residents stated that the facility has exercise sessions, Continued on LIC9099-C puzzles, crafts and take them outside of the facility. Residents stated that when they don’t want to go out staff do not force them to do so. It is alleged that residents are left unattended. Interview with staff stated that residents are always cared for and care is provided at all times. Residents are assisted when they ask for it and staff do resident checks all the time. There is always 3-4 staff on board at all times. File review LIC500 personnel report reflects that there are 4 staff listed. Interview with 3 of 3 residents stated that they are never alone and there is staff with them at all times. Interview with witness stated that they have always seen staff at the facility when they have conducted visits. It is alleged that licensee does not provide adequate care for residents, specifically to oxygen treatments for resident (R1). Interview with 3 of 3 staff stated that when R1’s oxygen is low they do utilize the oxygen for them. Staff stated that they check R1’s oxygen all the time because they know R1 needs it. Records review revealed that R1 has hospice services and part of services provided if oxygen treatment. Interview with R1 stated that they get oxygen treatment as much as they need it at all times. Based on the information mentioned above, 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 violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Oct 8, 2025 · control 22-AS-20250925090103

Type of visit: POC

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility for the purpose of conducting a POC inspection to verify correction of citation issued during the annual visit conducted on September 30, 2025. LPA arrived at the facility and was greeted and granted entry to the facility by staff. LPA met with Rico Mico, Administrator, and explained the nature of the visit. Upon entry LPA observed a resident in the dining room having breakfast, three residents in the living room and four staff at time of visit. LPA toured the physical plant of the facility. LPA was informed that records were updated and LPA began the review of records. LPA reviewed 5 resident records and observed that all resident files contained the required documentation. LPA observed that care staff were cleaning the facility as well as caring for residents’ needs. Based upon this inspection, LPA observed the following: *Deficiency cited under Title 22 Regulation 87506(a) has been cleared. The license complied with the terms of the citation by POC due date. *Deficiency cited under Title 22 Regulation 87203 has been cleared. The licensee complied with the terms of the citation by POC due date. LPA at the time of visit cleared the POC, generated a letter of deficiency citations cleared, and left a copy of the letter at the facility for their records. Exit interview was conducted with Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. LPA met with Rico Mico, Administrator and explained the nature if the visit. There are five residents at the facility and there are two residents receiving hospice services currently. LPA accompanied by Administrator began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage located in the garage in a freezer and a spare refrigerator. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage closet located in the bedroom hallway. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. Medication cross checked for accuracy of date and dosage. LPA inspected the bathrooms, and LPA measured the hot water temperature which measured 107.9 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked in the garage. The facility has an available clean supply of linens in the hallway storage and a Continued on LIC809-C storage closet by resident bedroom. LPA inspected residents’ bedrooms which has sufficient lighting to ensure safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Carbon monoxide and smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is several shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of November 1, 2023, mounted in the kitchen wall. LPA reviewed and verified fire drill logs. Facility has a second floor which is inaccessible to residents in care, door that leads to the second floor is in the garage. There are no residents residing on the second floor of the facility. LPA verified resident in care do not have access to the second floor. LPA began reviewing records. LPA reviewed five resident records. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated with the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC 809-D for deficiencies. This report was reviewed with the Administrator and a copy of this report LIC809, LIC809-D report was provided and left at facility. Appeal rights reviewed, and a copy provided.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. The Administrator, Rico Mico's Administrator's Certificate expires on March 26, 2026. LPA met with Assistant Administrator, Virgilio Delantar who's Administrator's Certificate expires on 10/18/2025. LPA explained the reason for the visit. LPA observed the facility is a two-story house with 5 resident bedrooms on the first floor, 3 bathrooms, living room, dining room and kitchen. The second floor is one room with a closet. A file review shows the fire clearance and facility sketch which was approved on September 9, 2020 does not have the second floor with the one room and closet. The facility does not have a current valid fire clearance. LPA observed the See Something, Say Something poster (PUB 475) posted in the entry way of the facility. LPA observed all 3 bathrooms are clean and operational. Hot water measured 111.9 degrees Fahrenheit. LPA observed all resident rooms had the required furnishings and bed linens. Smoke detectors and carbon monoxide detectors tested operational. LPA and the Administrator toured the kitchen. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the 5 burner gas stove does not light unassisted. LPA observed food debris on the stove and the top of the stove has grease stains. Administrator Rico Mico arrived during the visit. LPA and the Administrator toured the resident rooms. LPA observed all resident rooms have the required furnishings and bed linens. LPA observed the fireplace in the dining room has a glass door and there is a table placed right in front of the fireplace blocking access. LPA and Administrator toured the backyard. No bodies of water observed. There is a table with an umbrella and chairs to sit outside. LPA observed numerous items stored on the side of the house which has the exit gate. The exit gate is operational. LPA observed, ladders, chairs, bicycles, tools, buckets, walkers, commodes and empty containers stored on the side of the house with the exit gate. There is no record of a current fire drill. LPA reviewed 5 resident files. 5 out of 5 residents did not have a pre-appraisal conducted. 3 out of 5 residents did (Residents 1, 2 and 4) not have a current appraisal/needs and care plan. LPA and the Administrator toured the garage. The garage has a storage which is on the facility sketch. The storage room is used to store furniture. LPA observed a 72 hour emergency food and water supply in the garage. The garage is used to store extra supplies and is kept locked. LPA reviewed 3 staff files. 2 out of 3 staff did not have a health screening. 2 out of 3 staff members (Staff 2 and Staff 3) did not have the required annual training. All staff are background cleared and associated to the facility. Staff did have CPR training. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. A copy of the report along with appeal rights was provided to the Facility Administrator. An exit interview was conducted with Administrator.the state’s words, verbatim · CDSS document, Oct 24, 2024

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: POC

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the plan of corrections required after deficiencies were cited on February 9, 2024. LPA was able to clear some of the deficiencies, however two of the deficiencies initially cited were observed not to be resolved and were cited again during the present visit on the attached form LIC809-D. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Apr 19, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Apr 20, 2024

Per CCR Section 87705(f)(2) on Care of Persons with Dementia: "The following shall be stored inaccessible to residents with dementia: (...)Over-the-counter medication, nutritional supplements or vitamins, (...) cleaning supplies and disinfectants." This requirement is not met as evidenced by: Based on a tour of the physical plant, powdered bleach was observed to have been left accessible to residents on the dining room table. This constitutes an immediate risk to the health, safety and personal rights of individuals in carethe state’s words, verbatim · CDSS document, Apr 19, 2024

Plan of correction: Dangerous item removed during the visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: May 19, 2024

Per CCR Section 87608(a)(5)(B) on Postural Supports: "Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care(...)." This requirement is not met as evidenced by: The bed for one resident not currently receiving hospice care is observed to be equipped with full bed rails. This constitutes a potential risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Apr 19, 2024

Plan of correction: Licensee replaced the full rails with half rails during the visit based on the physician orders on file.

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of citing deficiencies observed during the initial investigation for complaint reference 22-AS-20240205155235. During the visit, LPA toured the physical plant of the facility in the company of facility administrator Rico Mico. LPA also requested and obtained relevant resident and staff records which were reviewed during the visit. Based on records reviewed and observations made, two type A citations and three type B citations are being issued at this time based on the following items of non-compliance: - Toxic substances are observed to be left accessible to residents in care, in spite of the presence of multiple residents with confirmed dementia diagnoses. - Resident records are observed to be missing signatures or physician reports for three of the six residents currently admitted. - Two residents are observed to have beds equipped with full bed rails despite not having been admitted to hospice. - One resident is diagnosed with a Prohibited Health Condition for which no hospice placement has been initiated, nor any exception has been sought. One Technical Assistance Advisory Note is additionally issued due to the presence of a staff member with a valid background clearance but no staff association in Guardian on the premices. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Feb 9, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Mar 8, 2024

Per CCR Section 87506(a) on Resident Records: "(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility (...) readily available to (...) licensing agency staff." This requirement is not met as evidenced by: Based on records reviewed at the facility, two resident files did not include the respective medical assessment form. A third file included an admission agreement that was not dated/signed by the administrator. This constitute a potential risk to the health, safety and personal risks of residents in care.the state’s words, verbatim · CDSS document, Feb 9, 2024

Plan of correction: Licensee will be ensuring that complete records for all six residents currently in care are present before the plan of corrections due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Feb 10, 2024

Per CCR Section 87705(f)(2) on Care of Persons with Dementia: "The following shall be stored inaccessible to residents with dementia: (...)Over-the-counter medication, nutritional supplements or vitamins, (...) cleaning supplies and disinfectants." This requirement is not met as evidenced by: Based on a tour of the physical plant, multiple instances ohe-counter treatments and cleaning supplies left accessible to residents were observed. This constitutes an immediate risk to the health, safety and personal rights of individuals in carethe state’s words, verbatim · CDSS document, Feb 9, 2024

Plan of correction: Licensee removed and made all dangerous items encountered inaccessible during the present visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87615(a)(2) · Plan of correction due date: Feb 10, 2024

Per CCR 87615(a)(2) on Prohibited Health Conditions: "Persons who (...) have a health condition including (...) those specified below shall not be admitted or retained in a residential care facility for the elderly: (2) Gastrostomy tubes." This requirement is not met as evidenced by: Based on a tour of the facility and records reviewed, resident R3 is noted to be fed through a gastrostomy tube but has not been admitted to hospice or been issued an exception by licensing staff. This constitutes an immediate risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Feb 9, 2024

Plan of correction: Licensee will submit a written statement that R3's family will be notified that either an hospice admission or discharge to a higher level of care is required at this time, before the plan of corrections due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Mar 8, 2024

Per CCR Section 87608(a)(5)(B) on Postural Supports: "Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care(...)." This requirement is not met as evidenced by: The beds for two of the residents not currently receiving hospice care are seen to be equipped with full bed rails. This constitutes a potential risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Feb 9, 2024

Plan of correction: Licensee replaced the full rails with half rails during the visit and will obtain relevant physician orders for half rails for both residents before the plan of corrections due date.