Golden Horizon Senior Care

Type of visit: Case Management - Other

On 08/21/2026 Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced case management at the facility. LPA met with Administrator Ebrahem Hamed and explained the purpose of today's visit. During visit, LPA conducted file review. LPA reviewed (3) residents files. LPA observed (3) residents cash resources are provided from SSI. Residents cash resources are then put onto a debit card and distributed to resident's. LPA observed current surety bond. LPA did not observe any issues with residents files or any health or safety concerns. No deficiencies were cited today. An exit interview was conducted, and a copy of this report was provided to Administrator Ebrahem Hamed.the state’s words, verbatim · CDSS document, Aug 21, 2026

Type of visit: Case Management - Other

On 07/10/2026 Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit in regards to complaint 56-AS-20260327161149. LPA met with Administrator Ebrahem Hamed and was granted entry to the facility. LPA explained the purpose of today's visit. LPA conducted (4) resident interviews and obtained pertinent documentation in regards to complaint. An exit interview was conducted, and a copy of this report was provided to Administrator Ebrahem Hamed.the state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Ebrahem Hamed and was granted entry to the facility. Licensed capacity is (22) current census (22). LPA was accompanied by Administraor Ebrahem Hamed to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA tested hot water temperature to be 113 degrees Fahrenheit. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. LPA observed (1) resident labeled as non-ambulatory and (1) resident labeled bedridden. Facility is only licensed for ambulatory residents. Deficiency and civil penalty will be issued. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (8) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA reviewed (8) resident medications. LPA also reviewed (4) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. No issues were observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, May 27, 2026

Allegation investigated: Staff did not allow resident to leave the facility

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administrator Ebraheem Hamed and explained the purpose of the visit. The investigation consisted of staff interviews, resident interview and facility tour. On 03/27/2026, the licensing department received a complaint in regards to not allowing resident to leave the facility. LPA conducted (3) staff interviews. Per staff interviews, the facility allows residents who are able to leave the facility unassisted and all residents that are not allowed to leave unassisted facility staff will accompany them. Per record review, Resident #1 (R1) is not able to leave the facility unassisted. Administrator Ebrahem Hamed stated an incident occured where R1 was attempting to leave with an unknown individual. 3 out of the 3 staff stated they did not feel safe leaving with R1 due to unknown individual and due to R1's safety was not advised to leave. Unsubstantiated Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit, pertaining to the allegations listed, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Apr 3, 2026 · control 56-AS-20260327161149

Allegation investigated: Staff allowed an underage individual to work at the facility Staff stole resident's funds Staff did not ensure a comfortable facility temperature was maintained for residents in care Staff allowed resident in care to leave the facility unassisted

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and facility tour. For the allegation, Staff allowed an underage individual to work at the facility. LPA Hernandez observed staff roster and did not observe underage staff working at the facility. Additionally, LPA Hernandez conducted (4) resident interviews that indicated 4 out of the 4 residents did not witness an underage individual working at the facility. Unsubstantiated For the allegation, Staff stole resident's funds. LPA Hernandez spoke with Administrator Ebraheem Hamed who stated all residents receive money monthly and is given to them to use. LPA Hernandez conducted (4) resident interviews. 4 out of the 4 residents stated facility staff have never stolen their funds. For the allegation, Staff did not ensure a comfortable facility temperature was maintained for residents in care. LPA Hernandez conducted (4) resident interviews. 4 out of the 4 residents stated facility temperature is maintained at a comfortable temperature. LPA observed facility temperature to be at 74 degrees Fahrenheit. For the allegation, Staff allowed resident in care to leave the facility unassisted. LPA Hernandez spoke with Administrator Ebraheem Hamed who stated Resident #5 is able to leave the facility unassisted. LPA observed Resident #5 physician report which indicates Resident #5 is able to leave the facility unassisted. Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit, pertaining to the allegations listed, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Staff Muhamad Hamad.the state’s words, verbatim · CDSS document, Sep 25, 2025 · control 56-AS-20250701160048

Type of visit: Case Management - Deficiencies

On 09/25/2025 Licensing Program Analyst conducted an unannounced case management visit to the facility. On 07/07/2025 LPA Hernandez visited the facility to conduct a complaint investigation. During LPA's visit, Administrator Ebrahem Hamed stated Resident #1 (R1) was given a Apple Air Tag that is able to locate R1 when they leave the facility. LPA noted R1 is able to leave the facility unassisted. LPA advised putting objects on residents in care to tell their location is considered a personal rights violation. During today's visit, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) and (LIC809D) was discussed and provided to Staff Muhamad Hamad. Along with Appeal Rights.the state’s words, verbatim · CDSS document, Sep 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 2, 2025

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall ... (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Licensee stated moving forward to not put any location objects on residents in care or to notify licensing department before use. Plan of Correction (POC) wil be cleared.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Ebraheem Hamed and was granted entry to the facility. Licensed capacity is (22) current census (22). LPA was accompanied by Administrator Ebraheem Hamed to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature at 72 degrees. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA tested hot water temperature to be 109 degrees Fahrenheit. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. LPA Hernandez observed scissors in kitchen drawer unlocked accessible to residents in care. Deficiency will be issued. There was a designated office for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Additionally, LPA Hernandez observed side gate locked. Deficiency will be issued. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (8) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA reviewed (8) resident medications. LPA Hernandez observed all PRN medications for (8) residents were documented. However, LPA advised Administrator to obtain resident's response in record of PRN dosage. Technical Violation will be issued. LPA also reviewed (4) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. No issues were observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Jul 18, 2025

Allegation investigated: Staff did not prevent residents from engaging in a physical altercation. Resident sustained severe injuries due to staff neglect.

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Facility Caregiver Staphanie Morales. The investigation consisted of resident interviews, staff interviews, and record review. For allegation, Staff did not prevent residents from engaging in a physical altercation: Interviews with the clients and the staff revealed that on 8/7/2023 Resident R1 was physically assaulted by Resident R2. On 8/6/2023, Staff S1 was the only staff on duty at the facility as of 6:00 PM. S1 went to sleep around 10:00 PM on 8/6/2023 which left the residents in the facility unsupervised from 10:00 PM on 8/6/2023 to 1:00 AM on 8/7/2023. Around 1:00 AM, S1 was awoken by Resident R3 and informed there was an assault between R1 and R2. At this time, S1 walked into the living room and found R1 sitting on the couch covered in blood. S1 asked R1 what happened, S1 told R1 that S1 was attacked by R2 with a laundry basket. Substantiated S1 went into R1’s bedroom and found blood on the floor and a bloody cracked laundry basket on R1’s bed. S1 accessed R1 and called emergency services. Document review of a special incident report (SIR) dated 8/72023, stated that R2 hit R1 on the head with a laundry basket more than twenty (20) times. Additionally, there were four (4) incidents reported in May of 2023 between R1 and R2. During these incidents, R2 attempted to throw a water bottle at R1, R2 was upset that R1 was in R2’s way, R2 knocked R1’s hat off R1’s head, R1 accused R2 of throwing R1’s walker and hitting R1 on the head. No injuries were reported for the prior incidents. S1 stated that they kept a closer eye on R1 due to believing R1 was at risk. No additional means were made by the facility to ensure the safety of R1., For allegation, Resident sustained severe injuries due to staff neglect: Medical record review of R1’s hospital records from 8/7/2023 revealed R1 sustained severe injuries due to the assault the occurred. R1 suffered from contusions and lacerations of the vertex of the head and the right parietal areas. R1’s wounds went down to the subcutaneous tissue. Based on evidence obtained during the investigation, the two (2) allegations listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because of the preponderance of evidence the standard has been met. In addition, an immediate civil penalty is assessed for $500.00, per Health and Safety Code. In addition, an additional review is being conducted and additional civil penalty may be imposed per Health and Safety Code During today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Facility Caregiver Stephanie Morales, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Apr 25, 2025 · control 56-AS-20230815163259

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87468.1(a)(3) · Plan of correction due date: Apr 28, 2025

Personal Rights of Residents in All Facilities....(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: based on interview and document review, the licensee did not comply with the section cited above evidenced by not ensuring the resident was safe and free from abuse and intimidation which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 25, 2025

Plan of correction: The licensee has agreed to read regulation 87468 entirely and send LPA a statement of understanding that the regulation was read and understood. The licensee has agreed to send LPA a plan that explains how the facility staff will ensure the residents are safe and how their daily functions will be supervised to ensure their safety. POC is due by 4/28/2025. The licensee has agreed to read regulation 87415 entirely and send LPA a statement of understanding that the regulation was read and understood. The licensee has agreed that moving forward the facility will staff an awake staff to supervise the residents. The licensee has agreed to send LPA a staff schedule that includes staff coverage for 24 hours a day, 7 days a week. POC is due by 5/2/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87415(a)(2) · Plan of correction due date: May 2, 2025

Night Supervision....(a) The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services and shall be available as indicated below to assist in caring for residents in the event of an emergency. (2) In facilities caring for sixteen (16) to one hundred (100) residents at least one employee shall be on duty on the premises, and awake. Another employee shall be on call, and capable of responding within ten minutes. This requirement is not met as evidenced by: based on interview and document review, the licensee did not comply with the section cited above evidenced by not having an awake night staff on duty which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 25, 2025

Allegation investigated: Staff inappropriately touched clients in care

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administator Ebarheem Hamed and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and document review. Community Care Licensing Division Investigator Dennis Seng conducted three (3) staff interviews. 3 out of the 3 staff believed there was sexual relationship between Resident #1 (R1) and Staff #1 (S1). Dennis Sang conducted four (4) resident interviews. 4 out of the 4 residents indicated they would see S1 spending time in R1’s room and Resident #5 (R5) witnessed S1 touching R1 inappropriately. Resident #4 (R4) stated they saw inappropriate photos of S1 on R1’s phone but did not see any inappropriate interactions between R1 and S1. R1 stated they had engaged in sexual intercourse with S1. Additionally, S1 stated to have a sexual relationship with R1 while working at the facility. Substantiated Based on the evidence gathered during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met. During today’s visit, pertaining to the allegation stated, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Ebraheem Hamed. LPA Hernandez conducted (7) resident interviews. 7 out of the 7 residents stated facility staff do take care of their personal belongings. Additionally, LPA Hernandez observed most of residents personal belongings are located in their room with them. LPA Hernandez conducted (3) staff interviews. 3 out of the 3 staff stated they do safeguard residents personal belongings when needed, however, most of their personal belongings are inside their rooms with them. Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit, pertaining to the allegations listed, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Apr 7, 2025 · control 56-AS-20241030141759

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(2) · Plan of correction due date: Apr 8, 2025

87413 Personnel Operations (a) In each facility: (2) Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. Based on interview and record review, the licensee did not comply with the section cited above evidenced by Staff #1 (S1) and Resident #1 (R1) admitted to have a sexual relationship while S1 was working at the facility, which imposes an immediate health, safety and personal risk to persons in care.the state’s words, verbatim · CDSS document, Apr 7, 2025

Plan of correction: Licensee stated to submit photo documentation of all staff reading over section 87413(2) and submitting to LPA Hernandez by Plan of Correction (POC) due date.

Allegation investigated: Staff did not obtain medical care for resident in a timely manner

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administator Ebarheem Hamed and explained the purpose of the visit. The investigation consisted of interviews and document review. LPA Hernandez interviewed (5) residents and (2) staff. 5 out of the 5 residents stated staff do help them in a timely manner. Additionally, 2 out fo the 2 staff stated they do help the residents in a timely manner. Administrator Ebraheem Hamed confirmed Resident #1 (R1) does not live at the facility. Administrator stated R1 has never lived at the facility or next door on additional property. Unfounded Based on the evidence gathered, the allegation is deemed UNFOUNDED. A finding that the complaint allegation is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the allegation dismissed. An exit interview was conducted where this report LIC9099 was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Apr 7, 2025 · control 56-AS-20250403085711

Allegation investigated: Staff are witholding food and water from residents Facility is not kept clean

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Administrator Ebraheem Hamed and explained the purpose of the visit. The investigation consisted of staff and resident interviews and facility tour. LPA Hernandez interviewed (4) residents and (1) staff. 4 out of the 4 residents stated staff do no withold food and water from residents in care. Staff interviewed stated facility staff do not withold food and water from residents. Additionally, 4 out of the 4 residents stated facility is kept clean. Staff stated facility is cleaned daily and all residents are assisted with cleaning needs. Administrator Ebraheem Hamed confirmed visitor does not live at the facility and visits residents at the facility from time to time. Administrator Ebraheem Hamed stated there is no unlicensed care being provided to the home next door to the facility. Administrator owns and rents out the property located next door. Unfounded Based on the evidence gathered, the allegation is deemed UNFOUNDED. A finding that the complaint allegation is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the allegation dismissed. An exit interview was conducted where this report LIC9099 was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Jan 24, 2025 · control 56-AS-20250123163833

Allegation investigated: Facility staff are not properly addressing rodents in the facility.

Licensing Program Analysts (LPAs) Raquel Hernandez and Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPAs met with Administrator Ebraheem Hamed and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and facility tour. For the allegation, Facility staff are not properly addressing rodents in the facility. LPA Hernandez conducted three (3) staff interviews and six (6) resident interviews. During residents interviews 3 out of the 6 residents stated they have seen rodents in the facility and kitchen. 3 out of the 6 residents also stated that staff removes the rodents with mouse traps. In addition, 2 out of the 6 residents stated they have not seen any rodents at the facility. During staff interviews, 3 out of the 3 staff stated they have not seen any rodents or bugs in the facility. Unsubstantiated On 10/4/2024 Licensing Program Analysts (LPAs) Raquel Hernandez and Mary Rico inspected the facility and observed mouse traps located in the kitchen and in the office room. LPAs did not see any rodents at the facility, and no rodents droppings. Futhermore, Administrator Ebraheem Hamed stated the mouse traps are for precaution and there hasn't been a rodent seen at the facility. During record review, LPA Hernandez observed the facility receives monthly pest control. LPA received copies of pest control invoices. Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Oct 4, 2024 · control 56-AS-20240930131922

Type of visit: Required - 1 Year

On 06/19/2024 at 09:20 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with Licensee/Administrator Ebraheem Hamed and was granted entry to the facility. At the time of the visit there was two (2) staff present, and sixteen (16) residents present. LPA Brown explained the purpose of the visit to Licensee/Administrator Ebraheem Hamed. The facility is eleven (11) bedroom, seven (7) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of twenty-two (22) ambulatory residents. The current census is twenty-one (21) residents. LPA Brown was accompanied by Licensee/Administrator Ebraheem Hamed to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. Moreover, during the tour of the facility, LPA Brown observed the knives drawer not locked and accessible to residents in care. Deficiency will be issued. In addition, LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 113 degrees Fahrenheit. LPA Brown observed one (1) window screen in disrepair. Technical Violation issued. LPA Brown observed movable waste bin in the kitchen does not have a cover. Deficiency will be issued. ***Continuation in LIC809C *** The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster, Labor Laws and the Emergency Disaster plan were posted in a common area. Also, LPA Brown observed that the facility does not have signal system. Deficiency will be issued. All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the Office room. Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Brown observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed eight (8) resident files for pre-placement appraisals, admission agreements, updated physician reports, and needs and services plans. LPA Brown observed five (5) of eight (8) files reviewed for physician’s reports do not have Physician signature date. Deficiency will be issued. LPA reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown found that Staff #2 (S2) and Staff #4 (S4) do not have Health Screening Report and Tuberculosis Test Result in their facility file as there's no physician signature in their Health Screening Reports. Deficiency will be issued. Furthermore, LPA Brown observed Staff #2 (S2) and Staff #4 without current cardiopulmonary resuscitation (CPR) training and first aid training Deficiency will be issued. Lastly, LPA Brown did not observe required trainings provided to the staffs at the facility. Deficiency will be issued. Also, three (3) residents medications were audited and LPA Brown observed that there's one medication not listed in Resident #2 (R2) Medication Administration Record (MAR) at the facility and LPA Brown observed that the facility's dispensing or giving R2's medications. Deficiency will be issued. To add to that, LPA Brown observed that Resident #9 (R9) medication was dispensed/given but Staff #2 (S2) did not sign/update R9's MAR. Deficiency will be issued. An exit interview was conducted where this report, (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Jun 19, 2024

The state marks this report as 33 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.

Allegation investigated: Staff made inappropriate comment towards resident. Staff yelled at resident.

On 12/20/2023 at 01:30 PM, Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Ebraheem Hamed at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and a review of pertinent documentation. The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The first allegation indicates that Staff made inappropriate comment towards resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with residents indicated that no staff at the facility made inappropriate comment towards resident. Resident #1 (R1) reported to LPA Brown that no staff at the facility made inappropriate comment to R1. ***Continuation in LIC9099C *** Unsubstantiated Staff interviews indicated that they never made inappropriate comment to a resident and no incident happened at the facility that staff made inappropriate comment towards a resident. During the visit on 12/14/2023, LPA Brown observed no staff making inappropriate comments to residents. The second allegation indicates Staff yelled at resident. Interviews with residents pointed out that no staff at the facility yelled at them. Interviews with residents revealed that the staffs at the facility are all nice and all staffs are assisting them with their needs. Interviews with staffs revealed that no staff at the facility yells at resident and there's no incident that happened at the facility that a staff yelled at resident. R1 reported to LPA Brown that no staff at the facility yelled at R1. During the visit on 12/14/2023, LPA Brown observed no staff yelling at residents. Based on interviews, observations and records review, the allegation Staff made inappropriate comment towards resident (Allegation #1) and Staff yelled at resident (Allegation #2) are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, where this report (LIC9099) was discussed and provided to Licensee/Administrator Ebraheem Hamed.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 56-AS-20231107100241