Great Golden Senior Living

Type of visit: Office

An Informal Meeting was conducted today in the San Diego Regional Office. Present at today’s meeting were: Licensing Program Manager (LPM) Robyn Clark, Licensing Program Analyst (LPA) Carmen Lopez, and Licensee Rose Dorvilus. The purpose of the informal meeting was to discuss facility operations, personnel, residents' rights, and basic services. During today’s meeting, LPA and LPM provided consultation on the California Code of Regulations and the Health and Safety Code. Also provided was a self-assessment for RCFE as well as Technical Support Program resources. Amended versions of the reports issued on 3/27/26 were also issued. A copy of this report was provided to Rose Dorvilus, Licensee. The Licensee was provided a copy of the Licensee Rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these rights.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by caregiver Dania Francois. LPA discussed the purpose of the visit with licensee Rose Dorvilus. According to the facility’s license, there may be a maximum of 6 residents, all of whom may be non-ambulatory at any given time at the facility site. The facility is approved for 1 bedridden resident in bedroom #4 and has an approved waiver for 4 residents. During today’s inspection, the facility’s current census is 4 residents living at the facility. There were 3 residents present at the facility site during the inspection. LPA inspected the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. Personal Protective Equipment was ordered during the inspection and will be delivered the following day, 04/21/26. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 75 degrees(º) Fahrenheit (F). Hot water temperature at taps accessible to residents was also compliant. There were at least 2 days of perishable food, and at least 7 days of non-perishable food present. Cooking, dining equipment, and utensils were present and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked locker, which LPA inspected. The facility-maintained medication logs, which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. Per administrator Dorvilus, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. Fire extinguishers were present (01) and was recently purchased. The first aid kit was complete and readily accessible. The facility maintained a first aid manual. LPA spoke with 2 residents and reviewed staff and resident records. The LPA's visit did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were no deficiencies observed or cited during today's annual inspection, but the facility received Technical Advisory (TA), which may be found within this report. An exit interview was conducted with Licensee Rose Dorvilus, to whom a copy of this report, along with the Licensee/Appeal Rights (LIC9058 03/22), were provided at the conclusion of the visit. The signature below confirms that the documents were received. LPA was provided an updated Designation of Administrative Responsibility (LIC 308) during the visit. LPA requested Licensee Dorvilus to submit a current Personnel Report (LIC 500) and Emergency Disaster Plan (LIC610-E) to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Apr 20, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: - Facility staff did not meet the care needs of resident(s)

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility, LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by caregiver Myrta Mompremier. LPA stated the purpose of the visit and reviewed the findings of the complaint with Administrator Rose Dorvilus, and caregiver Mompremier. The Department’s investigation consisted of interviews with residents, staff, outside source, records review of relevant documents pertinent to this investigation, and LPA observations. On March 23, 2026, it was alleged that the facility staff did not assist resident(s) out of bed. According to the facility’s documentation, resident #1 (R1) is cognitively sound and is able to follow directions, instructions, and communicate their self-care needs. They may take their own medications. R1 is non-ambulatory and, according to the Physician’s Report (LIC602), requires assistance with repositioning and transfers. They do have an assistive device for transferring and using their wheelchair. [Continuation on LIC9099-C] Substantiated [Continuation of LIC9099: p.2 of 3] Resident #2’s (R2) LIC602 indicates that they have a cognitive condition but has the ability to communicate their self-care needs and follow instructions. Their physical health states that they need assistance with repositioning and transferring. They do have an assistive device to assist with transferring. Due to their cognitive ability, they are unable to manage their own medications, lack hazard awareness, and are disoriented. Resident #3’s (R3) LIC602 shows that they are cognitively sound, but require assistance with repositioning and transferring. R3’s self-care capacity demonstrates that they are able to communicate their needs and follow instructions. They do have episodes of confusion and lack hazard awareness. R3 is unable to manage their own medication. According to the LIC602 for resident #4 (R4), they do display mild cognitive impairment and are confused/disoriented, but has the ability to follow instructions and communicate their needs. Their LIC602 shows that they require assistance with motor impairment and is non-ambulatory. They require assistance with self-care needs and are unable to manage their own medications. An overall interview with residents expressed that they desired to come out of their rooms. Interview with R1 said that they were told by the owner that they are allowed to come out of their room three times per week, but they have not been out in several days. They would like to be out of their room but need assistance with doing so. R1 also had issues with staff not providing their medications accurately. Interview with resident #2 (R2) preferred to have the ability to leave their bed to the living room. LPA inquired about the number of times they had left the room in the last 5 days, and R2 said that they had not left their room. Since they have been here, they have only left once. Interview with R3 said that they do have a Lyft, but not all the staff know how to use it. They are not often left in their room and would like to go, but the staff are busy. They mentioned that they have sat out in a chair possibly once but would like to go into the living room. Interview with resident #4 (R4) said that the facility at times have a shortage of workers and it takes a toll on them. They are supposed to get out of bed daily but there is no one to help the caregivers. Interview with staff #1 (S1) said that they did not have sufficient time to assist residents with the transfer. An outside source #1 (OS1) did corroborate that they observed resident in their room and R3 has mentioned that staff do not take them out of their room. [Continuation on LIC9099-] [Continuation of LIC9099-C: p.3 of 3] On March 27, 2026, LPA was at the facility and observed that there was insufficient staff to meet the residents' care needs. Residents were interviewed and expressed their desire to be out of their assigned rooms. Throughout LPA’s visit, the residents were not assisted with transferring onto their wheelchairs to come out of their rooms, until about 4:15 PM when one resident was assisted out. During the visit, LPA was left alone for approximately 20 minutes, and during that time, a hospice nurse came, and the staff was out of vicinity not attending with calls or the door when a hospice care staff arrived. LPA was provided a 31 day refusal log - Refusal to sit in chair / Go Outside log. The facility said that they only had this log sheet for resident in room #3 for the month of February 2026. Later LPA reviewed the medications for one resident which were not provided to resident as prescribed by their physician. Numerous medications were missed. Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff, resident and outside source interviews, records reviewed, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D page of this report. The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Administrator Rose Dorvilus via telephone, and caregiver Myrta Mompremier. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to caregiver Mompremier at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Mar 27, 2026 · control 08-AS-20260323115338

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 17, 2026

87411 (a) Personnel Requirements - General - (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs … this requirement was not met as evidenced by: Based on records review, interviews, and documentation,and LPA observations staff did not provide R1, R2, R3, and R4 with transferring out from their bed, and medications not being administered as precribed which posed an immediate personal rights risk to 4 of 4 residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2026

Plan of correction: The administrator agreed to assist with the care needs of residents and come in TWTH from 9am - 2pm; and MF from 9am - 12pm; and submit a schedule for themself along with scheduling medication training for staff by POC due date 04/17/2026. **This is an amended version of the initial report provided on 3/27/2026.**

Type of visit: Case Management - Other

During the visit on March 27, 2026, LPA observed that a bedridden resident, resident #1 (R1), was located in room #5, without a fire clearance. According to the facility sketch and the facility profile, the fire clearance only approved bedroom #4 for bedridden occupants. According to the R1’s Physician’s Report (LIC602), the resident is bedridden. LIC 602s for two other residents (R2) and (R3) indicated requirements for repositioning and transfers, but License Rose Dorvilus (LIC) clarified on 5/19/2026 that both were not bedridden. On 5/19/2026, LIC was also interviewed regarding medication bubble packs observed on 3/27/26 regarding R4, in which 6 doses of medications appeared to be missed. LIC clarified that R4 often received extra medications from their pharmacy and asserted that dosages were not missed as caregivers pulled from various bubble packs; no tracking method was in place to confirm this fact, such as records documenting the quantity of pills received. Deficiencies were observed and cited , and technical advisories (TA) were provided during today’s visit and may be found on the LIC809-D and TA9102 pages of this report, along with civil penalties (CPs) that were assessed. LPA provided technical assistance on additional Title 22 Regulations, including Maintenance and Operation; and Personnel Requirements, as well as resources to engage with the Department’s Technical Support Program. An exit interview was conducted, a copy of this report, CPs, along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Rose Dorvilus at the conclusion of the visit. The signature below confirms receipt of these documents. **This is an amended version of the initial report provided on 3/27/2026.**the state’s words, verbatim · CDSS document, Mar 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Mar 30, 2026

87204 (a) Limitations – Capacity and Ambulatory Capacity (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time… this requirement was not met as evidenced by: Based on records review, and observations, the facility did not provide R1 with an approved room for their ambulatory status which posed an immediate safety risk to 1 of 4 residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2026

Plan of correction: Facility agreed to speak with R1s family and inform them that R1 would need to move to the approved bedridden room by POC due date 3/30/26. **This is an amended version of the initial report provided on 3/27/2026.**

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(6)(C) · Plan of correction due date: Jun 10, 2026

87465 Incidential Medical and Dental Care: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (C) The drug name, strength and quantity. This requirement was not met as evidence by: Based on observation and the Licensee's interview the facility did not ensure quantity of one residents medication R3 was documented in the facility which posed a potential heath, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2026

Plan of correction: The Licensee has spoken with the pharmacy, responsible parties, and third party agencies regarding not providing additional medications to the facility and ensuring medications are administered and documented correctly. Licensee will be requesting a MAR from the pharmacies to assist. Licensee will send LPA all three residents MARs by POC due date 06/10/2026. **This is an amended version of the initial report provided on 3/27/2026.**

Allegation investigated: - Licensee did not ensure facility grounds were properly maintained

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility, LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Metanie Mossirel, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with Administrator Rose Dorvilus. The Department’s investigation consisted of interview with staff and LPA observations. On February 2, 2026, it was specifically said that the facility did not ensure their trash was disposed of inside a tight-fitted bin, which overflowed, causing malodorous smells to protrude into the community on hot days and cockroaches around the bin. It was said that the home did spray the cockroaches but may result in additional rodents. During today’s visit, LPA spoke with the Administrator who said they were aware of their trash overflowing but had already spoken to the city numerous times, but they were on the verge of changing the bins and was unsure if their request would go through. (Continuation on LIC 9099-C) Substantiated (Continuation of LIC9099) The Administrator said that they had spoken to the city last week and they had informed them they would need to wait approximately 3 days after their new bin arrived to order another bin. They recently received their new bins on Thursday, February 5, 2026, and were in the process of ordering their second bin. During today’s visit, LPA did observe that the facility’s trash bin was overflowing. Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff interviews, and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D page of this report. The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Administrator Rose Dorvilus. A copy of this report, along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Administrator Dorvilus at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 08-AS-20260202151918

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(f) · Plan of correction due date: Feb 24, 2026

87303 (f) Maintenance and Operation: All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents… this requirement was not met as evidence by: Based on interviews and observations, the facility did not ensure their trash was disposed of in a tight-fitted bin, which posed a potential personal rights risk to 3 of 3 residents in care.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: Administrator will be purchasing a new trash bin with a lid and send LPA a photo of the new bin purchased, by POC due date, 4/24/26. Licensee also agreed to continue to contact the city to ensure their request is processed.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Myrta Mompremier. LPA spoke with Administrator Rose Dorvilus via telephone during the visit. On 7/31/2025, the Department received an incident report from the facility regarding an alleged incident involving Resident 1 (R1) that occurred sometime in July 2025. [Caregiver was provided with an LIC811 Confidential Names List to identify R1] During today’s visit, LPA conducted a health and safety check, observed resident in care, reviewed facility records, and interviewed resident and staff. No deficiencies were cited on today’s date. An exit interview was conducted with Caregiver Myrta Mompremier, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit to conduct a post-licensing inspection. The LPA was granted entry into the facility and disclosed the purpose of the visit to Caregiver Myrta Mompremier. Licensee Rose Dorvilus arrived a short time after. A tour of the facility was conducted inside and out. The LPA accompanied by Licensee, conducted a general overall inspection, which included, but was not limited to, the following: facility physical plant, food service, medication management, records review, and facility administration. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, and meetings. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled and stored in a locked area. No pools or bodies of water on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detector, fire extinguisher, and facility telephone were present. The LPA provided technical advice. No deficiencies were cited during today's visit. An exit interview was conducted with Rose Dorvilus. A copy of this report, and the Licensee/Appeal Rights (LIC9058) were provided.the state’s words, verbatim · CDSS document, Jun 13, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ramon Serrano, conducted an announced Pre-Licensing inspection. LPA met with Licensee Rose Dorvilus and we discussed the purpose of the visit. LPA conducted a tour of the facility, both inside and outside. Their are no bodies of water on the premises. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains and paint throughout the rooms and the facility, were observed in good condition. Licensee stated there are no firearms stored on the premises. Hot water temperature and facility ambient temperature were both at compliant readings. The facility was observed to be clean and kempt with no strong malodors. The main kitchen refrigerator and freezer was observed to be clean and operational, with an ample amount of food to meet resident needs. Cleaning solutions were also properly secured in the garage storage areas. The Component III portion of the application process was completed with Licensee Rose Dorvilus on today's date as well. Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Rose Dorvilus and a copy of this report along with Licensee Rights was provided to Rose Dorvilus whose signature below verifies receipt of these.the state’s words, verbatim · CDSS document, Mar 10, 2025