Hacienda Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Raul Velazquez and was granted entry to the facility. At the time of the visit there was three (3) staff present, and five (5) residents present. The facility is a four (4) bedroom, four (4), bathroom home, with a kitchen/dining area, living room, and attached garage. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (5). LPA was accompanied by Facility Administrator, 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’s 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 observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 117.1 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. LPA observed an in-ground pool in the backyard, the perimeter of pool is gated and locked. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside medication cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed two (2) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made 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 (LIC809) was discussed and provided to Facility Administrator Raul Velazquez.the state’s words, verbatim · CDSS document, Aug 25, 2026

Allegation investigated: Staff do not ensure residents personal possessions are safeguarded at all times. Staff do not speak to residents in an appropriate manner. Licensee does not ensure all staff are able to communicate with residents in care.

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegations. LPA identified self and met with Administrator Raul Velazquez. The investigation consisted of LPA observation, reviewing pertinent records, and interviews with relevant parties. Regarding the allegation, staff do not ensure residents personal possessions are safeguarded at all times, interviews with the Administrator, three (3) staff, and three (3) residents reveal that staff are ensuring residents personal possessions are safeguarded and no resident personal items have been reported missing. The facility has a theft and loss policy and bedroom doors that lock. Regarding the allegation, staff do not speak to residents in an appropriate manner, interviews with the Administrator and three (3) staff reveal that staff do speak to residents in an appropriate manner. **continued on LIC9099-C*** Unsubstantiated Interviews with three(3) residents reveal that staff do speak to them in an appropriate manner. Regarding the allegation, Licensee does not ensure all staff are able to communicate with residents in care, interviews with the Administrator, three (3) staff, and three (3) residents reveal that staff are able to communicate with residents in care and there are no language barriers. Based on the Department's investigation the allegations mentioned in this report are Unsubstantiated. Unsubstantiated meaning that although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy provided to Administrator Velazquez at the conclusion of the visit. Regarding the allegation, staff do not ensure the medications are centrally stored and secured at all times for residents in care, LPA observed medications for residents being stored in an unlocked kitchen refrigerator. Regarding the allegation, staff do not ensure residents medication records are properly maintained, review of three (3) resident medications records reveals that all three (3) residents take PRN medications. Staff stated that although the residents' PRN medication have been administered, there is no documented record of when the medication was taken, the dosage taken, and the resident's response. Based on the Department's investigation, the allegations are Substantiated. A finding that the complaint is Substantiated means that the allegation(s) are valid because the preponderance of the evidence standard has been met. An exit interview was conducted. Copies of reports (LIC9099, LIC9099C & LIC9099-D) were provided with appeal rights to Administrator Velazquez at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 22, 2026 · control 56-AS-20231129141628

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 25, 2026

(a) A plan for incidental medical...The plan shall encourage routine medical... and provide for assistance in obtaining such care, by compliance with the following:(1)The licensee shall arrange, or assist in arranging, for medical appropriate to the conditions and needs of residents..this requirement is not met as evidenced by: The Licensee did not comply with the section cited above by Staff did not make appropriate arranges to obtain R1 prescribed medications resulting in R1 not having medications on hand; which poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: The Licensee/Administrator stated that they will obtain R1's daily medication#1 by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: May 25, 2026

(h) The following...apply to medications which are centrally stored:(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication; this requirement is not met as evidenced by: The licensee did not comply with the section cited above by LPA observed resident's medications stored unlocked in kitchen refrigerator; which poses an immedicate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: The Licensee/Administrator stated that the refrigerated medications will be placed in an appropriate locked container by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87465(d)(3) · Plan of correction due date: Jun 5, 2026

(d)If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication...facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided; (3)The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. The Licensee did not comply with the section cited above by not maintaining a record of when all three (3) residents PRN medications were taken.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: The Licensee shall provide staff training PRN medication management and submit documentation of training by POC due date.

Type of visit: Case Management - Other

On 5/11/2026 at 12:00PM Licensing Program Analyst (LPA) Eldin Serrano arrived to the facility to deliver findings on an amended report (LIC 9099) regarding complaint control number 56-AS-20250214093747.the state’s words, verbatim · CDSS document, May 11, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 13, 2026

Title 22, Division 6 Chapter 8 87468.1 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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. Based on interviews conducted, the licensee did not comply with the section cited above by not ensuring that resident #1 (R1) to be accorded dignity in their personal relationships with staff, residents, and other persons which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 11, 2026

Plan of correction: Licensee/Administrator agrees to submit a statement of understanding to follow the regulation cited above by plan of correction (POC) due date.

Allegation investigated: Licensee refuse to return resident medication unless rent was paid

On 10/15/2025 at 3:30 PM, Licensing Program Analysts (LPAs) Eldin Serrano and Magda Malcore made an unannounced visit to the facility to investigate and deliver the findings on the above allegations. LPAs met with caregiver Vilma Reyes to explain the purpose of the visit. The investigation consisted of interviews with facility staff, witnesses, outside parties, and record reviews. It is alleged that the licensee refused to return resident medication unless rent was paid. Interviews with facility staff and outside parties revealed that on 9/23/2025, W1 reported that they overheard a phone conversation between resident #1’s (R1) responsible party (RP) and the individual at the facility. W1 reported the phone conversation between responsible party, and facility representative was that the responsible party was told to “bring the check and I will give you the medication.” Interviews further confirmed that R1’s medications were released to the responsible party on January 8, 2025. ********continue on LIC9099C******* Substantiated Based on interviews conducted the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated under the California Code of Regulations Title 22, Division 6 Chapter 8. Deficiency was issued on todays visit recorded on LIC809D dated 5/11/26. An exit interview was conducted, and a copy of this report was reviewed with and provided to Raul Velazquez.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 56-AS-20250214093747

Allegation investigated: Licensee refuse to return resident medication unless rent was paid

On 10/15/2025 at 3:30 PM, Licensing Program Analysts (LPAs) Eldin Serrano and Magda Malcore made an unannounced visit to the facility to investigate and deliver the findings on the above allegations. LPAs met with caregiver Vilma Reyes to explain the purpose of the visit. The investigation consisted of interviews with facility staff, witnesses, outside parties, and record reviews. It is alleged that the licensee refused to return resident medication unless rent was paid. Interviews with facility staff and outside parties revealed that on 9/23/2025, W1 reported that they overheard a phone conversation between resident #1’s (R1) responsible party (RP) and the individual at the facility. W1 reported the phone conversation between responsible party, and facility representative was that the responsible party was told to “bring the check and I will give you the medication.” Interviews further confirmed that R1’s medications were released to the responsible party on January 8, 2025. ********continue on LIC9099C******* Substantiated Based on interviews conducted the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated under the California Code of Regulations Title 22, Division 6 Chapter 8. Deficiency was issued on todays visit recorded on LIC809D dated 5/11/26. An exit interview was conducted, and a copy of this report was reviewed with and provided to Raul Velazquez.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 56-AS-20250214093747

Allegation investigated: Staff did not provide responsible party with resident's medication for overnight outing

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility conduct complaint investigation regarding the above allegation. LPA Prieto met with licensee Raul Velazquez and discussed the elements of the complaint. Allegation #1, Interview with staff #1 (S1) states that the medication for resident #1 (R1) was provided to R1s responsible party (RP) the day of R1s departure for an outing. S1 adds that RP left behind one medication. Staff #2 (S2) made arrangements with RP, the following calendar day, to retrieve R1's medication. S2 states RP did not comply and medication was not retrieved. S2 states that she volunteered to deliver medication to RP's residence and RP refused. Licensee Velazquez stated to RP, two calendar days later, that the medication could be retrieved at the facility. RP refused to arrive to the facility to retrieve the medication. Instead law enforcement arrived and retrieved the medication from Licensee Velazquez and given to RP. Unsubstantiated Interview with RP states that medication was purposefully not included when R1's medication was retrieved from the facility, yet all attempts to deliver or retrieve this medication personally was not successful. Based on the information obtained there is not enough evidence that staff did not provide responsible party with resident's medication for overnight outing. Therefore, the allegations is deemed UNSUBSTANTIATED at this time. This report was discussed with Licensee Velazquez and a copy was left at the facility.the state’s words, verbatim · CDSS document, Jan 15, 2025 · control 56-AS-20250108081519

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Raul Velazquez and was granted entry to the facility. At the time of the visit there was three (3) staff present, and four (4) residents present. The facility is a four (4) bedroom, four (4), bathroom home, with a kitchen/dining area, living room, and attached garage. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (4). LPA was accompanied by Facility Administrator, 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’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be 112 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. LPA observed an in-ground pool in the backyard, the perimeter of pool is gated and locked. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside medication cabinet inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made 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 (LIC809) was discussed and provided to Facility Administrator Raul Velazquez.the state’s words, verbatim · CDSS document, Jul 31, 2024

Allegation investigated: Staff are not allowing resident to have visitors

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regrading the above allegation. LPA met with lead staff Mirian Velasquez to discuss the elements of the complaint. Regarding allegation that staff are not allowing resident to have visitors; interviews with staff #1 (S1), S2 and S3 and administrator reveal the resident #1 (R1), in question, does have their visitor on a daily basis for approximately 2 hours in the morning and 2 hours in the evening. Staff state that visitor has never been denied entry into the facility. This agency has investigated the complaint alleging staff are not allowing resident to have visitors. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Dec 14, 2023 · control 56-AS-20231208122525

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.