Hope Haven Care

Allegation investigated: Staff did not respect the residents reasonable accomodation right to room and roomate choices

Licensing Program Analyst (LPA) Jose De La Cruz conducted an unannounced visit regarding the above allegation. LPA was greeted by Licensee Lizelyn Gonzales (FA), to whom he identified himself and explained the purpose of the visit. The reporting party (RP) alleged that a resident (R1) was required to share a room with a resident in the final stages of life (R2), without consent. During an in-person visit on May 6, 2026, R1 was interviewed and confirmed that they shared a room with R2 for a few weeks, and described behaviors that were observed throughout the night as they were nearing death. [CONTINUED ON LIC9099-C] Substantiated [CONTINUED FROM LIC9099] LPA toured the facility, interviewed a client, FA, and outside sources (OS3 and OS4), and requested records. During an interview with FA, they acknowledged not consulting R1 before assigning them to share a room with R2, citing language compatibility as the reason. FA also mentioned that R2 moved to the facility from another facility managed by FA due to another resident who was R2's roommate at the time and having complained about the overnight noise made by R2. During records review it was found on the admissions agreement that a section for "Roommate Consent for Hospice" was signed by R1's POA regarding awareness that the resident might share a room with a resident on hospice care and allowing hospice into the shared living space. LPA however could not find a document signed by R1 agreeing to the same. LPA considers R1 to be in a good state of mind, aware of time, place and social environment. They are also aware that they are in a facility and the services being provided, as well as the people, and their relations to them (staff, administrators, family). Based on records reviewed, LPA observations, and interviews conducted with R1, and FA, the preponderance of evidence standard has been met, and the allegation is deemed substantiated. One deficiency was cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). Plan of Correction was jointly developed with the FA. An exit interview was conducted with Licensee Lizelyn Gonzales, to whom a copy of this report, the LIC 809-D pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit. Report and Appeal Rights discussed with and provided to Licensee Lizelyn Gonzales. Signature below confirms receipt. [CONTINUED FROM LIC9099] During an in-person visit on May 6, 2026, R1 reiterated the allegations. Regarding OS5, R1 said they were unsure why OS5 was asked to leave but speculated that it may have been due to OS5 wandering the facility and using areas without permission. Regarding privacy, R1 clarified they did not blame the unidentified male staff (AP1), stating that an unknown female staff (US) had asked AP1 to open a water valve during R1’s shower. R1 added that an unidentified staff member once looked through a partially open door but stated the incident had not occurred again. R1 confirmed that CA entered their room unannounced twice, over two months ago, and acknowledged not reporting these concerns earlier because they did not want to “make a big deal” and were more concerned on personal issues. LPA toured the facility, interviewed a client, FA, and outside sources (OS3 and OS4), and requested records. During the tour, LPA observed that doors connecting resident rooms to the exterior were locked. FA could not identify US or AP1, noting that the same staff have been employed since opening and that hospice or home health workers are sometimes mistaken for facility staff. Regarding OS5, FA stated this issue had been previously discussed with LPA and involved OS5 attempting to override the POA’s decisions and intervening in care for other residents. LPA tried to contact R1's POA (OS1), however they reached out OS3. Per OS3 they have not received any complaints regarding the facility or staff, and mentioned being aware of the situation with OS5. They mentioned not knowing the specific reason or circumstances, but clarified that they were related to R1, but they were not their POA. Based on records reviewed, LPA observations, and interviews conducted with R1, clients (R3), FA and outside sources OS3 and OS4, the preponderance of evidence standard has not been met, and the allegation is deemed unsubstantiated. No deficiencies were cited in accordance with the California Code of Regulations. Report and Appeal Rights discussed with and provided to Licensee Lizelyn Gonzales. Signature below confirms receipt.the state’s words, verbatim · CDSS document, May 6, 2026 · control 08-AS-20260501100312

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(h)(5) · Plan of correction due date: May 20, 2026

(h) For each terminally ill resident ... in the facility, the licensee shall ...: (5) A statement signed by the resident's roommate...indicating his or her acknowledgment ..., and the roommate's voluntary agreement to grant access to... the resident's support network..." Based on interview and record review, the licensee did not comply with the section cited above in one out of two residents which posed a personal rights risk to one person in care.the state’s words, verbatim · CDSS document, May 6, 2026

Plan of correction: Residents no longer share room

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose De La Cruz made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caretaker. The facility's license shows a maximum capacity of six (6) adult clients, ages 60 and over, three of them might be non-ambulatory and one bed ridden. Hospice waiver granted for six. LPA arrived at 1:50 pm to the facility. LPA requested facility files and around 2:10 pm. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. LPA and licensee reviewed the medications cabinet. Medications were labeled, as required, and stored in locked areas. No pools, bodies of water exist on the premises. There is a fireplace on the living room not in use. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC809] Per S1, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Water temperatures were measured around the facility with the following readings in Fahrenheit degrees: kitchen sink 108, bathroom 1 109. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited per California Code of Regulations. An exit interview was conducted with S1, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an announced Pre-Licensing for a change of ownership visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of California Code of Regulations and Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to applicants Jose Rafael Gonzales and Lizelyn Gonzales. The facility fire clearance was granted on and reflects that the facility is approved for six (6) residents in total, of which five (3) may be non-ambulatory and one (1) may be bedridden. The application included a request for a hospice care waiver for six (6) residents. During today’s visit, LPA, accompanied by the applicants, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets and showers were in working order. The facility’s ambient internal temperature was 72 F. Water temperatures at taps accessible to residents were also compliant: Kitchen was 110.5 F. The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future resident use. Refrigerator temperature was 38 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of medication and confidential resident and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant, no firearms or ammunition are or will be stored at the facility. (Continue at LIC 809C) (continue from LIC809) Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. One (1) fire extinguisher and two (2) first aid kits were present. Required licensing postings were observed in visible areas of the facility. The items reviewed were complaint with Title 22, Division 6 of California Code of Regulations and Health & Safety Code. The applicants passed the pre-licensing inspection. LPA also provided the Component III Training during today’s visit. The Gonzales' were advised that the facility’s application is pending management's final review and approval. An exit interview was conducted with the applicants, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jun 3, 2025