Integrated Care Communities - B2

Allegation investigated: Staff injured resident while in care.

On June 12, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit. LPA met with the Administrator (A1), Emily Rodriguez, and explained the purpose of the visit. The complaint investigations consisted of the following. On June 12, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 06/03/26) and the Resident Roster (dated 06/03/26). The Department reviewed and collected documents for Resident 1 (R1), including the Admission Agreement, the physician's report, the Resident moving out report (dated 07/16/2024), the facility note dated 06/19/2024, and staff training on the client's personal rights and Elder Abuse. The Department interviewed the Administrator (A1), five staff members (S1-S5), and five residents (R2-R6). The Department was unable to interview client R1 because R1 moved out of the facility on 07/16/2024. Unsubstantiated Allegation #1: Staff injured residents while in care. The complaint alleged that a staff member at the facility bent Resident #1's (R1) fingers to coerce the client into doing something. On June 12, 2026, the department interviewed the Administration (A1), which denied the allegation and stated that no staff member would ever engage in such behavior. On the same day, the department interviewed five staff members (S1-S5), all of whom denied ever bending or abusing any residents in their care. They also stated that the facility conducts quarterly training on resident rights and the prevention of elder abuse. Additionally, on June 12, 2026, the department interviewed five residents (R2-R6), all of whom denied any allegations of staff abuse or mistreatment while living at the facility. They remarked that the staff was excellent and always responsive when they asked for help. The department interviewed the resident's Power of Attorney (POA) as part of the investigation into the complaint and confirmed that R1 moved out of the facility on July 16, 2024. On June 12, 2026, while reviewing the facility's records, the department found that the facility had submitted a SOC 341 form and cross-reported the allegation to both the police and the Ombudsman on June 26, 2024. Report Continued On LIC9099C Additionally, the department examined the Unusual Incident Report submitted to Community Care Licensing on June 19, 2026, along with the facility notes dated June 19, 2024. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator, Emely Rodriguez.the state’s words, verbatim · CDSS document, Jun 12, 2026 · control 18-AS-20240626162252

Type of visit: Case Management - Other

On 11/3/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering an amended version of an original report for complaint for complaint 18-AS-20240712084308. LPA met with LVN, Amber Croft, and explained to Amber the purpose of the visit. LPA Flores did not observed any health and safety concerns. During the visit, no deficiencies were issued and no civil penalties were accessed per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted where a copy of this report was discussed with and provided to LVN, Amber Croftthe state’s words, verbatim · CDSS document, Nov 3, 2025

Type of visit: Required - 1 Year

On October 28, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with the Licensee, Emely Rodriguez. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for 20 Elderly Adults and is currently operating at a capacity of 16 Elderly Adults (740). LPA Mixson toured the facility along with Licensee and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The facility is a single-story cottage facility, located at 14315 Nason Street Moreno Valley, CA. 92555. Physical Plant: The facility phone number is (951) 601-9170 and it is operable. LPA Mixson observed the residents’ bedrooms, and each was furnished with required fixtures as per Title 22. LPA Mixson inspected the facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the LTCO poster. The cleaning supplies and sharp items were locked and inaccessible to the residents in care presently. There were designated storage spaces for the residents’ and staff’s files, and it was locked and inaccessible to residents in care at present. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. There were no documented errors observed on the centrally stored medication form, and medications were stored in their original containers during this visit. The facility has two caregivers present and a housekeeping staff arrived shortly after the LPA. Food Service& furniture: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents at this time. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The overall facility is clean; the furniture is in good condition and arranged in a manner which provides space for residents to move safely. The facility cooling system and other appliances were operable at present. Care & Supervision/Administration: Adequate staff are present for the supervision and care of residents. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Emely Rodriguez, possesses a current administrator’s certificate with an expiration date of 06/13/2026. Records Reviewed and Resident/Staff Files: LPA reviewed staff files and reviewed the facility's staff schedule. The staff files reviewed have criminal clearance, updated training, along with current First Aid certification. Resident files reviewed possessed the required paperwork as per Regulations at the present. Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the Department standards and was conducted as required per standards. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found required infection control measures met the Department requirements. An exit interview was conducted. A copy of this report was reviewed and given to Licensee, Emely Rodriguez.the state’s words, verbatim · CDSS document, Oct 28, 2025

Allegation investigated: Facility failed to assist resident with administration of medications.

On October 1, 2025, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Administrator Emily Rodriquez and the purpose of the visit was explained. Investigation consisted of the following: On 5/17/22, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, it was determined that the complaint required further investigation. On October 1, 2025, the Department toured facility’s med room, requested and received copies of the following: Staff roster (dated 9/3/25) Resident Roster (dated 10/1/25), R1’s Medication Administration Record (MAR)-dated March 2022, April 2022, May 2022, R1 physcian's report (dated:11/19/21, 2/15/18), Needs and Services Plan (dated 2/27/18). Medication audit sheet (dated 5/25/22), staff medication training (dated: 7/3/25, 6/25/25, 6/15/25, 5/30/25, 4/25/25, 4/9/25). The Department conducted interviews with 3 staff 1- (S1-S3 ) and Administrator (A1). The Department interviewed 3 residents (R2-R4). Page 1 of 3 Unsubstantiated The investigation revealed the following: Allegation: Facility failed to assist resident with administration of medications. The detail of the complaint alleges that R1 wasn’t receiving medication at the facility during the time of March 2022-May 2022.. On October 1, 2025, the Department conducted a review of R1 Medication Administration Record (MAR) for March 2022, April 2022 and May 2022. Records revealed that all of R1's medication including PRNs were given and properly initialed by staff; no discrepancies found. On October 1, 2025 at 1:17pm, The Department interviewed Administrator (A1), who denied the allegation stating there were no reports of R1 missing medication as mentioned in the complaint. A1 went on to state that in the event a resident medication has not arrived due to an any issue, the facility's pharmacy will provide them an emergency supply of medication until issue is resolved so that resident is not missing the medication. On October 1, 2025, between 1:00pm and 2:00pm, The Department interviewed 3 staff regarding the allegation and of those interviewed, 3 out 3 stated that at no time has R1 missed any of her medication. Additionally, 3 out of 3 stated that medications for all residents are dispensed as prescribed and are on time. Page 2 of 3 On October 1, 2025 between 2:45pm and 3:40pm, the Department interviewed 3 Residents (R-2 -R4). The Department was unable to interview R1 as she reportedly passed away on August 2023. Of those interviewed, 3 out of 3 state they receive their medication as prescribed and on time and that they have never miss medication due to staff not giving it. According to the information gathered there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. There were no deficiencies cited during today's visit. Exit interview conducted with Administrator Emily Rodriguez and copy of report provided. Page 3 of 3the state’s words, verbatim · CDSS document, Oct 1, 2025 · control 18-AS-20220511160759

Type of visit: Case Management - Other

On January 10, 2025, Licensing Program Analysts (LPAs), Abdoulaye Zerbo and Seo Jeon did an unannounced visit to conduct a case management, and met with the Administrator Emely Rodriguez. LPAs introduced themselves and stated the purpose of the visit. LPAs toured the facility, along with the Administrator Emely Rodriguez, conducted interviews and made observations. The facility have three(3) staff per shift attending the residents' needs and conducting rounds every hour or more frequently if needed. There were no imminent health and/or safety concerns observed at the time of visit. LPAs did not observe any obstructions or debris inside or outside of the facility at the time of this visit. LPAs observed that the facility is using a generator as a source of power due to the outage. LPAs assessed the available food and observed sufficient food to be available for the residents in care. The food supply meets the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. . The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care. The facility is clean, and meets all the requirements for the residents in care. Based on the information obtained during today's visit, there were no immediate health and safety issues of the residents in care. An exit interview was conducted, and a copy of this report was provided to the Administrator, Emely Rodriguez.the state’s words, verbatim · CDSS document, Jan 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by the Caregiver Linda Covington, notified her of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 10 residents bedrooms, and 11 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 07/15/2025. LPA observed the hot water temperature to meet requirements at 110.6°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of June 10th, 2026 and a CPR certification with the expiration date of 06-25-26 Record Review and Resident/Staff Files: LPA reviewed files for Four(4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) residents' files were reviewed and contained all required documentation. LPA observed resident files, to be stored in a locked cabinet in the office. The first aid kit was stored in a cabinet in the office. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the medication room. LPA reviewed medications for four residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 11-05-2024, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Emely Rodriguezthe state’s words, verbatim · CDSS document, Nov 27, 2024

Allegation investigated: Staff did not refill resident’s medication prescription in timely manner.

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Administrator, Emely Rodriguez, and informed her of the purpose for the visit. A report was received by the Department alleging one medication was not refilled in time to administer to Resident One (R1) by the resident's medical provider on 08/02/2024 or 08/03/2024. The LPA's investigation included interviews with relevant parties; a review of records; and collection of relevant documentation. The LPA conducted a medication audit of R1's medications. Two medication containers were observed to be available at the facility for the medication in question. Both medication bottles had contents available for the administration of the medication. The LPA reviewed the Medication Administration Record (MAR) for August 2024 and observed staff initials to suggest the medication was administered on 08/01/2024 and on 08/03/2024. No staff initials were present for 08/02/2024. A representative of the resident's medical provider was Unfounded interviewed and reported a visit to the facility was made by the representative during the first week of August 2024 there was no need to administer the medication at that time. Therefore, based on interview and observation, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. This report was reviewed with Administrator Rodriguez and a copy of the report was provided. have been observed when they have reviewed the resident's medications and medication records. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. This report was reviewed with Administrator Rodriguez and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2024 · control 18-AS-20240805130411

Allegation investigated: Staff does not ensure resident is provided a comfortable temperature.

***This is an amended version of the original report*** On 11/3/2025, Licensing Program Analyst (LPA), Valerie Flores conducted an unannounced visit to the facility to deliver the investigative findings into the listed allegation. LPA Flores met with LVN, Amber Croft, and explained to Amber the purpose of the visit. Information received alleged staff did not ensure Resident #1 (R1) is provided a comfortable temperature in R1’s unit. Upon review, LPA Flores discovered complaint 18- AS-20240712084308 and complaint 18-AS-20240711164133 are referring to the same resident and is detailing the same allegation. After speaking with Administrator Emely Rodriguez, Emely confirmed R1 was residing at Integrated Care Communities – B1 and has never resided at Integrated Care Communities – B2. Unfounded Being that R1 has never resided at Integrated Care Communities – B2, the allegation against Integrated Care Communities – B2 could not have happened. Therefore, the allegation of staff does not ensure resident is provided a comfortable temperature has been deemed unfounded. An allegation with a finding that is deemed unfounded means the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to LVN, Amber Croft. ***This is an amended version of the original report***the state’s words, verbatim · CDSS document, Jul 18, 2024 · control 18-AS-20240712084308

Type of visit: Required - 1 Year

On 11/16/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA met with Administrator, Emely Rodriguez and Relief Manager, Carol King who were informed of the purpose of visit. LPA toured the facility with Carol King. The following was observed, reviewed, and inspected: The physical plant, in general, was in good repair. The facility is operating in the capacity approved by Community Care Licensing (CCL). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. LPA inspected a sample of resident bedrooms and bathrooms. Resident bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. Room temperatures were comfortable for residents in care. LPA inspected a sample of resident bathrooms; LPA observed bathrooms to be clean and sanitary. There is also a good number of personal toiletries available for the residents in care. LPA measured the hot water temperature in the sampled bathrooms, in which all bathroom sinks measured within regulation. Sampled bathrooms were equipped with non-skid surfaces and grab bars. Bedrooms were equipped with a pull cord system to notify staff of any emergencies. LPA toured the kitchen and dining area. The facility was stocked with a 2-day supply of perishable and 7-day supply of non-perishable food items that were labeled appropriately. The facility had a menu posted and available for review. Dishes, glasses, and utensils were in good condition and stored in a healthful manner. LPA inspected the common areas. Smoke detectors were last tested on 7/24/2023 by Costco. LPA observed several carbon monoxide alarms throughout the facility. Continue on LIC809-C Continued from LIC809 There was a locked and centralized storage area for medications, including refrigerated medications. Medications appeared to be dispensed and documented appropriately. The facility had a designated area for resident files and staff files. All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Random staff and residents' records were reviewed. All required postings were posted near the entryway and throughout the facility. There was adequate seating in the common areas and several activity rooms. LPA observed several activity posters. The facility was also equipped with a complete first aid kit as well as the first aid manual. LPA inspected the outdoor area of the facility. There was shaded area with seating. Overall, the facility was clean, in good repair, and operating in safe conditions for residents in care. No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Emely Rodriguez.the state’s words, verbatim · CDSS document, Nov 16, 2023