Jasmin Terrace at Yucca Valley

Allegation investigated: Resident sustained multiple fractures and injury while in care Staff did not seek timely medical attention for a resident Staff caused a resident's medical insurance to lapse

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver the complaint investigation findings regarding the above allegations. After introducing and identifying herself, LPA met with Assiting Administrator, Maria Marima, to discuss the investigation findings. On February 14, 2025, the Department received a complaint regarding Resident #1 (R1) and the above allegations. The Department conducted an investigation, which included a review of facility files and other relevant records, observations, and interviews with R1, facility staff, residents, and other pertinent individuals. Regarding allegation#1, resident sustained multiple fractures and injury while in care, on February 13, 2025, at approximately 2:39 am, facility staff observed R1 lying in blood in their room during a routine check. Staff immediately contacted Emergency Medical Services (EMS), and R1 was transported to the hospital for evaluation and treatment. **continued on LIC9099-C** Unsubstantiated Hospital records documented that R1 was evaluated at approximately 3:33 am, and was diagnosed with fractured ribs, a fractured finger, a brain and rectal bleeding. The Department reviewed medical records and interviewed pertinent individuals regarding the reported injuries. The available records indicated that the rib fractures were associated with an older injury and that no recent trauma was identified. The brain bleeding was documented as nontraumatic, and no head injury was observed. The rectal bleeding was attributed to an underlying medical condition. Records also documented a prior injury to R1’s pinky finger. On August 5, 2022, R1 reportedly injured the finger after it became caught on a bottle. R1 was transported to the hospital, and facility staff documented the incident. A medical record dated December 18, 2023, documented a curved pinky finger on R1’s left hand. During the investigation, R1 was unable to recall how the injuries occurred and stated that the broken finger had occurred more than one month earlier. Interviews with R1 and pertinent individuals indicated that R1 had previously fallen outside of the facility and did not report the fall to facility staff or request assistance at the time. R1 recalled going to the hospital shortly after the fall. R1 did not report experiencing pain or sustaining an injury to facility staff. Resident and staff interviews revealed that residents have call buttons available in their rooms and that staff respond timely when residents use their call buttons for assistance. Based on the evidence obtained during the investigation, the Department was unable to corroborate that R1 sustained the identified injuries because of staff neglect while in care. Regarding allegation #2, Staff did not seek timely medical attention for a resident. On February 13, 2025, at approximately 2:39 am, staff observed R1 lying in blood in R1’s room during a routine check. **continued on LIC9099-C** Staff immediately contacted EMS, and R1 was transported to the hospital for medical evaluation. Hospital records documented that R1 received medical treatment. The investigation did not identify evidence that facility staff were aware of R1’s injuries prior to discovering R1 during the routine check or that staff delayed obtaining medical assistance after discovering R1’s condition. Resident and staff interviews indicated that residents have access to call buttons and that staff respond timely to assist. Based on the evidence obtained, the Department was unable to corroborate that facility staff failed to obtain timely medical attention for R1. Regarding allegation #3, staff caused a resident's medical insurance to lapse, the Department interviewed two facility staff members regarding the allegation that staff caused R1’s medical insurance to lapse. Both staff denied causing R1’s insurance to lapse. R1 was also interviewed and did not identify any facility staff member as having caused the lapse in insurance coverage. Based on the evidence obtained during the investigation, the Department was unable to corroborate that facility staff caused R1’s medical insurance to lapse. Based on the Department's investigation, there is not enough evidence to corroborate that the alleged violations occurred, therefore the allegations are Unsubstantiated. A finding of unsubstantiated means there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Assisting Administrator Molina, during which the investigation findings were discussed. A copy of this report and appeal rights was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 18, 2026 · control 56-AS-20250214143236

Type of visit: Case Management - Other

On 8/18/2026, Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to the facility. LPA met with Assisting Administrator, Maria Molina. Administrator, Michael Garcia, was informed via telephone of the visit. The purpose of the visit is to obtain follow-up information pertaining to complaint #56-AS-20241108092028. During today's visit, LPA conducted interviews with staff and residents. No deficiencies were cited during today visit. An exit interview was conducted were this report was discussed and a copy provided to Assisting Administrator Molina.the state’s words, verbatim · CDSS document, Aug 18, 2026

Type of visit: POC

On 08/18/2026, Licensing Program Analyst (LPA) Magda Malcore conducted a unannounced Plan of Correction (POC) inspection at the facility. LPA met with Assisting Administrator, Maria Molina and explained the purpose of the visit. On 08/07/2026, a deficiency was issued for not maintaining the carpet in Resident #1’s (R1’s) bedroom in a clean and sanitary condition. During today's visit, 08/18/2026, LPA conducted a tour of R1’s bedroom and interviewed staff and R1 to ensure that the correction had been completed. Staff and R1 confirmed that the carpet was shampooed and cleaned on 08/10/2026. The Plan of Correction (POC) was due on 08/14/2026. During today’s visit, the citation was cleared, and a Letter of Deficiency Citation Cleared was provided to the Assisting Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 18, 2026

Allegation investigated: Resident sustained unexplained injury while in care Staff did not bathe resident in care Staff did not report incident to resident's authorized representative Staff do not ensure resident's hydration needs are met.

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to conclude the investigation on the above allegations. LPA met with Administrator, Michael Garcia, and informed the purpose of the visit. The investigation consisted of pertinent document review, and interviews with residents and staff. Regarding the allegation, Resident sustained unexplained injury while in care, it was alleged that resident#1 (R1) had an unexplained body injury. There is not enough evidence to corroborate this allegation. Staff interviewed deny that (R1) had sustained unexplained injuries while in care. (R1) refused LPA's interview attempt. Regarding the allegation, Staff did not bathe resident in care, it was alleged that staff did not bathe (R1). Staff interviewed denied not providing or assisting any residents with baths; however, R1 would refuse baths. R1 also refused LPA’s attempt to interview. **continued on LIC9099-C** Unsubstantiated Interviews with six (6) residents reveal that they either they do not require staff assistance with bathing/showers or that staff do provide baths/showers. Regarding the allegation, Staff did not report incident to resident's authorized representative, it was alleged that staff did not report an unexplained injury to (R1’s) authorized representative. Staff interviewed denied failing to report injuries to any resident’s authorized representative. Staff stated that when injuries occur, they are documented, reported to a medtech, and reported to resident’s responsible party. R1 refused LPA’s interview attempt. Regarding the allegation, Staff do not ensure resident's hydration needs are met, it was alleged that (R1) was not provided with drinking water. During LPA’s tour of facility, LPA observed a water pitcher placed on the R1’s nightstand in their bedroom. Staff interviewed denied failing to ensure that any resident’s hydration needs were met. Staff stated that water and other beverages are routinely offered to residents, and hydration provided is documented. Interviews with six (6) residents indicate that staff offer water or coffee to them and their hydrations needs are met. Based on the Department’s investigations, the allegations are deemed Unsubstantiated. An Unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) did or did not occur. An exit interview was conducted where this report was discussed and a copy provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 7, 2026 · control 56-AS-20241108092028

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Magda Malcore conducted a case management visit to the facility. LPA met with Administrator, Michael Garcia. The purpose of the case management was to address a deficiency observed during complaint investigation #56-AS-20260422150746 LPA observed that the carpet in the bedroom 110 was heavily stained and soiled with dirt. The Administrator could not confirm when the last time the room was shampooed clean. Resident#1 (R1) interview reveals that they do not know when the last time the carpet was shampooed clean. A deficiency is being cited in accordance with Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted where this report and correction plans were discussed with Administrator Garcia. Report copy and appeal rights were provided to Administrator Garcia.the state’s words, verbatim · CDSS document, Aug 7, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 14, 2026

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors..This requirement is not met as evidenced by: The licensee did not comply with the section cited above by LPA observed the carpet in bedroom 110 was stained and soiled with dirt; which poses a potentional health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 7, 2026

Plan of correction: The Administrator has agreed to clean the carpet and provide photo proof by POC due date.

Allegation investigated: Facility staff did not address change in resident’s condition Facility staff are not following hospice plan(s)

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegations. LPA met with Administrator Michael Garcia who was informed of today’s visit. Regarding the allegation, facility staff did not address change in resident’s condition, based on LPA’s record review, interviews with five (5) staff and four (4) residents revealed not enough evidence to corroborate this allegation. Regarding the allegation, facility staff are not following hospice plan(s), LPA record review, interviews with five (5) staff and four (4) residents reveal not enough evidence to corroborate this allegation. **continued on LIC9099-C*** Unsubstantiated Based on this Department’s investigation the allegations mentioned in this report are Unsubstantiated. Unsubstantiated meaning that 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. An exit interview was conducted were this report was discussed and a copy provided to Administrator Garcia.the state’s words, verbatim · CDSS document, Jul 20, 2026 · control 56-AS-20250124113217

Allegation investigated: Staff are not ensuring the facility is free of bed bugs

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the investigation and deliver the findings on the on the above allegation. LPA met with Administrator Michael Garcia and informed the purpose of the visit. Regarding the allegation that staff are not ensuring the facility is free of bed bugs, it was alleged that bed bugs were observed in common areas and in bedrooms #104 and #137. LPA conducted a tour of the common areas and did not observe any bed bugs. In addition, interviews with staff and residents revealed that the common areas are cleaned daily. Regarding bedroom #104, LPA did not observe bed bugs, and no residents were occupying the bedroom. LPA also observed a protective cover on the mattress, and the bedroom and floors were observed to be clean. Documentation reveals that the room was heat treated to ensure it was free of bed bugs for a future resident. **continued on LIC9099-C*** Unsubstantiated Regarding bedroom #137, interviews with staff and the two residents occupying the bedroom revealed that on or around January 4, 2026, staff observed bed bugs in the bedroom. Staff removed the bedding and checked residents for bug bites. Staff chemically treated and then heat-treated the bedroom. The carpet was replaced with new flooring and the rooms were painted. The two residents were temporarily relocated to another room until the treatment was completed, and no further signs of bed bugs were observed. Based on interviews with pertinent parties and observations, the allegation is Unsubstantiated. A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed and provided to the Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 56-AS-20260107125029

Allegation investigated: Facility staff did not safeguard resident's valuables Facility staff did not assist resident with ambulating as needed Facility staff did not ensure resident was properly clothed Facility staff did meet resident's bathing needs Facility staff are not properly addressing roaches in the facility Facility staff are not providing medical records to resident's family

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the investigation and deliver the findings on the on the above allegations. LPA met with Administrator Michael Garcia and informed the purpose of the visit. Regarding Allegation #1, facility staff did not safeguard resident’s valuables, it was alleged that staff did not safeguard Resident #1’s (R1’s) belongings. LPA was unable to interview R1 due to R1 passing away in December 2023. Interviews with five (5) staff and five (5) residents reveal that there are not enough witnesses to corroborate the allegation that staff did not safeguard the residents’ valuables. Regarding Allegation #2, facility staff did not assist resident with ambulating as needed, interviews with five (5) staff and five (5) residents reveal that staff do assist residents with their ambulating needs. Regarding Allegation #3, facility staff did not ensure resident was properly clothed, interviews with five (5) staff and five (5) residents reveal that staff do ensure residents are properly clothed. **continued on LIC9099-C*** Unsubstantiated Regarding Allegation #4, facility staff did not meet residents’ bathing needs, interviews with five (5) staff and five (5) residents reveal that staff do meet residents’ bathing needs. Regarding Allegation #5, facility staff are not properly addressing roaches in the facility, interviews with five (5) staff and four (4) out of five (5) residents reveal that the facility does have a pest control company that inspects and treats the facility for roaches and other insects. LPA also observed that the facility has an active contract with a pest control company. Regarding Allegation #6, facility staff are not providing medical records to resident’s family, it was alleged that facility staff did not provide Resident #2 (R2's) medical records when requested by R2’s family. Interviews with staff and outside parties reveal there is not enough evidence to corroborate the allegation that staff are not providing medical records to residents’ family. LPA was unable to interview R2 due to R2 passing away in November 2023. Based on pertinent record review and interviews with relevant parties, the allegations in this complaint are Unsubstantiated. A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed and a copy provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 56-AS-20240116094042

Allegation investigated: Staff verbally abused resident

On 05-04-26, Licensing Program Analyst (LPA) Abdoulaye Zerbo made an unannounced visit to the facility to deliver findings on the above allegation. LPA met with Office Manager Janine Lewis and explained the purpose of the visit. Regarding the allegation that staff verbally abused resident, It was alleged that staff 1 (S1) was verbally abusive with R1. Interviews with multiple staff members at the facility confirmed that S1 was verbally abusive to the residents in care. The facility conducted an internal investigation in regards to S1 yelling at R1 and the findings were deemed substantiated. Substantiated Based on interview statements and reviewed information, S1 engaged in inappropriate and abusive conduct toward R1 by poking the resident. The incident was serious enough that the family contacted law enforcement and the facility terminated S1 terminated from employment on 01-14-2021. Based on record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report, the 9099-D and the appeal rights were provided to Office Manager Janine Lewis Regarding the allegation that Staff gave resident the wrong medication. It was alleged that R1 was sent to the hospital because they were given another resident’s medication LPA conducted interviews with facility staff and the information obtained revealed medication was dispensed as prescribed and do not recall any incidents where the wrong medication was administered to R1. Attempts to interview confidential witnesses for this allegation were not successful. Records to determine if R1 was given the wrong medication could not be obtained. Regarding the allegation that staff do not have training. It was alleged that staff are not trained to care for individuals with dementia. LPA interviewed facility staff who stated the facility regularly conducts dementia in-service training. Staff training records in regards to dementia training could not be obtained. Regarding the allegation staff are not assisting resident with hygiene needs. It was alleged that R1 has not been showered. LPA interviewed facility staff and the information obtained revealed that R1 was scheduled for showers twice a week, with additional showers provided as needed. Shower logs to determine if R1 was showered as schedule could not be obtained. Attempts to interview confidential witnesses for this allegation were not successful. Regarding the allegation that staff left resident in soiled diapers. It was alleged that R1 had a soiled brief during a visit at the facility. LPA interviewed facility staff and the information obtained revealed that R1 received scheduled and as needed hygiene care. Attempts to interview confidential witnesses for this allegation were not successful. Records to determine R1’s two hour incontinence checks could not be obtained. Based on interviews and records review, the allegations are unsubstantiated. A finding that the complaint is unsubstantiated means the preponderance of the evidence standard has not been met to prove the alleged violations occurred. An exit interview was conducted, and a copy of this report was provided to Office Manager Janine Lewisthe state’s words, verbatim · CDSS document, May 4, 2026 · control 18-AS-20210119115339

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87413(a)(2) · Plan of correction due date: May 4, 2026

87413 (a)(2) Personnel – Operations (a) In each facility: (2)Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. R1 was verbally abused by S1 while in care.the state’s words, verbatim · CDSS document, May 4, 2026

Plan of correction: Licensee terminated and dissociated S1 from the facility

Allegation investigated: Facility staff are not ensuring resident is adequately fed resulting in weight loss Facility staff did not appropriately safeguard resident's personal belongings Facility hallways floors in memory care are not maintained clean and sanitary

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegations. LPA met with Administrator, Michael Garcia, and explained the purpose of the visit. The investigation consisted of LPA observations, record review, interviews with residents and staff. Regarding the allegation that facility staff are not ensuring the resident is adequately fed, resulting in weight loss, it was alleged that staff were not ensuring that Resident #1 (R1) was adequately fed. An interview with R1 revealed that they are provided a sufficient amount of food and are able to feed themselves without assistance. Staff interviews confirmed that R1 is able to feed themself; however, staff provide verbal reminders when meals are being served. Review of R1’s medical assessment dated May 2025 indicates R1 appeared well and well nourished. Additionally, the medical assessment from March 2026 reflects that R1 was in good physical health. ***continued on LIC9099-C*** Unsubstantiated Regarding the allegation that facility staff did not appropriately safeguard the resident’s personal belongings: It was alleged that one of R1’s clothing items was missing and had not been returned. Staff interviews revealed that residents clothing items are labeled with the resident’s name or initials for identification. LPA observed that R1’s clothing items were properly labeled. During the investigation, LPA observed R1 wearing the shirt that had been described and reported as missing. Regarding the allegation, facility hallways floors in memory care are not maintained clean and sanitary: LPA observed the hallway floors in the memory care unit to be clean, and no malodorous odors were noted. Staff interviews indicate that the hallway floors are cleaning daily. Resident interviews indicate that the hallways floors are maintained clean. Based on the Department’s investigation, the allegations mentioned in this report are Unsubstantiated. A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed. A copy of this report with appeal rights was provided to Administrator Garcia.the state’s words, verbatim · CDSS document, Mar 25, 2026 · control 56-AS-20250527134209

Allegation investigated: Staff spoke inappropriately to resident Staff yelled at resident Staff did not ensure the electricity in resident's room was not in disrepair

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegations. LPA met with Administrator, Michael Garcia, and explained the purpose of the visit. The investigation consisted of LPA observations, record review, interviews with residents and staff. Regarding the allegation, staff spoke inappropriately to resident, five (5) out of six (6) resident interviews indicated that staff have not spoken inappropriately to them. Six (6) staff interviews indicated that they have not spoken inappropriately to a resident. Regarding the allegation, staff yelled at a resident, five (5) out of six (6) resident interviews indicated that staff have not yelled at them. Six (6) staff interviews indicated that they have not yelled at a resident. ***continued on LIC9099-C*** Unsubstantiated Regarding the allegation, staff did not ensure the electricity in resident's room was not in disrepair, LPA conducted observations of six (6) resident bedrooms. LPA observed that the electricity in the residents’ bedrooms and bathrooms was working properly. Six (6) residents interviewed confirm that the electricity in their bedroom and bathroom is working properly. Based on the Department’s investigation, the allegations: Staff spoke inappropriately to resident, Staff yelled at resident, and Staff did not ensure the electricity in resident's room was not in disrepair are Unsubstantiated. An Unsubstantiated finding means, although the allegation(s) may have happened or is/are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted where reports (LIC9099 & LIC9099-C) was discussed and provided to Administrator Garcia. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099, LIC9099-C, LIC9099-D) were discussed. Report copies were provided with appeal rights to the Administrator Garcia.the state’s words, verbatim · CDSS document, Mar 25, 2026 · control 56-AS-20240701121842

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(2) · Plan of correction due date: Mar 31, 2026

87465(a)A plan for incidental medical and dental care shall be developed by each facility…(2)The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation…to available medical or dental facility which will meet the resident's need…This requirement is not met at evidenced by: The Licensee did not comply with the section cited above, as staff #1(S1) did not ensure resident #1 (R1) was transported to their medical appointment as scheduled; which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: The Licensee/Administrator has agreed to provided staff inservice training on ensuring resident medical/transportation needs are met. Proof of training to be submitted to the licensing agency by POC due date.

Allegation investigated: Facility staff did not ensure carpets in residents’ bedrooms were maintained clean Facility staff did not maintain sink faucets in residents’ bedrooms in good repair

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to initiate a complaint investigation on the above allegations. LPA met with Assisting Administrator Maria Molina and Administrator Michael Garcia and explained the purpose of the visit. The investigation consisted of LPA observations and interviews with residents and staff. Regarding the allegation, facility staff did not ensure carpets in residents’ bedrooms were maintained clean, LPA observed that the carpet in resident bedrooms 108, 109, and 123 was visibly soiled with dark stains. The Administrator and one (1) staff interviews reveal carpets are not routinely checked for cleanliness; instead, they are cleaned as needed or upon request. Regarding the allegation, facility staff did not maintain sink faucets in residents’ bedrooms in good repair, LPA observed that the sink faucet in resident bedroom 109 was continuously leaking. LPA also noted that the cold water side was not operating, as no water came out when the faucet was turned on. Interviews with two (2) staff members revealed that they became aware of the leak approximately one month ago, and maintenance had tightened the hot water side at that time. ***continued on LIC9099-C*** Substantiated Today, the two (2) staff members discovered that the sink was still leaking and that the cold water side was not functioning properly. The resident in bedroom 109 confirm that the faucet had been leaking for about a month. Based on the Department’s investigation, the allegations mentioned in this report are Substantiated. Substantiated meaning that the allegation(s) is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099, LIC9099-C, and LIC9099-D) were discussed and provided with appeal rights to Administrator Garcia.the state’s words, verbatim · CDSS document, Mar 16, 2026 · control 56-AS-20260312160937

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 31, 2026

87303(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not ensuring that resident bedroom carpets in rooms108, 109, and 123 were clean and the sink faucet in resident bedroom #109 was operating properly; which poses an potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2026

Plan of correction: During today's visit, LPA observed the sink faucet in bedroom #109 was repaired. The Administrator stated that the carpets in bedrooms #108, 109, and 123 will be replaced by POC due date. Proof of correction shall be submitted to the licensing agency by POC due date.

Allegation investigated: Staff do not meet residents dietary needs Staff do not provide residents snacks between meals Staff do not ensure facility bathroom doors are in good repair Staff do not intervene when residents engage in physical altercations Staff did not safeguard resident’s belongings Staff kicked resident Staff yell at residents Staff do not ensure facility showers are in good repair

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced facility visit to conclude the investigation on the above allegations. LPA met with Assisting Administrator Maria Molina and Administrator, Michael Garcia, who were informed of today’s visit. The investigation consisted of department observations, reviewing pertinent records, and interviews with staff and residents. Regarding allegation #1, staff do not meet resident’s dietary needs, resident interviews indicate that their dietary needs are being met. Interviews with staff also confirm that residents’ dietary needs are being met. Regarding allegation #2, staff do not provide residents snacks between meals, Six (6) out of seven (7) resident interviews indicate that staff do provide snacks between meals. Staff interviews indicate that they provide residents with snacks between meals. **continued on LIC9099-C** Unsubstantiated Regarding allegation #3, staff do not ensure facility bathroom doors are in good repair, during the department’s investigation, five (5) resident showers doors were observed to be in good repair. Regarding allegation #4, staff do not intervene when residents engage in physical altercations, residents and staff interviews do not indicate that staff do not intervene when residents engage in physical altercations. Regarding allegation #5, staff did not safeguard resident’s belongings, resident and staff interviews indicate not enough evidence to corroborate the allegation that staff did not safeguard resident belongings. Regarding allegation #6, staff kicked resident, resident interviews indicate that staff have not kicked them. Staff interviews indicate that they have not kicked residents. Regarding allegation #7, staff yell at residents, six (6) out of seven (7) resident interviews indicate that staff have not yelled at them. Staff interviews indicate that they have not yelled at a resident. Regarding allegation #8, staff do not ensure facility showers are in good repair, during the department’s investigation, five (5) resident showers were observed to be in good repair. Based on the Department’s investigation, the allegations mentioned in this report are Unsubstantiated. An Unsubstantiated finding means, although the allegation(s) may have happened or is/are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed and provided to Administrator Garcia.the state’s words, verbatim · CDSS document, Mar 16, 2026 · control 56-AS-20240104144140

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Magda Malcore initiated a case management based on observations conducted during complaint investigation #56-AS-20260312160937. LPA met with Administrator Michael Garcia and informed the purpose for the visit. During today's visit, LPA observed a hand saw left unattended in the facility's dining room table. LPA observed two (2) residents present sitting at another dining room table. Administrator interview reveals that the saw was left there by a resident while the resident was conducting an wood working activity. A deficiency has been cited per Title 22, Division 6, of the California Code of Regulations (CCR). An exit interview was conducted. Copy of reports (LIC809 and LIC809-D) and appeal rights were provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 16, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Mar 16, 2026

87309(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: The Licensee did not comply with section cited above by a hand saw left unlocked and unattended in the facility's dining room; which poses an immediate, health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 16, 2026

Plan of correction: Correction: the hand saw was removed and placed in a locked box.

Allegation investigated: Resident's representative was not provided prompt access to resident's records

On 2/12/2026, Licensing Program Analysts (LPA) Eldin Serrano visited the facility to investigate the above-mentioned allegation and deliver findings. LPA met with the administrator Michael Garcia to discuss the purpose of the visit. The investigation consisted of interviewing relevant parties and record reviews. The allegation indicates that resident's representative was not provided prompt access to resident's records – Based on interviews with relevant parties and file review, the facility did not provide the documents requested upon the resident's written consent or that of their designated representative within the time allowed by the regulation. Based on interviews and file review, the preponderance of evidence standard has been met, therefore, the allegation is substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 8). An exit interview was conducted, where this report, LIC9099, LIC9099D along with appeal rights, was provided to the administrator Michael Garcia. Substantiatedthe state’s words, verbatim · CDSS document, Feb 12, 2026 · control 56-AS-20250508165707

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Feb 18, 2026

Title 22, Division 6 Chapter 8 Article 09. Resident Records(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible...for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement is not met as evidence by: Based on interviews and file reviews, the licensee did not comply with the section cited above by not ensuring that the licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of their designated representative which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee agreed to read regulation 87506 in its entirety and submit a statement of understanding to follow the regulation above by plan of correction (POC) due date.

Allegation investigated: Facility staff did not provide resident's authorized representative with resident's records.

On 2/12/2026, Licensing Program Analysts (LPA) Eldin Serrano visited the facility to investigate the above-mentioned allegation and deliver findings. LPA met with the administrator Michael Garcia to discuss the purpose of the visit. The investigation consisted of interviewing relevant parties and record reviews. The allegation indicates that the facility staff did not provide resident's authorized representative with resident's records. – Based on interviews with relevant parties and file review, the facility did not provide the documents requested upon the resident's written consent or that of her designated representative within the time allowed by the regulation.. Based on interviews and file review, the preponderance of evidence standard has been met, therefore, the allegation is substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 8). An exit interview was conducted, where this report, LIC9099, LIC9099D along with appeal rights, were provided to the administrator Michael Garcia. Substantiatedthe state’s words, verbatim · CDSS document, Feb 12, 2026 · control 56-AS-20250214135233

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Feb 18, 2026

Title 22, Division 6 Chapter 8 Article 09. Resident Records(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible...for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement is not met as evidence by: Based on interviews and file reviews, the licensee did not comply with the section cited above by not ensuring that the licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee agreed to read regulation 87506 in its entirety and submit a statement of understanding to follow the regulation above by plan of correction (POC) due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced follow-up facility visit to gather information pertaining complaint # 56-AS-20260107125029. LPA met with Assisting Administrator, Maria Molina and discussed the purpose of the visit. During today’s visit, LPA conducted interviews and obtained copies of relevant documents. An exit interview was conducted where this report was discussed and a copy of this report was provided to Assisting Administrator Molina at the conclusion of the visitthe state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management to following up and concluded the Department's investigation on an incident report reported by the facility. LPA met with Assisting Administrator, Maria Molina, and informed the purpose for the visit. On 7/24/2025, Community Care Licensing Division (CCLD) regional office received an incident report that on 7/23/2025, resident #1 (R1) sustained injury during an alleged altercation with Staff #1 (S1). Interviews with residents, staff, and outside party witnesses reveals that S1 was not near R1 when the injury occurred. R1 sustain cuts to their arm due to R1 attempting to move a medication cart on their own. Facility staff provided first aid to R1 and staff contacted emergency services due to the nature of the allegation. Regarding this incident, the Department has concluded their investigation and no deficiencies were cited. An exit interview was conducted where this report was discussed and a copy of this report was provided to Assisting Administrator Molina.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct interviews with staff and residents pertaining to complaint #56-AS-202301084530. LPA Prieto met with Administrator Garcia who assist LPA with tour of facility and introduction to residents. LPA interviewed staff and residents during this visit.the state’s words, verbatim · CDSS document, Feb 4, 2026

Allegation investigated: Staff neglect resulted in resident’s death

On 01/16/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to deliver findings regarding the allegation listed above. LPA met with Assistant Administrator (AA) Maria Molina who was informed of the purpose of the visit. The department investigated the complaint of staff neglect resulted in resident’s death. The investigation consisted of interviews and records review. It was alleged staff neglect resulted in Resident #1 (R1) falling, hitting their head and ultimately passing away. R1 succumbed to the injury from the fall and passed away on 05/02/2020. Unsubstantiated Based on staff interviews it was revealed R1 transferred to another licensed facility and later returned to this facility, Jasmin Terrace of Yucca Valley. Overall, interviews revealed, that the facility was short-staffed at the time of this incident. Initially it was alleged the fall was unwitnessed. However, during the course of the investigation a witness was identified. Staff reported hearing R1 call out for help. As staff was walking towards R1 to provide the assistance, they witnessed R1 fall to the floor and suffer the laceration. Staff immediately called 9-1-1 and R1 was transported to the hospital. Staff interviews further revealed a change in condition of R1. R1 went from being independent and needing minimal assistance with activities of daily living to being described as “lethargic, and more medicated”. An updated Needs and Services plan was completed on 04/08/2020. The updated plan noted R1 to be a fall risk, due to poor safety awareness. Frequent checks were reported to have been implemented as an intervention method. Overall, interviews with staff revealed a staff shortage and staff not being properly trained. Therefore, the allegation of staff neglect resulted in resident’s death is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that 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. An exit interview was conducted, and a copy of this report, LIC 9099-C, Confidential Names list (LIC 811), and appeal rights were reviewed and provided to AA Molina.the state’s words, verbatim · CDSS document, Jan 16, 2026 · control 18-AS-20210219134833

Allegation investigated: Staff did not prevent inappropriate resident behavior Staff did not safeguard resident's personal items Staff do not assist resident when called upon Staff did not accord resident dignity in their relationship with staff or other persons Staff do not ensure that residents are appropriately dressed Staff do not give resident medication as prescribed Facility is in disrepair

On 01/09/2026 at 10:20AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with the Asssitant Administrator, Maria Molina and Administrator, Michael Garcia. The investigation consisted of interviews, observation and record review. In regards to the allegation of staff did not prevent inappropriate resident behavior: LPA interviewed six (6) staff , seven (7) residents and the relatives of two (2) residents. Staff denied the allegation and stated that they redirect residents when needed. Residents stated that staff are available to assist and the residents get along. Based on interviews, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff did not safeguard resident's personal items: Staff stated that the independent residents are responsible for their own valuables and their rooms have locks. For residents safety in memory care, rooms remain unlocked. Unsubstantiated The facility encourages family not to bring valuable items to the facility. Based upon interviews and observation, this allegation is UNSUBSTANTIATED. In regards to the allegation that staff do not assist resident when called upon: Staff stated that all residents are checked every two (2) hours. All of the resident rooms have working call buttons. Seven (7) out of seven (7) residents interviewed stated that staff assist when they need help. Based upon interview, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff did not accord resident dignity in their relationship with staff or other persons: Staff denied the allegation and stated that staff treat all of the residents with respect. The residents that were interviewed stated that staff treat them well. Based on interview, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff do not ensure that residents are appropriately dressed: LPA observed the temperature in the facility to be comfortable and residents were wearing appropriate and clean clothing. Staff stated that before residents leave the facility, they ensure residents have what they need based on the weather. Based on interview and observation, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff do not give resident medication as prescribed: LPA observed the Medication Administration Record (MAR) for Resident 1 (R1) and did not observe any discrepancies. Staff stated the they have regular training on medication and give the medication as prescribed. Based on interview and observation, this allegation is UNSUBSTANTIATED. In regards to the allegation of the facility is in disrepair: LPA observed the facility to be clean with no visible safety hazards. LPA observed staff with cleaning carts moving throughout the facility. LPA also observed various receipts confirming maintenance supply purchases. Based on observation and record review, this allegation is UNSUBSTANTIATED. UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted where this report LIC9099 and LIC9099C were discussed and copies were provided to Administrator, Michael Garcia.the state’s words, verbatim · CDSS document, Jan 9, 2026 · control 56-AS-20240619083431

Allegation investigated: Staff are not providing adequate food service to residents Staff are not providing menus for residents Staff are not meeting residents dietary needs Staff are engaging in inappropriate behaviors in the presence of residents Administrator is not meeting a sufficient number of hours in the facility

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegations. LPA met with Assisting Administrator, Maria Molina, who was informed of today’s visit. The investigation consisted of pertinent record review, observations, and interviews with staff and residents. Regarding allegation 1, staff are not providing adequate food service to residents, four (4) staff interviews indicate that they are providing residents with adequate food service. Six (6) out of eight (8) resident interviews indicate that staff are providing them with adequate food service. Regarding allegation 2, staff are not providing menus for residents, four (4) staff interviews indicate that menus are available for review and posted in dining area. Six (6) out of eight (8) resident interviews indicate that staff are providing menus for residents by posting them in the dining areas. In addition, LPA did observe menus posted in the dining area. Unsubstantiated Regarding allegation 3, staff are not meeting resident’s dietary needs, four (4) staff interviews indicate that they are meeting resident’s dietary needs. Six (6) out of eight (8) resident interviews indicate that staff are meeting their dietary needs. In addition, LPA observed a list in the kitchen area of residents with special diets and/or preferences. Regarding allegation 4, staff are engaging in inappropriate behaviors in the presence of residents, Five (5) staff interviews indicate that they are not engaging in inappropriate behaviors in the presence of residents. Seven (7) out of eight (8) resident interviews indicate that staff have not engaged in inappropriate behaviors in their presence. Regarding allegation 5, Administrator is not meeting a sufficient number of hours in the facility, Five (5) staff interviews indicate that the Administrator is meeting a sufficient number of hours at the facility. Seven (7) out of eight (8) resident interviews indicate that the Administrator is at the facility a sufficient number of hours to address their concerns. Based on the Department’s investigation, the allegations mentioned in the report are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed, and a copy was provided to Assisting Administrator Molina with appeal rights.the state’s words, verbatim · CDSS document, Dec 15, 2025 · control 56-AS-20230810094038

Allegation investigated: Staff engaged inappropriately in the presence of residents in care Staff retaliated against a resident in care

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a complaint investigation on the above complaint allegations. LPA met with Assisting Administrator, Maria Molina and discussed the purpose for the visit. The investigation consisted of LPA observations, interviews with residents and staff. Regarding the allegation, staff engaged inappropriately in the presence of residents in care, four (4) staff interviewed deny engaging inappropriately in the presence of residents in care. Six (6) out of eight (8) residents interviewed deny that staff engaged inappropriately in their presence. Regarding the allegation, staff retaliated against a resident in care, four (4) staff interviewed deny retaliating against a resident in care. Six (6) out of eight (8) residents interviewed deny that staff retaliated against them. **continued on report LIC9099C** Unsubstantiated Based on the Department’s investigation, the allegations mentioned in this report are Unsubstantiated. A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed and a copy with appeal rights was provided to Assisting Administrator Molina at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 4, 2025 · control 56-AS-20241119110411

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management to following up on an incident report reported by the facility. LPA met with Assisting Administrator, Maria Molina, and informed the purpose for the visit. On 7/24/2025, Community Care Licensing Division (CCLD) regional office received an incident report that on 7/23/2025, resident #1 (R1) sustained injury during an alleged altercation with Staff #1 (S1). During today's visit, LPA obtained pertinent documentation and conducted interviews. The Assisting Administrator was informed that incident needs further review by the Department. An exit interview was conducted where this report was discussed and a copy of the report was provided to the Assisting Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 4, 2025

Allegation investigated: Staff do not ensure residents receive medications in a timely manner Staff do not ensure residents' medication records are maintained Staff do not ensure feeding assistance is provided to residents in care Staff do not conduct scheduled recreational activities for residents Staff leave residents in soiled clothing for extended periods of time Staff do not ensure residents have clean linens

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint investigation at the facility. LPA met with Assisting Administrator Maria Molina and Administrator Michael Garcia and discussed the purpose of the visit. The investigation consisted of observations, reviewing pertinent records, and interviews with relevant parties. Regarding allegation#1, staff do not ensure residents receive medications in a timely manner, six (6) resident interviews and five (5) staff interviews revealed that staff are ensuring residents receive their medications in a timely manner. Regarding allegation #2, staff do not ensure residents’ medication records are maintained, LPA review of five (5) resident medications records revealed that staff are ensuring residents’ medication records are maintained. **continued on LIC9099C** Unsubstantiated Regarding allegation #3, staff do not ensure feeding assistance is provided to residents in care, interviews with six (6) residents and five (5) staff revealed not enough evidence to corroborate the allegation that staff do not ensure feeding assistance is provided to residents in care. Regarding allegation #4, staff do not conduct scheduled recreational activities for residents, interviews with six (6) residents and five (5) staff revealed that staff do conduct scheduled recreational activities for residents. In addition, LPA observed activities calendars posted in assisting living and memory care common areas. Regarding allegation #5, staff leave residents in soiled clothing for extended periods of time, interviews with six (6) residents and five (5) staff revealed that staff do not leave residents in soiled clothing for extended periods of time. Regarding allegation #6, staff do not ensure residents have clean linens, interviews with six (6) residents and five (5) staff revealed that staff do ensure residents have clean linens. In addition, LPA observed clean linen stored in assisting living and memory care areas. Based on the Department’s investigation, the allegations mentioned in this report are Unsubstantiated. A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed and a copy was provided with appeal rights to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 24, 2025 · control 56-AS-20231023151043

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Assisting Administrator, Maria Molina and Administrator, Michael Garcia and discussed the purpose of the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (85), and a current census of (60). LPAs conducted a general inspection of facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. The facility is kept at a temperature of 75 degrees F. Resident bedrooms had mattresses, bedlinen, chairs, dressers, and lighting. Resident’s bathroom equipment were maintained in sanitary and operating conditions. The hot water temperatures in resident's bathroom tested at 105 degrees F. The facility is equipped with operating smoke/carbon monoxide alarms, laundry equipment, and telephone service. Facility has a dedicated activities director and activities calendar is posted in a common area. Posters such as personal rights, the Community Care Licensing complaint information, Ombudsman poster, emergency telephones, and license were posted in a common area. Sharp knives were observed unlocked in the kitchen and unattended by staff. Staff obtained a locked safe were knives will be stored and kept inaccessible to residents in care. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Facility refrigerators and freezers were maintained in operating condition. The facility has posted a monthly menu for review. Health Related services: The facility keeps record of resident’s medications and medications are centrally stored in a locked medication room. Record Review: Review of resident files reveals resident #1(R1), resident #2(R2), resident#3(R3) admissions agreements were not signed by resident or their authorized representative. Review of staff files reveals staff#1 (S1's) first aid/CPR certification expired in August 2025. Staff#2 (S2) did not have a current annual dementia training on file for review. Last dementia training on file was conducted in September 2023. Administrator's personnel file was not maintained at the facility when LPA's requested file for review. Based on LPAs observations and records reviewed, deficiencies are being cited per Title 22, of the California Code of Regulations. An exit interview was conducted where this report (LIC809) and a plan of correction were discussed with Administrator Garcia. Copies of the reports were provided with appeal rights to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 3, 2025

The state marks this report as 14 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced Plan of Correction (POC) visit to the facility. LPA met with Administrator, Michael Garcia and discussed the purpose of the visit. On 07/03/25 deficiencies were cited during a complaint visit and correction plans were due on 07/09/25. As of today’s visit, (07/14/25) the Licensee has not provided the Community Care Licensing Division(CCLD) documentation of bed bug treatment and/or inspection conducted by an outside extermination company. Therefore, civil penalties of $500 are being accessed today for failure to correct deficiencies due on 07/09/25 and civil penalties will continue to accrue $100 per day until proof of correction has been received. An exit interview was conducted were this report was discussed and a copy provided to the Administrator with appeal rights at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 14, 2025

Allegation investigated: Staff did not properly relocate resident Staff are withholding resident’s personal belongings

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver complaint investigation findings. After identifying self, LPA met Administrator Michael Garcia to discuss the findings. Regarding the allegation, staff did not properly relocate the resident, resident #1 (R1) no longer resides at the facility and was unavailable for an interview. Interviews with staff reveal R1 chose what facility to move to. Regarding the allegation, staff are withholding resident’s personal belongings, R1 no longer resides at the facility and was unavailble for an interview. Interviews with staff reveal they are not withholding R1’s personal belongings. In addition, five (5) resident interviews reveal that staff have not withheld their personal belongings. Based on insufficient evidence the allegations are Unsubstantiated. An Unsubstantiated finding means that 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. ***continued on LIC9099-C*** Unsubstantiated An exit interview was conducted where this report was discussed and a copy was provided to Administrator Garcia with appeal rights at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 3, 2025 · control 56-AS-20240328092723

Allegation investigated: Staff did not keep facility free of insects

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to conduct a complaint investigation on the above allegation. After identifying self, LPA met with Administrator, Michael Garcia and informed the purpose of the visit. Regarding the allegation, staff did not keep facility free of insects, interviews with the five (5) staff reveal that that they have observed bed bugs in the facility. Staff interviews and documentation reveal that on 6/30/2025, room #133 in memory care was chemically sprayed for bed bugs. On the same day (6/30/2025) all rooms in memory care were chemically sprayed as a preventative measure. Rooms with minimal bed bug activity is sprayed and then deep cleaned. Rooms with high levels of bed bugs are heat treated and deeped cleaned. The heat treatment equipment is currently stored at the corporate facility in Pasadena. Five (5) out of (7) residents interview reveals that they have observed bedbugs in their bedrooms and bed bugs were treated by facility staff. Review of facility files reveals from June 2024 until June 2025, the facility has treated resident's bedrooms and common areas several times for bedbugs. LPA was not provided documentation of a professional extermination company treating for bed bugs. In addition, LPA observed several dead insects in room #107's shower. Substantiated Based on investigation findings, the facility is not utilizing effective measures to control the spread of bed bugs; therefore, the allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 3, 2025 · control 56-AS-20240822152146

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87303(a) · Plan of correction due date: Jul 9, 2025

87303Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors…this requirement is not met as evidenced by: Interviews with staff, residents, and document review reveal that the facility does have bed bugs and the Licensee is not utilizing effective measures to mitigate the spread of bed bugs. This poses/posed an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2025

Plan of correction: The Administrator/Licensee has agreed to have an exterminator company conduct an inspect resident bedrooms, common areas, and treat rooms if bed bugs are observed & clean room 107's shower by POC due date.

Allegation investigated: Staff are financially abusing resident

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator, Michael Garcia, and informed the purpose of the visit. Regarding the allegation, staff are financially abusing resident, it was alleged that staff were financially abusing resident #1 (R1) while in care. Staff interviews reveal that R1 had bank statements which showed multiple bank transactions made on his account that they did not approve. On 02/01/2023, Community Care Licensing received an incident report of financial abuse involving R1 and staff #1 (S1). The incident report reveals that S1 attempted to open a store credit account in R1’s name and borrowed money from R1. The Administrator made multiple attempts to contact S1 but received no response. S1 was in violation of facility policy for taking R1 out of the facility without proper authorization. It was also alleged that S2 was making purchases using R1’s bank card during their off-work hours. Review of pertinent documents and staff interviews reveals that, on 11/07/2022, S2 did not report to work. On the same day, multiple transactions and withdrawals were made using R1’s bank card, including transactions in Mexico. Transactions were found near S2’s reported address in Mexico. Substantiated S2 found R1’s bank card outside of their vehicle and S2 returned it to Administrator Garcia. Based on this investigation, the allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099, LIC9099-C, LIC9099-D) were discussed and provided with appeal rights to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 19, 2025 · control 56-AS-20230109112326

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: May 22, 2025

87468.2Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all the following personal rights: (8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical...abuse. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by facility staff financially exploiting R1 while in care; which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: The Licensee and Adminstrator has agreed to provide inservice training on financial abuse and a resident council meeting and provide documentation of training to the licensing agency by POC due date. Both S1 and S2 no longer work for the facility. .

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced follow-up visit to gather information pertaining to complaint #56-AS-2025021414323investigation. LPA met with Administrator, Michael Garcia, and discussed the purpose of the visit. During today’s visit, LPA toured the facility and conducted interviews. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 19, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to the facility. LPA met with Assisting Administrator, Maria Molina and informed the purpose of the visit. During today's visit, LPA requested to review resident files related to complaint investigation (56-AS-20250508165707). Assisting Administrator and staff were not able to locate Resident #1 (R1's) facility file for LPA to review. Assisting Administrator stated that R1 was discharged from the facility in early 2024. A deficiency has been cited and civil penalties of $250 dollars are being accessed for repeating the same violation within 12 months per Title 22 of the California Code of Regulations. The same citation [87506 (e)] was issued on 2/19/2025. An exit interview was conducted where this report was discussed and copies with appeal rights were provided to the Assisting Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 9, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(e) · Plan of correction due date: May 15, 2025

87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: The Licensee/Administrator did not comply with the section cited above by not maintaining copies or orginals of R1's facility records for three years after being discharged from the facility for LPA review.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: The Licensee and/or Administrator shall review the regulation cited and submit a statement of understanding to the licensing agency by POC due date.

Allegation investigated: Facility staff does not keep facility common areas free of malodorous odors Facility air conditioning is not working properly

Licensing Program Analyst (LPA) Magda Malcore conducted an unannouced visit to the facility to conduct a complaint investigation. LPA Malcore met with Administrator, Michael Garcia, and informed the purpose of the visit. Regarding the allegation, facility staff does not keep facility common areas free of maldorous odors, LPA conducted a tour of the facility. LPA observed a mild scent of cleaning solutions and air freshers in facility entryways, hallways, visitors bathrooms, activity and dining areas. Four (4) out of five (5) resident interviews reveal that they have not observed malodorous odors in the facility's common areas. The Administrator and three (3) staff interviews reveal that the facility's common areas are cleaned daily to prevent malodorous odors. Regarding the allegation, facility air conditioning is not working properly, LPA observed the air conditioning was operating during visit. Five (5) out of five (5) residents interviews reveal the air conditioning/heater is operating properly and the their rooms are maintained at a comfortable temperature for them. Unsubstantiated Based on LPA observations, resident and staff interviews, the allegations mentioned in this complaint are Unsubstantiated. A finding of unsubstantiated means that although the allegations may have happened or are 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 was discussed. A copy with appeal rights was provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 56-AS-20250408154836

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility. LPA arrived at the facility in order to conduct a case management visit to follow up on a resident death. LPA met with Maria Molina, Assisting Administrator and explained the purpose of today's visit. LPA met with Administrator Michael Garcia shortly after. On 3/04/2025, Community Care Licensing Division receive a death report of resident #1 (R1). During today's visit, LPA collected pertinent documentation and conducted staff interviews in regards to the death of R1. Administrator Garcia stated that no official death certificate has been issued at this time but the preliminary cause of death is believed to be from possible heart failure. LPA advised the Administrator to send a copy of the death certificate the Community Care Licensing Division (CCLD) Riverside Regional Office as soon as it is available. An exit interview was conducted where this report (LIC 809) was discussed and a copy provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to the facility. LPA met with Administrator, Michael Garcia, and informed the purpose of the visit. During today's visit, LPA requested to review resident files related to complaint 56-AS-20250214135233. Administrator Garcia stated that resident #1 (R1) has not been residing at the facility since January 2025. R1's records were removed from the facility temporary for Corporate review. Administrator Garcia stated that he will obtain R1's records and provide to LPA for review. A deficiency has been cited per Title 22, California Code of Regulations. An exit interview was conducted where this report was discussed and copies with appeal rights were provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(e) · Plan of correction due date: Feb 28, 2025

87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not maintaining copies or orginals of R1's facility records for three years after being discharged from the facility for review.the state’s words, verbatim · CDSS document, Feb 19, 2025

Plan of correction: The Administrator has agreed to provide licensing with requested resident records by POC due date.

Allegation investigated: Facility staff does not ensure residents care plan needs are being met Staff did not ensure food is served in a healthful manner to residents in care

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a complaint investigation. LPA met with Administrator, Michael Garcia and discussed the purpose of the visit. Regarding the allegation that facility staff do not ensure residents' care plan needs are being met, interviews with three (3) facility staff, resident #1 (R1), and a review of pertinent documents reveal that there is not enough evidence to corroborate the allegation. Interviews reveal that staff did assist or obtain outside agency assistance to repair R1's catheter bag leak. Regarding the allegation, staff did not ensure that food was served in a healthful manner to residents in care. Interviews with three (3) staff revealed that food is kept covered when distributing food trays to residents in their rooms. For residents who eat in the dining area, meals are served when residents are seated to ensure that food is served at appropriate temperatures. Four (4) out of five (5) residents stated that meals are served at appropriate temperatures. Unsubstantiated Based on LPA record review and interviews with pertinent parties, the allegations mentioned in this report are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy of this report was provided with appeal rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 22, 2025 · control 56-AS-20240625125630

Allegation investigated: Staff does not provide adequate supervision resulting in resident eloping from the facility

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced facility visit to commence a complaint investigation. LPA met with Administrator, Michael Garcia and informed the purpose of the visit. Regarding the allegation, staff does not provide adequate supervision resulting in resident leaving the facility, interviews with staff and pertinent record review reveals: On 1/10/25, staff reported resident (R1) missing from the facility. R1 was last seen in the facility between the hours of 7:30 p.m. and 8:00 p.m. The resident was found outside of the facility at around 1:00 a.m. on 1/11/25. R1 was transported to the hospital due to cold exposure. On 1/15/24, two (2) staff received disciplinary action for failure to meet performance standards related to R1 leaving the facility. LPA record review reveals, R1 was medically assessed as confused/disoriented and unable to leave the facility unattended. On 12/12/24, R1 had also attempted to leave the facility by pushing memory care egress doors. Substantiated Based on pertinent record review and interviews, the allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to the Administrator at the conclusion of the visit. Based on pertinent record review and interviews, the allegation is Unsubstantiated. A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed and provided with appeal rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 17, 2025 · control 56-AS-20250113103428

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 21, 2025

Additional Personal Rights of Residents in Privately Operated Facilities 87468.2(a) In addition to...Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs...this requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not ensuring resident had sufficient supervision to meet their care needs resulting in R1 eloping from the facility; which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 17, 2025

Plan of correction: The Licensee/Administrator shall conduct in-service training on resident eloping prevention and wandering behaviors and submit documentation of training to the Licensing Agency by POC due date.

Allegation investigated: Staff are unable to communicate with residents to meet their needs

Licensing Program Analyst (LPA) Magda Malcore conducted an announced visit to the facility to conduct a complaint investigation. LPA met with Administrator, Michael Garcia and discussed the purpose of the visit. Regarding the allegation, Staff are unable to communicate with residents to meet their needs, four (4) out of (6) resident interviews reveal that staff are unable to communicate with them due to language barriers. Staff use a phone application to communicate with residents in English. During an interview with Staff #1 (S1), LPA asked S1 a question related to resident showers. S1 asked if LPA could type the question into Google Translate to translate it into English. An interview with Administrator Garcia reveals there is a language barrier between staff and some residents. Staff either ask other staff to translate for them when assisting residents, or use their phones for English translation, or use picture books. Based on LPA observations and interviews with staff and residents, the allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Substantiated An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 15, 2024 · control 56-AS-20241108092028

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Dec 3, 2024

Additional Personal Rights of Residents in Privately Operated Facilities87468.2 (a) In addition to the rights listed in Section 87468.1...residential care facilities for the elderly shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by staff unable to communicate with residents to meet their needs, which poses a potential heath, safety, or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Nov 15, 2024

Plan of correction: The Licensee/Administrator shall submit to the Licensing Agency a statement of understanding on the regulation cited by plan of correction date.

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.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management based on deficiencies observed during today’s visit, 10/21/24. LPA met with Administrator, Michael Garcia and was informed of the visit. On 10/21/24, LPA's record review of resident's files, reveals resident #1(R1) was sent to the hospital by ambulance on 6/18/24, 9/24/24, and 10/08/24. Resident#2(R2) was sent to the hospital by ambulance on 7/06/24 and 9/23/24. Resident#3 (R3) had a physical altercation with Resident #4(R4). R4 sustained injuries and facility staff called law enforcement. During today's visit, LPA observed dark discoloration around Resident #5 (R5's) eye. Staff #1 (S1) informed LPA is was due to a fall and Hospice was notified. LPA review of Regional Office files and interview with the Administrator reveals, staff did not submit a written report to Community Care Licensing on these incidents which involved the health and safety of the residents in care. On 10/21/24, LPA toured the memory care area of the facility. During the tour, LPA observed a strong odor in the hallway. S1 stated that R1 had just been changed. However, LPA observed R1 was in the activities room which was a lengthy distance from R1' room. LPA entered R1's room, noticed the strong odor and noticed that the room floor was sticky. Deficiencies are being cited in accordance with Title 22, Division 6, of the California Code of Regulations (see LIC809D). A civil penalty of $250 is hereby assessed today for repeat violations within a 12-month period for regulation 87211(a)(1)(D)previously cited on 12/09/23. Another civil penalty is also being assessed for repeat violation within a 12-month period for regulation 87303(a) previously cited on 8/23/24. The Administrator was informed civil penalties will continue to accrue $100 per day until the deficiency is corrected. An exit interview was conducted where this report and correction plans were discussed. A copy of this report with appeal rights was provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 21, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 31, 2024

87211 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence of...(D)Any incident which threatens the welfare, safety or health of any resident...This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not reporting incidents that threatened the health and safety of R1, R2, R3, R4, and R5; which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 21, 2024

Plan of correction: The Administrator stated that changes have been made as to staff self-reporting incidents to the Licensing Agency. The Administrator has agreed to submit LIC624 reports to the licensing agency on the incidents by POC due date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 31, 2024

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times...this requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not maintaining resident's room and facility hallway free of odor; and not maintaining resident's floor clean; which poses a potential health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 21, 2024

Plan of correction: During LPA's visit, staff mopped R1's bedroom floor and odors were removed. No further action required.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to the facility. LPA met with Administrator, Michael Garcia, and provided the following report regarding the Department's investigation of the death of Resident#1 (R1). Investigation included interviews and review of records for R1. Investigation revealed that on December 21, 2022, R1 was observed with an abrasion and open sore on right knee. R1 complained that leg hurt. R1 was sent to the hospital around 2:00 pm and returned to the facility between 6:00-6:30 pm on same day. R1 was observed to be walking with a gait. R1 was then observed to leave the facility by self around 7:00 pm. Around 8:30 pm, local law enforcement came to the facility to inform staff that R1 was struck by a vehicle while attempting to cross the highway. Law enforcement informed staff that R1 was transported to the hospital and died around 10:00 pm. Physician's report dated December 12, 2022, indicated that R1 was ambulatory and was “unable to leave facility unassisted.” In addition, report indicated that R1 “has episodes of forgetting, being distracted.” On December 21, 2022, facility staff allowed R1 to leave facility by self and failed to provide R1 with adequate observation and supervision to meet R1 needs. Soon after leaving the facility, R1 crossed a nearby highway and subsequently was struck and killed by a vehicle. The Licensee is cited per violation of Title 22, California Code of Regulations. In addition, this violation posed an immediate Health and Safety risk to resident(s) in care. An Immediate Civil Penalty of $500 is being assessed. The licensee was also informed that an additional civil penalty may be assessed based on Health and Safety Code § 1569.49. An exit interview was conducted where reports LIC809, LIC 809-D, LIC421IM, and appeal rights were discussed and provided to Administrator Garcia. Signature on this report acknowledges receipt of the appeal rights.the state’s words, verbatim · CDSS document, Oct 21, 2024

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(6) · Plan of correction due date: Oct 23, 2024

H&S:1569.269(a)(6) Enumerated rights; severability: Residents of residential care facilities for the elderly shall have all of the following rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met at evidenced by: The Licensee did not comply with the section cited by facility staff were not competent in meeting R1 needs. Facility staff failed to properly supervise R1. Following R1 leaving facility premises on December 21, 2022, R1 was struck by a vehicle and killed while attempting to cross a highway. This posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 21, 2024

Plan of correction: The Licensee/Adminstrator has agreed to provide in-service staff training on regulations: 87466 Observation of the resident, 87463 reappraisals and 87461 Mental Condition as submit to proof of training to the Licensing Agency by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Magda Malcore and Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Assisting Administrator, Maria Molina, and discussed the purpose of the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (85), and a current census of (70). LPAs conducted a general inspection of facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient space for resident activities; however, the facility does not have a up-to-date activity plan on file. The facility does not maintain resident's common areas free of mosquitos. Ten (10) resident bedrooms were inspected, LPAs observed that room#115 did not have a required chair. Ten (10) resident’s bathrooms were inspected, LPAs observed the following hot water temperatures: room#107 tested at 94 degrees f, room#110 tested at 91 degrees f, room# 115 tested at 101.6 f, and room# 137 tested at 98 degrees F. LPAs observed several roaches in resident room# 140 bathroom. The facility maintains a sufficient supply of bed linen, towels, and personal hygiene products for residents in care. The facility is equipped with operating smoke/carbon monoxide alarms, laundry equipment, and telephone service. Posters such as personal rights, the Community Care Licensing complaint information, Ombudsman poster, emergency telephones, and license were posted in a common area. Cleaning supplies, toxins, and sharps were kept inaccessible to residents in care. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Facility refrigerators and freezers were maintained in operating condition. The facility has posted a monthly menu. Health Related services: LPAs reviewed (6) resident medications. The facility keeps record of resident’s medications and medications are centrally stored in a locked medication room. Record Review: LPAs reviewed (6) resident files. LPA's observed resident #1(R1), resident #2(R2), resident#3(R3), resident#4(R4), and resident#5(R5) did not have admissions agreements on file. LPAs observed resident#6 (R6's) physicians report was not signed by the resident and/or legal representative. LPAs reviewed (6) staff files for First Aid/CPR certifications, criminal record clearances/exemptions, training, and health screenings. The Administrator’s certification is current. The facility has a emergency and disaster plan on file; however the facility did not have a current disaster drill conducted with staff on file for review. Based on LPAs observations and records reviewed, deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report (LIC809) and a plan of correction were discussed with the Assisting Administrator. Copies of the reports were provided with appeal rights to the Assisting Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 23, 2024

Allegation investigated: Staff did not transport resident to appointments Staff stole resident's cell phone

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to initiate a complaint investigation on the above allegations. LPA met with Administrator Michael Garcia and informed the purpose of the visit. Regarding the allegation, Staff did not transport resident to appointments, interviews with seven (7) residents reveal residents are provided transportation to appointments. Interviews with outside parties, Administrator and three (3) staff reveal that the Resident #1 (R1) did have outside transportation arranged by the R1's POA for their 8/09 and 8/12 appointment. On 8/12/24, R1 had an appointment; however; it was not clearly stated to the Administrator or staff that outside party transportation was not being provided for this appointment. Regarding the allegation, staff stole resident's phone, interviews with outside parties, seven (7) residents, the Administrator, and three (3) staff reveals not enough evidence to corroborate the allegation. Based on LPA observations and interviews, the above allegations are Unsubstantiated. 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. Unsubstantiated An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided with Appeal Rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 21, 2024 · control 56-AS-20240813154402

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(d) · Plan of correction due date: Aug 26, 2024

87303 Maintenance and Operation(d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility; this requirement is not met as evidenced by: The licensee/Administrator did not comply with the section cited above by not maintaining sufficient lighting in bedroom #103's hallway; which poses a potentional health, safety, and/or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2024

Plan of correction: The lighting was fixed in bedroom #102 during LPA's visit. no further action required.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Magda Malcore initiated a case management visit based on observations made during complaint investigation #56-AS-20240813154402. LPA met with Administrator, Michael Garcia, and informed the purpose of the visit. LPA entered bedroom #139 to conducted an interview with resident #1 (R1), a non-ambulatory resident. LPA observed a Raid insecticide spray on a tray next to R1's bed. LPA alerted Assisting Administrator Maria Molina who removed the can. The Assisting Administrator stated that R1's brother my have brought and left the insecticide spray. Based on LPA observations, a deficiency is being cited in accordance with Title 22, of the California Code of Regulations. An exit interview was conducted where this report was discussed. A copy of this report was provided with Appeal Rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 21, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 22, 2024

87309 Storage Space(a) Disinfectants, cleaning solutions, poisons...and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients..this requirement is not met by: Based on LPA observations the Licensee/Administrator did not comply with the section cited above by having a Raid insecticide spray next to resident's bed; which poses an immedicate health, safety and/or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2024

Plan of correction: The Administrator removed the can from resident's bedroom and placed inaccessible to residents.

Allegation investigated: Staff moved resident to memory care without responsible party consent Staff failed to safeguard resident's personal belongings

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the investigation on the above allegations. LPA met with Administrator, Michael Garcia, and discussed the purpose of the visit. Regarding the allegation, staff moved resident to memory care without responsible party consent, interviews with staff and resident #1 (R1’s) responsible party reveal, there is not enough evidence to corroborate the allegation. Regarding the allegation, staff failed to safeguard resident’s personal belongings, on 7/24/23, Community Care Licensing Division Regional office received an incident report stating that on 7/19/23, resident #2 (R2) stole personal belongings from resident #3 (R3) and resident #4 (R4). On 7/20/23, staff reported the theft to the Sheriff’s Department. LPA record review reveals the facility does have a written theft and loss policy. Interviews with (R3) and (R4) reveal, there is not enough evidence to corroborate the allegation. Unsubstantiated Based on LPA pertinent document review and interviews, the above allegations are Unsubstantiated. An Unsubstantiated finding means, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where the Licensing reports were discussed and copies were provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 2, 2024 · control 56-AS-20230725161544

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 31, 2024

Resident Records.The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility…this requirement is not met as evidenced by: resident #1 (R1’s) last medical exam on file was conducted on 6/23/2022, due to R1’s cognitive condition an annual medical assessment is required. Resident #2 (R2) physician’s report was missing physician’s signature. Resident #5 (R5) did not have a complete physician's report or a medical assessment on file, which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 2, 2024

Plan of correction: The Administrator stated that both R2 and R5 no longer reside at the facility. The Licensee/Administrator shall submit to the Licensing Agency a statement of understanding on the regulation cited by POC due date. The Licensee/Administrator shall submit to the Licensing agency proof of R1's current physician's report or medical assesment as per regulation 87458 medical assessments.

Allegation investigated: Staff do not assist resident with incontinence needs

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conduct a complaint investigation. LPA met with Maria Molina, Assistant Administrator and discussed the purpose of the visit. Regarding the allegation, staff do not assist resident with incontinence needs, staff interviewed deny not assisting a resident with incontinence needs, Four (4) out of (6) residents interviewed deny that staff are not assisting them with their incontinence needs. Based on LPA observations and interviews conducted, the allegation is Unsubstantiated; 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. No deficiencies were cited. An exit interview was conducted where this report was discussed, and a copy was to provided to Maria Molina at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 11, 2024 · control 56-AS-20240108141506

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 26, 2024

87464 Basic Services(f) Basic services shall at a minimum include:(4)Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing...this requirement has not been met as evidenced by: interviews with staff #1(S1) and staff #2 (S2) reveal they were told by resident #1 (R1) that they have not received their scheduled bath. review of daily care logs reveal no record of baths for R1 from 12/27/23 through 1/08/2024,which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 11, 2024

Plan of correction: Licensee/Administrator shall conduct an in-service staff training regarding bath and shower care and submit proof of training to Licensing Agency by POC date.

Allegation investigated: Staff unlawfully evicted resident

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above mentioned allegation. LPA Prieto met with administrator Garcia and explained the elements of the complaint. Regarding the allegation that staff unlawfully evicted resident; Resident #1 (R1) was not available for interview. Interview with administrator Garcia states R1 was sent to Hemet Global Medical Center, on 12/26/23, due to R1 having combative behaviors. Documentation obtained, from Hemet Global, gives instructions to facility staff to return R1 to Hemet Global if R1's behaviors persist or worsens. ****continued on LIC 9099C**** Unsubstantiated Per such directive, Garcia returned R1 to Hemet Global and waited approximately 9 1/2 hours until Garcia was told that the wait was due to obtaining a bed for R1. Upon notice that R1 was admitted, Garcia states he left the medical facility in the early hours of 12/27/23, and submitted documentation of the incident to the Licensing Office. Based on the information obtained there is not enough evidence that staff unlawfully evicted resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Garcia and a copy was left with the facility.the state’s words, verbatim · CDSS document, Dec 28, 2023 · control 56-AS-20231227085724

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to have administrator Michael Garcia sign an amended Complaint Investigation Report (LIC 9099) regarding complaint (56-AS-20230920141310) dated 09/25/2023. Administrator Garcia signed the amended report, along with LPA Prieto, and a copy was left with the facility.the state’s words, verbatim · CDSS document, Dec 28, 2023

Allegation investigated: Staff did not ensure that a resident had a sufficient supply of medication stored at the facility Staff do not provide residents with linen Staff do not supply residents with an adequate supply of a toiletry

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator Michael Garcia and discussed the purpose of the visit. Regarding allegation #1, staff did not ensure that a resident had a sufficient supply of medication stored at the facility, staff interviews reveal, the facility does ensure the residents have a sufficient supply of medications. Four (4) out of six (6) resident interviews reveal, staff do ensure they have a sufficient supply of medication. Regarding the allegation #2, staff do not provide residents with linen, LPA toured the facility and observed a sufficient supply of linen for residents in care. Staff interviews reveal, the facility does provide linen for the residents. Five (5) out of six (6) resident interviews reveal, linen is provided to the residents by the facility. Regarding the allegation #3, staff do not supply residents with an adequate supply of a toiletry, LPA toured the facility and observed a sufficient supply of toiletry for residents in care. Staff interviews reveal, the facility has an adequate supply of toiletry for residents. Five (5) out of six (6) residents stated that they have an adequate supply of toiletries. Based on LPA observations and interviews, the allegations are Unsubstantiated. Unsubstantiated A finding of Unsubstantiated means that although the allegations may have happened or are 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 was discussed and a copy was provided with Appeal Rights to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 56-AS-20230921104701

Type of visit: Case Management - Deficiencies

At 1:20PM LPA arrived at the facility Michael Garcia was called directly and stated he would be arriving at the facility in 30 minutes. LPA Allen informed him of the purpose of the visit and that I would wait for is arrival. On 8/23/2023 Licensing Program Analyst (LPA) Bernadette Allen was at the facility to initiate a complaint investigation and deliver the findings on complaint 56-AS-20230815162748. During the course of investigation LPA discovered that the licensee did not submit a Special Incident Report (SIR) regarding the altercation between Resident 1 (R1) and Resident 2 (R2) resulting R1 going to the hospital and returning back to the facility with stiches. Based on the information gathered during the investigation the licensee is being cited for not reporting the incident that occurred on 6/2/2023. A deficiency is being cited in accordance with the California Code of Regulations, Title 22, see LIC809-D and LIC421FC An exit interview was conducted where this report was discussed and a copy was provided to Michael Garcia at the conclusion of LPA’s visit.the state’s words, verbatim · CDSS document, Dec 9, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Dec 10, 2023

REPORTING REQUIREMENTS (a)Each licensee shall furnish to the licensing agency…(1)A written report…within seven days...(D)Any incident which threatens the welfare, safety or health of any resident…This requirement is not met by: The licensee did not provide the licensing agency with written reports regarding R1 injuries which occurred on 6/11/23 and 6/15/23 with 7 days; which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 9, 2023

Plan of correction: The Administrator has agreed to provided the SIR for the altercation between R1 and R2 by the POC 12/10/23

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to get a complaint amended that was processed on 8/23/2023 control number 56-AS-20230814142101. During the visit LPA informed the administrator Michael Garcia about the corrections to original report. Michael signed the amended 9099 and 9099-C. An exit interview was conducted where this report was discussed and a copy of the report was provided to Michael Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 9, 2023

Allegation investigated: Resident developed food poisoning while in care Staff do not ensure resident's are provided nutritious meals Facility has pests

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA Malcore met with Michael Garcia, Administrator and discussed the purpose of the visit. The investigation consisted of LPA facility tour, pertinent record review, interviews with residents and staff. Regarding the allegation, resident developed food poisoning while in care, LPA toured the kitchen. Facility refrigerators and freezers were operating in a healthful manner. Pesticides and other cleaning solutions are stored away from food areas. Kitchen area was free of litter and roaches. Staff interviewed deny residents developed food poisoning while in care. Eight (8) residents interviewed deny developing food poisoning while in care. Regarding the allegation, staff do not ensure resident's are provided nutritious meals, facility menus reflect a variety of nutritious meals. Staff interviewed deny not ensuring residents are provided nutritious meals. Six (6) out of eight (8) residents interviewed stated that meals provided are nutritious. Regarding the allegation, facility has pest, staff interviews reveal, the facility has a monthly contract with an outside extermination company for pest control maintenance. LPA record review reveals the facility was last treated for pest control on 11/10/23. Six (6) out of (8) residents interviewed deny having roaches in their bedrooms. LPA did not observe roaches in resident's bedrooms. Unsubstantiated Based on observations, record review, and interviews, the allegations mentioned in this report are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy with appeal rights was provided to Administrator Garcia at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 21, 2023 · control 56-AS-20231120225037

Allegation investigated: Staff mishandled resident's medications Staff did not ensure resident was transported to resident's medical appointment.

Licensing Program Analyst (LPA) Javier Prieto and LPA Paula Guitierrez arrived to the facility to conduct a complaint investigation regarding the above-mentioned allegations. LPAs met with Assistant Administrator Molina to discuss the elements of the complaint. Regarding the allegation staff mishandled resident's medications, staff #1 (S1) interviews and medical records obtained reveal the medications were prescribed for resident #1 (R1) on 09/22/23 and medication was not located for approximately 7 days, when R1 was dispensed the first dose. Regarding the allegation that staff did not ensure resident was transported to resident's medical appointment, S1 interview reveal that R1 missed a scheduled doctor's appointment on 09/19/23 due to staff miscommunication and later attended doctor's appointment on 09/22/23. **** continued on LIC 9099C*** Substantiated Based on evidence obtained during the investigation, the allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports LIC9099 and LIC9099-D were discussed and a copy of the reports with Appeal Rights was provided to Assistant Administrator Maria Molina at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 4, 2023 · control 56-AS-20230929095525

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Oct 6, 2023

Incidental Medical and Dental Care For every prescription and nonprescription PRN medication for which the licensee provided assistance there shall be a signed, dated written order from the Physician, on a blank prescription, maintained in resident's file. This requirement is not met as evidence by the following: Records reveal that medications were prescribed to resident #1 and medication were not located and dispensed according to doctor's ordersthe state’s words, verbatim · CDSS document, Oct 4, 2023

Plan of correction: Administrator is to train their staff on medication dispensing and storing of medication and a copy of that training to be sent to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Oct 9, 2023

Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: This requirement is not met as Records revealed resident #1 had an appointment on 09/19/23, missed appt and later attended on 09/22/23the state’s words, verbatim · CDSS document, Oct 4, 2023

Plan of correction: Administrator to send declaration to LPA on POC date indicating that staff will better communicate with residents or resident's responsible party.