Joy and Love Home Care

Type of visit: Required - 1 Year

On May 08. 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the House Manager, Hector Soto. The facility file review was conducted in the Regional Office and additional forms were requested and reviewed on site. The facility is licensed for 18 Elderly Adults but is currently operating at a capacity of 14 Elderly Adults, for a facility type (740). LPA Mixson toured the facility and made observations pertaining to the annual visit. The facility was inspected inside and outside. There were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a two-story structure, located at 1178 Evergreen Lane, Vista , CA. 92084. Physical Plant: The facility phone number is (661) 754-0261 and it is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. The facility bathrooms were inspected and the hot water temperature is tested and logged. The bathrooms were clean, and appliances were operating appropriately at present. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers.LPA made observations of the required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. Facility cleaning supplies and sharp items were locked and inaccessible to the residents at the time of this visit. There was a designated storage space for the residents and staff files. The staff office was locked and inaccessible to residents. Medications: Were locked and inaccessible to residents in care. There were a sufficient supply of medication for each resident. Overall facility is clean, furniture is in good condition, and home is free of odors. Facility's cooling system and other appliances were operable currently at the time of this visit. There are night lights inside and outside of the facility. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Staff advised food shopping is done on a weekly rotation and as needed. Facility has a posted menu and staff indicated that the menu is followed. Dishes and utensils were in sufficient supply and stored orderly, and sharp items are locked. Care & Supervision/Administration: Adequate staff are present for the supervision of resident in care. Three staff total providing care for after lunch activity. Floor plans, telephone numbers and personal rights were found posted in the facility. Listed Administrator possesses a current administrator’s certificate with an expiration date of 11/11/2026, Aila Sarapat, and it is posted in the facility. Records Reviewed and Resident/Staff Files: LPA reviewed staff files and reviewed the staff schedule. Staff files reviewed have criminal clearance and updated training along with First Aid Certification. Resident files reviewed possessed requested documentation and current weight records. Disaster preparedness: LPA Mixson reviewed facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill was conducted 2026, was facilitated by House Manager and met regulations. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms, PPE equipment, and cleaning supplies. LPA reviewed the facility's infection control plan and found required infection control measures. There were no observable deficiencies noted or cited per Title 22, Division 6 of the California Code of Regulations at the time of this annual inspection. An exit interview was conducted where a copy of this report was discussed and given to House Manager, Hector Sotothe state’s words, verbatim · CDSS document, May 7, 2026

Allegation investigated: Staff member struck a resident in care, causing an injury.

On 12/05/2025, at 11:00 a.m., Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit regarding the allegations above. LPA met with the Administrator, as the purpose of today’s visit was explained. The investigation consisted of the following: On 04/17/2024 and 05/08/2024, Licensing Program Analyst (LPA) Venus Mixson conducted unannounced complaint visits. LPA Mixson interviewed residents and staff. On 12/04/2025, LPA Richard reviewed and obtained the resident and staff rosters. LPA reviewed and obtained documents for Resident #1 (R1), including the hospice file, doctor orders (dated 05/02/2023), Physician Report for Resident (R1) (dated July 2023), Admission Agreement (dated June 26, 2022), and Needs of Service Plan (dated April 2024). Preplacement Appraisal Information (dated July 05, 2021). On December 4, 2025, LPA also interviewed four staff members, #1-4 (S1-S4), and five residents, #2-6 (R2-R6). LPA received a copy of the Unusual Incident Report Injury Report (dated 04/14/2024) for an unwitnessed fall. LPA interviewed the Administrator (A1), the Responsible Party (W1). LPA was unable to interview resident R1 because R1passed away in 2024. Unsubstantiated Allegation: Staff member struck a resident in care, causing an injury. The complaint alleged that the overnight caregiver had slapped R1 across the face while lying in bed. On 12/04/2025, at approximately 9:00 am, the LPA interviewed the Administrator (A1), who denied the allegation and stated that the resident (R1) was not struck or injured by any staff member. On 12/04/2025, the LPA interviewed four staff members 1-4 (S1-S4), all of whom denied the allegation and said they would have reported it if it had occurred. Also, on 12/04/2025, at about 9:00 am, the LPA interviewed five residents, R2 to R6, who all denied ever being struck or hit by staff. On 12/03/2025, the LPA interviewed the responsible party (W1), who stated that R1 was moved out of the facility on May 05, 2024, and R1 passed away in 2024. During the record review on 12/04/2025, the LPA found no hospital visits or police reports indicating that R1 was struck or injured at the facility. The LPA reviewed an Unusual Incident Report faxed to Licensing dated April 14, 2024, regarding an unwitnessed fall involving R1. Based on the information gathered, interviews, and record reviews, there is insufficient evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED. No deficiencies were cited. An exit interview was conducted. A copy of the report was provided to the Administrator Venkata Mullapudi.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 18-AS-20240415151334

Allegation investigated: Staff did not ensure hospice care plan for resident was followed. Staff did not ensur medication was dispense as prescribed. Staff does not ensure medical supplies are property managed for resident in care.

On December 5, 2025, at 10:00 am, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit and delivered findings. LPA met with the Administrator Venkata Sivaganesh and explained the purpose of the complaint visit. LPA and the Administrator toured the facility. The investigation included the following: On September 28, 2024, Licensing Program Analyst (LPA) Venus Mixson arrived unannounced at the facility to begin an investigation into the allegations. On December 4, 2025, LPA Richard requested the residents and staff roster, Medication Mar (MAR dated November 2025), and physician reports for five residents. Staff training certifications and schedules were also requested (dated November 2, 2023). LPA received copies of the Emergency Disaster plan (dated 12/2024), the Facility's daily notes (dated November 2025), and the caregiver/housekeeper schedules. On December 4, 2025, LPA interviewed five residents (#1-5, R1-R5), four staff members (#1-4, S1-S4), and the administrator (#1, A1). Continued Report LIC9099C Unsubstantiated Allegation #1: Staff did not ensure that the resident's hospice care plan was followed. The complaint alleged that resident #1 (R1) was receiving hospice care and that the hospice agency provided the facility with a care plan for pain management. However, the facility reportedly refused to administer pain medication to R1. On December 4, 2025, LPA Richard interviewed Administrator #1 (A1), who denied the allegation, stating that the medication technician would follow the hospice and doctor's orders for all residents. A1 also mentioned that all staff members responsible for administering medications had received proper training. During the same period, LPA Richard interviewed five residents (R1-R5), all of whom denied the allegation. Additionally, LPA interviewed four staff members, #1-4 (S1-S4), who also denied the allegation. LPA Richard reviewed medication records and PRN medications on December 4, 2025, confirming that all residents received their medications without discrepancies. LPA also examined the facility's notes, which verified that no medication errors had occurred and that no medications were missing from any residents' medication records. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations occurred. Therefore, the allegation is unsubstantiated. Allegation #2: Staff did not ensure medication was dispensed as prescribed. The complaint alleged that the facility refused to provide R1 with pain medication. On December 4, 2025, LPA Richard interviewed Administrator #1 (A1), who denied the allegation. A1 stated that the medication technician would adhere to the hospice and doctor's orders for all residents. A1 also explained that staff would not administer any medications to residents without a doctor's orders. If the pharmacy fails to send the doctor's orders, the medication technician would call the pharmacy to request that they fax the orders to the facility. During the same timeframe, LPA Richard interviewed five residents (R1-R5), all of whom denied the allegations. Additionally, LPA Richard interviewed four staff members (S1-S4), all of whom also denied the allegations and affirmed that they followed the doctor's medication orders for all residents. On December 4, 2025, LPA Richard reviewed the medication records and PRN (as needed) medications, confirming that all residents received their medications without discrepancies. LPA Richard also examined the facility's notes and MARs, which confirmed that no medication errors had occurred and that no medications were missing from any residents' medication charts. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations occurred. Therefore, the allegation is unsubstantiated. Allegation #3: Staff does not ensure medical supplies are properly managed for residents in care. The complaint stated that the licensee fails to ensure that insulin medical supplies are reordered promptly. On December 4, 2025, LPA Richard interviewed the Administrator (A1) regarding the allegation. A1 denied it and explained that the facility does not administer insulin or order insulin supplies for any residents. LPA interviewed four staff members #1-4 (S1-S4), who denied the allegation. The facility does not use needles but provides a comfort kit for residents on hospice care. LPA inspected the facility's medications and supplies and found that it has sufficient medicines and supplies for all residents. LPA observed a first aid kit at the facility. On December 4, 2025, LPA interviewed residents #1-5 (R1-R5), who stated the staff takes good care of them. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations occurred. Therefore, the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the Administrator, Venkata Sivaganesh Mullapudi.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 18-AS-20230927134713

Allegation investigated: Facility does not have sufficient staff to meet residents' needs. Residents had access to medications.

On December 5, 2025, at 10:00 am, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit and delivered findings. LPA met with the Administrator Venkata Sivaganesh and explained the complaint visit. LPA and the Administrator toured the facility. The investigation included the following: On September 11, 2024, Licensing Program Analyst (LPA), Venus Mixson, arrived unannounced to initiate the investigation and met with the Lead Caregiver, Viviana Labra. On December 4, 2025, LPA Richard requested the residents and staff roster, Medication Mar (MAR dated November 2025), and physician reports for five residents. Staff training certifications and schedules were also requested (dated November 2, 2023). Facility daily notes (dated November 2025) and caregivers/housekeepers' schedules were examined. On December 4, 2025, LPA interviewed five residents #1-5, (R1-R5), four staff members #1-4, (S1-S4), and the Administrator (#1, A1). Continued Report LIC9099C Unsubstantiated Allegation #1: The Facility does not have sufficient staff to meet residents’ needs. The complaint alleged that residents were wandering unsupervised and that no staff were available. On December 4, 2025, LPA Richard interviewed Administrator #1 (A1), who denied the allegations and stated that the facility employs three staff members per shift. A1 also mentioned that they have two staff on call every day, seven days a week. During the same time frame, LPA Richard interviewed five residents (R1-R5), all of whom denied the allegation. Additionally, LPA Richard interviewed four staff members (S1-S4), all of whom also denied the allegations. They confirmed that the facility provides 24-hour care and that residents are never left alone and stated that the facility operates in three shifts: 6:00 A.M. to 2:30 P.M., 2:30 P.M. to 10:30 P.M., and 10:30 P.M. to 6:30 A.M., from Sunday through Saturday. On December 4, 2025, LPA Richard reviewed the staff schedule and confirmed that the facility maintains three staff members per shift, along with additional staff on call. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated. Report Continued LIC9099C Allegation #2: Resident had access to medications. The complaint alleged that residents were eating breakfast and had small cups on their trays with different pills. On December 4, 2025, LPA Richard interviewed Administrator #1 (A1), who denied the allegations and stated that the facility has a locked room for storing medications, accessible only by staff. A1 also mentioned that staff need a code to open the medication room. The staff regularly assists residents with their medications by placing them on their trays at breakfast, lunch, and dinner. LPA Richard interviewed four staff members (S1-S4), all of whom also denied the allegation. On December 4, 2025, LPA Richard toured the facility and observed that without a code, the medication room could not be opened. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator Venkata Sivaganesh Mullapudi.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 18-AS-20240905154448

Allegation investigated: Staff mishandled the residents medications. Staff are not providing adequate care and supervision. Staff do not keep the facility free from odor.

On December 4, 2025, at 10:30 am, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit and delivered findings. LPA met with the Administrator Venkata Sivaganesh and explained the complaint visit. LPA and Administrator toured the facility. The investigation included the following: On January 30, 2024, Licensing Program Analyst (LPA) Venus Mixson arrived unannounced at the facility to begin an investigation into the listed allegations. On December 4, 2025, LPA Richard requested the residents and staff roster, Medication Mar (MAR dated November 2025), and physician reports for five residents. Staff training certifications and schedules were also requested (dated November 2, 2023). Facility daily notes (dated November 2025) and caregiver/housekeeper schedules were examined. On December 4, 2025, LPA interviewed five residents (#1-5, R1-R5), four staff members (#1-4, S1-S4), and the administrator (#1, A1). Continued Report LIC9099C Unsubstantiated Allegation #1: Staff mishandled the residents' medications. The complaint alleged poor management, lack of knowledge regarding medication and Title 22, and stated that medications were seen on the floor, then picked up and given to residents. On December 4, 2025, LPA Richard interviewed Administrator #1 (A1), who denied the allegation and stated that no staff had ever mishandled any residents' medications. A1 also said that all staff members who assist with medications had proper training. During the same timeframe, LPA Richard also interviewed five residents, #1-5 (R1-R5), all of whom denied that staff ever gave them medications from the floor. Additionally, LPA interviewed four staff members, #1-4 (S1-S4), all of whom denied the allegation. On December 4, 2025, LPA Richard reviewed medication records and confirmed that all residents received their medications without discrepancies. LPA also reviewed the facility's notes, which confirmed that no medication errors occurred and that no medicines were missing from any residents' Medications Mar. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated. Report Continued on LIC9099C Allegations #2: Staff are not providing adequate care and supervision. The complaint alleged that the residents are not being adequately cared for. On December 4, 2025, the LPA interviewed the Administrator (A1), who denied the allegation and stated that the facility has many staff members working to ensure the residents are well cared for and supervised. During the same period, LPA Richard also interviewed five residents, #1-5 (R1-R5), all of whom denied the allegation and said they are satisfied with how staff care for them. Additionally, the LPA interviewed four staff members, #1-4 (S1-S4), all of whom denied the allegation and stated that the facility is fully staffed, and staff are always available to assist residents. S1-S4 noted that this is a 24-hour care facility operating seven days a week, 365 days a year. Residents are never left alone at the facility without supervision. The facility operates in three shifts: 6:00 A.M. - 2:30 P.M., 2:30 P.M. - 10:30 P.M., and 10:30 P.M. – 6:30 A.M., Sunday through Saturday. A1 stated that they are on call 24 hours a day. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated. Report Continued on LIC9099C Allegation #3: Staff does not ensure the facility is free of odor. The complaint alleged that the facility had a strong odor. On December 4, 2025, LPA Richard interviewed Administrator #1 (A1), who denied this allegation. A1 explained that the facility employs multiple caregivers/housekeepers who clean and disinfect both the facility and the residents' rooms daily. The housekeepers perform tasks such as mopping and vacuuming each resident's room. During the same period, LPA Richard interviewed five residents (R1-R5), all of whom also denied noticing any unpleasant smells in the facility. Additionally, LPA Richard spoke with four staff members (S1-S4), who similarly denied the allegation, stating that the facility is cleaned, sanitized, and disinfected daily to maintain a pleasant atmosphere. On December 4, 2025, LPA Richard reviewed the schedule records for caregivers and housekeepers and confirmed that all residents' rooms are cleaned daily. LPA Richard also conducted a facility tour and observed that all 9 inspected rooms were clean and odor-free. Based on the information collected from the facility inspection, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of the report was provided to the Administrator Venkata Sivaganesh Mullapudi.the state’s words, verbatim · CDSS document, Dec 4, 2025 · control 18-AS-20240122153249

Allegation investigated: Staff does not ensure food of adequate quantity is provided to residents in care Staff did not ensure emergency disaster plan was followed for residents in care.

On 11/22/2025, Licensing Program Analyst (LPA), Sandra Urena conducted a subsequent unannounced visit to deliver the findings for the allegations listed above. The LPA met with the licensee Siva Mullapudi over the phone and explained the reason for the visit. LPA Urena, along with the Med tech, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. No concerns were observed. On 09/26/2023, the Centralized Complaint and Information Branch (CCIB) received an online complaint. On 09/28/2023, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to the facility to initiate an investigation into the listed allegations. LPA Mixson interviewed the Licensee via the telephone, the Community Manager, and several staff and residents, and requested records pertinent to the investigation. On 02/23/2024, LPA Mixson arrived unannounced to the facility and conducted a subsequent visit to conduct additional interviews, record reviews, and make observations regarding the listed allegations. Continues on LIC 9099C... Unsubstantiated Staff do not ensure food of adequate quantity is provided to residents in care. On the allegation that staff do not ensure residents in care receive an adequate amount of food, it is the concern of the reporting party (RP) that the licensee asked staff to feed the residents small portions of food, because food is being wasted. To investigate the allegation, LPA Mixson conducted interviews with staff, residents, licensee and two witnesses, on 09/20/2023 and on 02/23/2024. Six out of six (6) staff interviews revealed that the staff always ensure that residents receive sufficient food, and plenty of water and drinks. Three out of three (3) residents interviews revealed that they receive plenty of food, and there was never a time when there was not enough food or that they missed any meals. Witnesses’ interviews revealed that when they visit the residents at the facility, they have observed sufficient food being served as part of the residents’ meals; they have not heard concerns from the residents about meals and food portions. The interview with the licensee revealed that the licensee had a meeting with staff, in which the licensee stated that there was a concern about the food, however the concern had to do with the excessive amount of food which was being wasted and being thrown out. The licensee stated that the management team is simply saying “serve smaller portions and if the residents consume all the meal and request more, offer/serve more”. Furthermore, LPA Mixson conducted a tour of the kitchen area, and the food supply was adequate as per CCL Regulations. The LPA observed residents eating their meals. LPA Mixson was able to observe that residents with special diets were provided with special meals. Based on the information obtained through observation, and interviews, the facility staff is providing residents with adequate amounts of food. Therefore, this allegation is deemed Unsubstantiated at this time. Continues on LIC 9099C... pg.3 pg.3 Staff did not ensure emergency disaster plan was followed for residents in care. On the allegation that staff did not ensure they followed the facility’s emergency disaster plan, it is the concern of the reporting party (RP) that the facility lost electricity on a weekend for five hours and the facility did not have a backup generator to assist residents who require use of oxygen. To investigate the allegation, on 09/20/2023 and on 02/23/2024, LPA Mixson conducted interviews with staff, residents, licensee and two witnesses. Witnesses’ interviews revealed that they visit the facility at least once a week and have been doing so since 2020 and have not witnessed any emergencies, nor has anyone mention to them of any disasters, and they were not aware of the electricity shut off. Residents interviewed stated that they have not experienced facility emergencies or concerns of electricity or water at the facility being shut off. Staff interviews revealed that they are aware of the emergency disaster plan, location where it is posted, and that they receive training when they get hired. One staff stated that “emergency” was not actually an emergency but a scheduled and planned power outage by the city. The staff shared that the facility management team was aware of the outage and were prepared for a downed power line. The facility knew the power would be scheduled to be off for several hours and the staff planned accordingly. The meals went forth, there were no missed meals, the activities went forth as scheduled. There was plenty of water and if any of the residents were on oxygen at the time of the power outage there were portable tanks that were battery operated. There was no need for a generator at the time of the outage at all. The licensee’s interview revealed that if any of the residents were on oxygen at time of the electricity shut off, there were portable battery-operated oxygen tanks and there was no need for a backup generator, however, there is one available. LPA Mixson conducted a physical plant tour of the facility and observed numerous regulation postings throughout the facility and the required emergency numbers posted for the fire department, and for the ambulance service, as well as the local pharmacies. Smoke detectors were observed; the fire extinguishers were operable and serviced. There were no observable issues or concerns noted during this site visit.Based on the information obtained through observation, and interviews, the facility staff does follow the emergency disaster plan for residents in care. Therefore, this allegation is deemed Unsubstantiated at this time. Licensee was away from the facility and the designated facility staff signed off on the report. No citations were issued. Exit interview was conducted, and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 22, 2025 · control 18-AS-20230927100327

Allegation investigated: Staff did not dispense medication according to doctor's orders. Staff mismanaged resident's medications. Staff are not following resident's special dietary needs.

On 11/22/2025, Licensing Program Analyst (LPA), Sandra Urena conducted a subsequent unannounced visit to deliver the findings for the allegations listed above. The LPA met with the Licensee Siva Mullapudi over the phone, and explained the reason for the visit. LPA Urena, along with the designated staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. No concerns were observed at the time of the visit. On 10/16/2023, the Centralized Complaint and Information Branch (CCIB) received an online complaint. On 10/19/2023, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to the facility to initiate an investigation into the listed allegations. LPA Mixson interviewed the Licensee, two residents, two staff and requested and received documents pertinent to the investigation. On 05/22/2024, LPA Mixson arrived unannounced at the facility and conducted a subsequent visit to conduct additional interviews, record reviews, and make observations regarding the listed allegations. Continues on LIC 9099C... Unsubstantiated pg. 2 Staff did not dispense medication according to doctor's orders. On the allegation that staff do not dispense medication according to doctors’ orders, it is the concern of the Reporting Party (RP) that R1’s medicine patch was not removed and replaced as prescribed and was two days overdue. On 10/19/2023 and 05/22/202 LPA Venus Mixson conducted interviews, record review pertinent to the allegation and made observations related to the allegation. The interview with one hospice nurse revealed that their client was R1, and that R1did have a medication patch, which was part of R1’s pain management. Furthermore, the hospice nurse stated that it was the responsibility of the Hospice team and the facility staff to care for the replacement and documenting on the condition of the patch. The hospice nurse stated that at no time there were concerns regarding the dispensing of medication according to the doctor's orders or concerns brought to their attention by any residents or staff. On 02/26/2024, LPA Mixson interviewed R1’s responsible party, and the interview revealed that “they are pleased with the overall operation and the running of the facility. There have been some changes put into place to prevent what was a simple mishap”. Furthermore, the party responsible stated that all is well and there are no concerns, there are protocols in place from the Administration, and shared that R1 seems much happier. Interviews conducted with four (4) residents revealed that they have never missed any of their scheduled medications that are prescribed by their doctor. LPA Mixson made observations pertaining to the listed allegation: Medication Administration Records (MARS) charts were reviewed and there was no documentation alluding to "Staff did not dispense medication according to doctor's orders." Additionally, residents’ medication refusals were documented. Although the allegation may have happened or is valid, based on the interviews, observation, record review, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation that Staff do not dispense medication according to doctor's orders is deemed Unsubstantiated at this time. Continues on LIC9099C... pg.3 pg. 3. Staff mismanaged resident's medications. On the allegation that staff mismanaged the resident’ medication; it is the concern of the Reporting Party (RP) that the facility’s staff informed R1’s responsible party that at least one of R1’s medications was improperly dispensed and that the hospice nurse could no longer be directly involved with R1’s medication management, and that information was incorrect. To investigate the allegation, LPA Mixson interviewed R1’s hospice nurse, and the hospice nurse indicated that they were not aware or had any concerns regarding the staff mismanaging R1’s medications. LPA Mixson reviewed the residents’ Medication Administration Records (MARS), and the list of residents who were receiving Hospice. There were no documented issues or concerns with medication management or "Staff mismanaging resident's medications" by any of the Hospice Nurses at the time that the observation was made. Interviews with the residents revealed that they have never had any incidents when the wrong medication was given to them by the med techs. LPA Mixson interviewed the licensee Siva who shared that the facility staff did dispense medication according to doctor's orders. The staff were to change the resident’s patch every three days and this was completed, however, what was missing was the logging of the changed patch. The licensee stated that they spoke with the hospice nurse and they figured out “the patch was changed but the staff did not initial on the medication log that it was changed”. LPA Mixson asked the licensee if there was a patch with a date on it, and the licensee said they did not see any date on the patch. Based on the information obtained through interviews, observation, and record review, there is not sufficient evidence to prove that staff mismanaged the residents’ medication. Therefore, the allegation is deemed Unsubstantiated at this time. Continues on LIC 9099C...pg. 4. pg. 4 Staff are not following resident's special dietary needs. On the allegation that Staff are not following resident's special dietary needs; the concern of the reporting party is that the kitchen staff do not review R1’s food sensitivities and no-go items and indicated that some of those items have been part of R1’s recent meals. To investigate the allegation, LPA Mixson interviewed residents and staff and made observations pertaining to the listed allegations. R1’s hospice nurse stated that there were no concerns brought to their attention regarding staff not following R1’s special dietary needs and that R1 did not share with them that there were any issues with not having food, enough food or special diet food. The LPA interviewed R1’s responsible party and they stated that they visited R1 at the facility, and “everything is nothing but good intentions and all is well”. Four (4) residents’ interviews revealed that they do not have a special diet, and that they get plenty of food and snacks, which some residents keep in their room. Furthermore, LPA Mixson conducted a tour of the kitchen area, and the food supply was adequate as per CCL Regulations. The LPA observed residents eating their meals. LPA Mixson was able to observe that residents with special diets were provided with special meals. Based on the information obtained through interviews, and observation, there is not sufficient evidence to prove that staff are not following resident's special dietary needs. Therefore, the allegation is deemed Unsubstantiated at this time. Licensee was away from the facility and the designated facility staff signed off on the report. No citations were issued. Exit interview was conducted, and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 22, 2025 · control 18-AS-20231016203222

Type of visit: Required - 1 Year

On May 23, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with Licensee, Sivaganesh Mullapudi. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. This facility is licensed for 18 Elderly Adults and is currently operating at a capacity of (11)RESIDENTIAL CARE ELDERLY (740). LPA Mixson toured the facility along with Licensee Sivaganesh Mullapudi and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Currently there are no bodies of water on the premises. The facility is a Two-story structure located at 1178 Evergreen Lane Vista CA. 92084. Physical Plant: Facility phone number is (760) 630-8122 and it is operable. LPA Mixson observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights." The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications: Were locked and inaccessible to residents in care. There were a sufficient supply of medication for each resident. Overall facility is clean, furniture is in good condition, and home is free of odors. Facility's cooling system and other appliances were operable currently at the time of this visit. Licensee informed LPA there were night lights for safety throughout the facility. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. Care & Supervision/Administration: Adequate staff are present for the supervision of resident in care. Four staff total including Licensee for five. Floor plans, telephone numbers and personal rights were found posted in the facility. Listed Administrator possesses a current administrator’s certificate with an expiration date of 11/11/2026, Aila Sarapat, and it is posted in the facility. Records Reviewed and Resident/Staff Files: LPA reviewed staff files and reviewed the staff schedule. Staff files reviewed have criminal clearance and updated training along with First Aid Certification. Resident files reviewed possessed requested documentation and current weight records. Disaster preparedness: LPA Mixson reviewed facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill was conducted 04/14/2025, was facilitated by Licensee, Sivaganesh Mullapudi, and met regulations. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms, PPE equipment, and cleaning supplies. LPA reviewed the facility's infection control plan and found required infection control measures. There were no observable deficiencies noted or cited per Title 22, Division 6 of the California Code of Regulations at the time of this annual inspection. An exit interview was conducted where a copy of this report was discussed and given Licensee, Sivaganesh Mullapudi.the state’s words, verbatim · CDSS document, May 23, 2025

Type of visit: Case Management - Health Checks

On August 19, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit and met with the Facility Manager. LPA Mixson introduced herself and explained the purpose of the visit. LPA Mixson toured the facility, along with the Lead Caregiver, Elena Soto and made observations pertaining to another matter that CCL was made aware of via SIR. There were two staff present and 10 residents at the time of this case management health and safety visit. There are no imminent health and/or safety concerns observed at the time of visit. LPA Mixson requested and received pertinent documentation pertaining to R1 and S1. Staff involved in the incident has been removed from the schedule pending further investigation. LPA Mixson did not observe any health and/or safety hazards inside or outside of the facility at the time of this visit. LPA observed the facility utilities to be operating without issue. LPA Mixson assessed the available food and observed there was a variety of food types available for the residents in care. The food supply meets the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care. CONTINUATION An Unusual Incident Report was submitted to CCL on August 13, 2024, Regarding Resident Number 1 (R1), Catherine Zumpone. Administrator shared that the following steps are in place to assure there are no contact with the staff who was stated to have caused the resident any type of stress. Follow up information: Nurse evaluation is performed, and no injuries were identified, during investigations, Administrator identified change in information by the Resident probably due to cause of dementia and past UTI. As a proactive measure, alleged caregiver's access to the client room was revoked. Resident is being served majority of the times with female caregivers only. Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and/or welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to Lead Caregiver Elena Soto. No further information was obtained at this time.the state’s words, verbatim · CDSS document, Aug 19, 2024

Type of visit: Required - 1 Year

On May 08. 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Lead Caregiver, Maria Lara. The facility file review was conducted in the Regional Office and additional forms were requested and reviewed on site. The facility is licensed for 18 Elderly Adults but is currently operating at a capacity of 11 Senior Adults. LPA Mixson toured the facility along with the Lead Caregiver and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home located at 1178 Evergreen Lane, Vista , CA. Physical Plant: The facility phone number is (661) 754-0261 and it is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications: Were locked and inaccessible to residents in care, and there were a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit, and there were safety lights for night. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharps are locked. Care & Supervision: Facility has sufficient staff, two staff on site at the time of this visit. Records Review: The LPA reviewed resident and staff files, conducted staff and resident interviews. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Lead Caregiver, Ana Kincaid.the state’s words, verbatim · CDSS document, May 8, 2024

Allegation investigated: Staff did not respond to resident's call button. Facility staff are requiring a resident in care to go to sleep at an unreasonable time

On February 23, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted a visit and met with the Community Manager, Jazmin. The visit was conducted to provide the findings for the investigation pertaining to the listed allegation. The investigation consisted of staff and resident interviews, witness interviews, record reviews, and observations. On September 11, 2023, Community Care Licensing received a complaint alleging that staff did not respond to a resident's call button and facility staff are requiring a resident in care to go to sleep at an unreasonable time. It was reported that staff did not respond to the resident's call button. It was also alleged that staff make residents go to bed at 6pm. Regarding the allegation staff did not respond to a resident's call button, information obtained from interviews stated this resident uses a portable nebulizer, which is attached to their hip. It was advised that staff responded to the call button but saw the resident in the television room and Resident’s nebulizer was attached to the resident’s hip, staff must go to the resident to depress the button. Additionally, information obtained from the resident’s interview stated there has not been a time the button was pushed, that staff did not respond. The information obtained does not corroborate the listed allegation. Regarding the allegation facility staff are requiring a resident in care to go to sleep at an unreasonable time, information obtained from interviews with residents stated residents can go to bed whenever they choose. It was stated there is a schedule posted, but there are no lights out or enforced rules pertaining to bedtimes. Additional information stated a resident may stay up in their respective room if they like and watch TV in their rooms if they select to and the resident in question has their own TV in their room. The information obtained from interviews and the LPA's observations does not support the allegation. Based on information obtained from interviews, record reviews, and observations, the information obtained was not sufficient to demonstrate the listed allegations were accurate. Therefore, the allegations have been deemed as "UNFOUNDED." An allegation deemed unfounded means "the allegation is false, could not have happened and/or is without a reasonable basis." Therefore, the outcome of the allegation is regarded UNFOUNDED. The Department has investigated the listed allegations and the information obtained has demonstrated the listed allegations did not occur and therefore, has dismissed the allegations. An exit interview was conducted, and a copy of this report was provided to Jazmin Espinoza, the Community Manager / Med-Tech. Unfoundedthe state’s words, verbatim · CDSS document, Feb 23, 2024 · control 18-AS-20231011155620

Allegation investigated: Staff are not properly trained. Facility is not properly maintained.

On 10/11/2023, Licensing Program Analyst (LPA), Venus Mixson conducted an office visit and met with the Licensee, Siva Mullapudi. The visit was conducted to provide the findings for the investigation pertaining to the listed allegations. On September 06, 2023, Community Care Licensing (CCL) received a complaint alleging staff are not properly trained and the facility is not properly maintained. During the investigation, the LPA conducted interviews with staff, residents, and additional witnesses. The LPA reviewed pertinent documentation and made observations regarding the allegations. Regarding the allegation of staff are not properly trained, the information obtained from interviews did not corroborate the allegation that the staff are not properly trained. The facility staff receive several training courses pertaining to the care and supervision of the residents, resident rights, medication management, and housekeeping. Additional information obtained from recorded reviews demonstrated the facility provides additional training's covering other areas of care and supervision. It was advised that staff are provided continuous training on an ongoing basis. The information obtained does not corroborate the alleged allegation. Regarding the allegation of the facility is not properly maintained, information obtained from interviews and observations, does not corroborate the allegation. The facility was observed to be clean, well maintained, and free of odors. The LPA toured the facility inside and out and observed all resident's rooms to be clean, organized, and consisted of the required furniture. The facility was free of clutter and obstructions. The facility has working utilities, food supply met required regulations, and the temperature was within regulations. Based on interviews, recorded reviews, and observations, the allegations of facility staff are not properly trained and the facility is not properly maintained has been deemed "Unsubstantiated." An allegation finding of "unsubstantiated" means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegations are unsubstantiated. An exit interview was conducted, a copy of this report, along with the appeal rights were provided to the Licensee, Siva Mullapudi. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 11, 2023 · control 18-AS-20230906101030

Allegation investigated: Staff did not properly destroy resident's medication.

On 10/ 11/2023, Licensing Program Analyst (LPA), Venus Mixson conducted an office visit at 1650 Spruce Street Riverside, and met with the Licensee, Siva Mullapudi. The visit was conducted to provide the findings for the investigation pertaining to the listed allegation. During the course of the investigation, the LPA conducted interviews with staff, residents, and additional Witness. Pertinent documentation was reviewed and observations were made regarding the allegations. The LPA was unable to interview additional witnesses due to a high turnover in staff. On August 01, 2023, Community Care Licensing (CCL) received information which stated staff did not properly destroy resident's medication. It was reported that facility staff were discarding resident’s medicating in the public trash can. Pictures were provided. Information obtained from administration and staff interviews stated that the facility is under new management and there have been new procedures and policies implemented which will prevent any type of mishandling of unused medications. It was reported that only the Med tech, Facility Nurse, and the Licensee will have access to the locked medication cabinets and will process the proper destruction of any unused or left behind medications, and/or of empty bubble packets. It was also advised that each Hospice Agency Nurse has the responsibility for properly destroying any unused or left behind resident medication for whom they provide hospice services for. Training documents regarding proper destruction and documentation of medication were observed. The LPA was unable to verify that the pictures of the medication in the trash can belonged to any resident placed at the facility or if the trash can belonged to the facility. Based on interviews, record reviews, and observations the preponderance of evidence standard has not been met. Therefore, the allegation that facility staff did not properly destroy resident’s medication has been deemed as "UNSUBSTANTIATED." An allegation finding of "unsubstantiated" means 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. A copy of this report, along with appeal rights were provided to the Licensee, Siva Mullapudi. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 11, 2023 · control 18-AS-20230801091504