Lakewood Villa Care Center

Type of visit: Case Management - Other

On August 19, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct a case management visit. LPA met with administrator, Charlotte Lewis (AD), and stated the purpose of the visit. LPA explained to AD that the LPA amended the LIC9099-C of the report for complaint investigation #27-AS-20260108120509 delivered on 06/24/26. This amendment did not change the deficiency or its plan of correction. LPA reviewed the report again with AD and provided a new copy for their records. Pursuant to California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided and an exit interview was conducted with AD.the state’s words, verbatim · CDSS document, Aug 19, 2026

Type of visit: Office

A Non-Compliance Conference (NCC) was conducted on this day, July 21, 2026 by the Sacramento South Regional Office via Microsoft Teams. The purpose of this NCC meeting was to discuss the high volume of deficiencies/inability of this facility to remain in substantial compliance with the regulations that have occurred within the last 12 months. Present at the meeting were Regional Manager (RM), Stephenie Doub, Licensing Program Managers (LPMs), Stephen Richardson and Arielle Pascua, Licensing Program Analyst (LPA), Arvin Villanueva, Ombudsman, Patrice Wright and Facility Representatives, Licensees, Umesh Pandey and Joycelin Pandey and Administrator, Charlotte Lewis. The Non-Compliance Conference process was explained during this meeting to include the administrative process. Items discussed during the Non-Compliance Conference were: Care and Supervision Administrator Qualifications and Duties Maintenance and Operations Personal Rights Health and Safety Medication Management Food Service AWOL procedures {1 of 3} Per discussion, The facility reported that the kitchen, office, and bathrooms have been remodeled and plans to add a patio and recreation area in the backyard. The Department reminded the facility that all future building changes must be reported in advance, including any impact on residents and plans to reduce disruptions. The facility stated that past repairs were completed in phases to limit resident impact and agreed to notify the Department of future alterations. The Department also noted that the required documents for the new administrator, Charlotte Lewis, had not been received. Ms. Lewis stated that she emailed the documents to LPA Shakaricka Hughes and LPA Arvin Villanueva on June 4, 2026; however, the LPA was unable to locate the email. The Department requested that the documents, including an updated LIC 500 and LIC 200, be resent. The facility reported that it currently serves 13 residents with three staff on the day shift and two staff on the night shift. The facility stated that residents with a history of elopement are monitored with 15-minute checks and door alarms. The facility also plans to install a delayed egress system after Fire Marshal approval. The Department reviewed the approval process and required documentation. The facility explained that a former employee had stolen food, but the issue has been resolved. The facility now completes food inventory checks twice a week. The Department also reminded the facility that if the census reaches 16 or more residents, regulations require a designated person to oversee food planning, preparation, and service. Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates: Updated LIC500 Personnel Report, including additional administrator oversight in the facility by July 29, 2026. Resend administrator documentation for Charlotte Lewis by end of day today July 21, 2026. Administrator to attend a vendor training on Resident Assessment, medication, personal rights and care plans. Proof of training to be submitted by July 29. 2026. Medication Auditing system to be submitted by July 29, 2026. The facility was offered an opportunity for Technical Support Program (TSP) and agreed for referral. {2 of 3} The Department will do the following: Increase Monitoring to quarterly unannounced visits. The facility will have TSP (Technical Support Program) give technical advice to the facility. Completing the non-compliance conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Codes if such action is deemed necessary by the Regional Manager. In the event that the Department determines that the licensee has violated the law/regulations or is inadequately implementing the approved plans, the Department, in its discretion, may seek formal legal action or other appropriate administrative action. An exit interview was conducted via telephone with Charlotte Lewis and a copy of this report was sent electronically for signature. {3 of 3}the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Case Management - Annual Continuation

On July 1, 2026, Licensing Program Analyst Arvin Villanueva (LPA) arrived at this facility unannounced to conduct the annual continuation visit that was initiated on April 22, 2026. LPA met with designated administrator Charlotte Lewis (AD) and stated the purpose of this visit. This visit was conducted concurrently with a complaint investigation visit. Record Reviews: During this visit, LPA conducted record reviews. Review of 3 of 13 resident files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. Per review, one of the residents (R1) did not have their care plan (LIC625) available for review. Per interview with AD, she stated she did it but cannot find the document. Per review, same resident (R1) has a restricted health condition (C1) but facility does not have a restricted health condition care plan available for review during this visit. Per interview with AD, she stated that she does not know it is needed. LPA informed AD that LPA will conduct medication review on next visit. Review of 5 staff files included but not limited to background clearance, first aid/CPR certification, and training. Per review of Guardian, all staff listed on the Personnel Record (LIC500) were associated with this facility. Facility conducts quarterly Fire/Emergency Drill. Advisory provided to facility to review their Emergency Disaster Plan and Infection Control Plan at least annually and document each review. Interviews: 3 staff members and 2 residents in care. Documents Requested: LPA requested a copy of updated Liability Insurance, LIC500, and LIC308. Per the California Code of Regulations, Title 22, Division 6, Chapter 8 deficiencies were cited. Plan of correction and appeal rights were discussed during exit interview with AD. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Jul 8, 2026

All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: Based on record review and interview, the facility does not have a restricted health care plan for at least one of the residents with restricted health condition who is receiving home health services. This poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: Per discussion, designated administrator agreed to obtain a restricted health care plan for all residents in care with restricted health condition. Submit documents by POC due date.

Allegation investigated: Questionable death. Staff did not address resident's change in condition.

On 06/24/2026, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with Charlotte Lewis and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 15. Allegation: Questionable death. It was alleged that a resident in care had a questionable death. This investigation consisted of records review. On 01/09/2026 LPA Hughes conducted a visit to the facility and obtained records pertaining to resident (R1). On 01/14/2026 additional medical records for resident (R1) were obtained from UC Davis Medical Center were reviewed. The records did not identify any circumstances indicating the resident’s death was questionable. Documentation reviewed reflected that resident (R1) had significant medical conditions and began receiving end-of-life care services on 12/30/2025, prior to death. Based on the information obtained during the investigation, there was insufficient evidence to corroborate this allegation. Therefore, the allegation is unsubstantiated. Continuation 9099-C Unsubstantiated *This LIC9099-C is being amended to disclose that this incident will be under review by the department and a future civil penalty may apply. Records further indicated that resident (R1) subsequently required a higher level of care and was placed on Hospice services on 12/30/2025. Based on the evidence and information obtained this allegation was observed not in compliance with Title 22 regulation 87628(a). As the facility did not ensure a resident in care was provided with adequate care and supervision to meet the residents care needs. Allegation: Staff did not administer medication as prescribed. It was alleged that staff did not administer medication as prescribed. This investigation consisted of interviews with facility staff. On 01/09/2026 LPA Hughes conducted a visit to the facility and obtained records for resident (R1). On 06/12/2026 LPA conducted a follow-up visit to the facility and interviewed two (2) facility staff who stated that resident (R1) medications were not administered as prescribed as the medications were expired. Staff further stating that the facility notified (R1)’s POA, prescribing pharmacy however, the facility was unable to obtain replacement medications prior to their expiration. Records review did not indicate that resident (R1’s) medication had expired. Additionally, the facility did not provide documentation supporting its claim that the medications had expired, nor did the facility provide documentation demonstrating efforts to obtain replacement medications. Based on the information and evidence obtained, this allegation was observed not in compliance with Title 22 regulation 87628(b)(2). As the facility did not ensure sufficient medications were available for the resident’s diabetic care needs. As a result, the allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. This incident is currently under review, and a future civil penalty may apply pursuant to H&S Code section 1569.49(f). An exit interview was conducted with Charlotte copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility. Allegation: Staff did not address residents’ change in condition. It was alleged that staff did not address residents’ change in condition. This investigation consisted of interviews with facility staff and residents. On 01/09/2026 LPA Hughes conducted a visit to the facility and obtained records for resident (R1). On 06/12/2026 LPA conducted a follow-up visit to the facility and interviewed 3 facility staff who stated that residents are monitored for changes in condition, facility administration is notified when a resident condition worsens, and residents are sent to the hospital when medically necessary. LPA interviewed 5 residents who stated that they have no concerns regarding the facility addressing changes in resident conditions. Based on the information obtained during the investigation, there was insufficient evidence to corroborate this allegation. Therefore, the allegation is unsubstantiated The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. .the state’s words, verbatim · CDSS document, Jun 24, 2026 · control 27-AS-20260108120509

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Jun 26, 2026

87628 Diabetes (a)The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing...and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by a skilled professional. This requirement was not met as evidenced by: Based on interviews with facility staff it was learned that resident (R1) was unable to perform their own glucose testing, monitoring, and injections as they were legally blind, and required ongoing assistance and supervision with diabetes related care.the state’s words, verbatim · CDSS document, Jun 24, 2026

Plan of correction: The facility agrees to remain in compliance with Title 22 regulation 87628 at all time. The facility will review Title 22Restricted Health Conditions and Diabetes with facility staff and send a statement of acknowledgement of the regulation, including a staff sign-in sheet of all staff who attended training.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(b)(2) · Plan of correction due date: Jun 26, 2026

87628 Diabetes (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following (2) (2) Ensuring that sufficient amounts of medicines...other supplies are maintained and stored in the facility as specified... This requirement was not met as evidenced by: Based on staff interviews, resident (R1) prescribed diabetic medications were not administered as ordered. It was stated the medications were expired. As a result, resident (R1) did not receive prescribed diabetic medications.the state’s words, verbatim · CDSS document, Jun 24, 2026

Plan of correction: Review resident pre-placement process, and ensure resident medication and supplies are sufficient in the facility. The facility agrees to implement additional screening efforts prior to resident placement inside of the facility.

Type of visit: Post Licensing

On April 22, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the Annual Inspection visit. This visit was conducted concurrently with the Post Licensing visit. LPA met with Charlotte Lewis and stated the purpose of the visit. Charlotte identified herself as the new administrator since February 2026. Per review of Guardian, she was associated to this facility on January 17, 2026. Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 5 of 9 resident bedrooms and 2 of 5 bathrooms. Room temperature was maintained at 73 degrees F. The hot water temperature was measured at 112 degrees Fahrenheit. 3 fire extinguishers were observed throughout the building. LPA observed sprinkler system. Smoke and carbon monoxide detectors were observed throughout. In the kitchen, the facility maintained at least a seven-day supply of non-perishable foods and a two-day supply of perishable foods. Cleaning supplies, dish soaps, aerosol spray cans, and dish detergents were observed accessible inside unlocked cabinet located under the stove. Laundry room was inspected. Laundry soaps and hygiene supplies were observed in an accessible cabinet. The lock of the cabinet can be opened without a key. Other cleaning supplies were also in a cabinet that was accessible to residents. Outdoor area was inspected. LPA observed covered areas with outdoor furniture. Ramps, fence, and exit gate were observed to be in good repair at this time. LPA observed the 3 exit gates at the back to be locked with padlocks. Deficiencies were observed. Citations will be assessed in the annual report dated April 22, 2026. Exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Required - 1 Year

On April 22, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA met with Charlotte Lewis and stated the purpose of the visit. Charlotte identified herself as the new administrator since February 2026. Per review of Guardian, she was associated to this facility on January 17, 2026. Overview: Facility is a one-story building located in a residential neighborhood. Facility is licensed to serve up to 18 elderly residents, 9 of which may be non-ambulatory and 6 may be bedridden. Facility has a hospice waiver up to 18 residents. Facility does manage residents’ cash resources. Facility does not have delayed egress, and/or locked interior/exterior. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA inspected 5 of 9 resident bedrooms and 2 of 5 bathrooms. Room temperature was maintained at 73 degrees F. The hot water temperature was measured at 112 degrees Fahrenheit. 3 fire extinguishers were observed throughout the building. LPA observed sprinkler system. Smoke and carbon monoxide detectors were observed throughout. In the kitchen, the facility maintained at least a seven-day supply of non-perishable foods and a two-day supply of perishable foods. Cleaning supplies, dish soaps, aerosol spray cans, and dish detergents were observed accessible inside unlocked cabinet located under the stove. Laundry room was inspected. Laundry soaps and hygiene supplies were observed in an accessible cabinet. The lock of the cabinet can be opened without a key. Other cleaning supplies were also in a cabinet that was accessible to residents. Outdoor area was inspected. LPA observed covered areas with outdoor furniture. Ramps, fence, and exit gate were observed to be in good repair at this time. LPA observed the 3 exit gates at the back to be locked with padlocks. Based on today’s visit, this annual inspection will require a continuation visit. The Department will return at a later date to continue the inspection. Deficiencies are being cited based on today’s visit. Immediate Civil Penalty in the amounth of $500 was issued today due to fire safety violation. Exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 22, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Apr 23, 2026

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This is not met as evidenced by: Based on observation and interview, the licensee did not maintain proper fire clearance by padlocking the outside emergency gate at the backyard near the parking lot. This poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: Per discussion, Administrator will removed all the three padlocks from the three gates. A photo will be sent to the Department as evidence of correction by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Apr 23, 2026

Storage Space and Access 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: Based on observation, cleaning solutions, disinfectants, detergents, hygiene and other similar items were found accessible in the kitchen and laundry room. This poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: Per discussion, the administrator will put lock on all cabinets where they store dangerous items. A photo will be sent to the Department as evidence of correction by POC due date.

Type of visit: Case Management - Other

On 1/13/2026 at 2:30 PM Licensing Program Analyst (LPA) Shakaricka Hughes conducted an unannounced visit to the facility. The purpose of this visit was to conduct a case management visit regarding an elopement incident report received by the Dept on 01/07/2026. LPA met with the facility administrator Kimberly. The current census is 15 with 3 facility staff present. During todays visit LPA reviewed the LIC 421IM with the administrator. The document was not signed at the time of the previous visit conducted on 01/09/2026. No citations were issued during this visit. A copy of the LIC 809, LIC 421IM reports were provided to the facility.the state’s words, verbatim · CDSS document, Jan 13, 2026

Type of visit: Case Management - Incident

On 01/09/2026 at 10:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management regarding an Elopement incident report received by the Dept on 01/07/2026. LPA met with the facility administrator Kimberly. The current census is 15 with 3 facility staff present. LPA’s interviewed the facility administrator and reviewed incident report dated 01/07/2026. Based on interview and incident report R1 left the facility unassisted. Per interview with facility administrator, there was 3 facility staff present at the facility. Law enforcement was not contacted, as the facility was not aware resident (R1) left the facility. Resident (R1) returned to the facility on 01/07/2025 and reported to facility staff that they left the facility. R1's LIC 602, Physician Report dated 05/15/2025 was reviewed by LPA Hughes and it revealed that (R1) is unable to leave the facility unassisted. Interview with Administrator revealed facility's internal plan includes providing supervision for R1 and all other residents in care. Based on today's case management, a citation is issued under Title 22, Division 6. An immediate civil penalty in the amount of $500 is issued in addition to citation due to absence of supervision. An exit interview was conducted with the facility administrator Kimberly. A copy of this report LIC 809, LIC 809-D and appeal rights was provided to direct care staff at the end of the visit.the state’s words, verbatim · CDSS document, Jan 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jan 12, 2026

87464(f) Basic services shall at a minimum include (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidenced by: Based on records review, and interview with the care staff the facility did not ensure staff provided care and supervision to R1. Due to not providing care and supervision, R1 left the facility unassisted. This posed an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Jan 9, 2026

Plan of correction: Licensee agrees to conduct basic services (to include care and supervision) training for all staff using an approved vender through CCLD. Administrator will read the regulation cited and provide LPA Hughes a letter of acknowledgement that the regulation cited was reviewed and understood.... Administrator will email documents used for training and sign in sheet for all facility staff trained by POC Date 01/12/2026 by end of day 5:00pm.

Type of visit: Case Management - Other

On 1/6/2025 at 12:00 PM Licensing Program Analyst (LPA) Shakaricka Hughes conducted a visit to the facility. The purpose of the visit was to conduct a case management visit. LPA met with the facility administrator Kimberly Joaquin. The current census is 15 with 2 facility staff present at this facility. During today's visit LPA spoke with the facility administrator regarding food service in the facility. LPA observed the facilities 2-day perishable and 7-day non-perishable food supply and it was sufficient. LPA spoke with 5 residents in care who stated that they have no concerns about food service in the facility, and stated that they are receiving sufficient amounts of food daily. LPA attempted to interview additional residents but was unable as residents were in their rooms asleep at the time of the visit. LPA observed the quantity of food being served in the facility inadequate to meet the needs of residents in the facility. Additional interview with facility staff (S1) indicated that residents are unable to have additional servings of food based on food availability in the facility. This was observed not in compliance with Title 22 regulation 87555(a)General Food Service Requirements. As the facility did not ensure that residents daily diet was the quantity necessary to meet the needs of residents in care. An exit interview was conducted, and a copy of the LIC 809, and LIC 809-D were provided to the facility.the state’s words, verbatim · CDSS document, Jan 6, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Jan 7, 2026

87555 General Food Service Requirements(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: LPA observed facility meal lunch preparation quantity insufficient to meet the needs of residents in care. Additional interview with faciltiy staff (S1) indicated that residents are unable to request additional servings of food, due to meal quantity.the state’s words, verbatim · CDSS document, Jan 6, 2026

Plan of correction: The licensee will ensure that the facility remains in compliance with Title 22 regulation 87555(a) at all times. Licensee will review quantity necessary in order to assure availability of adequate food intake for all residents. Licensee will submit a statement of acknowledgement of the regulation to.. LPA Hughes via email by 01/07/2025.

Allegation investigated: Staff did not safeguard resident's medication.

On 12/19/2025 at 9:15 AM Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with facility staff and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 15. A brief interview with conducted with facilty staff Kimberly Joaquin . Allegation: Staff did not safeguard residents medication It was alleged that staff did not safeguard residents medication. This investigation consisted of interview with facility staff, residents, and resident’s (R1) responsible party. On 11/05/2025 LPA Hughes conducted a visit to the facility and spoke with 2 out of 3 facility staff who stated that they were aware of a residents medication missing in the facility, Staff reported that the medication cart is often left unlocked and that staff take breaks in the same room where medications are stored. Interview with 3 out of 3 residents expressed no concerns about their medications not being properly safeguarded. Additional interview with resident (R1) responsible party stated that facility staff (S1) was aware of an incident in which resident medications were not adequately safeguarded. Continuation 9099-C Substantiated Allegation: Staff did not follow proper eviction procedures It was alleged that staff did not follow proper eviction procedures. This investigation consisted of interviews with facility staff, and resident (R1) responsible party. On 12/19/2025 LPA spoke with the facility licensee who stated that resident (R1) was not evicted from the facility and left the facility because their health care needs were greater than the level of care offered by the facility. Interview with resident (R1) responsible party reflected that the R1 health care needs exceeded the services the facility could provide, and the decision to move the resident was made in the residents best interest after determining that the resident required a higher level of care. Furthermore, R1’s responsible party stated that the facility did not evict the resident from the facility. This allegation could not be corroborated due to lack of information and evidence therefore the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. This was observed not in compliance with Title 22 regulation 87465(h)(2) Incidental Medical and Dental Care. As the facility did not ensure that residents medication were safely stored and safeguarded, which resulted in medications being missing from the facility. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Kimberly and Joseline and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Dec 19, 2025 · control 27-AS-20251031145823

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 19, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: The facility did not ensure that centrally stored medications were kept locked and inacessible in the facility, which resulted in resident (R1) medications missing in the facility.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: The licensee will ensure that the facility is in compliance with Title 22 regulation 87465(h)(2) at all times. Licensee has implemented changes to medication accessibility including daily med quantity counts, and multiple staff MAR sign off for certain narcotics. Additonally, licensee has provided a medication cart. Licensee agrees to conduct professional vendor training for all facility staff on RCFE medication administration. Licensee agrees to submit the who they will contract with for training by 12/22/2025. Additionally, Licensee will submit proof of training by 12/31/2025.

Allegation investigated: Staff does not ensure medications were dispensed in a timely manner. Staff do not ensure facility is kept in clean sanitary conditions. Facility plumbing is in disrepair. Staff are not properly trained.

On 12/19/2025 at 9:15 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Kimberly Joaquin and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 15. A brief interview with conducted with Kimberly. Allegation: Staff does not ensure medications were dispensed in a timely manner It was alleged that staff does not ensure medications were dispensed in a timely manner . This investigation consisted of interviews with facility staff and residents, and records review. On 11/05/2025 LPA Hughes conducted a visit to the facility and spoke with 2 out of 3 facility staff reported that residents medications are not dispensed in a timely manner stating that in addition to medication administration, they are required to perform other assigned duties within the facility. Interview with 3 out of 3 residents in care expressed no concerns with medications being dispensed in a timely manner. Continuation 9099-C Substantiated Allegation: Licensee does not ensure staff have the ability to communicate with residents It was alleged that licensee does not ensure staff have the ability to communicate with residents this investigation consisted of facility observation and interview with residents. On 12/12/2025 LPA Hughes conducted a visit to the facility and spoke with 3 facility staff present in the facility LPA did not observe any delays in communication between residents and facility staff. LPA spoke with 3 residents in care, who all expressed no concerns about facility staff ability to communicate with residents. Additionally, LPA attempted to contact (2) facility staff present during NOC shift but was unable as the facility stated the staff no longer work for the facility. There is not enough evidence to corroborate this allegation, therefore the allegation is unsubstantiated. Allegation: Staff did not prevent resident from engaging in a physical altercation with another resident It was alleged that staff did not prevent resident from engaging in a physical altercation with another resident. This investigation consisted of interviews with facility staff and residents, and records review. On 11/05/2025 LPA spoke with 2 out of 3 facility staff who stated that an altercation between resident (R1) and (R2) was promptly intervened by facility staff. An interview was attempted with resident (R1) and (R2) however, no additional information was obtained due to both residents being primarily non-verbal. LPA reviewed a LIC 625 Unusual Incident/Injury Report sent from the facility regarding an incident that occurred in the facility on 10/20/2025 regarding resident (R1) and (R2) it was reported that facility staff promptly responded to an incident that occurred between residents in care and provided support and redirection. Due to insufficient evidence, this allegation is unsubstantiated. Allegation: Staff did not seek medical attention for resident in care It was alleged that staff did not seek medical attention for resident in care. This investigation consisted of interviews with facility staff and residents. On 11/05/2025 LPA spoke with 2 out of 3 facility staff who all stated the facility seeks medical attention promptly for residents in care. Interview with 3 out of 3 residents in care expressed no concerns about the facilities ability to seek medical attention for residents in care in a timely manner. There is not enough evidence to corroborate this allegation, therefore the allegation is unsubstantiated. Continuation 9099-C Allegation: Licensee does not ensure staff are in good physical health to perform assigned tasks. It was alleged that licensee does not ensure staff are in good physical health to perform assigned tasks. The investigation consisted of interview with facility staff and records review. On 12/17/2025 LPA conducted interviews with 2 out 4 facility staff which reflected that staff are not required to work when experiencing illness. Additional review of 4 out of 4 facility staff records LIC 503 Health Screening Report, indicated that facility staff are in compliance with health screening requirements. There is not enough evidence or information to corroborate this allegation, therefore the allegation is unsubstantiated. Allegation: Staff did not observe changes in residents health condition It was alleged that staff did not observe changes in residents’ health condition. This investigation consisted of interviews with facility staff and residents. On 12/12/2025 LPA conducted a visit to the facility. LPA interviewed 2 out of 3 facility staff, who stated the facilities protocol for assisting residents when a change in condition occurs for residents in care. Additional interview with 2 residents in care expressed no concerns about the facility not assisting residents when changes are observed in their health conditions. There is no evidence to corroborate this allegation, therefore the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. LPA reviewed the Medication Administration Record (MAR) for 3 out of 3 residents and medication administration was complete. However a review staff files, indicated that facility staff (S1) was reprimanded due to not administering medications to residents in a timely manner. This was observed not in compliance with Title 22 regulation 87465(b)(2) Incidental Medical and Dental Care. The facility did not ensure that resident’s medication were given in a timely manner in accordance with physician’s instructions. Allegation: Staff do not ensure facility is kept in clean sanitary conditions It was alleged that staff do not ensure facility is kept in a clean and sanitary condition. This investigation consisted of interviews with facility staff, residents, and facility observation. On 10/31/2025 LPA Hughes conducted interviews with 2 out of 3 facility staff who stated that the facility bathrooms are often unsanitary. Interview with 3 out of 4 residents in care expressed no concerns about the facility being unsanitary, however interview with resident (R1) reported concerns about the facility bathrooms being left unsanitary. LPA conducted a tour of the facility on 10/28/2025 and observed the facility bathrooms to be unclean and left in unsanitary conditions. The allegation was observed not in compliance with Title 22 regulation 87303(a)(1) Maintenance and Operation. As the facility did not ensure the facility was clean, sanitary, and odorless at all times. Allegation: Facility plumbing is in disrepair It was alleged that the facility plumbing is in disrepair. This investigation consisted of interviews with facility staff and residents, and facility observation. On 10/31/2025 LPA conducted 3 out of 3 interviews with facility staff who stated that the facility plumbing in staff and resident bathrooms have been in disrepair for over 2 months. Additional interview with 3 out of 4 residents in care expressed no concerns about the facility plumbing in bathrooms being in disrepair. Interview with resident (R1) reported concerns about a resident bathroom being in disrepair. LPA conducted a tour of the facility on 12/2/2025 and observed 1 resident bathroom toilet in disrepair. This allegation was observed not in compliance with Title 22 regulation 87303(a) Maintenance and Operation. As the facility did not ensure the facility was in good repair at all times. Allegation: Staff are not properly trained It was alleged that staff are not properly trained. This investigation consisted of interview with facility staff and records review. On 12/17/2025 LPA conducted an visit to the facility, and interviewed 2 out of 3 facility staff, which reflected that facility staff are not properly trained on Medication Administration. LPA reviewed 4 out of 4 staff files, and observed no training records for the staff files reviewed. Continuation 9099-C This was observed not in compliance with Title 22 regulation 87411 Personnel Requirements- (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. Based on records reviewed of staff files, it was observed that facility staff did not have any training on record in the facility. As a result, this allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Kimberly and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Dec 19, 2025 · control 27-AS-20251103135013

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(b)(2) · Plan of correction due date: Dec 22, 2025

87465 Incidental Medical and Dental Care (b)If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication...(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: The facility did not ensure that residents centrally medications were administered in a timely manner in accordance with physician's orders.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agrees to remain in compliance with Title 22 regulation 87465(b)(2). Licensee agrees to re-train staff on medication administeration, including conducting professional vendor medication training for RCFE. Licensee will send a statement of acknowledgment of the regulation by 12/22/2025. Additionally, Licensee will send proof of facility staff training by 12.31.2025 to LPA via email.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Dec 22, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include ...maintenance services and procedures for the safety and well-being of residents, employees and visitors (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by: The facility did not ensure the facility was clean, sanitary, and odorless at all times. During a visit to the facility on 10/28/2025 the facility bathrooms were observed unsanitary and not free of odor.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agrees to ensure that the facility including resident bedrooms are clean, sanitary, and odorless at all times. Licensee has implemented additional staffing with primary roles of ensuring the facility is clean, sanitary, and odorless at all times.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 22, 2025

87303 Maintenance 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 was not met as evidenced by: The facility did not ensure that resident/staff bathrooms were in good repair at all times. LPA toured the facility on 10/31/2025 and observed staff bathrooms in disrepair with the toilet clogged.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee to remain in compliance with Title 22 regulation 87303(a) Licensee agrees to ensure the facility is in good repair at all times. Licensee has repair all clogged/broken fixtures and resident and staff bathrooms.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Dec 31, 2025

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement was not met as evidenced by: Licensee did not ensure staff had any initial or annual training. LPA reviewed staff files, and it was observed that facility staff did not have any training on record in the facility.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agrees to ensure that the facility is in compliance with the Title 22 regulation 87411. Licensee agrees to ensure that all staff have a combination of hands on training initially, and as needed. Additionally licensee agrees that all staff working in the facility will recieve professional vendor training. Licensee agrees to send the contracted vendor who will conduct training for facility staff by 12/22/2025. Licensee agrees to send completion records of training conducted by 12/31/2025.

Type of visit: Case Management - Other

On 12/12/2025 Licensing Program Analyst (LPA) Shakaricka Hughes conducted an unannounced visit to the facility. The purpose of the visit was to conduct a case management visit at the facility. The current census is 15 with 3 facility staff. During today’s visit LPA toured the inside of the facility, and observed (3) surveillance cameras in the facility located in the kitchen area, staff office area, and medication/ staff room. On 12/05/2025 LPA Hughes provided guidance to the facility regarding the use of surveillance in the facility. As of 12/12/2025 the Dept has not approved the use of surveillance in the facility. LPA instructed the facility to remove the surveillance cameras in the facility, until the Dept reviews and approves the facilities plan related to surveillance in the facility. This was observed not in compliance with Title 22 regulation 87208 (a) Plan of Operation. Based on review the licensee did not ensure that the facility followed the approved Plan of Operation. An addition, LPA investigated an incident that occurred in the facility involving a facility staff (S1). LPA requested LIC 624 Special Incident Reports (SIR) involving facility staff (S1). LPA also requested the status of residents who were confirmed to have body lice residents (R1) and (R2), including physician clearance documents and any documentation demonstrating the facilities follow-up action. During today’s visit a citation was issued. An exit interview was conducted with the facility administrators Kimberly and Joseline and a copy of the LIC 809, LIC 809-D pages and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Dec 12, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a) · Plan of correction due date: Dec 15, 2025

87208 Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49... This requirement was not met as evidenced by: Licensee did not ensure that the facilities approved Plan of Operation was followed. The licensee installed (3) surveillance cameras observed in the facility kitchen, staff and medication room.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Licensee removed all cameras installed in the facility on 12/12/2025. Additionally licensee agrees to submit required documents to the Dept to be reviewed in order to install surveillance in the facility.

Allegation investigated: Staff does not ensure an adequate food supply is maintained on premises. Staff does not follow food menu for residents. Staff locks refrigerator preventing residents to have access. Facility does not have gloves for staff. Facility staff did not follow infection control plan

On 12/2/2025 Licensing Program Analyst (LPA) Shakaricka Hughes conducted an unannounced visit to the facility. The purpose of this visit was to deliver complaint findings for the allegations listed above. LPA met with the facility licensee Umesh Pandey. The current census is 14 with 4 facility staff present in the facility. A brief interview with conducted with Umesh and Joseline. Allegation: Staff does not ensure an adequate food supply is maintained on premises and staff does not follow food menu for residents. It was alleged that Staff does not ensure an adequate food supply is maintained on premises and staff does not follow food menu for residents. This investigation consisted of facility observations, and interviews with facility staff. On 10/28/2025 LPA Hughes conducted a visit to the facility and observed facility staff assisting residents with preparing for breakfast. LPA interviewed 3 out of 3 facility staff indicated that the facility consistently does not have an adequate 2-day or 7-day supply of food for residents in care. Continuation 9099-C Substantiated Facility staff stated that they are unable to follow facility designed food menus because of the lack of food supply on the premises. This was observed not in compliance with Title 22 regulation 87555(a) as residents are not provided with a sufficient supply of food of the quantity necessary to meet their needs. Allegation: Staff locks refrigerator preventing residents to have access. It was alleged that staff lock the refrigerator preventing residents from having access. This investigation consisted of interviews with facility staff. On 10/28/2025 LPA Hughes conducted interviews with 2 out of 3 facility staff who confirmed that the facilities refrigerator is locked at night per the request of the licensee. This was observed not in compliance with Title 22 regulation 87468.1(a)(3) as residents in care were not allowed to access the refrigerator as it is locked. Allegation: Facility staff does not have gloves and facility does not follow infection control plan It was alleged that the facility staff does not have gloves, and the facility does not follow infection control plan. This investigation consisted of facility observations, and interviews with facility staff. On 10/28/2025 LPA Hughes conducted a visit to the facility, during the visit LPA Hughes observed the facility did not have an adequate supply of gloves for all facility staff, LPA observed 1 box of gloves made available for all facility staff. Additionally, according to the facilities Plan of Operation, the facility did not ensure proper reporting of the scabies outbreak to CCLD, residents and their responsible parties, facility staff, and the Sacramento County Dept of Health, The licensee failed to comply with reporting requirements instructed by the Sacramento County Dept of Health on 11/17/2025 as the outbreak was not reported until 11/24/2025. Facility staff were not provided with appropriate and adequate PPE while caring for residents with body lice. Interview with 2 out of 3 facility staff indicated that they were not made aware of the scabies outbreak for 2 weeks following the diagnosis of residents (R3) and (R4). During this time facility staff did not have an adequate supply of PPE. This was observed not in compliance with Title 22 regulation 87208(a)(1). As the facility did not follow the approved Plan of Operation. As a result, this allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Umesh and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility. Allegation: Staff administering another residents medication to another resident It was alleged that Staff are administering another residents medication to another resident. This investigation consisted of facility observations, and interview with 2 out of 3 facility staff. LPA Hughes conducted a visit to the facility, during facility observation LPA reviewed the medications for residents (R3) and (R4) LPA observed the medications boxed separately, both residents were prescribed the same medication for their current condition with scabies. Interview with facility staff (S1) reflected that residents medications are separate, and residents are not administered other residents’ medications in the facility. Additional interview with 4 out of 4 residents in care, did not express any concerns with medication administration, stating that they are administered their own medications. There is no evidence to corroborate this allegation, therefore this allegation is unsubstantiated. Allegation: Staff does not keep facility free from pest It was alleged that Staff do not keep facility free from pests. This investigation consisted of facility observations, and interviews with facility staff. On 10/28/2025 LPA Hughes conducted a visit to the facility, during facility observation LPA did not notice any signs of pest in the facility. LPA reviewed Pest control records for the facility, with the last service date being in August 2025. Interview with 3 out of 3 facility staff indicated that the facility has an active issue with pest in the facility. However, the facility has been proactive in their approach to addressing and mitigating the problem. There is no evidence to corroborate this allegation, therefore this allegation is unsubstantiated. Allegation: Staff does not properly store medications It was alleged that Staff does not properly store medications. This investigation consisted of facility observations, and interviews with facility staff. LPA Hughes conducted a tour of the facility and noticed resident’s medications locked and inaccessible to residents in care. Interview with 2 out of 3 facility staff indicated that resident’s medications are locked in a medication cart and inaccessible to residents. There is no evidence to corroborate this allegation, therefore this allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.the state’s words, verbatim · CDSS document, Dec 2, 2025 · control 27-AS-20251024113750

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Dec 10, 2025

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... This requirement was not met as evidenced by: The facility did not ensure the facility had a sufficient quantity of food to meet the needs of the residents in care. Interview with facility staff (R1)(R2)(R3) indicated that the facility consistently did not provide a sufficient quantity of food in the facility.the state’s words, verbatim · CDSS document, Dec 2, 2025

Plan of correction: Licensee agrees to continue to provide food for residents in the quantity and quality necessary to the meet the needs of residents. Licensee has started to inventory food supply on a checklist of all food that is being purchased for the facility. Licensee agrees to send LPA the practice used to keep food supply in the facility sufficient.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Dec 3, 2025

87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights (3)..To be free from punishment, humiliation, intimidation...actions of a punitive nature, such as withholding...interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by: The facility did not ensure that the refrigerator was unlocked and accessible to residents in care. Interview with facility staff (R2)(R3) indicated that the refrigerator is locked per the request of the licensee.the state’s words, verbatim · CDSS document, Dec 2, 2025

Plan of correction: Licensee agrees to keep the refrigerator unlocked and accessible to residents in care. Licensee is evaluating alternative methods including surviellance in the facility to track inventory of the refridgerator.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a)(1) · Plan of correction due date: Dec 3, 2025

87208 Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49... This requirement was not met as evidenced by: The licensee did not ensure that the facility followed the Infection Control Plan as specified in the facility Plan of Operation. The licensee did not ensure reporting requirements were met, and the facility maintained proper PPE for all residents and facility staff.the state’s words, verbatim · CDSS document, Dec 2, 2025

Plan of correction: Licensee agrees to maintain proper reporting requirements to all required entities including CCLD. Licensee agrees to maintain proper PPE in the facility at all times. Licensee agrees to provide education and training to all facility staff, and send proof of training to LPA via email by 12/03/2025.

Type of visit: Prelicensing

On 4/23/25 at 10:05am, Licensing Program Analyst (LPA) Kevin Gould and conducted an unannounced follow up Pre-licensing inspection to ensure all previously identified deficiencies have been corrected and to ensure the facility has met all requirements to be licensed. LPA met with appointed administrator and together conducted a walk through of the facility to review previous items in need of correction. LPA observed the hot water temperature to be 113 and 116 degrees at the facility. The current hot water temperature meets title 22 regulations. LPA also observed all drawers for resident use to be in working order and meeting regulations. This facility has met all requirements to be licensed at this time. LPA has no objections to the facility being licensed at this time. Exit interview conducted and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 23, 2025

Type of visit: Prelicensing

On 4/16/25 at 1:30pm, Licensing Program Analysts (LPAs) Kevin Gould and Cynthia Tamayo conducted an unannounced follow up Pre-licensing inspection to ensure all previously identified deficiencies have been corrected and to ensure the facility has met all requirements to be licensed. LPAs met with appointed administrator and together conducted a walk through of the facility to review previous items in need of correction. LPAs observed one dresser drawer in need of repair and the hot water temperature measured 93.2 degrees F which did not meet title 22 regulations. Administrator stated both items will be corrected by 4/17/25. The facility has not yet met all requirements to be licensed at this time a follow up inspection has been scheduled for 4/17/25. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 16, 2025

Type of visit: Prelicensing

On 3/26/25 at 9:00pm Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced follow up pre-licensing, change of ownership inspection at Lakewood Villa Care Center LPA met with appointed administrator Shreetika Chand. LPA again observed sharp knives unsecured and accessible to residents in care LPA also observed cleaning supplies unsecured from residents in the laundry room and kitchen. LPA also observed medications being left unsecured in the kitchen where the medications were accessible to residents in care. LPA has also observed not all furniture has been repaired or replaced and is not currently in working order. The licensee has not met the requirements to be licensed at this time. A follow up inspection to ensure identified corrections have been made for 4/2/25. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 26, 2025

Type of visit: Prelicensing

On 2/26/25 at 1:40pm Licensing Program Analyst (LPA) Kevin Gould Conducted an unannounced pre-licensing, change of ownership inspection at Lakewood Villa Care Center LPA met with appointed administrator Shreetika Chand. LPA conducted a walk through of the facility and observed several deficiencies while conducting the inspection. Two staff member (S1 & S2) has a criminal record clearance but was not associated to the facility. Two staff members (S3 & S4) do not have a health screening or TB clearance Furniture: dressers in multiple resident bedrooms were missing drawers or had drawers that were not operable. LPA observed thee knives, bleach unsecured from residents in care. Hot water temperature exceeded 150 degrees F. Residents identified as non ambulatory are residing in rooms designated for ambulatory residents per fire clearance. R1, R2, R3 and R4 all need to be moved to appropriate rooms based on their ambulatory status and the facility fire clearance. Due to time constraints LPA was unable to complete the inspection and will return at a later date to complete the inspection. At the time of this inspection the facility does not meet the requirements to be licensed. Exit interview conducted and a copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Feb 26, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 18 Census (if any clients in care): 12 COMP II Participants: Umesh Pandey (CEO) & Angeline Singh (Administrator) Interview Method: Virtual interview via Microsoft Teams On February 24, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 24, 2025