Lotus Homes Assisted Living I

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 07/30/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person, Giselle Haroornelas, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. The facility designated Administrator, Olivia Perez, arrived later to this facility while this LPA was conducting this annual visit. Current census was 3 residents. It was learned that there were (2) residents under the care of hospice at this time. It was learned that this facility does have an approved hospice waiver to be able to accept and retain up to (6) hospice residents at any given time. It was learned that there weren't any residents deemed to have the diagnosis of dementia at this time. It was learned that this facility does have a dementia program on file at this time. It was learned that there weren't any residents receiving services through home health at this time. It was learned that there weren't any residents deemed to be bedridden at this time. This facility does have an approved bedridden fire clearance to be able to accept and retain up to (1) resident at this time. Tour of the facility was conducted. A tour of the living area, dining area, and all other areas intended for resident use was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were reviewed at this time. Drawers storing knives and sharps were reviewed to make sure that they were locked and made inaccessible to the residents at all times. Cabinets storing detergent and all cleaning supplies were reviewed to make sure that they were locked and made inaccessible to the residents at all times. Facility restrooms were toured. Grab bars and non skid mats were observed to be present and in good working order at this time. Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees at all times. A review of the facility medications for the residents was conducted. It was learned that all of the resident medications were centrally stored. First aid kit, located in the facility medication closet located in the hallway, was reviewed. It was observed that it did contain all of the required components and was in compliance at this time. A review of the facility food supply was conducted. A tour of the facility pantry was conducted to make sure that there was a sufficient supply of 2-day perishable and 7-day non perishable food quantities on hand at all times. It was learned that there was an additional refrigerator being used in the garage area. Tour of the garage area was conducted. It was observed that this space was being used to store household items and personal items for the residents in care at this time. Laundry area was toured. It was observed that the door leading into the laundry area did have the ability to be locked at this time. This door was reviewed to make sure that it was locked to be able to store detergents and bleach so that they were inaccessible to the residents at all times. A tour of the facility resident bedrooms was conducted. Furniture and furnishings were observed to be present and able to meet the needs of the residents at this time. Linen closet, located in the facility hallway, was reviewed. Administrator certificate for Olivia Perez was observed to be present with certification #6071401740 set to expire on 07/10/2026. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and all other exits was conducted. A review of (3) facility resident files was conducted and noted on the following LIC 858. A review of (3) facility staff files was conducted and noted on the following LIC 859. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 07/30/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person, Giselle Haroornelas, who was briefly interviewed at this time. This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Olivia Perez, to inform her that CCL was present at this time. The facility designated Administrator, Olivia Perez, arrived later to this facility while this LPA was conducting this visit. A brief interview was conducted with the facility designated Administrator at this time. Current census was 3 residents, of which (1) resident was out of the facility at the hospital, at this time. It was learned that this facility is licensed to able to accept and retain up to (6) non ambulatory residents at any given time. Tour of the facility was conducted. This Post Licensing visit was conducted in conjunction with the Annual visit as well. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 30, 2026

Allegation investigated: Licensee does not ensure that resident's incontinence needs are met Licensee confines resident to bed Licensee confines resident to wheelchair Licensee yelled at resident Licensee pushed resident Licensee does not distribute resident's medications as prescribed Licensee does not provide resident with adequate supervision, resulting in multiple falls Licensee does not maintain a centrally stored medication log for resident

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with the Administrator Olivia Perez and explained the reason for the visit. Census: 2 Licensee does not ensure that resident's incontinence needs are met - LPA Lund reviewed facility records, interviewed staff, Reporting Party, Resident (R1), witness. LPA Lund reviewed LIC 602A dated 10/17/2025 for Resident (R1) which states that R1 has bladder and bowl impartment. LPA Lund also reviewed R1 facility notes when R1 has bowl movements from 11/1/2025 through 2/15/2026. LPA Lund interviewed Administrator Olivia Perez who stated that R1 is the only resident in care at the time of complaint being opened and either herself or staff would constantly check on R1 and change R1 when R1 uses the bathroom. LPA Lund interviewed R1 who stated that R1 get changed when R1 uses the bathroom. LPA Lund interviewed witness who stated that when she visits R1 everyday R1’s incontinence needs are being met. Unsubstantiated Based on records reviewed, interviews with staff, R1, Reporting Party and witness on the information provided, it was unclear if licensee does not ensure that resident's incontinence needs are met, therefore the allegation was deemed UNSUBSTANTIATED. Licensee confines resident to bed- LPA Lund reviewed facility records, interviewed staff, Reporting Party, Resident (R1), and witness. LPA Lund reviewed LIC 602A dated 10/17/2025 for R1 which states R1 is non- ambulatory. LPA Lund interviewed staff who stated that R1 does need guidance but can get up out of bed and wheelchair. LPA Lund interviewed R1 who stated that R1 can get up to R1 wheelchair or walk to a chair but can’t walk that far. LPA Lund interviewed witness who is there every day stated that staff help R1 out of bed but never confine to just the bed or wheelchair. R1 goes outside when it is nice or in the living room to watch TV. Based on reviewed facility records, interviewed staff, Reporting Party, R1 and witness, on the information provided, it was unclear if licensee confines resident to bed, therefore the allegation was deemed UNSUBSTANTIATED. Licensee confines resident to wheelchair- LPA Lund reviewed facility records, interviewed staff, Reporting Party, Resident (R1) in care and witness. LPA Lund reviewed LIC 602A dated 10/17/2025 for (R1) which states R1 is non- ambulatory. LPA Lund interviewed staff who stated that R1 does need guidance but can get up out of bed and wheelchair. LPA Lund interviewed R1 who stated that R1 can get up to R1 wheelchair or walk to a chair but can’t walk that far. LPA Lund interviewed witness who is there every day stated that staff help R1 out of bed but in never confine to just the bed or wheelchair R1 goes outside when it is nice or in the living room to watch TV. Based on reviewed facility records, interviewed staff, R1 and witness, on the information provided, it was unclear if licensee confines resident to wheelchair, therefore the allegation was deemed UNSUBSTANTIATED. Licensee yelled at resident- LPA Lund reviewed facility records, interviewed staff, R1 and witness. LPA Lund reviewed staff training, and all staff have been trained to know that they are mandated reporters and know how to report any abuse to Community Care Licensing (CCL). Staff stated they have taken the mandatory training and Dementia Care: Managing Challenging Behaviors. LPA Lund interviewed R1 who stated that staff are great and help with all needs. LPA Lund interviewed witness who stated staff help R1 with just about everything and never seen any staff yell or do anything to R1. Based on reviewed facility records interviewed staff, R1 and witness, on the information provided, it was unclear if licensee yelled at resident, therefore the allegation was deemed UNSUBSTANTIATED. Licensee pushed resident- LPA Lund reviewed facility records, interviewed staff, Resident (R1), Reporting Party and witness. LPA Lund reviewed staff training, and all staff have been trained to know that they are mandated reporters and know how to report any abuse to Community Care Licensing (CCL). Staff stated they have taken the mandatory training to work at the facility and know how to report any issues to management or to CCL. LPA Lund interviewed R1 who stated that staff are great and help with all needs. LPA Lund interviewed witness who stated staff help R1 with just about everything and never seen any staff yell or do anything to R1. Based on reviewed facility records interviewed staff, R1, Reporting Party and witness, on the information provided, it was unclear if licensee pushed resident, therefore the allegation was deemed UNSUBSTANTIATED. Licensee does not distribute resident's medications as prescribed – Based on facility records and interviews with staff, Reporting Party and witness. LPA Lund reviewed facility Medication Administration Records (MARS) 10/1/2025 through 11/30/2025 were completed and in compliance. Bristol Hospice orders medications for R1. LPA Lund interviewed witness who stated that she sees staff giving medications and believes that R1 get medications that R1’s supposed to get. Based on facility records and interviews with staff, Reporting Party and witness, on the information provided, it was unclear if licensee does not distribute resident's medications as prescribed, therefore the allegation was deemed UNSUBSTANTIATED. Licensee does not provide resident with adequate supervision, resulting in multiple falls - Based on facility records, interviews with staff and Resident (R1) and witness. Staff records show that the facility always had one staff member for the one resident in care at all times. LPA Lund did receive a Unusual Incident/Injury Report dated 10/12/2025 which states R1 was trying to get up and fall and had no injury. Administrator Olivia Perez stated that she notified hospice, POA and CCL of the fall. Staff do half hour checks on R1 to make sure R1 has not slipped out of bed. Based on facility records, interviews with staff and Resident (R1) and witness, on the information provided, it was unclear if Licensee does not provide resident with adequate supervision, resulting in multiple falls, therefore the allegation was deemed UNSUBSTANTIATED. Licensee does not maintain a centrally stored medication log for resident - Based on LPA’s Lund observation of the centrally stored medications on 10/28/2026 and interviews with staff and witness. LPA observed the medications to stored in a hallway closed locked and secured. LPA Lund interviewed Administrator Olivia Perez who states that she stores all medications in the hallway closet locked. Witness stated that she see staff taking medications from hallway closet. Based on LPA’s Lund observation of the centrally stored medications on 10/28/2026 and interviews with staff and witness, on the information provided, it was unclear if licensee does not maintain a centrally stored medication log for resident, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegations may have happened or is valid, there is not preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 27-AS-20251020154200

Type of visit: Prelicensing

Announced pre-licensing visit was made with Applicant Olivia Perez. LPA Jason Lund explained the reason for the visit. Census:0 The facility will be licensed to serve up to (6) clients at any given time. This applicant has a hospice wavier for one. The facility has five non- ambulatory and one bed ridden. Tour/Inspection of the facility was conducted. LPA toured/Inspected the dining area, living area, and all other areas intended for client use. LPA observed to be furnished and maintained in compliance at this time. The Facility had a Medication closet (locked) where medication will be stored. The first aid kit was observed in the Medication closet to be present and contained all required components at this time. A tour of the (4) resident bedrooms, was conducted. The facility will have two rooms with two residents per room and two private rooms. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. There are one linen closets, in the hallway, it was observed to contain a sufficient supply of towels and linens able to meet the needs of the clients at this time. A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. The facility has one fire extinguisher and a working telephone. Applicant Olivia Perez completed the Component 111 requirements. This facility has been found to be in compliance at this time. An exit interview, report left.the state’s words, verbatim · CDSS document, Jul 7, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: PEREZ, OLIVIA B - Licensee/Administrator Interview Method: Telephone interview On 05/06/2025, 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, May 6, 2025