Loveland Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff at 8am. LPA met with Administrator, Suha Abdalla and explained the purpose of the visit. The facility is a four bedroom, two bathroom, single story residential home with an approved fire clearance of six non-ambulatory residents; in which six may be bedridden. The facility has an approved hospice waiver for six residents. Currently there are six residents in care with one resident receiving hospice services. Upon entry, LPA observed four of six residents eating breakfast. Residents shared that the food at the facility is good. LPA observed the kitchen was clean, knives were secured in a drawer and chemicals were secured beneath the sink. The facility had two days of perishable items and seven days of non perishable items. The facility was 75 degrees Fahrenheit. The hot water temperatures were measured in two of two resident bathrooms and ranged between 113.8 to 116.7 degrees Fahrenheit. Bathrooms had non-skid flooring and grab bars but did not have covered trash bins. LPA observed six of six resident bedrooms. All rooms had clean linens and required furnishings of a bed, night stand, dresser drawers and a lamp. Three of six resident beds have bed rails and LPA did not observe any orders on file. A deficiency will be given for postural supports. . During the tour LPA inspected the facility smoke detectors. Smoke detectors are interconnected and are operational. A carbon monoxide detector was not observed on site and a deficiency will be cited. The facility (Continued on LIC 809-C) (Continued from LIC 809) has a sprinkler system that was tested in April 2026 and passed. A fire extinguisher was charged and inspected on May 15, 2026. The facility had not conducted a quarterly fire drill and a deficiency will be cited. The facility has cameras, without audio, in common hallways. LPA observed the PUB 475, See Something, Say Something poster but was not the required size. LPA also observed the Long Term Care Ombudsman poster, Liability Insurance, Visiting Hours, Emergency Disaster Plan and Facility Client Roster, posted in a prominent area next to the office and piano. A resident/family council notice was not posted. LPA toured the exterior and observed a shaded seating area and ample room for outdoor activities. Pathways were clear of hazards and obstructions and exterior gates were operational. The garage had a washer and dryer and locked cabinets with additional cleaning supplies and detergents. Emergency food supplies were also observed. LPA reviewed the Centrally Stored medications for six of six residents. Per review, medications are being given as prescribed. The facility First Aid Kit was observed to have the required elements and a First Aid Book was available on-site. LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on May 2, 2028. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Suha Abdalla, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, LIC9102-TV and Appeal Rights.the state’s words, verbatim · CDSS document, Sep 3, 2026

The state marks this report as 11 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Resident developed a UTI due to staff neglect. Staff is verbally abusing residents. Staff is physically abusing residents. Staff does not ensure resident's catheter bag is being changed.

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unnanouced visit to deliver complaint findings. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received a complaint on June 24, 2026 and LPA Mendivil conducted the initial 10 day visit on June 30th, 2026. LPA Mendivil conducted interviews of staff and residents. Regarding the allegations Resident developed a UTI due to staff neglect. Staff is verbally abusing residents, Staff is physically abusing residents, Staff does not ensure resident's catheter bag is being changed, the investigation revealed the following: It was reported that Resident 1 (R1) moved into the facility from a skilled nursing facility on June 20, 2026 around 4pm. Per interview with Administrator, Suha Abadallah, the Administrator stated that at the time of appraisal she was not aware of the use of catether for R1 and due to that was unable to set up home health prior to admission. Administrator stated she contacted a home health agency and scheduled an appointment on June 23, 2026. Per Administrator R1 then called 911 around 12:40 am due to issues with their catether. Unsubstantiated It was then reported R1 was taken to the hospital and discharge back into a Skilled Nursing Facility due to their health. Interviews with two out of two staff present stated that R1 was alert and was able to communicate their needs. Per interviews with two out of two staff, staff stated R1 did not ask for assistance with emptying out the catheter. Two out of two staff deny neglecting R1. It was alleged that staff verbally abused residents, per interviews with two out of two staff deny verbally abusing residents. LPA was unable to interview four out of four residents as they were not oriented to time and space. Administrator also denies verbal abuse. It was alleged that staff physically abused residents, per interviews with two out of two staff deny physically abusing residents. LPA was unable to interview four out of four residents as they were not oriented to time and space. Administrator also denies physical abuse. It was alleged that Staff does not ensure resident's catheter bag is being changed. Based on interviews with staff R1 did not ask for assistance with their catheter and no issues were noted. Therefore based on the preponderance of evidence through records reviewed and interviews the allegations Resident developed a UTI due to staff neglect, Staff is verbally abusing residents, Staff is physically abusing residents and Staff does not ensure resident's catheter bag is being changed are determined to be UNSUBSTANTIATED, meaning 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 as reported. An exit interview was conducted with Administrator and copy of report was discussed and provided.the state’s words, verbatim · CDSS document, Aug 13, 2026 · control 22-AS-20260624151503

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit injunction with complaint control # 22-AS-20260624151503. During the investigation for the complaint listed above it was reported that Administrator Suha Abdalla was unaware that Resident 1 (R1) had a catheter when Suha was conducting the assessment prior to admission to the facility. Suha stated it was not found out until R1 was admitted to the facility on June 20, 2026 around 4pm and staff discovered that R1 had a subpubic catheter. It was then reported R1 requested 911 to be called due to issues with the catheter. R1 was discharged from the hospital back to a skilled nursing facility, as they require a higher level of care. Based on observations made the following is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided to the facility.the state’s words, verbatim · CDSS document, Aug 13, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87456(a)(3) · Plan of correction due date: Aug 26, 2026

(a)Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8:(3) Obtain and evaluate a recent medical assessment. This requirement was not met as evidence by Administrator was not aware that R1 had a sudpubic catheter. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator will create an assessment document and a guide for assessments and provide proof to LPA by POC due date.

Type of visit: Case Management - Other

On today's date Licensing Program Analyst (LPA) conducted an unannounced visit for the purposes of completing a case management inspection for the purposes of ensuring the Administrator is in compliance with the previously cited deficiency stating that a staff member was residing in the same room as a resident in care. Upon arrival LPA was greeted and granted entry into the facility by facility staff. LPA explained the purpose of the visit to facility staff and began to inspect the facility for any observable deficiencies. Per LPA observations there were no observable deficiencies. Per LPA's observations the administrator is in compliance with previously issued deficiency. Furthermore an interview conducted with the resident who resides in the room confirmed that there is no longer anyone sleeping in the same room as them. Based on observations made during today's visit no additional deficiencies will be issued at this time. An exit interview was conducted with Care giving staff and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 1, 2026

Type of visit: POC

On today's date Licensing Program Analyst (LPA) William Vanegas conducted an unannounced inspection for the purposes of conducting a plan of correction visit. Upon arrival LPA was greeted and granted entry to the facility. LPA explained the purpose of the visit and began a tour of the facility. LPA observed no staff sleeping in the resident rooms proving that the plan of correction was adhered too. LPA explained that the deficiency given for this issue will be cleared and documented. An exit interview was conducted and a copy of this report along with plan of correction letter were provided to the facility.the state’s words, verbatim · CDSS document, Apr 21, 2026

Type of visit: Case Management - Other

On today's date Licensing Program Analyst (LPA) William Vanegas conducted an unannounced case management visit for the purposes of providing the facility with an amended deficiency. Upon arrival LPA was greeted and granted entry to the facility by facility staff. LPA explained the purpose for the visit and Administrator was notified via telephone. LPA amended previous deficiency in the presence of facility staff, LPA provided a copy of the amended deficiency, and appeal rights. An exit interview was completed with facility staff and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 14, 2026

Type of visit: Case Management - Other

On today's date Licensing Program Analyst (LPA) William Vanegas conducted an unannounced inspection for the purposes of completing a case management visit in order to amend a previously given deficiency. AS LPA completed the visit LPA observed a staff member sleeping in the same room as a resident. Staff assisting LPA with visit admitted to LPA that the staff is a live in staff and regularly sleeps in this room with the resident in it. LPA advised that this was a violation of title 22 chapter 8 division 6 of the California Code of Regulations. LPA Vanegas provided the facility with a deficiency due to the violation. LPA conduced an exit interview with staff on duty, provided a copy of this report, the deficiency, and appeal rights.the state’s words, verbatim · CDSS document, Apr 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(D) · Plan of correction due date: Apr 28, 2026

87307 Personal Accommodations and Services (a)Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) bedrooms shall be provided which meet, at a minimum, the following requirements: (D) Not more than two residents shall sleep in a bedroom.the state’s words, verbatim · CDSS document, Apr 14, 2026

Allegation investigated: -Staff are not administering resident's medication

On Today's Date Licensing Program Analyst made an unannounced visit to deliver findings in regard to the complaint investigation regarding the complaint listed above. Upon arrival LPA was greeted and granted entry to the facility by facility staff. LPA explained the nature of the visit and began to discuss the following with facility staff. based on the evidence observed and gathered the department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the allegation is Substantiated. See LIC9099D for cited deficiency per title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided to the facility. Substantiatedthe state’s words, verbatim · CDSS document, Apr 7, 2026 · control 22-AS-20260209104718

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 20, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as neededthe state’s words, verbatim · CDSS document, Apr 7, 2026

Plan of correction: Administrator will document and administor all medications as perscribed by physician. Adimistrator will send proof of correction will be sent to LPA before POC due date.

Allegation investigated: Staff do not ensure medication records are properly maintained

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to conduct complaint investigation. LPA Tirre was greeted and granted entry into the facility by staff and explained reason for visit with Administrator Suha Abdalla. During the course of investigation, LPA reviewed records and conducted interviews. Department requested pertinent documentation such as Physician’s Reports, Medication Administration record,Medication Training and Centrally Stored Medication and Destruction Record. The investigation conducted revealed the following: On March 25, 2026 the department received a complaint alleging Staff do not ensure medication records are properly maintained. Regarding Allegation Staff do not ensure medication records are properly maintained, Record Review was conducted and Department reviewed Medication Administration Records for current residents (Residents 3 and 4) and previous residents (Residents 1 and 2). Facility provided records for four individuals CONTINUED ON 9099C Unsubstantiated Two of four resident records (R3-R4) Medication Administration Records (MAR’s) revealed to be current and complete. Records for R2 were completed by facility staff and Hospice staff. MAR’s for R1 were provided for December 13, 2025 to February 23, 2026 and LPA observed that medications for R1 for December 13, 2025 to December 31, 2025 were initialed and signed off by Staff1. A as needed PRN MAR for same dates of December 13-31st was also provided with three PRN (as needed meds) for R1. LPA observed the PRN MAR had signatures for one medication by staff 1. LPA observed that it was unclear what PRN medication was signed off by Staff 1 due to signature was signed on a line that was in between two medications (Lactulose and Olanzapine). R1’s MAR for month of January 2026 was signed off by two different staff members (S2 & S6). One medication for R1 (Nitrofurantoin) was missing signatures from January 7-19, 2026. R1’s MAR for the month of February 1-23rd was signed off by two staff members (Staff 2 and 5). R1’s MAR for February was missing signatures for three PM medications (Levothyroxine, Synthroid, and pantoprazole) on February 23rd. Medication Training verification was provided for four of six staff members of which four staff administered meds to R1. Interviews conducted with staff revealed that staff stated they verify one by one medications for AM, NOON and PM medications before dispensing to each resident one by one. Staff interviews stated that once medications are dispensed to residents and they visually see that Residents have swallowed medications, Staff sign off MAR for given meds. Staff interviews stated that if Resident refuses medications or are out of facility in example if they are out at hospital, MAR should not be signed off if medications are not dispensed. Interviews with three staff members stated they had Medication Training. Interview with Staff 1, stated that due to S1 no longer working at facility, S1 could not recall and wished not to disclose information regarding medications given to residents. Interviews with two residents R3-R4 stated that they receive their medications timely and have no issues regarding medications or staff. Interview with Witness 1 revealed that staff members were incorrectly filling out Resident MAR’s and stated that medication was listed that Resident was not supposed to be given. Based on information provided in investigation, the preponderance of evidence has not been met, deeming the allegations Staff do not ensure medication records are properly maintained to be Unsubstantiated meaning 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 as reported. An exit interview was conducted with Administrator Abalia and copy of report was discussed and provided.the state’s words, verbatim · CDSS document, Apr 1, 2026 · control 22-AS-20260325115352

Allegation investigated: -Staff are not administering resident's medication

On this day, Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to the facility to deliver complaint findings for the allegation listed above. LPA was greeted and granted entry into the facility and explained the purpose for the visit. Administrator was on site and LPA began to explain the findings of the investigation and the following were discussed. Regarding the allegation Staff are not administering resident’s medication, the following has been concluded: During the observations and reviews of the medication administration record, for R1 it was observed that all medications found at the facility were not documented on the medication administration record. Furthermore, the following was observed; medications found in Resident 2 (R2) stored medications bubble pack medications were being dispensed on conflicting dates. It was observed that medications were dispensed from bubble packs as R2 was admitted to the hospital during the time periods of medications being dispensed. CONTINUED ON LIC9099C Substantiated CONTINUATION FROM LIC9099 Additionally, per LPA review one medication with a quantity of 60 pills 41 were not dispensed. A total of 19 pills were dispensed however the number of dispensed pills is not parallel to the number of Callander days that have passed in the month of March which is 18 days. Therefore, it is determined that medications were not administered per physicians’ orders. on the evidence observed and gathered the department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the allegation is Substantiated. See LIC9099D for cited deficiency per title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided to the facility.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 22-AS-20260209104718

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6)(C) · Plan of correction due date: Mar 26, 2026

Incidental Medical and Dental Care (h)The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (C)The drug name, strength and quantity.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Administrator will document all residents medications correctly in medication administration record, and will discard of any left over medication from previous months in order to not compromise the number of medications adminstered. Administrator will provide proof of correction via email to LPA.

Allegation investigated: Staff does not maintain adequate food supply at facility. Staff does not provide nutritious meals. Staff did not provide an accurate dosage of medication to resident.

On March 20, 2026, at 9:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA was greeted and granted entry by staff. LPA met with Administrator (ADMIN) Suha Abdalla. The investigation consisted of the following. LPA Kim toured the facility. LPA requested and obtained copies of the resident roster and staff roster. LPA requested a copy of three (3) resident service records which include Physician’s Report, Appraisal/Needs and Services Plan, admission agreement, and other document records. LPA requested and obtained copies of five (5) staff records. LPA conducted interviews with three staff, three residents, and one witness. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Staff does not maintain adequate food supply at facility. It is alleged the facility does not supply healthy foods and not enough food. It is alleged the facility would buy a rotisserie chicken for the week and tell staff to “figure it out”. It is alleged stated residents “constantly” have leftovers. Based on interviews conducted, three out of three staff and one out of three residents denied the allegation. One out of three residents confirmed the allegation. One witness confirmed the allegation. One out of three residents could not confirm or deny the allegation. All staff stated the facility provides enough food. No staff recalls a time where the Licensee or Administrator notified the staff to figure out the food to prepare to the residents by only providing a Costco rotisserie chicken. S1 and S2 stated they prefer to cook fresh food for the residents, but the residents request frozen meals and fast food. When they cook they have enough food supplies and provide according to the wants and needs for the residents. Based on observations, on January 22, 2026, LPA observed and took photos of the freezer and the refrigerator. The freezer had a chicken, ground beef, pizza rolls, Stouffers frozen meal, hot pockets, frozen meal pasta, frozen vegetables, and ice cream. The refrigerator contained eggs, tomatoes, lettuce, cabbage, cucumbers, bananas, onions, string cheese, ensure drinks, Vita coco water, pasta, yogurt, and tortillas. The pantry contained canned vegetables, pasta, bread, condiments, spam, beans, and other canned goods. On March 20, 2026, LPA observed the freezer contained a box of tilapia, bags of ground beef portioned out, frozen vegetables, sausages, chicken, and other frozen items. The refrigerator contained eggs, orange juice, mango, bananas, cabbage, lettuce, carrots, soups, tortilla, container of cream cheese, and other items. The pantry contained canned vegetables, canned soups, pasta, bread, and other condiments. Based on the information gathered, there is no sufficient evidence gathered to confirm the above allegation. It is determined that three out of three staff and one out of three residents denied the allegation. Continued on LIC9099C Allegation: Staff does not provide nutritious meals. It is alleged the facility does not supply healthy foods. Based on interviews conducted, three out of three staff denied the allegation. Two out of three residents confirmed the allegation. One witness confirmed the allegation. One out of three residents could not confirm or deny the allegation. S1, S2, and S3 stated that the facility has enough fresh and healthy fruits, vegetables, and protein. S1 and S2 stated all caregivers are ready to cook protein, provide fresh fruit and vegetables, and healthy alternatives, but residents always request ensure, microwave food, and fast food. They provide based on what the residents want, and always have fresh fruit, vegetable, and nutritious options available. Based on observations, on January 22, 2026, LPA observed and took photos of the freezer and the refrigerator. The freezer had a chicken, ground beef, pizza rolls, Stouffers microwave meals, frozen vegetables, hot pockets, frozen meal pasta, and ice cream. The refrigerator contained eggs, tomatoes, cabbage, cucumbers, brocoli, mangos, bananas, onions, string cheese, leftover McDonalds, ensure drinks, Vita coco water, pasta, yogurt, boxes of pasta, and tortillas. The pantry contained canned vegetables, pasta, bread, condiments, spam, beans, and other canned goods. There are healthy and variety of fresh fruits. vegetables, food, and ingredients. On March 20, 2026, LPA observed and took photos of the freezer and the refrigerator. LPA observed the freezer contained a box of tilapia, bags of ground beef portioned out, sausages, chicken, frozen vegetables, and other frozen items. The refrigerator contained eggs, orange juice, leftover food in Tupperware, soups, tortilla, container of cream cheese, mangos, carrots, cabbage, lettuce, and broccoli. The pantry contained canned vegetables, canned soups, pasta, bread, and other condiments. There is a variety of fresh fruits, vegetables, food, and ingredients. Based on the information gathered, there is not sufficient evidence gathered to confirm the above allegation. It is determined that three out of three staff denied the allegation. LPA observed there is a variety of fresh vegetables and fruits, and other health nutritious ingredients or items. Continued on LIC9099C Allegation: Facility does not post menu. It is alleged that the facility does not post a food menu. Based on interviews conducted, three out of three staff and two out three residents confirmed the allegation. One witness and One out of three residents could not confirm or deny the allegation. S1, S2, S3, R1, and R2 confirmed there was no food menu posted during the visit. S1 and S2 stated that the facility removed the old menu so that S1 would replace it with a new one. S1 stated they did not make a new menu. Based on observations, on January 22, 2026, LPA observed there was no food menu posted when LPA arrived to the facility. During the visit, the staff printed and posted the old menu to the bulletin board. Based on the information gathered, there is sufficient evidence gathered to corroborate the above allegation. It is determined that three out of three staff and two out of three residents corroborated the allegation. LPA observed there was no menu when LPA arrived, and the facility printed and posted the menu during the visit. Therefore, based on the interviews which were conducted, LPA’s observations, and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation facility does not post menu deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. One deficiency is being cited on the attached LIC9099D. Exit interview was conducted and a copy of the report, LIC90999D, appeal rights, and LIC811 were provided to Administrator Suha Abdalla. Allegation: Staff did not provide an accurate dosage of medication to resident. It is alleged staff administered R1 the incorrect dosage of the medication (Synthroid). It is alleged that R1 is required 225mg, but was administered 200mg. Based on record review, R1’s Medication Administration Record for December 2025 and February 2026, and vital signs for 2025 and 2026, do not indicate that an inaccurate dosage of any medication was administered. For January 2026 Medication Administration Record did not have January 27 and January 28 initialed that medication was administered. S2 stated they administered the medication but the document that was originally marked for those dates are when one of liquid medications spilled over that document. They stated they forgot to initial they administered for those days on the new document. Based on interviews conducted, three out of three staff, two out of three residents, and witness denied the allegation. One resident out of three residents could not confirm the allegation. All staff, R1, R2. And witness stated there was no incident or situation where the staff provided an inaccurate dosage of medication to any resident. Based on observations, LPA has not observed any situation where a staff provided an inaccurate dosage of medication to a resident. Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegations that the staff does not maintain adequate food supply at facility, Staff does not provide nutritious meals, and staff did not provide an accurate dosage of medication to resident. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Exit interview was conducted and a copy of the report was provided to Administrator Suha Abdalla.the state’s words, verbatim · CDSS document, Mar 20, 2026 · control 22-AS-20260115164019

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(6) · Plan of correction due date: Apr 3, 2026

87555(b)(6)... Facilities licensed for less than sixteen (16) residents shall maintain a sample menu in their file. Menus shall be made available for review by the residents ... and the licensing agency upon request. This requirement is not met as evidenced by: Based upon observation and interview, the licensee did not comply with the section cited above. LPA did not observe the menu and S1-S3 and R1-R2 stated there was no food menu posted.This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: POC cleard during March 20, 2026 visit. During the January 22, 2026, staff posted an old menu and stated they would provide the new updated menu and post it. During the March 20, 2026, LPA observed the new menu posted.

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Edward Kim made an unannounced visit in conjunction with a complaint visit for complaint control #22-AS-20260115164019. During the visit, Administrator (ADMIN) Suha Abdalla indicated resident #1 (R1) passed away in February 3,2026. The facility did not provide written notice to the Department of Social Services Community Care Licensing Department Adult Senior Care Program Orange County Regional Office of this incident. Based on today’s visit, a deficiency was cited as per the Title 22 Division 6 Chapter 8 of California Code of Regulations (CCR). The facility did not send a Serious Incident Report of when R1 passed away on February 3, 2026. An exit interview was conducted and a copy of this report, appeal rights, and LIC809D were provided.the state’s words, verbatim · CDSS document, Mar 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Apr 3, 2026

87211(a) Each licensee shall furnish to the licensing agency... (1) A written report shall be submitted to the licensing within seven days of the occurrence (A) Death of any resident from any cause regardless of where the death occurred... This requirement is not met as evidenced by: Based upon observation and interview, the licensee did not comply with the section cited above. S1 stated they did not report to licensing of R1's death. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2026

Plan of correction: Licensee stated they will send LIC624A for R1 to CCLD via email to edward.kim@dss.ca.gov by POC due date 4/3/2026.

Type of visit: Case Management - Health Checks

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit in conjunction with a complaint visit for complaint control # 22-AS-20260226084047 . LPA Mendivil toured interior and exterior of facility. No imminent health and safety hazards were observed. Resident present was observed to be relaxing in their room. No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 27, 2026

Allegation investigated: Staff did not ensure resident's incontinence needs were met Staff did not respond to residents call for assistance in a timely manner Staff did not ensure medication was stored locked and inaccessible to residents in care Lack of supervision, resulting in resident unclothed in the facility Staff did not ensure that resident's grooming needs were met Staff did not provide resident with clean linen Staff did not maintain facility sanitary Facility is malodorous

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegation. LPA arrived at the facility and was greeted at the door and granted entry. LPA spoke with Suha Abdalla, Administrator and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records. It is alleged that staff did not ensure resident's incontinence needs were met. Interview with 2 of 2 staff stated that there were only two residents that wore diapers in the facility. Staff change resident’s diapers every 2-3 hours or sooner if necessary. Residents can express needs and call staff when a diaper needs Continues on LIC9099-C Unsubstantiated to be changed. LPA was unable to interview two residents in question that wore diapers as one resident no longer resides at the facility and another resident refused to interview. It is alleged that staff did not respond to residents call for assistance in a timely manner. Interview with 2 of 2 staff stated that residents when they need assistance call out the care staff’s name and/or would use their cell phone to call the facility number and ask for help. Staff stated that staff are making rounds every 10-15 minutes and checking on residents and there is always a staff on each side of the house where they could know when a resident is calling for help. Interview with 2 of 2 residents stated that they always get help when requested and never had issues getting help. It is alleged that Staff did not ensure medication was stored locked and inaccessible to residents in care, specifically to residents’ insulin pen. Interview with staff stated that medication is centrally stored and inaccessible to residents in care. Staff stated that there was one resident that needed insulin, however that resident is no longer a resident of the facility. Staff recall an occasion when residents (R1) was being assisted by staff with changing and giving R1 their insulin pen for them to administer injection and R1 received visitors, and they observed the insulin pen in their bedroom while being assisted. Staff stated pen was removed by staff once it was done being administered and staff finished changing R1. It is alleged that lack of supervision, resulting in resident unclothed in the facility. Record review revealed that resident in question no longer reside at the facility. Interview with 2 of 2 staff stated that there has not been any incident with any resident of the facility being unclothed. Staff stated that none of the residents ever had issues with getting themselves unclothed. Interview with 2 of 2 residents stated that they have never observed any resident being unclothed at the facility. When staff help them get dressed, they are done so in a private setting and with assistance. It is alleged that staff did not ensure that resident’s grooming needs were met. Interview with 2 of 2 residents stated that they get the help they need when they need it at all times. Staff help them get dressed when they need help and do it in a private setting. Staff stated that when residents need to get dressed, change or need assistance with grooming that they help them, but most residents are independent, and they can do it themselves with minimal assistance. Continued on LIC9099-C It is alleged that staff did not provide resident with clean linens. LPA toured the facility and observed a hallway closet full of cleans and sufficient linens for residents. LPA toured the resident bedrooms and observed all beds to have clean linens. Interview with staff stated that they change the residents’ linens twice a week and when necessary. It is alleged that staff did not maintain facility sanitary. LPA toured the physical plant of the facility and observed that upon arrival staff were cleaning the facility. LPA observed staff use cleaning supplies as well as sanitizing supplies. Interview with staff stated that facility gets cleaned in the morning and thorough the day as well as one last cleaning when residents have gone to their bedrooms. It is alleged that facility is malodorous. LPA toured the physical plant of the facility and did not observe the facility to have any malodorous. Interview with 2 of 2 staff stated that R1 had an ileostomy bag and at times when the bag would be drained it would leave a smell for a few minutes, but staff always opened windows to help the smell go away. Staff stated that at times when diapers are changed it can also smell but the smell doesn’t stay or linger in the facility. The smell went away within minutes, LPA at the time of visit observed a staff changing a resident’s diapers and there was a very small faint smell that lasted minimal minutes, once smell was gone the facility smelled fresh from the staff cleaning the facility. Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, this allegations is deemed Unsubstantiated. An exit interview was conducted with the facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Nov 24, 2025 · control 22-AS-20251113160957

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Ruth Martinez and Garlli Tat conducted an announced continued prelicensing visit today to ensure the facility had made all corrections required from the 8/14/2025 visit. During the visit the LPA verified the following is corrected: 1. Facility bathrooms (2) shall have slip-resistant mats, strips, or flooring. 2. Facility shall be equipped with a laundry unit: washer and dryer. 3. Complaint poster (PUB475) shall be 20” x 26” in size. 4. A complete first aid kit and current first aid manual. 5. Emergency food supplies and water. 6. Theft and loss posting. 7. The dining room electricity outlet shall be fixed. The LPAs observe that the item identified for correction during initial prelicensing visit of 8/14/25 is now corrected. With the above corrections completed the facility physical plant meets requirements of Title 22 Regulations. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. LPA was greeted and granted entry by applicant Suha Abdalla. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (0) non-ambulatory, and (6) bedridden residents was submitted to CCL on 3/7/25. Structure: The facility is a one story house with an attached garage with 4 resident bedrooms, 2 full bathrooms, a living rooms, a dining room, and a kitchen. The residents’ bedrooms are spacious and will easily accommodate the residents’ furnishings. There is a large backyard with a covered patio and one exit walkway on each side of the house with seating for the residents. Signal system: Central air/heating system installed with a central panel to control the entire house. Bedrooms Residents: Bedrooms are for 6 bedridden residents. Bedrooms will accommodate 6 residents with 2 private rooms and 2 shared room accommodating two residents per.Bedrooms Staff: No bedroom designated for awake staff. Bathrooms: All bathrooms have a working toilet, wash basin, bath-tub/shower. Linens & Hygiene Supplies: Adequate supply of linen stored in hallway space closet.Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and Continued LIC809-D available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen with surplus goods stored in the kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, were tested and found operational. Appliances: Gas five-burner stove, single oven, refrigerator/freezer, microwave, are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents are stored and locked in a storage cabinet located underneath sink and in the garage storage. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 116.7 Fahrenheit degrees. Medications, First-Aid Kit & Book: Medication will be stored in a locked cabinet located in kitchen and first aid/manual is missing. Resident & Staff Files: Records will be kept locked in a cabinet in the living room by piano. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents' use, commensurate with the plan of operation. Fire clearance: Was approved on 4/8/25. Component III: Component three waived during the visit. Applicant is Licensee/Administrator of other licensed facilities. Based on the observations made during this visit, the physical plant facility does not meet the requirements of Title 22 Regulations and is not ready for licensure. The following items must be completed prior to licensure: 1. Facility bathrooms (2) shall have slip-resistant mats, strips, or flooring. 2. Facility shall be equipped with a laundry unit: washer and dryer. 3. Complaint poster (PUB475) shall be 20” x 26” in size. 4. A complete first aid kit and current first aid manual. 5. Emergency food supplies and water. 6. Theft and loss posting. 7. The dining room electricity outlet shall be fixed. Any items noted during today’s visit are to be corrected and the verifications by LPA visit. Applicant will contact LPA once they are ready for the inspection. All corrections need to be completed prior to licensure. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Abdalla, Suha On 5/29/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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 29, 2025