Marigold Board and Care

Allegation investigated: Facility did not accept resident after seeking medical attention.

Licensing Program Analyst (LPA) Jerome Haley scheduled an office meeting with Licensee/Administrator Ukarjit to complete the complaint investigation into the allegation listed above. LPA Haley explained the reason for the office meeting upon Licensee’s arrival. Regarding the allegation: Facility did not accept resident after seeking medical attention. During the investigation 4 individuals confirmed the complaint allegation. Durin interviews it was discovered that Resident 1 (R1) was sent to the hospital on Friday, February 13, 2026. Buena Park Police and Adult Protective Services responded to the facility regarding concerns about R1. Facility staff was in communication with Hospital staff in regards to treatment for R1 and a possible return to the facility. During the investigation it was discovered, on Monday, February 16, 2025, R1 was ready to be discharged and sent back to the facility. However, when R1 made it back to the facility, R1 was not accepted and/or not allowed to return. Continued on LIC9099C Substantiated It is unclear if facility staff answered the door when R1 was returned via ambulance on Monday, February 16, 2026; however, R1 was not allowed back inside and was eventually sent back to the hospital while hospital staff looked for placement for the R1. Based on the evidence gathered through interviews, the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22. An exit interview was conducted, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 16, 2026 · control 22-AS-20260217104121

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Mar 20, 2026

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thrity (30) days written notice is required except as otherwise specified in paragraph (5). This requirement is not being met as evidenced by: R1 was not accepted back by facility staff after being released from the hospital. R1 was eventually sent back to the hospital and never returned to the facility.the state’s words, verbatim · CDSS document, Mar 16, 2026

Plan of correction: Licensee will read and review regulation section 87224 and email LPA Haley a signed statement of acknowledgement and understanding.

Allegation investigated: Staff does not provide adequate food service for resident.

Licensing Program Analyst (LPA) Jerome Haley scheduled an office meeting with Licensee/Administrator Ukarjit to complete the complaint investigation into the allegation listed above. LPA Haley explained the reason for the office meeting upon Licensee’s arrival. Regarding the allegation: Staff does not provide adequate food service for resident. During the investigation, 3 of 4 individuals confirmed and/or provided information that supports the complaint allegation. During the investigation it was discovered that Resident 1 (R1) is diabetic and on a special diet. However, it was discovered, R1 has complained to facility staff they're still hungry and/or they did not have enough to eat. Accroding to medical records, R1 has had a 2-centimeter loss in arm circumference since December 2025. Continued on LIC9099C Substantiated Based on the evidence gathered through interviews, the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22. An exit interview was conducted, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 16, 2026 · control 22-AS-20251223153341

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Mar 20, 2026

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings, and equipment. This requirement is not being met as evidenced by: R1 has reported that they are still hungry after eating meals, they have been denied the opportunity to eat additional food, and has shown signs of weight loss.the state’s words, verbatim · CDSS document, Mar 16, 2026

Plan of correction: Licensee will read and review the regulation section, and licensee agrees to provide a detailed plan on how to ensure residents: (1) will receive the proper amount of food, and (2) be provided with additional food or snacks when requested. POC will be emailed to LPA Haley by 2:00PM on the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six non-ambulatory residents, one of which may be bedridden. As of today, the facility has five residents admitted to the facility. Four residents were present during the visit. There’s a total of 4 bedrooms, 3 of which are for residents. One bedroom is being used as an office space. There are two restrooms, one for residents and one for staff. The staff restroom is locked, but can be used by residents. There’s a living room space, a dining space and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, sink, and tub/shower. Grab bars are tightly secured to the wall. Hot water measured at 113.7 degrees F. Kitchen: 4 of 4 burners were operational on the gas stove. Sharps are kept locked in the medication cabinet next to the refrigerator. Cleaning solutions are stored in a locked cabinet below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Client & Staff Files: Resident and staff files stored in a locked cabinet in the staff office room. File Review: 3 of 5 resident files were reviewed during the visit, and 3 staff files were reviewed. of 5 resident medications were reviewed during the visit. Continued on LIC809C Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet in the kitchen. Medication Review: 3 of 5 resident medications were reviewed during the visit. Linens & Hygiene Supplies: Hygiene items were observed in the main hallway cabinet with a supply of clean linens. An additional linen supply was observed in the staff office. Garage Area: The garage is organized and used mainly as a storage area. A washer and dryer was observed. An additional refrigerator was observed. Miscellaneous facility items were observed: matts, walker, and incontinent care supplies to name a few of the items observed. An emergency supply of water and emergency food was observed. Backyard/Exterior: The backyard is organized. Walkways are free of obstruction. A table with some chairs was observed under a shaded patio area. A storage shed used to store facility items like walkers, and wheelchairs was observed. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted on a wall in the main hallway and inside the garage near the door to enter the kitchen area. An emergency evacuation drill: June 30, 2025. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted, and available for review on the main postings wall as soon as you enter the facility. Additional Comments: Licensing fees are past due. LPA called the licensee during the inspection in regards to the licensing fees. LPA was expecting a call back before the end of the visit. LPA will follow up with licensee regarding the annual fees. During the visit, 3 of 5 resident files were reviewed, and medications were reviewed for 3 of 6 residents. 3 staff files were reviewed during the visit. Facility telephone number and the additional contact information was confirmed during the visit No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 18, 2025

Allegation investigated: Facility staff failed to properly report resident falls.

Licensing Program Analyst (LPA) Jerome Haley made unannounced follow up visit regarding the complaint allegation above. LPA explained the purpose for the visit upon entry. Regarding the allegation above, 3 of 5 individuals interviewed confirmed R1 has fallen in their bedroom and while out of the facility. During interviews, S1 admitted that all R1’s falls were not reported to the department. S1 explained reports were not written for falls that happened outside of the facility while the resident was at church or for falls that occurred in R1’s bedroom. S1 explained R1 would slip/trip/fall while in their bedroom due to the room being cluttered with the residents own belongings. According to S1, R1 fell down to one knee and had to be assisted up by two caregivers on duty. S1 explained there was no incident report submitted after that fall when R1 went down to one knee. Further, S1 confirmed R1 fell in their room and hit another residents walker causing some discoloration. Continued on LIC9099C Substantiated According to S1, caregivers assess the residents for injuries after falls, S1 mentioned they encourage all their residents to use their walker when ambulating, and they advise residents to keep walkways in their room free of clutter. Based on the evidence gathered through interview confirmation and document review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22. An exit interview was conducted and a copy of this report and appeal right were provided.the state’s words, verbatim · CDSS document, Jul 30, 2025 · control 22-AS-20250512085342

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 1, 2025

87211 Reporting Requirements (a) Each licensee shall furnish...reports as the Department may require, including, but not limited to... (1) A written report shall be submitted to the licensing agency... within seven days of the occurrence of any of the events specified... below. This report shall include the resident’s name, age...disposition of the case. This requirement is not being met as evidenced by: Administrator Gatlin confirmed no incident reports were completed and submitted to the department when R1 fell while outside of the facility or when R1 fell to their knee while in their room.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Administrator Gatlin will read and review the regulation section on reporting requirements and email LPA Haley a signed statement of acknowledgement and understanding by 4:00pm on the POC due date.

Allegation investigated: Facility is in disrepair

Regarding the allegation: Facility is in disrepair During the visit LPA Haley walked around the facility with staff to make a few observations. During the tour of the interior and exterior of the facility observations were made and photos were taken. During the tour of resident bedrooms, LPA observed one of the ceiling fans was not working in one of the resident bedrooms. After speaking to a staff member about the ceiling fan in the residents room, the staff member stated the maintenance person will come fix the ceiling fan tomorrow (Wednesday May 7th) morning. Based on the evidence gathered through interviews and observations, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22. An exit interview was conducted, and a copy of this report, and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, May 6, 2025 · control 22-AS-20250429145933

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 13, 2025

(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 being met as evidenced by: The ceiling fan in one of three resident rooms was not in good working order. The light worked, but the fan was not operating.the state’s words, verbatim · CDSS document, May 6, 2025

Plan of correction: Administrator stated the maintenance person will come and repair the ceiling fan tomorrow (5.7.25) morning. Administrator will email LPA Haley a video of the ceiling fan being turned on and spinning on it's own.

Allegation investigated: Facility does not provide enough food Facility staff not providing resident's with prescribed medication Facility staff are placing restrictions on residents

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received April 29, 2025. LPA Haley was greeted by staff and explained the reason for the visit upon entry. During the visit interviews were conducted with staff, residents, observations were made, and photos were taken. Regarding the allegation: Facility does not provide enough food During the investigation, 4 of 5 residents’ interview during the investigation denied the allegation. One of the residents stated they cook two times a week and whatever they need, facility staff will buy. One of the residents did not have a problem with the amount of food served, but stated the food is not always served warm. One of the residents interviewed stated they received enough food, but the resident stated they’re always hungry. The resident has talked to their physician about their hunger issue which is related to the resident’s diagnosis. Continued on LIC9099C Unsubstantiated The one resident who made a statement about the amount of food being served, later on during the interview the same resident said they’ve lost weight because they’ve chosen to eat less and drink less water. Regarding the allegation: Facility staff are not providing resident's with prescribed medication During the visit, 5 of 5 residents stated they received their medications. One of the residents receives their blood pressure medication after they return from dialysis because if they take it before they do to dialysis their blood pressure would drop too low, so the medication is administered when the resident returns home. One of the residents say they don’t take too much medication staff always prepares their medications for them, so the resident can take them on time. During a review of resident medication administration records (MAR) for 3 of 6 residents, medications were administered as prescribed, according to the MAR. Regarding the allegation: Facility staff are placing restrictions on residents During the visit, 0 of 5 residents were able to provide any evidence or information to support the allegation. According to one of the residents they can’t go anywhere alone. Staff also denied any restriction have been placed on any of the resident other than normal house rules. One of the staff explained one of the residents was recently married and their partner comes to the facility a lot, so staff had to speak to the resident about privacy of their roommate because the recently married resident has a roommate. Staff explained to the newly married resident they have to make sure their partner is not violating the privacy of the roommate. Based on the information gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there’s not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations above are deemed Unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 6, 2025 · control 22-AS-20250429145933

Allegation investigated: Staff does not ensure resident's dietary needs are being met. Staff does not ensure resident is administered the correct prescribed medications. Staff does not ensure resident's hygiene needs are being met.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to follow up and deliver findings in the investigation of the three allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Tranae Gatlin was notified via telephone and arrived later to assist with the visit. An initial complaint investigation visit took place on January 10, 2025. During the visit, LPA accompanied by staff conducted a tour of the facility's physical plant. There are currently six residents in care. LPAs requested and obtained resident records for all six individuals. Two staff and three resident interviews conducted during the visit. Additional witness interviews were conducted over the course of the investigation. During the follow-up investigation visit, LPA conducted one additional resident interview. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff does not ensure resident's dietary needs are being met, the following has been concluded: Based on observation and interviews conducted with residents present at the facility, it was confirmed that a variety of food was present at the facility and being offered to residents. Additional evidence showed occasional refusals to eat formulated by a resident due to health and/or gastro-intestinal concerns. A majority of the statements gathered demonstrated satisfaction in the meals provided by the facility in terms of quantity and variety, and confirmed the availability of snacks upon demand. Regarding the allegation that Staff does not ensure resident is administered the correct prescribed medications, the following has been concluded: A majority of the statements made by residents confirmed that they believed they were receiving their medication timely and adequately from facility staff. A review of the medication administration records provided by facility staff appeared to corroborate the statements made by residents, staff and witnesses. Regarding the allegation that Staff does not ensure resident's hygiene needs are being met, the following has been concluded: Most of the residents interviewed expressed their satisfaction with the toileting care and assistance provided by facility staff. One resident stated that their roommate's hygiene was occasionally problematic but denied that it was due to staff negligence as she described toileting care being offered on regular instances by staff. On the basis of the evidence gathered during the present investigation, all three allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of the present report was provided to a facility representative.the state’s words, verbatim · CDSS document, Mar 12, 2025 · control 22-AS-20241231115747

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Hanna Gough made an unannounced visit to the facility for the purpose of conducting a case management inspection documenting a deficiency observed during the investigation of complaint reference 22-AS-20241231115747. During the initial complaint investigation, facility staff was unable to provide proof of background clearance for staff member S1, who was stated to have been recently hired to work at the facility. S1 could also not be located in Guardian by licensing staff. As a result, a type A deficiency is being cited along with an immediate civil penalty. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 10, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jan 11, 2025

Per CCR Section 87355(e)(1) regarding Criminial Record Clearance: "All individuals subject to a criminal record review (...) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance (...)". This requirement is not met as evidenced by: Based on records review, facility staff was unable to provide proof of a background clearance for one staff member present on the premises. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Jan 10, 2025

Plan of correction: Staff member S1 instructed to leave the premises and confirmed to have been removed by licensing staff. Licensee will submit a fingerprinting application or proof of a valid background clearance to LPAs. IMMEDIATE CIVIL PENALTY ASSESSED.