Mi Luna Assisted Living

Type of visit: Case Management - Deficiencies

On July 28, 2026, Licensing Program Analysts (LPAs) Taylor Simerly and Eboni Bentley conducted a case management visit after observing a deficiency while conducting complaint investigation into control #22-AS-20260721153359. Per record review, Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), and Staff #4 (S4) do not have a record of their initial training and Health Screening Report (LIC 503). Licensee Jason Gettler reported the following start dates for the staff; S1 started on April 3, 2026, S2 started on May 18, 2026, S3 started on July 17, 2026 and S4 started on May 25, 2026. A deficiency 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, LIC809-D, LIC811, and appeal rights were provided to Jason Gettler, Licensee.the state’s words, verbatim · CDSS document, Jul 28, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(1) · Plan of correction due date: Aug 11, 2026

The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with... to receive appropriate training. This training shall consist of 40 hours of training... This requirement is evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above as three out of four staff did not have initial training. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 28, 2026

Plan of correction: Licensee stated they will have staff complete required training and send proof to LPA Bentley via email by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(f) · Plan of correction due date: Aug 11, 2026

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is evidenced by: Based on observation and record review, the licensee did not comply with the secti.on cited above in four of four staff files, which poses an immediate health and safety risk to persons in care. A record review revealed that four staff members do not have a completed Health Screening Report (LIC 503)the state’s words, verbatim · CDSS document, Jul 28, 2026

Plan of correction: Licensee stated they will complete all staff files and submit proof to LPA Bentley by POC due date.

Type of visit: Prelicensing

On May 7, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived announced for the purpose of conducting the Pre-Licensing visit for an Initial Application. LPA conducted the visit with Applicant Jason Gettler and Consultant John Atencio. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on June 18, 2025, for age range 60 and older, with Fire Clearance approved for five (5) non-ambulatory residents and one (1) Bedridden resident in Room #5. The applicant stated there is a pending request for a Hospice waiver for six (6). LPA toured the facility's indoor and outdoor physical plant with Applicant Jason Gettler. The following were observed: Structure: The facility is a single-story property in a residential neighborhood comprised of five resident bedrooms, three full bathrooms, and an attached two car garage. The common areas include the living room, dining area, kitchen, and backyard were observed. LPA observed an ADU in the backyard that is not on the facility sketch and separate from the facility. Cameras were observed on the front door and in the following common areas: interior entry way, dining room/kitchen, and hallway. Telephone Number: The facility currently has a land line with the number (657)204-9240. CONTINUE TO LIC809-C .... Emergency Phone Numbers/Exit Plan: Posted in the entry way. Postings: The See Something, Say Something (PUB475) was posted in the correct size and all other required posting were available in the entry way. Food Service and Menu: Supply of seven-day non-perishable and two-day perishables were observed in the kitchen. The emergency food and water supply were also available. LPA observed the Activity Schedule and Food Menu posted. Smoke and Carbon Monoxide Detectors: The smoke detectors and carbon monoxide alert systems were tested and found operational. Fire Extinguishers: A fire extinguisher was mounted, fully charged, and purchased on October 10, 2025. Fire Clearance: Approved on October 13, 2025, for five (5) non-ambulatory residents and 1 Bedridden resident in Bedroom #5 only. Signal System: The facility does not signal system. Bedrooms: The resident bedrooms had all required components and accommodate the residents’ furnishings. All rooms and closets contained space for residents’ personal items and belongings. CONTINUE TO LIC809-C .... Bathrooms: Bathrooms were clean with grab bars were available near toilets and in showers, and slip mats were present. Water Temperature: The water temperature in the resident bathroom measured between 110.3 and 114.4 degrees Fahrenheit. Linens and Hygiene Supplies: Clean linens and hygiene supplies for resident use were fully stocked. Appliances: Stove burners, microwave, refrigerator, freezer, and washer/dryer were inspected and operating. Resident and Staff Files: Resident and staff records will be maintained on site. Medication: Medication will be secured in a closet in the hallway. Reading Material, Games, Equipment, & Materials: Games and activities were available. Sharps and Toxins: Sharps will be secured in drawer in the kitchen and inaccessible. Cleaning supplies and toxins were observed locked under the sink. Medications, First Aid Kit, & Manual: The First Aid Kit was checked and contains all the required elements. CONTINUE TO LIC809-C .. Liability Insurance and Surety Bond: Facility does not have liability insurance for the new facility. A proposal for liability insurance protection was requested Component III was waived by the applicant as their consultant present and available, fulfilling the requirements previously for existing facilities. On today's visit, all items reviewed during this inspection are in compliance. The Pre-Licensing is now complete. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with the above individuals, and a copy of this report was provided at the time of this visit.the state’s words, verbatim · CDSS document, May 7, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 06 Census : 0 Method: Telephone call with CAB COMP II Participants: ATENCIO, EFRYLN; GETTLER, JASON Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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, Apr 6, 2026