Moai

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Craig M. Fowler, to obtain a signature relative to amending a report for an inspection conducted on April 28, 2026. Signature was obtained for amended document during visit. Exit interview was conducted. A copy of this report and was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 6, 2026

Allegation investigated: Staff spoke to resident in an inappropriate manner.

Licensing Program Analyst (LPA) Michael Hood arrived at the care home and met with Administrator, Craig M. Fowler, to deliver findings regarding the complaint allegation listed above. During the investigation, LPA conducted interviews and toured the premises. The results of the investigation are as follows: Allegation: Staff spoke to resident in an inappropriate manner. Relevant party reported that to the Department concerns regarding how Administrator communicates with resident (R1), including witnessing Administrator yelling at R1. ** Report continued on 9099-C ** Substantiated Interviews with staff member (S1) and residents R1 and R2 indicated that they have witnessed staff speak in an inappropriate manner with R1. R1 stated that Administrator and staff member (S2) yelled at them. R1 stated that Administrator did not treat them with dignity and respect. R1 stated that there have been multiple incidents in which Administrator become “enraged.” R1 stated that Administrator has gotten in their face and screamed at the top of their lungs, causing spit to get on their face. R1 stated that they have cried all night because of the way they have been treated by Administrator. S1 stated that facility staff treated R1 “terribly.” S1 stated that they heard that S2 yelled at R1 to get out of the house. R2 stated that they heard staff talk inappropriately to R1 while their bedroom shared a wall with R1's bedroom. R2 stated that Administrator spoke inappropriately to R1 and did not treat R1 with dignity and respect. During interview conducted with Administrator, LPA observed a recording initiated by Administrator in which Administrator spoke to R1 on Saturday, September 27, 2025 at around 7:45 AM. LPA observed Administrator tell R1 that R1 "can stay and make it as miserable for everyone as [R1] wants to make it." Based on interviews conducted and observations, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. Interview with R1 indicated that Administrator took $45,000 from R1’s Banker’s Life Long-Term Care Insurance. R1 stated that their account was depleted and that it wouldn’t be replenished until February 2026. R1 stated that they did not know how much Administrator charged R1 a month in rent. R1 stated that they handle their own money and have access to their bank accounts. R1 stated that Banker’s Life is a life insurance policy that offers long-term care coverage. R1 stated that they pay a premium of $200 a month to live at the facility. R1 stated that they have lived at the facility for a little over a year. R1 stated that the insurance pays directly to Administrator. R1 stated that their rent has always been paid this way. Interview with BLI Representative indicated that they provided R1 long-term care insurance in the amount of approximately $45,000. BLI Representative stated that they were approved to provide funds to Moai for R1. BLI Representative stated that the last expenses provided to Moai were for December, 2024. BLI Representative stated that R1’s benefits were exhausted at the time. BLI Representative stated that Moai collected money every month, from June, 2024 to December, 2024. BLI Representative stated that checks were sent to R1’s name and sent directly to the policy owner to the address registered. BLI Representative stated that they received a request for additional funds in June, 2025, but claim was not paid and denied due to benefits "maxing out" in December, 2024. BLI Representative stated that, in order for R1 to restore benefits, they would need to stop receiving any kind of professional care after six (6) months of no services, and they would need to file a claim for a different condition than their previous claim. BLI Representative stated that June, 2025 claim was denied because professional care did not cease for six (6) months and R1 did not file a claim for a different condition. BLI Representative stated that they did not have any evidence of theft regarding R1’s benefits. Interview with Administrator indicated that R1 pays $6,000 a month for rent. Administrator stated that R1’s rent is paid via their BLI. Administrator stated that they bill R1’s BLI directly. Administrator stated that R1’s insurance has expired. Administrator stated that R1’s insurance expired because R1 did not renew their contract with the insurance company. Administrator stated that R1’s insurance was covering the full $6,000 and capped at $45,000. Administrator stated that R1’s insurance ended February 2025. Administrator denied taking anything from R1. Interview with staff member (S2) indicated that they have never went through a resident’s property. S2 stated that they knew what R1 had and never observed anyone, including Administrator, going trough R1’s property. ** Report continued on 9099-C ** LPA observed R1’s Admission Agreement and invoices for the time in which R1 resided at the care home. LPA observed R1 was charged fees in accordance with their Admission Agreement. LPA did not observe any evidence of misappropriation of R1’s funds. Allegation: Staff did not ensure that facility was clean and sanitary. Allegation: Staff did not ensure resident’s room was free from odors. Allegation: Staff did not ensure residents’ furniture was in good repair. R1 stated that facility staff do a good job keeping the facility clean and sanitary. R1 stated that they feel the facility is clean and sanitary. R1 stated that they feel the facility is free of odor. R1 stated that no furniture at the facility is broken or in disrepair. R1 pointed out to LPA that there was a bolt that was loose on their bed (during visit, LPA mentioned screw to Administrator, who stated that they were not informed regarding the screw. Administrator fixed bed during visit.) Interviews with Administrator, staff member (S2), and Witness (W1) indicated they have never observed the care home to be unclean, malodorous, or in disrepair. Administrator stated that they had issues with the care home's washing machine balancing loads of laundry and has replaced the washing machine at the care home. During visits conducted on September 19, 2025, September 30, 2025, and October 28, 2025, LPA did not observe the facility to be unclean, malodorous, or in disrepair. Allegation: Staff did not ensure food was properly stored. Relevant party reported that staff cut vegetables or fruits and leave them sitting out instead of putting them in a container or storing them in the refrigerator. Relevant party reported that, if there is a rotten part to a fruit or vegetable, staff will just cut that part off and use what is left for the residents. Interviews with R1, R2, S2, W1, and Administrator did not indicate any concerns regarding food not being properly stored or handled. During visits conducted on September 19, 2025, September 30, 2025, and October 28, 2025, LPA did not observe any food items on the premises that were not properly stored. ** Report continued on 9099-C ** Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 59-AS-20250916091855

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 12, 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted and observations, the facility did not ensure that R1 was treated with dignity and respect, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 28, 2026

Plan of correction: Facility will complete a statement of understanding regarding regulation 87468.1 and submit statement to LPA by POC due date of May 12, 2026.

Allegation investigated: Facility staff physically abused resident in care.

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Craig Fowler, to deliver findings into the complaint allegation listed above. During the investigation, LPA conducted interviews, toured the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Facility staff physically abused resident in care. ** Report continued on 9099-C ** Unsubstantiated Interview with resident (R1) indicated that they moved into the facility on May 5, 2024 and are a family member of Administrator. R1 stated that they were physically assaulted by Administrator and staff member (S1). R1 could not recall time and date in which Administrator assaulted them, however, R1 stated that there was a witness (W1) who observed Administrator physically abuse R1. R1 stated that W1 will deny allegation to protect Administrator. R1 stated that S1 assaulted them on September 20, 2025 in their bedroom. R1 stated that there were no witnesses who observed S1 assault them. They contacted local law enforcement, but they felt that law enforcement didn't do anything. Interviews with Administrator and S1 indicated that they have never witnessed anyone physically abuse R1 or any other resident. Administrator and S1 both denied ever being physically abusive to R1 or any other resident. Administrator indicated that they have never been in a physical altercation with R1 and indicated that they ensured there was a witness when conversing with R1. Interview with W1 indicated that they have never witnessed physical abuse at the facility involving anyone. W1 denied witnessing Administrator physically assault R1 at the facility. W1 stated that they have spent a fair amount of time at the care home and they have never witnessed physical abuse. LPA contacted local law enforcement for records and information regarding 9-1-1 calls made from the care home on September 20, 2025, September 21, 2025, and September 22, 2025. LPA spoke with local law enforcement representative via telephone call, who stated that no police report was completed regarding incidents. Local law enforcement representative stated that there was a "disturbance" at the facility on September 20, 2025, September 21, 2025, and September 22, 2025, but no crime was found to be committed. Local law enforcement representative stated that there were no physical abuse claims made for any of the 9-1-1 calls mentioned above. Local law enforcement representative stated that there were claims of staff withholding medications from resident, staff yelling at resident, and staff pushing wheelchair of resident to face wall. Local law enforcement representative stated that all parties were advised of their options. Local law enforcement representative stated there were claims of mental abuse but not physical. LPA received Event Details documents from law enforcement which corroborated statements made by local law enforcement representative. ** Report continued on 9099-C ** Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Licensee. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 59-AS-20251021153337

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Craig M. Fowler, to address concerns discovered during a separate inspection conducted on September 30, 2025. LPA observed a doctor's order for resident (R1) dated August 28, 2025 stating "patient is unable to manage [their] meds caretaker advised to manage meds." LPA observed that R1 was managing their own medication during visit conducted on September 4, 2025. LPA observed R1's medications in Administrator's possession during visit conducted on September 19, 2025. Interview with Administrator indicated that they took over R1's medications on September 19, 2025. LPA observed a "30 Day Notice to Perform or Quit" in R1's possession. R1 stated that notice was issued to them on September 26, 2025. Interview with Administrator indicated that notice was issued to R1 on September 24, 2025. Interview with Administrator indicated that they informed R1 verbally that they would be facing eviction prior to issuing notice to R1. Notice indicates that R1 must have themselves and their possession removed from the premises on October 22, 2025, which is less than 30 days from the date issued. Per Title 22, Residential Care Facilities for the Elderly are not to issue notices to perform or quit to residents in care. ** Report continued on 809-C ** During today's visit, LPA observed a recording of Administrator speaking with R1. LPA observed Administrator mention to R1 that they may be issued a 3-day eviction notice at a later time. Interview with R1 indicated that they were aware of a potential 3-day eviction notice being issued. During today's visit, LPA observed pool in backyard to be empty of water and accessible. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on the attached 809-D pages. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Sep 30, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 1, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews conducted, observations, and records reviewed, the facility did not ensure to follow doctor's orders regarding R1's medications, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 30, 2025

Plan of correction: Facility will complete a statement of understanding regarding regulation 87465 and submit statement to LPA by POC due date of October 1, 2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87224(a) · Plan of correction due date: Oct 1, 2025

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). Thirty (30) days written notice to the resident is required (...). This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to issue a lawful eviction notice and provide 30-days notice upon issuance, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 30, 2025

Plan of correction: Facility will rescind notice issued to R1 in writing and submit written rescission to LPA by POC due date of October 1, 2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Oct 1, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by: Based on observations and interviews conducted, the facility did not ensure that R1 was free from intimidation when verbally informed of eviction prior to issuance of notice, informed of 3-day eviction, and issued a notice to perform or quit, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 30, 2025

Plan of correction: Facility will complete a statement of understanding regarding regulation 87468.2 and submit statement to LPA by POC due date of October 1, 2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Nov 30, 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 is not met as evidenced by: Based on observations, facility did not ensure that backyard of facility was in good repair with accessible empty pool, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 30, 2025

Plan of correction: Facility will either install gate surrounding pool and fix pool, or fill in pool with cement, by POC due date of November 30, 2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on September 4, 2025 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four (4) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 115 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA reviewed one (1) resident's medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed two (2) resident files and one (1) staff file. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual inspection. LPA met with Licensee/Administrator and explained the purpose of the visit LPA is conducting an annual inspection today but this report is being generated to clear the Post-Licensing inspection in the system. There are no citations issued on this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Required - 1 Year

On 9/10/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection visit utilizing the care tool. LPA met with Licensee/Administrator, Craig Fowler, and explained the purpose of the visit. During today's visit, LPA observed one caregiver present, census of two residents in care, with one resident on hospice services. Facility is licensed for five non-ambulatory, hospice waiver of three. File review conducted for three personnel records and two resident records. Records were not complete. LPA provided Licensee the following copies: HSC 1569.625 LIC 311F LIC 501 LIC 503 LPA and Licensee conducted a medication audit and observed R1's medication list to be outdated. LPA observed Trazodone 100mg present but with old physician order of Trazodone 50mg. LPA and Licensee discussed obtaining updated medication list and keeping all updated telephone orders on file. LPA and Licensee conducted a tour of the facility to ensure the health and safety of residents in care. LPA observed facility to have 2+ days of perishable and 7+ days of nonperishable foods. LPA observed cleaning supplies, medication and sharps to be stored inaccessible to residents in care. LPA observed fire extinguisher present with service date of 3/22/2024. LPA observed two residents in their private rooms resting. Additionally, LPA is requesting LIC 500 and liability insurance to be emailed to LPA by 9/17/2024. As a result of today's inspection, deficiencies were observed and cited. Please see LIC 809-Ds. Exit interview, a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Case Management - Licensee Initiated

On 3/27/2014, Licensing Program Analyst (LPA) Cassie Yang arrived to the facility to conduct a case management visit initiated by Licensee to discuss the fire clearance. LPA met with Licensee, Craig Fowler. During today's visit, LPA obtained an updated LIC 200, facility sketch and physical check for capacity increase. LPA informed Licensee that updated facility license will mailed to facility once generated. Additionally, LPA will provide an electronic copy to Licensee via email. No deficiencies cited. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2024

Type of visit: Case Management - Incident

On 2/23/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a case management visit regarding a death report the department received on 2/20/2024. LPA met with Administrator, Craig Fowler, and explained the purpose of the visit. Note: During time of LPA's visit, it was joined by Sacramento Metro Fire for fire clearance inspection. Facility was approved for change of ambulatory status to capacity of three- 2 ambulatory and 1 non-ambulatory. LPA will have license updated and mailed to facility once effective on system. LPA and Administrator discussed that on 2/17/2024, R1 passed away in her sleep. Administrator reported R1 was on hospice services. Based on file review, LPA observed that R1 has a LIC 602 PHYSICIAN'S REPORT FOR RCFE on file that states R1 had non-ambulatory status. Additionally, LPA conducted a file review for R2 and observed R2's LIC 602 on file that states R2 has non-ambulatory status. Facility was originally licensed for three (3) ambulatory. End of visit, facility was cleared for fire clearance of one non-ambulatory. R2 has been relocated to a non-ambulatory approved room. During today's visit, deficiencies was cited. Exit interview and a copy of report and appeal rights provided to Administrator via email.the state’s words, verbatim · CDSS document, Feb 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Feb 24, 2024

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license... This requirement is not met as evidenced by: Based on file review, Licensee did not comply with the section cited above as R1 and R2 was accepted to the facility when facility was not licensed for non-ambulatory residents, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2024

Plan of correction: Licensee has moved R2 to an approved non-ambulatory room. Licensee will submit a statement of compliance to operate based on licensure. POC due 2/24/2024.

Type of visit: Case Management - Annual Continuation

On 10/4/2023, Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived to the facility unannounced to conduct a case management visit to complete the inspection tool from annual inspection conducted on 09/27/2023. LPAs met with Licensee, Craig Fowler, and explained the purpose of the visit. LPAs completed the CARE tool which was not finalized during last visit. During today's visit, no deficiencies cited. Exit interview, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 4, 2023