Monument Park Manor

Type of visit: Required - 1 Year

On 7/29/26, Licensing Program Analyst (LPA) Kyle Wellington arrived unannounced to conduct an annual inspection. LPA was greeted and granted entry by Caregiver, Teresita Mendoza. LPA met with Administrator (Admin), Carlos Magistrado, who was informed of the purpose of the visit. The census at the facility is three (3) residents. There were two (2) staff and three (3) residents at the facility during the visit. LPA received a resident and staff roster from Admin. LPA toured the inside and outside of the facility with Admin. LPA conducted an observation and record review for the inspection. Facility Overview: Facility is a one story house with staff room, four (4) resident bedrooms, three (3) resident bathrooms, kitchen, 2 dining rooms, family room, laundry room and attached garage. There are no pools, bodies of water or firearms at the facility. Facility has a fire clearance for six (6) non-ambulatory adults. Infection Control: LPA observed hand sanitizers and soap dispensers throughout the facility. Cleaning equipment and cleaning supplies were kept in the locked garage and available for regular facility maintenance. LPA reviewed the facility’s infection control plan which met the department’s requirements. Physical Plant: LPA observed the inside and outside of the facility to be clean, safe and well kept. The floors, windows and doors were clean and well maintained. The family room and dining room furniture was in good repair. The residents’ bedrooms were neat, organized and contained the required bedding, lighting and furniture. Bathrooms were clean, tidy and had paper towels, soap, grab bars and non-slip floors in the showers. Extra linen was kept in the laundry room. Laundry equipment appeared to be in good working condition. Laundry supplies were kept in a locked cabinet in the laundry room. The one (1) fire extinguisher was charged and last tested on 10/7/25 which was within the last year. LPA tested the smoke and carbon monoxide detectors and found them to be hard-wired and operational. The backyard was free of hazards and contained outdoor furniture and shaded area for the residents. Kitchen/Food Service: LPA observed the kitchen to be sanitary, organized, and well maintained. The kitchen had the ability to prepare and store food in a safe and clean environment. Kitchen appliances appeared to be in good working condition. All sharp objects were kept in a locked drawer in the kitchen inaccessible to residents. Cleaning supplies were kept in a locked cabinet under the kitchen sink inaccessible to residents. Facility has over a two day supply of perishable foods and over a seven day supply of non-perishable foods. Care & Supervision: LPA observed two (2) staff and three (3) residents at the facility. Facility has sufficient staff to supervise the residents. Administration: LPA observed facility sketch, personal rights, emergency and disaster plan, complaint procedures, long-term care ombudsman information and visiting policy posted in the hall. Admin holds a current Administrator Certificate, CPR/First Aid Certificate and a Criminal Record Clearance. Record Review and Resident/Staff Files: LPA reviewed the records of three (3) resident files and two (2) staff files. Staff present have criminal record clearance and are associated with the facility. The files contained all the required documentation and paperwork. The staff and client files were kept in a locked cabinet in the dining room inaccessible to unauthorized individuals. Health Related Services/Incidental Medical Services: LPA observed clients' medications were centrally stored in a locked cabinet in the kitchen inaccessible to residents. First aid kit was kept in a locked cabinet in the kitchen and it contained all the required items. LPA reviewed three (3) residents' medications to the facility’s medication log to make sure all medication was accounted for and dispensed correctly. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. It is current and up to date. Fire drills are done quarterly and last done on 4/30/26. Facility's property and liability insurance is current and expires on 3/29/27. All facility exits had signage and were clear of obstructions. No deficiencies were cited during this visit. An exit interview was conducted with the Administrator, Carlos Magistrado, and a copy of this report was given to Administrator, Carlos Magistrado.the state’s words, verbatim · CDSS document, Jul 29, 2026

Allegation investigated: Facility does not provide a safe environment for resdient in care. Staff member inappropriately handled resident in care.

On 09/17/2025, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit at this facility. LPA met with staff, Noel Gonzalez, who contacted Administrator Carlos Magistrado, and the Licensee, who later joined the visit. LPA explained that the purpose of this visit is to complete the investigation and deliver the findings regarding the allegations mentioned above. LPA was granted access to the facility. Investigation included: On 09/17/25, LP interviewed the Administrator (A1), the Licensee, three Residents (R4-R4), one staff member (S1), and two witnesses (W1), (W2). LPA review and obtained the following documents: Resident roster, personnel roster, service records for (S1), facility staff in-service trainings, and other relevant records related to this complaint, including (R1’s) Admission Agreement (dated 02/06/22), Identification And Emergency Information (dated 02/06/22), Physician Report LIC 602A (dated 02/07/22), Needs of Service Plan (dated 02/10/22), And Physician Report for Residents #2-4 (R2-R4) (dated 02/02/, 06/07, 10/09/24). Evaluation Report continues LIC 9099 Unsubstantiated Allegation #1: Facility does not provide a safe environment for residents in care. The complaint alleges that residents feel unsafe living at the facility. On September 17, 2025, between 9:00 AM and 11:00 AM, the Licensing Program Analyst (LPA) interviewed the Administrator, who denied the allegation and stated that the facility has staff available 24 hours a day from Monday to Sunday. The Administrator also mentioned that two caregivers are assigned to assist Resident 1 (R1) at all times. On the same day, the LPA interviewed the Licensee during the same time frame, who also denied the allegation. Additionally, three residents (R2-R4) were interviewed between 9:00 AM and 11:00 AM. They all denied feeling unsafe and expressed that they feel secure living at the facility, noting that staff are always present to assist them. On September 17, 2025, between 9:00 AM and 11:00 AM, the LPA interviewed Staff Member #1 (S1), who denied the allegations. S1 stated that the facility has a 24-hour caregiver available. S1 mentioned that when S1 worked at night, they checked on the residents before bedtime and during the night to ensure that everyone was okay. Additionally, on September 17, 2025, between 9:00 AM and 11:00 AM, the LPA interviewed Witness #1 (W1), who also denied the allegations, affirming that the facility provided a safe environment for Resident #1 (R1). Later, at 12:30 PM on the same day, the LPA interviewed Witness #2 (W2), who similarly denied the allegations, reiterating that the facility ensured a safe environment for R1. W2 explained that R1 did not return to the facility because R1 required a higher level of care following hospitalization. Unfortunately, the LPA was unable to interview R1 due to R1’s passing in April 2023. On September 17, 2025, records reviewed by LPA regarding employee schedules (dated July 30, August 30, and September 30, 2025) indicated that residents receive care and supervision 24 hours a day, every day of the week. Additionally, the LPA reviewed records of employee fire drills and emergency drills conducted between January 30 and April 15, 2025. During the visit on September 17, the LPA observed that the residents were very active and interacted with the administrator, licensee, and staff with laughter. Based on the information collected, record reviews, and interviews, the department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation that the facility does not provide a safe environment for residents in care is Unsubstantiated. Allegation #2: Staff members inappropriately handled residents in care. The complaint alleges that a staff member was torturing the client by punishment, by having the client lie at the edge of the bed. On September 17, 2025, between 09:00 AM and 11:00 AM, the Licensing Program Analyst (LPA) interviewed the Administrator (A1), who denied the allegation. A1 stated that the client never mentioned that any of that had happened. A1 emphasized that all staff receive training in residents' rights and that any staff member found to have violated a Resident’s rights would be terminated immediately, regardless of the circumstances. On September 17, 2025, between 9:00 AM and 11:00 AM, the Licensing Program Analyst (LPA) interviewed the Licensee, who denied the allegations. During the same time period, the LPA also interviewed three residents (R2-R4), all of whom denied the allegations and stated that the staff had never mishandled or punished them. They described the staff as always being very nice and helpful. Additionally, the LPA interviewed one staff member (S1) between 9:00 AM and 11:00 AM, who also denied the allegations. S1 emphasized that residents have rights and that staff should never mishandle or punish them. At 12:30 PM on the same day, the LPA interviewed a witness (W1), who likewise denied the allegations, asserting that the facility did not mishandle Resident 1 (R1) and that R1 was very happy living there. Another witness (W2) confirmed during their interview that the facility took good care of R1, explaining that R1 did not return to the facility because R1 required a higher level of care. It is important to note that the LPA was unable to interview R1 due to R1's passing in April 2023. On September 17, 2025, the LPA reviewed staff training records, which included: 20 Hours of Caregiver Training (dated 01/30/25), Catheter Care, Wound Care (dated 01/30/25), Employee Orientation Training, Aging Progress, Physical Needs, Resident Rights (dated 06/09/25). On 09/17/25, the LPA observed that the residents were very active and interacted with the Administrator, Licensee, and staff with laughter. Based on the information collected, record reviews, and interviews, the department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation staff member inappropriately handled the resident in care is Unsubstantiated. No deficiencies cited. An exit interview was conducted. A copy of this report was provided to the Administrator, Carlos Magistrado.the state’s words, verbatim · CDSS document, Sep 17, 2025 · control 18-AS-20220420145745

Type of visit: Case Management - Health Checks

On 09/10/2025, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conduct a case management visit to deliver an Immediate Exclusion order for Staff, Ismael Loyola. LPA was greeted and granted entry by Caregiver, Noel "John" Gonzales who was informed of the purpose of the visit. Caregiver Lolita Laurente was also present during the visit along with three (3) residents. During the visit, Administrator Carlos Magistrado arrived to the facility to meet with LPA and was also informed of the purpose of the visit. Upon arrival to the facility, LPA observed Staff Loyola present in the facility. LPA handed Staff Loyola and Administrator Magistrado the Immediate Exclusion orders dated 09/09/2025 and Staff Loyola immediately left the premises. LPA toured the facility with Administrator Magistrado and did not observe any additional imminent health or safety concerns. No deficiencies were issued during today’s visit. Administrator Magistrado was strongly advised to comply with the Immediate Exclusion order for Staff Loyola, which he agreed to. An exit interview was conducted and this report was reviewed and provided to Administrator Magistrado.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Case Management - Health Checks

On 08/29/2025, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced health and safety visit to the facility. LPA was greeted and granted entry by Caregiver, Noel Gonzales. Administrator, Carlos Magistrado arrived to the facility to meet with LPA. LPA toured the facility, conducted interviews, and obtained copies of documentation. Administrator Magistrado was advised to ensure that all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) obtain a criminal record clearance or exemption prior to working, residing or volunteering in the facility as required by the Department. LPA also provided a copy of the California Code of Regulations, Title 22, Division 6, Chapter 8 regulation section 87355 Criminal Record Clearance for their records. During today's visit, LPA did not observe any imminent health or safety concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Magistrado.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Case Management - Deficiencies

This Case management– Deficiencies inspection is being conducted by Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Javina George for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 18-AS-20250812102840. LPAs met with Licensee Carlos Magistrado and explained purpose of the visit. During the visit, LPAs confirmed with Licensee that an Incident report was not sent to Licensing after the event that occurred on 06-25-25. Based on observations, record review and interview, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to licensee Carlos Magistradothe state’s words, verbatim · CDSS document, Aug 14, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 21, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case (D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Licensee did not report to the Department the incident that occurred on 06-25-25 involving staff member being arresting at the facilitythe state’s words, verbatim · CDSS document, Aug 14, 2025

Plan of correction: Licensee will conduct staff training on the reporting requirements and provide proof of training and training material to LPA by the plan of correction date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver Noel Gonzales, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Licensee Carlos Magistrado joined the visit at a later time. Facility Overview: The facility is a single story building with four(4) residents bedrooms, 1 staff room, three (3) bathrooms, a dinning room, an office, a kitchen and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen and inaccessible to residents. The smoke detector and carbon monoxide detector were in good working condition. Water temperature was measured at 121.1 meeting the department's requirement. LPA observed fire extinguishers to be in compliance with the department's requirements and with an expiration date of October 07, 2025. Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise residents during the visit. The administrator holds a current administrator’s certificate with expiration date of June 05, 2027 and a CPR certification with the expiration date of January 30th, 2027 Record Review and Resident/Staff Files: LPA reviewed files for two(2) staff members, confirming criminal clearance, updated training, health screening, and CPR/First Aid certification. Two (2) residents' files were reviewed and contained all required documentation. LPA observed first kit to be available. The residents and staff files were kept locked and inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPA reviewed medications for two (2) residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on April-15-2025, which met the department's requirements. All facility exits were clear of obstructions. No deficiencies were cited during today's visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee Carlos Magistrado.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit/annual inspection. LPA George met with and informed Administrator's Genefer Gabana and Carlos Magistrado and informed them of the purpose day's visit. At the time of the visit there were two (2) staff and two (2) residents present. Below is a summary of what was observed during today’s inspection: Physical Plant: LPA toured the interior and exterior of the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. The facility was observed to have the required furniture and linen to be present and in good condition inside the occupied resident bedrooms. The exits are free from obstruction. The facility was observed to have operable flashlights. There are no pools or bodies of water on the premises. There is a shaded patio, for the residents to enjoy and to promote socialization. Staff Records Review: LPA observed that there are sufficient staff present to meet the needs of residents. LPA George additionally confirmed that there is an Administrator present. LPA George confirmed staff have criminal record clearance and were associated to the facility and have training to perform their required duties. Staff present were observed have current CPR/First Aid Certification. Resident Records Review: A review of all three (3) files was conducted and revealed that the files have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. There is one resident where the 602 was requested, but has not been received. Administrator will follow up on the request. Food Services: The kitchen and dining area to be maintained in a clean and healthful manner. LPA George observed the facility to have the required amount of 7 day supply non-perishable and a two supply perishable food items. The facility was observed to have five (5) recently (6/1/24) expired canned goods that were discarded at the time of LPAs visit, therefore no citation issued. Medication: Resident medication was observed to be stored in a locked cabinet leading to the hallway. The medication were inaccessible to residents. A review of medication revealed that the medication is being given as prescribed as evidenced by the Medication Authorization Record (MAR) and medication (bubble packs and or pill bottle). Disaster Preparedness: The facility has an Emergency Disaster Plan on file. The last emergency disaster drill was conducted on 5/29/24 .The smoke and carbon monoxide detectors were tested and were found to be operable. The facility was observed to have a fully charged fire extinguisher. There is a total of four (4) firearms on the premises that is locked in a DOJ gun locker . Per Administrator Carlos there is no ammunition here at the facility. Note that LPA did not observe any ammunition, inside the locker. The gun locker is stored in a locked/secured area. The hot water was tested and was found to be within regulatory limit measuring at 109.7-113.3 degrees Fahrenheit. The sharps and hazardous chemicals were observed to be locked and inaccessible to residents in care. Based on today's inspection there were no deficiencies cited. An exit interview was conducted and a copy of this report, were provided to Administrator's Genefer Gabana and Carlos Magistrado.the state’s words, verbatim · CDSS document, Jun 5, 2024