Moonstone Care Home

Allegation investigated: Staff yell at residents

Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility to conclude the complaint investigation and deliver the findings on the allegation listed above. LPA was greeted and granted entry into the facility by House Manager, Clarita Navab. Clarita notified Administrator of LPA arrival. Later during the visit Administrator Arminda Lopez met with LPA and LPA explained the purpose of the visit. During the investigation LPA, conducted a tour of the facility, reviewed and collected documentation, interviewed staff and residents in care. The allegation is staff yells at residents. LPA conducted interviews with staff and residents. Interviews with four (4) out of four (4) staff revealed that staff do not yell at residents in care. Staff stated they have a pretty good relationship with residents in care. Interviews with S1, S2, S3, and S4 revealed that staff have not observed any caregivers being rude or mistreating residents in care. Unsubstantiated LPA interviewed five (5) residents in care. Interviews with R1, R3, R4 and R5 revealed the S1 is nice and treat residents good. Interviews with residents revealed that overall all staff treat residents in care with dignity and respect. During LPA's visit and based on LPA's observation it appears that care, supervision, and respect is provided to residents in care. Based on interviews, and observation the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report LIC 9099 and LIC 9099C was discussed, and a copy was provided to Licensee, Arminda Lopez.the state’s words, verbatim · CDSS document, Jul 10, 2026 · control 56-AS-20260430133303

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow, arrived at Moonstone Care Home, to conduct an unannounced comprehensive annual inspection. LPA was greeted and granted entry by House Manager Clarita Navab. LPA introduced self and stated purpose of the visit. Clarita informed Licensee Arminda Lopez, of LPA's arrival. During the course of the visit LPA completed a tour the facility inside and outside and observed the following: Physical Plant: Facility is a one story house with five residents bedroom, one staff bedroom, two bathrooms, living room, family room, dining area, kitchen, pantry, laundry area, backyard and an attached two car garage. The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, chair, storage space, and sufficient lighting. LPA inspected client bathrooms; bathrooms were clean and appliances were found functional. LPA observed that facility has a sufficient supply of hygiene items for residents in care. Water temperatures tested at 119.9 and 117.5 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and charged fire extinguisher which were tested 4/6/2026. LPA observed poster on display for personal rights, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets, inaccessible to residents. There was a designated storage space for client/staff files. Medications and first aid kit were in secure cabinets and inaccessible to clients. There are no firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions. Food Service: LPA observed that the facility has a sufficient supply of perishable and non-perishable items. The facility has sufficient supply of dishes, cups, and utensils were also stored properly. Emergency food and water were observed. (See LIC809C) Yards/Outside: LPA observed one shaded patio, a side gate with self-latching handle on the left and right side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Record Review: LPA reviewed Administrator and 2 staff files for First Aid/CPR certification, criminal record clearance, training, health screenings and TB test. LPA reviewed 3 residents files for admissions agreements, pre-admissions appraisals, physician's reports, and care plans. Personnel records and residents file appeared to be complete and in order. LPA conduct an Audit of the residents MARs for three (3) out of three (3) residents in care. During the audit the facility received a package from Amazon with a bottle of Vitamin B Complex, that was ordered by the residents family to issue to the resident. LPA advised the facility to verify with the doctors that this vitamin is prescribed and authorized to be given with other medication being issued. A Technical Advisory issued. LPA conducted an audit of facility records, for LIC610E, Emergency Disaster Plan, LIC9282, Infection Control Plan, Liability Insurance, and Fire Drills. Based on LPA observation and document review the facility folder appears to be maintained. During today's visit no deficiency was cited one technical advisory issued per Title 22, Chapter 6 of the California Code of Regulation. An exit interview was conducted where this report LIC809, and LIC809C, was discussed and copies were provided to Licensee, Arminda Lopez.the state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) LaVette Farlow, arrived at Green Willow Home Care, to conduct an announced Pre-Licensing visit for a change of ownership and change of facility name to Moonstone Care Home. LPA was greeted by Licensee Arminda B. Lopez. LPA introduced self and stated purpose of the visit. Moonstone application was submitted on 09/04/2024 for 6 RCFE, Non-Ambulatory clients. Fire Safety Inspection clearance was granted for 5 Non-Ambulatory clients and 1 Bedridden. LPA toured the facility inside and outside and observed the following: Structure: Facility is a one story house with five client bedrooms, one staff bedroom, two bathrooms, living room, family room, dining area, kitchen, pantry, laundry area, backyard and an attached two car garage. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: All bedrooms have the required bedding and furniture, such as, clean mattresses/linen, night stands, dressers, chairs, and lighting. Per facility sketch it states that bedroom #6 and bed #2 is for bedridden residents, which is currently unoccupied. Bathrooms: The client bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. The bathroom water temperature was measured 119.5, which is in regulation. (See LIC809C) Common Sitting Areas: There is adequate seating in the common areas. The facility has a supply of activities for the residents. During LPA tour of the facility, LPA observed resident watching an exercise video with staff assisting and encouraging residents to participate. Kitchen/Laundry Room/ Garage: There was a locked and secured location where medication, sharps, chemicals and residents/staff files are stored. There was non-perishable food in the pantry and perishable food in the refrigerator. The water temperature was measured at 113.8 degrees Fahrenheit. The laundry machines is in a common area in the kitchen next to an exit to the backyard. The garage has an emergency supply of food, water, and hygiene items. Chemicals, laundry soap and toiletries were safely locked. Backyard: There is covered patio, furniture and chairs in the backyard for residents to sit. There are two side gate with self-latching handle on the left and right side of the house that leads into the backyard and no bodies of water. All passageways were free from obstruction. Fire extinguisher, carbon monoxide, firearms: There is one charged fire extinguisher in the facility. LPA observed operating smoke detectors and carbon monoxide alarms. The home does not have any firearms and ammunition. Postings/ Facility Records: LPA observed required postings including the CCL complaint poster, emergency disaster plan, and facility sketch. LPA reviewed three (3) out of three (3) residents files for Physicians report, Admission agreement, Appraisal needs and service plan, and MARS. After careful review of records LPA observed that the file were free of discrepancies. LPA reviewed three (3) out of three (3) staff files. LPA reviewed staff files for the following records: Health Screening Reports, TB clearance, Personal Records, and background clearance. LPA observed files to be free of discrepancies. First aid and telephone: The facility was equipped with a complete first aid kit. The facility has a functioning land line and telephone for clients use. Pre-Licensing is complete and Comp III are complete and ready for licensure. An exit interview was conducted, and this report LIC809 and LIC809C was discussed and provided to Licensee Arminda B. Lopez.the state’s words, verbatim · CDSS document, Jun 2, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 5 Method: Telephone call with CAB COMP II Participants: Lopez, Arminda On 3/5/25, 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, Mar 5, 2025