New Bethany

Type of visit: Case Management - Incident

On July 16, 2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management visit for an incident previously reported to the Dept. LPA met with Administrator Nicole. R1 and R2 are a married couple who share a room in memory care. R1 was assisting R2 when R2 fell on top of R1, causing injury. R1 will return to the facility from skilled nursing once they have completed their rehab. LPA informed Administrator to report each time R2 falls, and to reach out to family regarding R1 returning to a shared room with R2. Administrator stated R2 does fall frequently. LPA will follow-up with LPM and if warranted a follow-up visit will be conducted at a later time. No deficiencies were noted and no citations were issued during today's visit. Exit interview was conducted and a copy of this report LIC809 was provided to Administrator Nicole Lowe Ciuffo.the state’s words, verbatim · CDSS document, Jul 16, 2026

Allegation investigated: Staff handled resident in a physically inappropriate manner. Staff did not provide adequate supervision to prevent resident from eloping. Staff withheld resident’s personal property. Staff did not safeguard resident's personal property. Staff did not report incident(s) involving resident as required.

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations listed above. LPA met with facility Nicole Lowe Ciuffo, and explained the purpose of today's visit. Regarding the allegation Staff handled resident in a physically inappropriate manner. LPA conducted interviews with the reporting party, Resident 1’s responsible party, Staff 1, current and former staff members, and other individuals familiar with the facility. The reporting party alleged Staff 1 grabbed Resident 1 by the arm and pushed Resident 1 toward their room. The reporting party acknowledged they did not witness the incident and obtained the information from Resident 1 and another staff member. Unsubstantiated Staff 1 denied physically grabbing or pushing Resident 1 and stated no physical altercation occurred. Staff members interviewed stated they had never observed Staff 1 physically handle residents in an inappropriate manner. No interviewed witness corroborated the allegation that Staff 1 grabbed or pushed Resident 1. The Department made multiple attempts to interview the staff member identified as witnessing the incident; however, the witness did not respond. Based on interviews conducted and information obtained during the investigation, the Department did not obtain sufficient evidence to support that Staff 1 physically handled Resident 1 in an inappropriate manner. 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, therefore the allegation is unsubstantiated. Regarding the allegation Staff did not provide adequate supervision to prevent Resident 1 from eloping. LPA interviewed the reporting party, Staff 1, current and former staff members, and conducted an inspection of the facility’s memory care courtyard and secured perimeter. Interviews consistently indicated Resident 1 occasionally exited the memory care unit into the enclosed courtyard or other secured areas of the facility but remained within the facility’s delayed-egress secured perimeter. During the inspection, LPA observed the courtyard was enclosed by fencing with delayed-egress exit gates, preventing residents from leaving the secured grounds without activating the delayed-egress system. Staff interviewed stated Resident 1 did not leave the secured facility grounds and remained within the secured perimeter while outside. The Department did not obtain evidence establishing Resident 1 eloped from the facility or was inadequately supervised. 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, therefore the allegation is unsubstantiated. Regarding the allegation Staff withheld Resident 1’s personal property. The reporting party alleged Staff 1 took possession of Resident 1’s cellular phone and failed to return it. Staff 1 denied ever taking possession of Resident 1’s phone and stated Resident 1’s responsible party withheld the phone because Resident 1 repeatedly contacted law enforcement. Other individuals interviewed similarly recalled Resident 1’s phone being removed by her responsible party due to repeated calls to law enforcement. However, witness statements regarding the disposition of the phone were inconsistent, LPA was unable to determine who last possessed the device. 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, therefore the allegation is unsubstantiated. Regarding the allegation Staff did not safeguard Resident 1’s personal property. The investigation did not identify sufficient evidence establishing facility staff failed to safeguard Resident 1’s personal property. Although Resident 1’s cellular phone could not ultimately be accounted for, witness statements regarding the phone’s disposition were conflicting. LPA was unable to determine that Staff 1 or facility staff failed to safeguard Resident 1’s property. 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, therefore the allegation is unsubstantiated. Regarding the allegation Staff did not report incidents involving Resident 1 as required. The reporting party alleged facility staff failed to report incidents involving Resident 1, including incidents related to Resident 1 being outside the memory care unit and the missing cellular phone. The investigation determined Resident 1 remained within the facility’s secured delayed-egress perimeter and did not elope from the facility grounds. The Department did not obtain sufficient evidence establishing a reportable incident occurred that required notification to the Department or the resident’s responsible party under reporting requirements. 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, therefore the allegation is unsubstantiated. No deficiencies cited today Per title 22 Regulations. Exit interview conducted with facility Administrator, Nicole Lowe Ciuffo and copy of report providedthe state’s words, verbatim · CDSS document, Jul 7, 2026 · control 24-AS-20250613111910

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management. LPA met with facility Medication Technician, Sister Astrida D' Cruz and explained the purpose of today's visit. LPA observed long stick on outside of resident 1's bedroom placed in a way that would prevent Resident 1 from leaving their bedroom and entering the courtyard. The following deficiencies are being cited Per title 22 Regulations. Exit interview conducted with facility Medication Technician, Sister Astrida D' Cruz, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 19, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(6) · Plan of correction due date: Jul 3, 2026

87468.1 Personal Rights of Residents in All Facilities (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. The following requirement has not been met as evidenced by: LPA observed a long stick blocking Resident 1's screen door and preventing Resident 1 from leaving their bedroom and entering the courtyard, which poses a potetial, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2026

Plan of correction: Administrator will install alarm/chimes on resident 1's sliding glass door in place of object blocking resident's door.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with DSD Nurse Nicole Lowe Ciuffo. Facility is licensed for 76 residents and has a current census of 38. Nicole stated currently there are no residents on hospice and 1 resident with home health. Home Health Plan was reviewed. Water temperature was checked in 2 different wings in the facility, first bathroom water temperature read at 113.1 degrees Fahrenheit and the second bathroom read at 106.3 degrees Fahrenheit. Fire Extinguishers were serviced March 18, 2026 and is within the safety regulation period. Carbon monoxide detectors were tested and in working order. Facility had the annual inspection for the sprinkler system on February 12, 2026, and passed with no concerns. Basuny Eldaouch Administrator's Certification expires November 20, 2026. Staff files were reviewed, and not complete at this time. Resident files were reviewed, and some are not complete. First aid kit on site and complete. There is a locked storage are for medications. LPA inspected the interior and observed the exterior of the facility including the common areas, resident bedrooms, bathrooms, medication storage, and kitchen. Bedrooms are clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed the following deficiencies: Laundry detergent accessible to residents under the sink in a laundry room. Cleaning/disinfectant in unlocked utility closet in activity room. Scissors, hand pruners, and insect killer in unlocked closest in the activity room. Ice machine had build up on the inside and hard water build up on the outside Water dispenser in activity room has hard water build up on dispenser. Current physician reports for residents. Pre-Admission Appraisals for residents. Personal inventory logs for residents. R1's centrally stored medication log which did not have a start date for Tamsulosin 0.4MG & Atorvastatin Calciui/40MG LPA reviewed staff files and some of the following were missing: TB test results, current training, physicals. Training duration for completed training. Deficiencies observed were cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing by April 6, 2026. Exit interview conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to DSD Nurse Nicole Lowe Ciuffo.the state’s words, verbatim · CDSS document, Mar 25, 2026

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Daiquiri Boyd and Shawna Doucette made an unannounced visit to the facility for the purpose of conducting a case management visit. LPAs met with Administrator Basuny Eldaouch and explained the reason for the visit. LPA asked for the updates and outcomes for three separate incident reports that had been submitted to licensing. See separate LIC811 for confidential names. Residents named in the reviewed reports had outcomes that were within regulation and no deficiencies were cited. Administrator's signature confirms receipt of this document.the state’s words, verbatim · CDSS document, Sep 9, 2025

Allegation investigated: Staff not allowing resident to receive hospice care

On 7/25/25, Licensing Program Analyst (LPA) R. Bruce conducted a complaint visit to deliver findings for the above allegation. The complaint findings were delivered as UNFOUNDED, however the document is not available in FAS. This document will serve as a replacement for the original. On 8/09/2025, LPA M. Medina conducted a subsequent visit to re-create this form, and obtain signature for documenting purposes. Nicole Lowe, LVN/Administrator contacted by telephone and arrived a short time later to meet with LPA Medina. During complaint investigation, it was alleged that staff is not allowing resident (R1) to receive hospice care. Based on interviews and record review it has been determined that the facility has followed their business plan and will continue to not offer hospice at the assisted living level of care. Doctor reports on file indicate R1 needs a higher level of care and refer R1 to skilled nursing. This Department has found that the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint. Nothe state’s words, verbatim · CDSS document, Aug 9, 2025 · control 24-AS-20250415165724

Type of visit: Required - 1 Year

On 2/26/24, Licensing Program Analyst (LPA) R. Bruce conducted a required unannounced Annual Inspection visit. LPA introduced self, stated purpose of visit, was allowed entrance and met with Sister Acacia. LPA toured the facility inside and out to include entry, kitchen, dining, bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstructions. LPA observed the facility to be clean free from clutter, and odor free. Medications are stored in a locked cabinet in individual wings. LPA observed knifes and cleaning supplies are locked and stored appropriately. Other storage spaces containing toxins & cleaning supplies were locked. LPA checked the water temperature in a common bathroom in A and B wing which read at 105.9 and 105.2. Water temperature in the kitchen was at 125.2 degrees Fahrenheit and had appropriate signage to warn of hot water temperature. Facility has license for capacity of 76, and current census is 42. Resident’s do not share bedrooms, and each bedroom has their own bathroom. Five resident and five staff files were reviewed and found to contain all required documentation. Fire extinguishers are located throughout the facility and were last serviced on 12/23/2024 by Jorgenson Fire, and are in good standing. LPA reviewed Fire and Disaster plan noting fire drills are held monthly and meet regulatory requirements. Smoke alarms are tested periodically throughout the year. No deficiencies were issued at today's inspection visit. EXit interview was conducted and a copy of this report LIC809, was provided to facility. LPA requested the following documents to be submitted to CCL via fax line at 559-243-8088: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing by March 15, 2025.the state’s words, verbatim · CDSS document, Feb 26, 2025

Type of visit: Case Management - Incident

On 10/21/24 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct a case management visit regarding R1. LPA introduced herself and explained the reason for the visit. LPA met with Administrator Basuny Eldaouch. The Dept. received a report on 10/6/24 regarding an incident that happened on 10/3/24 with R1. R1 was taken to the hospital and had colon surgery. LPA reviewed R1's chart to see the reason leading to the surgery and if there is a change in condition for R1. LPA spoke with Administrator who stated R1 did not return to the facility and was sent to a skilled nuring facility. LPA also spoke with S1. S1 stated R1 was not eating for 2 days and was sent to the hospital. S1 stated at the hospital it was found R1 had a blockage, prior being sent to the hospital R1 did not display any other complications or new health conditions. R1's chart was reviewed and LPA did not observe any discrepancies. No citation was issued. Exit interview was conducted and a copy of this report LIC809 was provided to Administrator Basuny Eldaouch.the state’s words, verbatim · CDSS document, Oct 21, 2024

Type of visit: Case Management - Incident

On 9/27/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to conduct a case management regarding an incident report received from the facility listed above. LPA introduced herself and explained the reason for the visit. LPA was allowed entrance into the facility. LPA met with Sister Astrida D. Cruz (SAC) and Basuny Eldaouch (BE- New Administrator) The Dept. received an incident report stating caregiver found R1 to have a swollen ankle on 9/15/2024 and it was reported. R1 previously had a fall the week before. Basuny Eldaouch stated he spoke with the doctor who stated the fracture may have occurred due to R1 hitting their ankle while walking with the walker. No previous reports were submitted regarding the fall prior to 9/15/24. LPA interviewed R1. LPA was shown incident report for a fall on 8/7/2024 which was not previously reported to the Dept. R1 previously had a fall prior to the ankle swelling, report was not provided to the Dept. SAC & Basuny Eldaouch were informed of the reporting requirements. Citation was issued under Title 22, Division 6, Chapter 8. Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Basuny Eldaouch.the state’s words, verbatim · CDSS document, Sep 27, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Oct 4, 2024

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. This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee did not comply with the regulation listed above. LPA was provided internal incident reports which were not reported to the Dept.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: Administrator will make sure reports are submitted within 7 days. Administrator will provide a statement to LPA.

Allegation investigated: Caregivers are injecting residents with insulin.

On 2/23/24 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to deliver the finding for the allegations listed above. LPA introduced herself and explained the reason for the visit. Sister Lucinda Fonseca was contacted. Licensing Program Analyst (LPA) B. Miranda conducted the subsequent complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: Caregivers are injecting residents with insulin. LPA interviewed R1 who was not able to answer LPA's questions. LPA spoke with staff who stated R1 was moved to memory care as a recommendation. LPA explained even as a recommendations this indicates a change of condition and there should have been a re-appraisal and new physician's report. A new physician's report was completed and sent to LPA after the LPA's initial visit on 1/19/24. The physician's report indicated the resident is not able to give their own injections. Substantiated LPA also reviewed staff schedule which also shows there is no licensed professional at the facility after 2:00 p.m. to provide injections to R1. The MARS indicates some MedTech/Caregivers are giving R1 their injection instead of assisting with injections. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report LIC9099, LIC9099D, and appeal rights were provided to Sister Lucinda Fonseca.the state’s words, verbatim · CDSS document, Feb 23, 2024 · control 24-AS-20240112164025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80075(b)(2) · Plan of correction due date: Feb 26, 2024

80075 Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (2) Facility staff, except those authorized by law, shall not administer injections but staff designated by the licensee shall be authorized to assist clients with self-administration of injections as needed. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Based on observations, interviews, & record review(s), the licensee failed to only allow licensed professionals administer injectable medications. R1 was not able to communicate how they give their own injection, staff schedule indicates no licensed professional staff at the facility after 2:00 p.m., physician report states R1 is not able to administer their own injectable medication. This poses an immediate Health, Safety or Personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2024

Plan of correction: Facility has made arrangements with nursing staff to give injections. Statement will be provided to LPA.

Type of visit: Required - 1 Year

On 2/23/24, Licensing Program Analyst (LPA) B. Miranda conducted a required unannounced Annual Inspection visit. LPA introduced self, stated purpose of visit, was allowed entrance and met with Sister Lucinda Fonseca. LPA toured the facility inside and out to include entry, kitchen, dining, bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstructions. LPA observed the facility to be clean free from clutter, and odor free. Medications are stored in a locked cabinet in individual wings. LPA observed a small kitchen in the activities room to be unlocked and contained knifes and cleaning supplies. Other storage spaces containing toxins & cleaning supplies were locked. LPA checked the water temperature in a common bathroom in D wing which read at 125.2 degrees Fahrenheit. Facility has license for capacity of 76, and current census is 38. Resident’s do not share bedrooms, and each bedroom has their own bathrooms. Fire extinguishers have been services as of 3/22/23 and are in good standing. Smoke alarms are tested periodically throughout the year. LPA observed a sample of resident's medications. LPA observed R1's medication to show in the MAR as given, but was still in the bubble pack. Deficiencies were noted and citations issued per the California Code of Regulations Tittle 22. Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Sister Lucinda Fonseca.the state’s words, verbatim · CDSS document, Feb 23, 2024

Allegation investigated: Staff are not meeting residents showering needs Staff are not meeting residents needs Staff are not administering residents medicine in a timely manner

On 01/19/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver the findings for the allegations listed above. LPA introduced herself and explained the reason for the visit. Sister Lucinda Fonseca was contacted. LPA conduct a walk around tour of the facility to verify there was no immediate danger. LPA requested the following documents: Shower schedule for September 2023, and are due by the end of business day 01/24/2024. 1. The Department investigated the allegation: Staff are not meeting residents showering needs. LPA interviewed multiple staff members, and multiple residents. None of the interviewees stated showering needs are not being met. It was stated if a shower can not be made on the scheduled date/time then it will be reschedule for another date/time. Unsubstantiated 2. The Department investigated the allegation: Staff are not meeting residents needs. LPA interviewed multiple staff members, and multiple residents. None of the interviewees stated the resident's needs are not being met. Interviewees did not state any concerns regarding the allegation listed above. 3. The Department investigated the allegation: Staff are not administering residents medicine in a timely manner. LPA interviewed multiple staff members, and multiple residents. None of the interviewees stated medication is not be administered in a timely manner. Interviewees did not state any concerns regarding the allegation listed above. Exit interview was conducted and a copy of this report LIC9099 was provided to Sister Lucinda Foncesa.the state’s words, verbatim · CDSS document, Jan 19, 2024 · control 24-AS-20230920100634