North Lake Villas

Allegation investigated: Staff are not following refund conditions Staff did not ensure resident received P & I money

Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to complete an investigation and deliver findings of the above noted allegations. LPA met with Med-Tech and explained the reason for the visit. The Assistant Administrator later joined today’s visit During initial visit on 09/22/2025 due to the destruction of North Lake Villas, Inc. by fire, the complaint visit was conducted at 10:35 am by Licensing Program Analyst (LPA) Tihesha Smith at Encino Terrace Senior Living Adult Residential, a facility that residents from North Lake Villas were relocated. LPA Smith met with staff and disclosed the purpose of the visit. LPA Smith conducted an interview with a licensee via telephone, requesting documents relevant to the investigation to include but not limited to a copy of admissions agreement, personnel report, staff schedule, resident roster. Prior to this visit on 03/13/26 LPA Alvizar- Ettima conducted an interview with Assistant Administrator and Cont. on LIC 9099 Unsubstantiated Cont. from LIC 9099 Staff #1 (S1) via telephone, request documents relevant to the investigation payable check to social Security Administration and P& I in behalf of R1 and other documents obtained from the facility. During this visit at approximately 9:30a.m., LPA Alvizar- Ettima and Med-Tech conducted a physical plan tour and did not observe any immediate health and safety issues. Between 10:45a.m. – 12:45p.m LPA interviews with Resident #2 - #3 (R2 - R3) and Med-Tech staff. 1.) Staff are not following refund conditions It was alleged that Assistant Administrator received a payment and did not follow proper refund procedures. Assistant Administrator interview revealed that Resident (R1) relocated mid-month and that the Social Security Office was not provided with sufficient time to update the payee information. The Assistant Administrator reported that the payment was returned to the Social Security Administration in accordance with their instructions. Resident #2 (R2) stated that they have not experienced issues related to refunds and reported receiving refund payments as applicable. Additional resident interviewed did not express concerns related to the allegation. Staff #1 (S1) and Med-Tech interviews confirmed the information provided by Assistant Administrator. Records reviewed revealed that R1’s funds were returned to the Social Security Administration. Based on interviews, information obtained and record review, there is insufficient evidence to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. 2.) Staff did not ensure resident received P & I money It was alleged that R1 have not received Personal and Incidental (P & I) money. Assistant Administrator and staff denied the allegation. The Assistant Administrator reported that that Resident (R1) consistently received P& I money and that any remaining funds were returned upon moving out of the facility. Resident #2 (R2) stated they were roommates with R1 for an extended period and reported that R1 did not express concerns regarding P & I money . R2 also reported receiving their own P & I money in full and on time. Additional resident interview did not report concerns related to P & I money. Staff #1 (S1) and Med-Tech interviews corroborated with Assistant Administrator’s statements. Records reviewed indicated that R1 received P & I money as required. Based on interviews, information obtained, and record review, there is insufficient evidence to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit Interview conducted/Copy of report provided.the state’s words, verbatim · CDSS document, Apr 21, 2026 · control 31-AS-20250917150613

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Antonia Alvizar-Ettima and Huma Rahimi conducted an unannounced annual inspection visit at this facility. LPAs met with staff Office Assistant and Office Assistant who called the Assistant Administrator and explained the reason for the visit. The Assistant Administrator arrived about thirty (30) minutes later and joined LPAs. LPAs utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today. A tour of the physical plant was conducted at 10:10AM with Resident Care Coordinator/ Med-Tech and Assistant Administrator for compliance with safety, maintenance and operational requirements. The following was noted: Facility is a single-story residence in a residential community. The facility has fifteen (15) bedrooms and nine (9) bathrooms in multiple interconnected residential type building. The facility is fire cleared for thirty (30) non-ambulatory residents, twenty-three (23) of which maybe bedridden in rooms 1 to 15. Hospice waiver for ten (10) residents. Living and dining rooms furniture were checked. The living rooms were neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. The smoke/carbon monoxide detectors are duel hardwired interconnected and observed to be operational. Fire extinguishers are located all throughout the facility and last inspected on 12/30/25. The facility is equipped with sprinkler system. Fire inspection including alarms and full fire inspection was last done on 12/30/25. Passageways were observed to be clear from obstruction. (Cont. on LIC 809-C) (Cont. from LIC 809) Laundry area is located in the lower level. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet inaccessible to the residents. The kitchen appeared to be clean and the appliances and fixtures functional. This kitchen is used to prepare and cook all meals for residents in care. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored in the lower level area of the facility. Sharp objects are stored and locked in a drawer in the kitchen. The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured at 111. 7-degree Fahrenheit within title 22 regulations. Medications were kept in a medication cart located in the medication room adjacent to the kitchen. The medications were observed to be locked and inaccessible to residents. There were two (2) complete first aid kits located in the medication room. The surrounding grounds (outdoors) were well landscaped and a covered patio with proper furniture for residents outdoor use. There are no bodies of water on the premises. Staff records were reviewed. Staff present have criminal record clearances and associated to this facility. Staff records appear to be complete and current. Resident records were also reviewed and appeared to be complete and current. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Gary Tan and Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection at this facility. LPAs met with staff Maria Heredia who called the administrator and explained the reason for the visit. The Assistant Administrator Adam Braun arrived forty (45) minutes later. A tour of the physical plant was conducted at 9:48 AM and the following was noted: There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet and hand sanitizer is available. The facility had submitted and approved Mitigation Plan and Infection Control Plan. Signs of COVID-19 prevention protocol were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has multiple screening stations all through out the facility. The facility has sufficient stock of PPE in the storage. The facility has fifteen (15) bedrooms and nine (9) bathrooms in multiple interconnected residential type building. The facility is fire cleared for thirty (30) non-ambulatory residents, twenty three (23) of which maybe bedridden in rooms 1 to 15. Hospice waiver for ten (10) residents. Living and dining rooms furniture were checked. The living rooms were neat, clean and in proper order. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 11/08/23. The facility is equipped with sprinkler system. (continued to LIC 809-C) (continued from LIC 809) Fire inspection including sprinkler inspection, alarms and full fire inspection was last done on 12/29/23. There is no body of water at the facility. Passageways were observed to be clear from obstruction. Laundry area is located in the lower level. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at a range of 105.1°F to 116.5°F. There were enough clean linen available in the closets. Medications were kept in a medication cart located in the medication room adjacent to the kitchen. The medications were observed to be locked and inaccessible to residents. There were two ( 2) complete first aid kits located in an office adjacent to the kitchen. Staff records were reviewed. Staff present has criminal record clearances and associated to this facility. Staff records appear to be complete and current. Resident records were also reviewed and appeared to be complete and current. Disaster drill was last conducted on 07/16/24. Required posting are observed to be complete and current and displayed properly at the facility. There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Aug 18, 2024