Oakwood Memory & Senior Care

Type of visit: Case Management - Annual Continuation

At approximately 12:15 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and was greeted by staff. Theresa "TJ" Ilagan, Designated Responsible Party (DRP) was contacted by staff via telephone and arrived at approximately 1:00 PM. LPA was informed that Administrator was unable to be present for today's inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with 12 residents in care. Facility serves memory care residents, has a Hospice waiver for 10, and approval for 10 bedridden residents. Facility has a Department approved waiver for a secured perimeter which was granted in 08/2016. At approximately 12:30 PM, LPA conducted file review of five (5) staff files and observed the following: One (1) of five (5) staff files reviewed was served missing proof of some of the required annual training hours, (see LIC809D). Two (2) of five (5) staff files reviewed were observed missing proof of some of the required annual medication training hours for staff who give medications, (see LIC809D). Five (5) of five (5) staff files reviewed were observed to have the additional required paperwork and proof of current first aid and CPR training certifications. At approximately 2:15 PM, LPA conducted file review of five (5) resident files and observed the following: Three (3) of five (5) resident files reviewed were observed missing the required current care plan updated and reviewed within the last 12 months, (see LIC809D). One (1) of five (5) resident files reviewed was observed missing a current LIC602A Physician's Report updated within the last 12 months as required for residents with dementia, (see LIC809D). Continued on LIC809C... Continued from LIC809... At approximately 3:45 PM, LPA reviewed medications and medication records. LPA observed facility maintaining centrally stored medication records in their computer system and the logs do not reflect all of the required information. LPA observed missing physician directions, separate line entries for each bottle of a medication received in the facility, as well as the name of the prescribing physician. DRP has a copy of the Departments Centrally Store Medication and Destruction log and agrees to use this format going forward to ensure compliance with regulation. The remaining medications and medication records reviewed were observed stored and maintained in compliance with regulation. If not already submitted since LPA's last visit, updated copies of the following documents are to be submitted to CCL by COB 09/03/2026: LIC500 - Personnel Roster (updated to include administrators schedule) Proof of current liability insurance in the required amounts LIC610E Emergency Disaster Plan (updated) Deficiencies are being cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the deficiencies by the plan of correction date and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with DRP whose signature on form confirms receipt of documents Appeal rights provided.the state’s words, verbatim · CDSS document, Aug 10, 2026

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 1:15 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with care staff. Reynaldo Gutierrez, Administrator was contacted via telephone and arrived at the facility at approximately 2:30 PM. Facility is a Residential Care Facility for the Elderly (RCFE) with 12 residents in care. Facility serves memory care residents, has a Hospice waiver for 10, and approval for 10 bedridden residents. Facility has a Department approved waiver for a secured perimeter which was granted in 08/2016. At approximately 2:30 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a on story building and was a comfortable temperature. LPA observed chairs and outdoor furniture stored on the patio outside of room three. Facility staff moved the chairs immediately and agreed to ensure the facility is operating in compliance with regulation moving forward. The remaining passageways were observed free from obstructions. Facility has the required postings in the main common areas which are accessible to the public. However, LPA did not observe an activity calendar or menu posted. Administrator agreed to post these immediately to ensure the facility is operating in compliance with regulation. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. However, LPA observed multiple instances of furniture and window covering that were in disrepair, such as missing or broken dresser drawers, missing or broken knobs or handles on furniture drawers, curtains and blinds ripped or broken, and couches and chairs with torn fabric. Administrator agreed to either repair or replace the observed items before LPA returns to the facility to finish this annual inspection. Closets containing cleaning supplies and other items that could potentially pose a risk to residents in care were observed locked. Continued on LIC809C... Continued from LIC809C... Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. LPA informed Administrator and kitchen staff that food shall be properly labeled and stored to ensure quality healthy food is being served to residents in care. Both agreed to ensure compliance with regulation moving forward. Medications were observed centrally stored and locked. There are outdoor shaded seating areas for activities. LPA observed residents engaged in activities in common areas. Facility has internet service and an internet access device designated for resident use. Facility's last fire inspection was conducted 1/2026. Fire extinguishers were observed fully charged, two were last inspected 01/2026, one was last inspected 7/2025, and one was missing an inspection tag. Administrator agreed to have the two extinguishers missing proof of inspection within the last year inspected immediately. Emergency Disaster Plan was reviewed and updated 08/2026. Staff 1 (S1) states that facility conducts quarterly disaster drills however was unable to provide any proof of a drill being conducted since 7/2025, (see LIC809D). Facility has a back up generator for emergency preparedness. Facility has emergency lighting and a first aid kit. Residents' families mostly coordinate medical and dental appointments as well as transportation to and from appointments but facility will assist as needed and utilizes a third party transportation service when needed. Facility does not handle P&I cash resources. LPA will return at a later date to review staff and resident files, medications, and medication records. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Roster (updated to include administrators schedule) Proof of current liability insurance in the required amounts LIC610E Emergency Disaster Plan (updated) Deficiencies are being cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the deficiencies by the plan of correction date and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 4, 2026

Allegation investigated: Staff did not provide proper medication assistance to resident in care.

On 07/07/2026, at approximately 11:20 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a subsequent complaint investigation for the above allegation and deliver findings regarding LIC802 - Complaint Report #21-AS-20260422105832, which was received by Community Care Licensing (CCL) on 04/22/2026. LPA met with Theresa "TJ" Ilagan, Designated Responsible Party (DRP). On 04/28/2026, durig the initial complaint investigation, LPA btained documents and conducted interviews with facility staff. During the inspection, LPA obtained a physician's report for Resident 1 (R1) dated 04/01/2026 which indicates that R1 is unble to administer their own medications. An interview with Staff 1 (S1) revealed that staff "are trained to stand there and wait until the resident takes the medication." S1 further stated that in this case, "the pill was so tiny, it may have slipped and the staff may have not seen it fall." Continued on LIC9099C... Substantiated Continued from LIC9099A... Further, an interview conducted with Staff 1 (S1) the same day revealed that the evening hours when the incident allegedly occurred are some of the facility's busiest hours "with evening meals, showering, getting ready for bed, medication administration, etc." S1 also stated, "the other staff would have said something to me too." A subsequent interview with S1 today, 07/07/2026, revealed that an internal investigation conducted by the facility with staff concluded that no staff are known to have been sleeping on the job as alleged. Based on interviews conducted, observations made, and records obtained, the Department received conflicting information. Based on interviews conducted, observations made, and records obtained, the allegation that staff sleep at the facility while on shift is 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 evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited. Exit interview conducted with DRP, whose signature on form confirms receipt of document(s). Continued from LIC9099... Based on documents obtained and interviews conducted, the allegation that staff did not provide proper medication assistance to resident in care is SUBSTANTIATED. A finding that a complaint allegation is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency is cited from Title 22 Regulations, Division 6, (see LIC9099D). Exit interview conducted with DRP, whose signature on form confirms receipt of document.the state’s words, verbatim · CDSS document, Jul 7, 2026 · control 21-AS-20260422105832

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 7, 2026

87465 Incidental Medical and Dental Care (a) (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on documents obtained and interviews conducted, the Licensee did not ensure that R1 took their medication as directed per their physicians orders which posed a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: Licensee to submit proof of a medication administration re-training of all staff giving medications to CCL by POC due date 08/07/2026.

Type of visit: Case Management - Other

On 07/07/2026, at approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a case management - incident visit and met with Theresa "TJ" Ilagan, Designated Responsible Party (DRP). LPA arrived to follow up on a complaint investigation and upon entering the facility, the LPA observed the two doors immediately to the left closed and a solid wood console table blocking access to the doors which lead to resident room numbers 9-16 as indicated on the facility's sketch. Upon moving the table and attempting to access the area, the LPA observed large boxes on the other side of the doors preventing them from opening fully. All items were removed by staff immediately. LPA was informed that no residents currently reside in that wing of the facility. LPA spoke via telephone with Rose Mahawar, Manger, who stated the facility is participating in a County funded program and was approved for a grant which will pay for renovations to the entire facility. Rose stated that the facility plans to begin with the wing which was observed blocked off. She is still waiting on permits and fire department approvals for the renovations and the County is coordinating the contractors for the work. Rose was unable to provide LPA with more detailed information about the program, the renovations, approvals, and timelines but agreed to submit such information in writing to the Department by COB 07/21/2026. No deficiencies were cited during todays visit. Exit interview was conducted with Theresa "TJ" Ilagan, DRP, whose signature on form confirms receipt of document.the state’s words, verbatim · CDSS document, Jul 7, 2026

Type of visit: Office

The California Department of Social Services (CDSS) Community Care Licensing (CCL) Santa Rosa Regional Office conducted an in office on August 26, 2025. Present in the meeting, Victoria Bertozzi, Licensing Program Manager (LPM), Licensing Program Analyst (LPA) Elias Magdaleno,and Licensee, Rose Mahawar. Licensee, Suresh Mahawar and LPM Bethany Moellers were available remotely. LPM and LPA reviewed the Default Decision and Order with the licensees during the meeting. A copy of the Default Decision and Order signed 8/1/2025 and effective 9/30/2025 was provided to the licensee. Suresh Mahawar and Rose Mahawar operated Rose Haven, 286803790 which is now closed. Oakwood Memory Care & Senior Care, 486803614 with licensee on record MAHAWAR CARE,LLC was discussed during today’s meeting. There are currently 14 residents in care. It was advised changes to the LLC members will need to be made in order to be in compliance with the Default Decision and Order. Licensee was informed failure to make required changes may result in the Department taking further action regarding the operation of Oakwood memory Care & Senior Care. In the event Licensee decides to close 486803614 Health and Safety code was provided to ensure compliance with regulation. Licensee confirmed she has contact information for the Department’s attorney handing the stated case and was provided the Department’s application unit information for clarifying questions. Continued LIC809C... Continued from LIC809... Licensee has provided an LIC3 8- Designation of Facility Responsibility for change of Administrator. The following items are requested for review: Copy of active and current Administrator Certificate Copy of Board of Directors Resolution Meeting Minutes Signed Administrator Resume LIC500 - Personnel Report LIC501 - Personnel Record CCL has also requested the operating agreement for Mahawar Care, LLC to determine what percentage each individual owns. No citations issued at time of office meeting.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

At approximately 9:30 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Administrator Rashmika Mahawar was called and gave permission for Manager Theresa Ilagan to sign and receive report. Facility is a Residential Care Facility for the Elderly (RCFE) with twelve (12) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for ten (10), with two (2) Hospice residents currently in care, and is approved for all non-ambulatory residents and ten (10) bedridden. At approximately 10:30 AM, LPA initiated a tour of the facility with Manager and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 1/25. Smoke and Carbon Monoxide detectors are hardwired and serviced by fire department alongside the fire extinguishers. Water temperatures in spot check of resident bathrooms measured 110.8-,114-, and 115.3 degrees F and communal bathroom sink measured 113.7 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. Facility activity room was stocked with games, books, and a piano. Throughout visit, LPA observed activities director conducting various group and one-on-one activities. Facility phone was tested and operational during today's inspection. Continued 809C... Continued from 809... Facility conducts quarterly disaster drills. LPA observed facility's infection control plan and emergency disaster plan which was last updated 6/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Facility has an emergency back-up generator. At approximately 12:30 PM LPA conducted review of five (5) staff records. All required documentation present. At approximately 1:00 PM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 1:30 PM LPA and Manager conducted a spot check of medication and medication records. Medication is centrally stored and locked. Administrator Recertification for Rashmika Mahawar was shown to have been submitted 10/24 and is still pending as of this visit. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Manager, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Jun 30, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff not properly trained to provide care to residents.

At approximately 10:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Facility Manager Theresa Ilagan, toured the facility and reviewed documents. LPA spoke with Administrator Rose Mahawar via telephone during this visit. Based on records reviewed, Facility did not have documentation of 5 of 8 staff required training hours completed. LPA discussed the requirements for staff training hours with Administrator and provided a copy of regulation. All staff have received their training since the last visit. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with House manager and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Jan 21, 2025 · control 21-AS-20241004094644

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Jan 22, 2025

87412 Personnel Records:(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not have documentation of required staff training as required. This poses a potential Health Safety or Personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: Licensee reviewed staff training records and had all staff complete their required annual training. POC cleared at time of visit.

Type of visit: Required - 1 Year

At approximately 12:05 PM, Licensing Program Analyst (LPA) Araceli Canela made an unannounced annual required 1 Year inspection of this licensed senior care facility. LPA met with facility manager, Theresa Ilagan aka TJ; Administrator, Rashmika "Rose" Mahawar was not available during the visit. LPA toured the building and grounds, Facility is not using the left wing and LPA observed 2 beds in the wide hallway that will need to be removed. This facility has two wings and at this time the facility is only using the right wing as there are only 14 residents living in the facility. Upon arrival the residents were waiting to have lunch and LPA observed the dining area closed and several tables that had a plate of food covered and a drink for the residents to come in and eat. LPA observed and felt the top of the cover and the food appeared to be cold. LPA checked with several residents that were able to communicate with LPA and they all expressed the food was cold, but they can ask to be re heated. LPA went over food requirements with cook and TJ and explained the food should be warm and the solution is not to reheat it because the food is being left there for several minutes. LPA toured the kitchen and observed the refrigerators and freezer need a little cleaning. LPA also observed that the dishes appear to be getting washed by hand and the unit that they have to do a disinfecting cycle was observed to have the rack filthy with dark dirt/stain. LPA requested TJ to show LPA how it worked and after a few minutes when the machine finished, LPA observed that the machine does not operate with Hot water and the dishes came out cold. LPA requested facility to get machine fixed so that it is operational and provide proof. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Continued on LIC809-C... Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and locked. Fire extinguishers located in the kitchen and hallways was last inspected 01/12/2024. Smoke alarm system and sprinkler system were last inspected 7/3/2024. The last Disaster Drill was conducted on 7/3/2024. Staff and 12 out of 14 resident records were reviewed. Administrator Certificate for Rashmika Mahawal, #6029802740 expired March 5, 2024 but was said to have been renewed. Staff have required First Aid and CPR certificates. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/8/2024: LIC500- Personnel Report LIC9020- Register of residents Evidence of Liability Insurance Copy of current Administrator Certificate No deficiencies cited during todays visit.the state’s words, verbatim · CDSS document, Sep 9, 2024