Pacific Sun Senior Care

Allegation investigated: Due to lack of care and supervision Resident eloped out of facility

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Office Administrator Marla Punzalan and explained the reason for the visit. The investigation into the allegation revealed the following. It was reported that on February 23, 2026, Resident 1 (R1) eloped from the facility around 4:30 am. LPA interviewed R1, R1 did not remember the incident and did not know the date, time or where they were. LPA interviewed Staff 1 (S1). S1 reported that around 4:30 am they heard the doorbell and a person (Witness 1, W1) was with R1 and reported they needed to go back inside. W1 reported they were walking their dog in the morning and came across R1 standing in front the facility on the steps next to the garage leading to the sidewalk. W1 reported that R1 looked distressed and appeared lost so they took them to the front door of the facility and staff let them in. S1 reported that they assessed R1 and there were no apparent injuries and R1 denied any pain. S1 reported they put R1 to bed and they went to sleep. S1 reported that she did not know R1 had left the facility. Staff 2 (S2) reported they were asleep during the incident until R1 was returned to the facility. Substantiated A review of records shows R1 has early signs of Dementia and possible Lewey Body Dementia. R1's responsible party signed their admission agreement. S1 and the Office Administrator reported R1's responsible party was notified about the incident. The Office Administrator reported they have an extra staff member to help prevent future elopements. The preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 22-AS-20260223142018

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Feb 25, 2026

87464(f)(1)Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by... R1 left the facility on February 23, 2026 around 4:30 am, was outside the facility and was brought back by Witness 1. This posed an immediate health and safety risk to R1.the state’s words, verbatim · CDSS document, Feb 24, 2026

Plan of correction: Licensee agrees to train staff on CCR 87464 and to provide additional safety precautions such as a mattress pad alarm and door alarm on R1's door to minimize the risk of elopement for R1. Proof of correction to submitted to LPA by the POC due date.

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Arnel Mojica was also present on the premises. There is currently one resident in care who is also receiving hospice care at this time. Resident is observed to be sleeping and/or relaxing in their respective bedroom. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with six private bedrooms, only one of which is observed to be occupied. One additional locked room is assigned for use by overnight staff. There are two full bathrooms for use by the residents along with three half bathrooms on the premises. The current resident is not presently assessed to be bedridden. All occupied and vacant bedrooms appear clean and sanitary. The resident in care uses full rails for postural support, with adequate orders reviewed to be present in the resident's hospice plan of care. All bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are all equipped with grab bars and slip mats. Hot water temperature measured at 118F and 119F at two separate sinks used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secure. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Wall-mounted fire extinguishers are present and verified to be charged with up-to-date maintenance tags. Carbon monoxide and smoke detectors were found to be present and operational. LPA and facility staff toured the outside of the facility. LPA observed a large shaded outdoor seating area with outdoor furniture for resident use. The two identified routes of egress are free of clutter and obstructions. There are two self-latching gate on the side of the premises. There are no bodies of water on the premises and the facility does not utilize either locked perimeters or delayed egress. Landscaping work is observed to be in progress, however some outdoor space remains accessible for resident use. LPA reviewed records for one resident. Records reviewed include all necessary components. LPA reviewed resident medication records and prescription orders with no discrepancies observed. LPA reviewed staff records for three staff members during the visit. Proof of current CPR training reviewed. Disaster drills are conducted in a timely manner. All staff members scheduled are verified to be background cleared and associated to the licensed location. The administrator certificate is current. Based on the observations conducted during the present visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Nov 12, 2025

Type of visit: Collateral

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced collateral visit in conjunction with complaint 22-AS-20251021161230 (complaint is not filed at Pacific Sun Senior Care) to interview possible witnesses. LPA Alejandre was allowed entry into the facility and met with staff. LPA explained the purpose of the visit. LPA toured the facility and interviewed staff and resident. LPA reviewed and obtained a copy of the staff roster and resident roster. An exit interview was conducted with staff and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jessica Cho made an announced Case Management visit for the purpose of conducting an inspection after alterations were made within the facility. LPA met with Administrator's Assistant (AA) Marla Punzalan and two caregivers. During today's visit, there were no residents in care. Facility appeared clean, operational, and in good repair. There are six private resident bedrooms and one caregiver's room which will be occupied by two staff. There are three private resident bathrooms, one shared resident bathroom, and a powder room for visitors. The hot water temperature in the resident bathrooms measured at 112.6, 111.7, 113.7, and 114.4 degrees Fahrenheit. Resident bath towels and personal hygiene supplies were adequately stocked including paper towels and hand soaps. Facility maintains sufficient two day supply of perishable and seven day supply of non-perishable food. All sharps and toxins were secured and inaccessible. The medication closet and garage can be accessed via the electronic keypad. The fire extinguisher was mounted, charged, and serviced on April 29, 2025. All auditory devices, carbon monoxide, and smoke detectors were tested and operational. Facility maintains emergency food/water and first aid kit which contains all elements including scissor, tweezer, and a first aid manual. The 'See Something, Say Something' poster was in the correct size posted in the entry way. LPA observed two surveillance cameras in the living and dining areas. AA stated that additional surveillance cameras will be installed in the common areas. LPA requested documents related to the cameras to be submitted to the Department as well as the amended Emergency Disaster Plan (LIC610E) by August 22, 2025. There are no health and safety issues observed during the inspection, and the facility is ready to accept new residents. No deficiency is cited during today's visit. An exit interview was conducted with Administrator's Assistant Marla Punzalan, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Jessica Cho made an unannounced Case Management- Health Checks vist after receiving an email on June 26, 2025 notifying the approval of the fire clearance inspection and requesting approval to accept new residents after discovering alterations were made during the annual inspection conducted on October 31, 2024. Upon arrival, LPA observed facility was not operational and no residents and staff were present at the facility to grant entry. LPA called Administrator (Admin) Muqeet Dadbhoy by telephone and explained the reason for the visit. Caregiver Christopher Martinez arrived to assist LPA at 9am and Admin along with Administrator's Assistant Marla Punzalan at 9:30am. During the walk through accompanied by Caregiver Martinez, LPA observed the facility was not ready to accept new residents for the following reasons but is not limited to: To deep clean the facility to ensure all areas are clean, sanitary, and in good repair for residents To ensure rooms are fully furnished To remove all trash in the patio area to ensure clear passageways The following items will be addressed on an unannounced continuation case management visit at a future date. Administrator Dadabhoy acknowledges and understands that the Department will be notified once the above items have been addressed prior to accepting new residents. No deficiencies cited for today's visit. An exit interview was conducted with Administrator Muqueet Dadabhoy and Administrator's Assistant Marla Punzalan, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jessica Cho and Ebony Bentley arrived unannounced for the purpose of conducting the Required 1 Year Inspection. LPAs observed trash and debris in a trailer parked in the driveway. LPAs observed a sign indicating facility closure due to a water leak. LPA Cho contacted Administrator (Admin) Muqeet Dadabhoy by telephone at 12:37pm and stated the purpose of the visit. Admin stated that the water leak occurred from the kitchen approximately April 2024. There were two residents residing at the time of the leak. Two residents had agreed to relocate and was placed at another facility operated by the administrator. Admin stated that he is not accepting any residents until the renovation is complete. Admin acknowledged that the Department was not notified of the leak and the alterations made inside the facility. Approximately 12:56pm, Caregiver Christopher Martinez arrived to the facility on behalf of Admin to assist LPAs with the annual inspection. LPAs conducted a tour of the facility and observed there were no residents/staff on site. LPAs observed part of the floors replaced, installation of a small bathroom which used to be a closet, renovated one large bathroom as well as expanding a bathroom and eliminating a closet in Room #6, and renovating the backyard landscape. Facility is not accepting residents at this time. The annual licensing fee remains current with a balance of $0. Admin was advised on the following: to submit a written report of any major occurrences which threatens the health, safety, and welfare of residents within 24 hours, to notify the Department when renovations or alterations being made to the facility and upon completion and prior to admitting a new resident. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC9099Ds. Administrator Dadabhoy verbally authorized Caregiver Martinez to sign the report on his behalf. An exit interview was conducted with Caregiver Christopher Martinez, and a copy of this report, along with the LIC9099s, and the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Oct 31, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Nov 1, 2024

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above in which the facility did not maintain an approved fire clearance for the installation of a new bathroom as well as the expansion of the resident's bathroom eliminating the closet which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 31, 2024

Plan of correction: Adminstrator stated that they will submit a letter of intent, LIC200, copy of the original and the new facility sketches indicating the changes, and submiting a check in the amount of $25.00 payable to (and spelled out) California Department of Social Services.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(2) · Plan of correction due date: Nov 7, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department...: (2) Occurrences, such as..., catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours...to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidenced by: Based on observations and interviews, the Department was not notified of the water leak and renovation which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 31, 2024

Plan of correction: Adminstrator stated that a written incident report of the water leak and an Acknowlegement of Understanding of the said deficiency will be submitted to LPA via email by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Jessica Cho and Ebony Bentley made a subsequent visit for the purpose of issuing a civil penalty in connection to the Type A Fire Clearance citation issued today during the annual inspection at 12:20. Administrator Muqueet Dadabhoy was notified by telephone explaining the reason for the civil penalty. Immediate civil penalty LIC421IM is being assessed. An exit interview was conducted with Caregiver Christopher Martinez (authorized by Administrator Dadabhoy), and a copy of this report along with the LIC421IM were provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 31, 2024