Pico De Loro

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Imaculada Vasquez conducted an unannounced required annual visit. LPA met with Administrator, Yamberly Genessis Garcia, and Licensee Efren Rillo who were informed of the purpose of the visit. The facility is a one story building with twenty three(23) resident bedrooms, (25)bathrooms, shower rooms, staff office, activity spaces, and outdoor spaces. The facility does not have a pool or firearms. The facility is a residential care facility for the elderly ages 59 and above, approved for fourty five(45) non ambulatory residents, all of which may be bedridden. Approved for ten(10) hospice waiver. and approved for a locked perimeter. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. LPA observed locked dangerous items, such as centrally stored medication, sharps, and cleaning supplies. Documentation was provided showing carbon monoxide, smoke detectors and fire extinguishers which were charged and tested on March 09,2026 and are operational. LPA observed the facility signaling system and location in resident bedrooms and bathrooms were operational. Hot water temperature was recorded at 111.7F in a hallway bathroom. The facility has cleaning supplies to conduct regular cleaning of the facility, and personal hygiene supplies for the residents. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 7- day non perishable and 2-day perishable food items. The menus are posted and resident's prescribed diets and allergies are accessible to kitchen staff. LPA reviewed the staff schedule for staff coverage. LPA observed staff rounding and active care and supervision of residents. The current administrator has a current certificate that expires on 01/22/2027. Required postings are found in the facility. LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last fire drill was conducted on 06/05/2026. Record Review and Resident/Staff Files: LPA reviewed five (5) staff files which possess all required documents such as criminal record clearances and training including CPR and First aid training. (5) resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication was locked in a medication room. LPA reviewed three(3) resident medication lists and found medication accounted for. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Garcia.the state’s words, verbatim · CDSS document, Jul 8, 2026

Allegation investigated: Staff exploiting resident’s finances.

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegation. LPA met with… who was informed of the purpose of the visit. During the visit, LPA conducted interviews, observations and conducted records review. It was alleged staff had forced Resident #1 (R1) to designate the facility as their payee for social security, staff had possession of R1’s bank card and PIN code to the bank card. Initial interview with R1 on 04/02/2025 revealed their payee was changed to the facility, Pico de Loro, without their authorization and they were unsatisfied with their new payee. R1 stated they wanted to change their payee from the facility to themselves. R1 was shown the form “Advance Notice of Representative Payment” and R1 did not recall signing the form. Unsubstantiated However, an additional interview conducted with R1 on 07/24/2025, revealed R1 reported they had been upset with the licensee prior and had made false allegations about the facility and the finances. R1 claimed the false allegation was R1 not authorizing the facility as the payee, when in fact she did give authorization for the change. R1 also revealed during the 07/24/2025 interview, that R1 no longer wished to change the payee. R1 wanted Pico De Loro to continue to be the payee and R1 had no issues with the facility. The administrator provided form “Advanced Notice of Representative Payment” which revealed the facility was chosen to be R1’s payee by the Social Security Administration and was signed on 09/24/2024 by R1 and the administrator as a witness. Interviews with the Licensee and the administrator revealed R1 consented to the facility being their payee. A review of R1’s Physician Report dated 11/10/2024 revealed R1 could handle their own finances, and report was marked “no” under confused or disoriented. R1’s admission agreement dated 11/30/2023 revealed R1 was their own responsible party. Interview with R1 on 04/02/2025 revealed the facility had taken R1’s bank card. R1 also recanted this allegation on 07/24/2025 and claimed the allegation was because R1 upset with the facility. R1 further revealed in the 07/24/2025 interview, that the administrator assisted R1 by taking them to the bank but denied that the administrator took possession of the bank card. R1 stated the administrator assisted them in regaining access to their bank account when they had been locked out. Interview with the licensee and the administrator revealed, administrator corroborated that they had assisted R1 to the bank and assisted R1 in obtaining a new bank card and bank account details. Both staff revealed that R1 consented to safeguarding their personal belongings at the facility and showed the LPA a signed form “Authorization to Handle Debit Card” signed 12/01/2023 for R1. On 07/24/2025 LPA observed the locked safe where the facility safeguards resident personal information, including R1’s debit card. LPA also observed R1 had their bank card in their possession at the time of the visit, with the administrator reporting R1 had requested their card earlier that day. Both the administrator and R1 revealed the facility safeguards the card and gives the card to R1 when they request it. It was alleged facility took the bank card and PIN from Resident 2 (R2) as well. R2 was interviewed and denied the licensee took their bank cards and PIN numbers. R2 stated only they have access to their bank cards. LPA interviewed the administrator and the licensee. Both staff denied they asked R2 for their bank card or PIN. Interview with R2’s roommate revealed they were not aware of the licensee requesting R2’s bank card or PIN number. Interview with R2’s responsible party revealed only they handle R2’s finances and were not aware of the licensee requesting R1’s bank card or PIN number. A review of R2’s file revealed no agreement to handle or safeguard R2’s bank card by the facility. During the LPA’s observation of the locked safe, R2’s bank card was not in the safe. Therefore, based on interviews, record reviews, and observation the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 9, 2025 · control 18-AS-20250324120159

Type of visit: POC

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit in order to verify the Plan of Correction (POC) issued on 10/03/2025. LPA met with Administrator, Genesis Yamberly Garcia, who was informed of the purpose of the visit. LPA conducted record review and interviews during the time of the visit. Findings for complaint #18-AS-20250513170142 resulted in a deficiency cited for 87468.1(a)(27) Additional Personal Rights of Residents in Privately Operated Facilities for a resident being overcharged for room and board. The plan of correction was for the licensee to repay R1 the overcharged fee, and document a new procedure to account for Room and Board expenses and resident Personal and Incident funds. LPA received on 10/03/2025 documentation of R1 receiving the money owed, retraining of business office staff on new procedure for account for funds for residents was received. During the time of the visit, LPA interview R1 and confirmed the amount was received and is being safeguarded. Therefore, the POC has been met and the deficiency was cleared at the time of the visit. An exit interview was conducted where this report, and clearance letter was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 9, 2025

Allegation investigated: Resident being overcharged for services

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Efren Rilo, who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations/conducted a walk through, and conducted records review. It was alleged “Resident being overcharged for services”. It was alleged that Resident #1 (R1) was being overcharged for services by the facility applying R1’s personal and Incidental funds (P and I) to pay for R1’s owed rental amount. The Department conducted an audit, interviews, and records review. Substantiated Interview with R1 revealed that for a period of time their social security income was frozen and their rent went unpaid. The facility became their representative payee and since October of 2024 R1 had not received any of their P and I funds. Interview with (2) facility staff including the licensee, revealed that R1 owed the facility rent and when they became the payee for R1 they applied R1’s P and I to the owed rental amount. Record review of form “Advanced Notice of Representative Payment” revealed the facility was appointed as R1’s payee by the Social Security Administration and was signed by R1 since October 2024. The audit revealed that from October 2024 to July of 2025 the facility had applied R1’s P and I to R1’s owed rent in the amount of $2,076.00. As of 07/25/2025, interviews with (2) staff including the licensee, LIC405 Record of Resident's Safeguard Cash Resources revealed that the owed rent for R1 was recovered and R1’s account was current. R1 confirmed they were paid $500.00 on 07/25/2025. It was determined the facility owes R1 this total amount. Based on record review and interview the allegation that the facility overcharged the resident is substantiated, the preponderance of the evidence standard has been met. It was determined that the facility owes R1 $1,576.00. Per California Code of Regulations Title 22, a deficiency was cited and a plan of correction was created. An exit interview was conducted where this report and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, Oct 3, 2025 · control 18-AS-20250513170142

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(27) · Plan of correction due date: Oct 3, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (27) To keep, have access to, and use their own personal possessions, including … to…be allowed to spend their own money, unless limited by statute or regulation. This requirement was not met as evidenced by: Based on interview and record review the licensee used R1’s personal and incidental funds to pay to pay rent owed by R1 against R1’s wishes. This poses an immediate health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: The licensee agreed to pay R1 the money owed and send proof by the POC due date. The licensee stated new procedure for accounting for resident personal incidental funds and board and care.

Allegation investigated: Staff refused to accept resident back into the facility.

On August 10, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Administrator Genessis Garcia greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above. The investigation included interviews, a collection of records, and a tour of the facility. Interviews were conducted with Resident #1 to Resident #7, Staff #1 through Staff #6 (S1-S6), and Witness #1 (W1). The Department reviewed several documents, including the Register of Facility Residents LIC 9020 (dated 07/14/25), the Personnel Report LIC 500 (dated 07/01/25) and Resident #1 (R1)'s Physicians Report LIC 624A (dated 12/10/22), Residential Care for Elderly Admission Agreement (dated 12/09/22), Identification and Emergency Information LIC 601 (dated 12/09/22), Narrative Charting (dated 02/10/23 through 02/15/23) and telecommunications messages dated 02/14/23), In Service/Meeting Training (dated 06/08/25), and as well as other pertinent records associated with this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff refused to accept resident back into the facility. The complaint states that the staff refused to accept Resident #1 (R1) back into the facility. It is reported that (R)1 was hospitalized and ready for discharge, but the facility administrator declined to allow (R1's) return due to the resident's behavior. Additionally, reports indicate that the facility has a history of "patient dumping," which involves refusing to readmit (R1). No further details were provided regarding this situation. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to support this claim. (S1-S2) stated that (R1) was hospitalized on February 11, 2023, at Global Medical Center for medical evaluation and was kept under assessment. (S1) said to have been in touch with the hospital during (R1's) hospitalization and denied not accepting (R1) back into the facility when available for discharge on February 15, 2023. (S1) stated to have been in contact with (R1's) primary conservator and mentioned that (R1) will need to be reexamined by the neurologist upon (R1's) return to the facility. (S1) stated that (R1's) conservator disapproved of (R1's) neurologist and had disagreements regarding patient care and prescribed medications, which led to (R1) exhibiting malevolent behaviors. Evidence of narrative charting and telecommunication messages between (R1's) family conservator and (S1) will reveal that the facility has not abandoned (R1) and has not evicted (R1) according to (S1). (S1-S2) reported that (R1) was never served with an eviction notice and denied practicing "patient dumping." Furthermore, (S1-S2) emphasized that (R1's) conservator did not notify them regarding (R1's) decision to no longer return to the facility while still receiving care at the hospital. It became apparent that (R1) had been transferred to another assisted living facility selected by the conservator, and (R1's) residency was abruptly terminated without any warning. (S1-S6) all claimed to have completed Personal Rights in Residential Care Facilities for the Elderly (RCFE). On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #2 through Resident #7 (R2-R7). Six (6) out of the seven (7) residents were not able to support this claim. (R2-R7) stated that they had no concerns regarding this matter. They expressed appreciation for the treatment they receive from the staff, who are professional and welcoming. All have stated they have not seen residents denied re-entry into the facility after hospitalization. (Evaluation Report continues LIC 9099-C) The Department was unable to interview Resident #1 (R1) because (R1) was no longer available at the facility and had left with no forwarding contact information. The Department attempted to contact the family conservator, identified as Witness #1 (W1), multiple times by telephone; however, the calls went unanswered. As a result of the review of Resident #1 (R1's) Physicians Report LIC 624A (dated 12/10/22) revealed that (R1) suffers from a neurological disorder and requires medications to control aggressive behaviors. A review of (R1's) Medication Administration Record (MAR) (dated 02/01/23 through 02/28/23) revealed (R1) was prescribed (9) medications and (5) out of the (9) are to treat neurological disorder. Further review of (R1’s) Residential Care for Elderly Admission Agreement (dated 12/09/22), Identification and Emergency Information LIC 601 (dated 12/09/22) revealed (R1’s) family member (W1) holds conservatorship and has control to make decisions for (R1). Narrative Charting (dated 02/10/23 through 02/15/23) and telecommunications messages dated 02/14/23) showed that the facility was not engaging in “patient dumping” nor had the facility served an eviction notice to (R1) and that the conservator had decided to terminate residency by choice. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Aug 10, 2025 · control 18-AS-20230216085532

Allegation investigated: Staff forged a confidential document for a resident. Staff are financially abusing a resident while in care.

On August 10, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Administrator Genessis Garcia greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above. The investigation included interviews, a collection of records, and a tour of the facility on November 11, 2023, August 09, 2025, and August 10, 2025. Interviews were conducted with Resident #1 to Resident #7, Staff #1 through Staff #6 (S1-S6). The Department reviewed several documents, including the Register of Facility Residents LIC 9020 (dated 07/14/25), the Personnel Report LIC 500 (dated 07/01/25) and Resident #1 (R1)'s Physicians Report LIC 624A (dated 09/19/24 & 01/05/23), In Service/Meeting Training(dated 06/08/25), and as well as other pertinent records associated with this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #3: Staff are barricading the residents while in care. The complaint alleges that the staff at the facility barricaded Resident #1 (R1) while in care. It is reported that (R1) is unable to leave the facility, as the doors are secured with chains. No additional details were provided regarding this situation. On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to corroborate this claim. (R2-R7) asserted that the facility's doors are not secured with chains, which restricts their ability to leave the premises. Furthermore, no residents are prohibited from leaving the facility. (R1) firmly stated that this claim is invalid. (R1) confirmed (R1's) independence and said that (R1) can leave the facility unattended. (R1) expressed the ability to be independent and continued to drive a vehicle without any restrictions on leaving the premises. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to validate this claim. (S1-S6) stated (R1) is independent and can leave the facility no assistance. According to (S1-S3), (R1) enjoys the liberty of exploring various rooms within the premises freely. The environment is open and accessible, there are no locked chains on the doors that would serve as barriers. (R1) has the freedom to leave the facility with no assistance at any time without any restrictions. As a result of review of Resident #1 (R1's) Physicians Report LIC 624A (dated 09/19/24 & 01/05/23) revealed the (R1) is able to leave the facility unassisted. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. An inspection of the premises and (R1’s) room on August 10, 2025 and November 13, 2025 revealed no restricted chains on any doors. (Evaluation Report continues LIC 9099-C) Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided. INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff forged a confidential document for a resident. The complaint alleged that staff at the facility forged a confidential document for Resident #1 (R1), a life-sustaining form. This form, featuring signatures from both (R1) and the primary physician at the facility, was completed in April 2023. However, (R1) was only made aware of the forgery on October 19, 2023. No additional details were provided regarding this matter. On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to validate this claim. (R2-R7) indicated they were aware of signing confidential records and had no issues or concerns with their confidential documents. (R1) claimed that this assertion is false. Furthermore, (R1) confirmed that the signature on the Physician’s Order for Life Sustaining Treatment (POLST) form is indeed (R1’s) signature, eliminating any possibility of it being forged. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to validate this claim. (S1-S3) indicated that (R1) was admitted to the facility without having a power of attorney, conservator, or public guardian representing (R1). (R1) signed all confidential agreement documents, including the life-sustaining record. (S1-S6) all claimed to have completed Personal Rights in Residential Care Facilities for the Elderly (RCFE). A review of Resident #1 (R1's) Physician's Orders for Life Sustaining Treatment (POLST) (dated 04/06/23), Identification and Emergency Information LIC 601 (dated 01/04/23), Residential Care for Elderly Admission Agreement (dated 01/04/23), Admission Financial Agreement (dated 01/04/23), and Preplacement Appraisal LIC 603 (dated 07/28/22) revealed all had identical signature to (POLST). Further review of Physician's Orders (dated 06/26/25) listed (R1) is prescribed a total of (14) medications. It revealed that (12) out of the (14) medications have side effects of cognitive effects, depression, anxiety, confusion, or dizziness (ref: National Institute of Health). A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. (Evaluation Report continues LIC 9099-C During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. Based on the information gathered, there is not enough evidence to corroborate the allegation mentioned above. Allegation #2: Staff are financially abusing a resident while in care. The complaint alleges that the staff are financially abusing Resident #1 (R1). It has been reported that the facility's administrator is withholding (R1’s) money and checks, as well as (R1’s) bank statements. The administrator only provides (R1) with $100 in cash, while the remainder of the funds goes to the facility. No additional details were provided regarding this matter. On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to support this claim. (R2-R7) stated that they had no issues or concerns regarding their financial matters, as the facility's administrators do not manage their finances. (R1) asserted that the claim is incorrect. Additionally, (R1) stated that (R1) independently manages (R1’s) finances and that no one else has access to (R1’s) financial bank accounts. On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to support this claim. (S1-S3) indicated that (R1) self-admitted to Pico De Loro on January 4, 2023. They stated that the facility does not manage (R1's) finances; (R1's) rent expenses will be covered through (R1's) personal bank account. Additionally, the facility does not maintain any Personal and Incidental funds for (R1). A review of Resident #1 (R1's) Physicians Report LIC 624A (dated 09/19/24 & 01/05/23) revealed that (R1) has the capacity for self-care and can manage cash resources. Further review of Rent Receipts (dated 01/01/23 through 07/31/23) validated that (R1) handles (R1’s) finances. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly. (Evaluation Reports continues LIC 9099-C) During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. Based on the information gathered, there is not enough evidence to corroborate the allegation mentioned above. Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated. An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Aug 10, 2025 · control 18-AS-20231020110520

Allegation investigated: Resident sustained unexplained bruising while in care.

On 08/10/2025, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to the facility above. LPA met with the Administrator Genessis Garcia, and the purpose of the visit was to deliver findings. On 08/09/2025, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced visit to the facility to initiate a complaint investigation into the allegation above. LPA met with the Administrators Vivien Rillo and Genessis Garcia, and the purpose of the visit was explained. The investigation included the following: On 08/09/2025, LPA obtained the staff and residents roster (dated 07/01/2025), Resident #1's records, Face sheet. The investigation also reviewed the admission agreement (dated 02/09/2016), Physician Report (dated 05/31/2022), Preplacement Appraisal Information, Appraisal/Needs and Services Plan (dated 04/01/2023), Medication Administration Records.Unusual Incident/Injury report (dated 06/06/2022). The LPA conducted six staff and seven resident interviews and toured both the interior and exterior of the facility areas. LPA inspected six residents rooms. On 08/09/2025, LPA interviewed two witnesses. Unsubstantiated Allegation: Resident sustained unexplained injuries while in care The complaint details indicate that resident #1 (R1) was transferred to Riverside Regional Medical Center on June 6, 2022, for labored breathing. During this visit, the hospital staff discovered various bruises on R1's left chest. On August 9, 2025, the Licensing Program Analyst (LPA) interviewed Administrator #1 (A1), who denied the allegations. A1 explained that R1 sometimes becomes agitated due to medication side effects. On the same day, the LPA interviewed five staff members (S1-S5), all of whom also denied the allegations. They emphasized that they treat all clients with respect and dignity and would never mistreat any residents in their care. Additionally, the LPA spoke with six residents (R2-R7) on August 9, 2025. All of them denied the allegations and stated that the staff provide care and assistance with their daily activities. And never mistreated them. On August 8, 2025, the LPA interviewed two witnesses (W1-W2), both of whom also denied the allegations. They reported observing R1 when agitated and noted that R1 had been hitting R1's chest. The witnesses affirmed that the facility staff are always caring and take good care of R1. Report Continued LIC9099C On 08/09/2025, LPA record review of the Medication prescribed list found that R1 was taking four medications, with their side effects being anger, hostility, Mild skin rash, hives, bruising, itchy skin, and weight loss. LPA was not able to interview Resident #1 due to R1 passed away on 05/29/2025. Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the Administrator Genessis Garcia.the state’s words, verbatim · CDSS document, Aug 10, 2025 · control 18-AS-20220607081916

Allegation investigated: Staff member hit resident in care. Staff member threatened resident in care. Staff member handled resident in care in a rough manner. Staff member yelled at resident in care. Staff member did not treat resident in care with dignity. Staff member did not ensure that resident in care had access to clean linens.

On August 10, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) staff conducted a subsequent complaint visit to continue investigation and to deliver findings. The Department met with Administrator Genesis Garcia who assisted with this visit. Investigation consisted of: On May 13.2024, the Department conducted an initial complaint visit and determined that this investigation required further inquiry and possible additional visits and/or phone calls may be necessary to determine findings. On 7/23/25, the Department obtained (via email) and reviewed the following documents: Staff roster (dated 7/1/25), Resident Roster (dated 7/7/25), R1’s Pre-placement appraisal (dated 1/18/24) R1’s Physician’s report for RCFE (dated 2/24/25, Medical Progress notes (dated 5/8/24) Internal investigation notes-- written statements (dated 5/7/24, 5/1/24) Incident Report/SOC341 (dated 5/7/25), Appraisal/Needs and Services Plan (dated 2/11/2024) and staff training on residents rights (dated 6/8/25) Page 1 of 7 Unsubstantiated On 7/14/25, 8/4/25-8/6/25, the department conducted telephone interviews with staff (S2-S8) and Administrator (A1). S1 no longer works at the facility. On 8/9/25, the department conducted interviews with 7 Residents (R1-R7) The investigation revealed the following: Allegation: Staff member hit resident in care. The details of the complaint allege that S1 "punched" R1 twice for no reason (once in the chest and the other behind her head). On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that an internal investigation was conducted including a body check and it was found that the allegation is false. On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding allegation, and of those interviewed, 6 out of 6 denied allegation stating that a no time have they ever “punched” or hit a resident in care. 6 out of 6 stated that they have never witnessed any other staff “punching or hitting a resident at any time. Lastly, 6 out of 6 staff interviewed stated that they have received Residents' Rights Training. On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 6 out of 7 stated that staff has never “punched” or “hit” them at any time. 6 out of 7 stated that staff treats them “good” and they feel safe in the facility. Lastly, 1 of 7 stated that staff are nice sometimes. R1 further stated that generally R1 feels safe in the facility. Page 2 of 7 On 8/9/25, the Department obtained and reviewed a copy of the in-service training on Residents’ Rights (dated 6/8/25). On 7/23/25, the Department received (via email) and reviewed a copy of progress notes from doctor (dated 5/8/24, the day after the allegation was made). The progress note did not indicate that there was bruising or indication of distress resulting from a “physical assault.” Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegation above 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. Allegation: Staff member threatened resident in care. The details of the complaint allege that S1 told R1 “You better not tell anyone about this, no one will believe you, and if you do, I will kill you.” On 7/14/25 at 4:15pm the Department interviewed the Administrator (via telephone) who denied allegation, stating that there was an internal investigation that found the allegation to be false. On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and of those interviewed, 6 out of 6 denied the allegation stating they have never witnessed any staff making threats to R1. Page 3 of 7 On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 7 out of 7 stated that staff never made threats to them nor have they witnessed any staff making threats to other residents. Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegation above 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. Allegation: Staff member handled resident in care in a rough manner. The details of the complaint allege that on Saturday (5/4/24) R1 was “roughed up” by S1. On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that based on their internal investigation, the allegation that S1 “roughed up” R1 is false. On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and of those interviewed, 6 out of 6 denied the allegation stating they have never handled a resident in a rough manner, nor have they witnessed any other staff handling a resident in a rough manner. Page 4 of 7 On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed 6 out of 7 stated that they have never been handled in and rough manner nor have they witnessed any staff handling a resident in a rough manner. Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegation above 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. Allegation: Staff member yelled at resident in care. The details of the complaint allege that staff yelled at resident in care. On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that based on their internal investigation, the allegation of S1 yelled at R1 is false. On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and 6 out of 6 denied the allegation stating they have never yelled at a resident, nor have they witnessed any other staff yelling at a resident. On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 6 out of 7 stated that they have never been yelled at nor have they witnessed any other staff yelling at a resident. Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegation above 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. Page 5 of 7 Allegation: Staff member did not treat resident in care with dignity. The details of the complaint allege that S1 shoved R1 into her wheelchair to take a shower On 7/14/25 at 4:15pm the Department interviewed the Administrator (via telephone) who denied allegation, stating that based on their internal investigation, the allegation of S1 shoving R1 into a wheelchair to take a shower is false. On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and 6 out of 6 denied the allegation stating they have never witnessed R1 being shoved in her wheelchair to take a shower at any time. On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 6 out of 7 stated that they have never witnessed staff shoving R1 in a wheelchair to take a shower. Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegation above 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. Page 6 of 7 Allegation: Staff member did not ensure that resident in care had access to clean linens. The details of the complaint allege that S1 gave R1 dirty towels to dry herself after the shower. On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that the facility always provides clean linens to the residents. On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed 7 out of 7 stated that they are provided with clean towels when they take showers and/or bath. On 8/10/25 during the tour of the facility the Department witnessed that there was an ample supply of clean linens available for residents’ use. Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegation above 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. Page 7 of 7the state’s words, verbatim · CDSS document, Aug 10, 2025 · control 18-AS-20240507145414

Allegation investigated: Staff did not prevent resident from being injured by another resident. Facility staff did not ensure resident's furniture was in good repair.

On 08/10/25, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaints investigation into the allegations above to deliver findings. LPA met with the staff, and the purpose of the visit was explained. LPA toured the facility and inspected six residents' rooms. The investigation consisted of the following: On July 29, 2025, LPA obtained the staff and resident roster (dated July 14, 2025), Resident #1's records, and the Face sheet. The investigation also reviewed the admission agreement (dated December 14, 2022), Physician Report (dated December 14, 2022), Preplacement Appraisal Information, Appraisal/Needs and Services Plan (dated December 26, 2022), Medication Administration Records, and Unusual Incident/Injury Reports (dated December 18, 2022, January 11, 2023, and February 21, 2023). On 07/29/25, LPA obtained the Riverside County Sheriff’s Department Report Case# PE223520058, dated 12/19/22. The Riverside University Health System R1 visit occurred on 12/18/22. The LPA conducted interviews with five staff members and six residents. The LPA interviewed the Administrators, Vivien Rillo and Efren Rillo. Unsubstantiated Allegation #1: Staff did not prevent the resident from being injured by another resident. The complaint alleges that the staff did not prevent the resident from being injured by another resident, which resulted in the residents being taken to the hospital. On August 9, 2025, between 09:00 AM and 03:30 PM, the LPA interviewed Administrators #1- 1(A1-A1), who denied the allegations. A1s stated that they ensured all residents received adequate supervision and provided the necessary training to the facility staff to care for the residents effectively. During the same time frame, the LPA interviewed five staff members (S1, S2, S3, S4, S5). All five staff members denied the allegations and asserted that they consistently provided supervised care for Resident #1 (R1) daily. Later, on August 9, 2025, between 10:30 AM and 03:30 PM, the LPA interviewed six residents (R2, R3, R4, R5, R6, R7). All six residents denied the allegations and stated that the staff took good care of them. They also stated that when residents fight among themselves, the staff promptly separates them. Records reviewed from R1’s medical discharge papers from Riverside University Health System indicated that R1 fell on December 18, 2022, but sustained an abrasion to the head and a black eye on the left side. On 08/29/25, the LPA obtained the Riverside County Sheriff’s Department Report Case# PE223520058, dated 12/19/22, which indicated that R1 was not assaulted but had fallen. Report Continued LIC9099C On August 09, 2025, records reviewed showed that staff completed training in Fall Prevention and Safety Protocols, Personal Rights for residents. Staff also learned how to prevent residents from fighting or arguing by redirecting them. The LPA also reviewed R1's Appraisal/Needs and Services Plan, which did not indicate that R1 was considered a fall risk and showed that R1 did not need assistance walking. The LPA was unable to interview Resident #1 because R1 passed away on 05/29/25. Records reviewed also indicated the facility send an unusual incident/injury report to Licensing depart on 12/23/22 about the incident. Based on the LPA observations, interviews, and record reviews, the preponderance of evidence has not been met. Although the allegation may have happened or is valid, there is insufficient evidence to prove whether the alleged violation did or did not take place; therefore, the allegation is unsubstantiated. Allegation #2: Facility did not ensure resident's furniture was in good repair. The complaint alleges that the facility staff did not ensure the resident's furniture was in good repair and that food and utilities were functioning properly. On 08/09/2025, LPA interviewed the Administrators #1-#1 (A1-A1), who denied the allegation and stated that the furniture in the resident rooms is in good condition. On the same day, 08/09/2025, LPA interviewed five staff members #1-5 (S1-S5), all of whom denied the allegations that the furniture was in disrepair and that the utilities were not functioning. Report Continued on LIC9099C On the same day, 08/09/2025, LPA interviewed six residents #2-7 (R2-R7). All six residents denied the allegations that the furniture in their rooms was in disrepair, that they lacked food, and that their facilities' utilities were not working. They also stated that they have not noticed the furniture falling apart. On 08/10/2025, LPA toured the facility and inspected six residents' rooms #1, #8, #10, #12, #14, and #20; all inspected rooms were in good condition, with no tears, damaged furniture, or broken items. The lights in the resident rooms were working properly. On the same day, 08/10/2025, LPA observed the residents having lunch. The food served was an ample portion. LPA was unable to interview Resident #1 because R1 had left the facility on 03/10/2023,and passed away in 2025. Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the Administrator Genessis Garcia.the state’s words, verbatim · CDSS document, Aug 10, 2025 · control 18-AS-20230103131101

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced required annual visit. LPA met with Administrator, Yamberly Genesis Garcia, and Licensee Efren Rilo who were informed of the purpose of the visit. The facility is a one story building with resident bedrooms, bathrooms, shower rooms, staff office, activity spaces, and outdoor spaces. The facility does not have a pool or firearms. The facility is a residential care facility for the elderly ages 59 and above, approved for (45) non ambulatory resident, all of which may be bedridden, and approved for locked perimeter. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. LPA observed locked dangerous items, such as centrally stored medication, sharps, and cleaning supplies. Documentation was provided showing carbon monoxide, smoke detectors and fire extinguishers were charged and tested July of 2025 and are operational. LPA observed the facility signaling system is operation and location in resident bedrooms and bathrooms. Hot water temperature was recorded at 105F in a resident bathroom. The facility has cleaning supplies to conduct regular cleaning of the facility, and personal hygiene supplies for the residents. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 7- day non perishable and 2-day perishable food items. The menus are posted and resident's prescribed diets and allergies are accessible to kitchen staff. LPA reviewed the staff schedule for staff coverage. LPA observed staff rounding and active care and supervision of residents. The current administrator has a current certificate. Required postings are found in the facility. LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last fire drill conducted on 7/2025. Record Review and Resident/Staff Files: LPA reviewed (3) staff files which possess all required documents such as criminal record clearances and training including CPR and First aide training. (5) resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication was locked in a medication room. LPA reviewed (3) resident medication lists and found medication accounted for. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was reviewed and provided. *LPA was off site from 11:38am to 1:38pm in order to prepare today's report.the state’s words, verbatim · CDSS document, Jul 24, 2025

Allegation investigated: Staff did not prevent resident from getting injured while in care

On July 23, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with Administrator, Genessis Garcia. LPA explained the reason for the visit was to provide findings for the allegation listed above. On March 28. 2024, Community Care Licensing received a complaint alleging staff did not prevent resident from getting injured while in care. During the investigation, LPA conducted interviews, record reviews, and made observations. It was reported Resident #1 (R1) had a bruise on their eye and bruising on their hand. Additionally, it was reported the facility staff did not know how it occurred but advised R1’s roommate can be aggressive and may have hit R1. Information obtained from interview with Administrator stated R1 had bruises on their hand, but did not have a bruised eye. Administrator also denied that the bruises did not come from being hit by R2 because R2 is on hospice and require full assistance to transfer from bed to chair. Information obtained from interviews with staff confirmed R1 had bruises on their hand. Additional staff further advised there were no observed or documented incidents of R2 being aggressive towards R1. Unsubstantiated Information obtained from interview with R1 did not indicate they had any bruises, due to R1 not able to coherently answer questions pertaining to the allegation. Information obtained from interview with R2 indicated there was no hitting and/or fighting, between them. Additionally, there were no interactions between R1 and R2. Information obtained from interviews with additional residents stated they were not aware of any of the residents being involved in any kind of altercation. Residents were unable to advise if they observed R1 to have a bruised eye or hand. LPA’s review of the records confirmed R1 and R2 had been receiving services through hospice care since being admitted to the facility. LPA made several attempts to obtain hospice notes regarding whether R1 was observed to have a bruised eye or hand. LPA was unable to obtain any additional documents. On 03/28/2024, LPA made observations of R1 and observed skin discoloration on R1’s hands, however, LPA did not observe any bruising to the eyes. Based on information obtained from interviews, record reviews, and observations, the information obtained regarding the allegation staff did not prevent residents from getting injured while in care was not sufficient. Due to the inability to obtain pertinent documentation, and additional hospice records, the allegation has been deemed unsubstantiated. An allegation deemed unsubstantiated means although the allegation may have happened, but there is not a preponderance of the evidence to demonstrate if the alleged violation did nor did not occur. An exit interview was conducted, and a copy of this report was discussed and provided to Administrator, Genessis Garcia.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 18-AS-20240328100409

Allegation investigated: Staff not allowing residents to leave facility.

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Administrator, Yamberly Genesis Garcia, and spoke with License Vivien Rilo over the phone who were informed of the purpose of the visit. During the visit, LPA conducted interviews, conducted a walk through, and conducted records review. It was alleged "Staff not allowing residents to leave facility." It was alleged Resident #1 (R1) was not allowed to leave the facility and the resident's were being locked in. It was alleged residents are not allowed to come and go as they please. Unsubstantiated LPA conducted an unannounced visit to the facility on 04/02/2025 and observed the facility entrance and emergency exits were free of obstructions. Based on file review, the facility’s license permits for locked perimeters per the local fire jurisdiction. LPA observed this is being observed with locked exterior gates and locked door leading to residents rooms, bathrooms and dinning area. LPA interviewed (5) residents. Interview with R1 revealed staff do not allow them to leave the facility. Interview with (4) residents revealed they are allowed to go out into the community with permission from their doctor or with assistance of visitors. LPA interviewed (4) staff who revealed some residents are allowed to leave on their own, while others must be accompanied by a family member. (4) of (4) staff revealed this is based on the resident's medical assessment by their doctor. (4) of (4) staff revealed R1 is able to leave with family or friends and stated that on the week of 05/05/2025 R1 left the facility with visitors and returned. R1's physician's report dated 01/29/2025 revealed R1 is unable to leave the facility unassisted. LPA reviewed the Resident Sign out Log which revealed resident sign out when assisted by visitors, and some residents are able to sign themselves out. On 05/01/2025 R1 signed out to go to the store at 11:50am. Therefore, the allegation that R1 and other residents cannot come and go as they please and are being locked into the facility is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 14, 2025 · control 18-AS-20250324120159

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Administrator is not on the premises a sufficient number of hours to permit adequate attention to the facility Facility did not ensure that there were sufficient staff on the premises to assist and monitor residents

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Administrator, Yamberly Genesis Garcia, and Licensee Viven Rilo over the phone who were informed of the purpose of the visit. During the visit, LPA conducted interviews, conducted a walk through, and conducted records review. It was alleged that "Administrator is not on the premises a sufficient number of hours to permit adequate attention to the facility." It was alleged Staff #1 (S1) who was the administrator of the facility in May of 2024 was not present at the facility to allow visitors into the facility. It was alleged on several visits S1 was not present at the facility. Unsubstantiated LPA attempted to conducted interview with S1, but they were unavailable for interview. LPA conducted interview with (5) staff who worked at the facility May of 2024. (5) of (5) staff revealed S1 was at the facility almost every day. The staff revealed S1 was seen continuously and from morning to afternoon at the facility. LPA conducted (5) resident interviews. (3) of (5) residents stated they did not know who S1 was, while (2) of (5) resident's stated they regularly see S1 at the facility checking on residents. LPA attempted to conduct records review for staff schedule from March 2024, however none was available at the time of the visit. Therefore, the allegation that S1 was not present at the facility enough hours to oversee the operations is unsubstantiated. It was alleged "Facility did not ensure that there were sufficient staff on the premises to assist and monitor residents." It was alleged around May of 2024 only (2) staff were present at the facility. It was also alleged the week of 09/16/2024 there were only (3) staff present at the facility. LPA attempted to interview S1 on staffing, but S1 was unavailable for interview. LPA interviewed (5) staff who worked May and September of 2024 at the facility who denied the facility is short staffed. LPA interviewed (5) residents. (4) of (5) stated there are enough staff at the facility to check on residents every 30 minutes, and residents use call buttons to summon staff. (1) of (4) residents stated the facility is short staffed and stated they are often short (1) care giver. LPA attempted to conduct records review for staff schedule from March 2024 and September of 2024, however none was available at the time of the visit. LPA conducted record review of the current schedule and observed staff present during the visit who were checking on residents and assisting residents with activities of daily living. LPA observed (5) staff present during the visit. Therefore, the allegation that staff is not present at the facility enough hours to monitor the residents is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 14, 2025 · control 18-AS-20240522141952

Allegation investigated: Staff are disclosing personal information about the residents

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced to the facility in order to conduct an investigation into the above allegation. LPA met with Administrator, Yamberly Genesis Garcia and spoke with Licensee Viven Rilo over the phone who were informed on the purpose of the visit. LPA conducted interviews and records review. It was alleged "Staff are disclosing personal information about the residents." It was alleged staff speak to others about Resident #1 (R1)'s personal information including those who was not R1's legal representative. Unsubstantiated LPA conducted interviews with (5) facility staff who denied they disclose personal information on R1 to others outside the facility. (5) of (5) staff revealed they communicate to R1's legal representative (Power of Attorney POA), and R1's doctors. (2) of (5) staff revealed R1 has a POA but did not have supporting documents in R1's file. Interview with R1 confirmed the identity of their POA. R1 stated they did not know if staff was disclosing their personal information to others. Therefore, the allegation that staff speak about R1 to others on R1's personal information is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 14, 2025 · control 18-AS-20250512145014

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Licensee Initiated

Licensing Program Analyst (LPA) Sara Martinez conducted an announced case management visit to increase the capacity per licensee request. LPA met with Administrator Efren Rillo and Administrator Assistant Earlienne Rillo and explained the purpose of the visit. At the time of visit there were 42 residents. Licensee requested a capacity increase from forty-three (43) residents to forty-five (45) residents. A Fire Clearance was approved on 09/10/2024 for two (2) additional non-ambulatory residents, of which of the 2 may also be bedridden. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA Martinez discussed the facility sketch with Licensee which provided amble space for 45 residents. LPA Martinez toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA Martinez confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. The facility has 23 bedrooms for the residents with 21 bedrooms containing an attached bathroom. The facility has 4 additional bathrooms located throughout the facility. LPA Martinez additionally confirmed that there are sufficient bathrooms in the facility to meet Title 22 requirements for ratio of residents to bathrooms. The physical plant is ready for increase in capacity. LPA will submit file for capacity increase approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA with Licensee. An exit interview was conducted where this report was discussed with and a copy was provided to Rillo.the state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Collateral

On September 24, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility to conduct an unannounced collateral visit. LPA conducted interviews for an unrelated matter to the facility. The collateral visit was conducted to make observations, interviews and records reviews pertaining to another matter. The LPA met with Lead Med-Tech, Maria Valencia introduced herself and stated the purpose of the visit. LPA Mixson toured the facility along, with Med-Tech and made observations relating to another matter altogether and interviewed Resident Number 1 (R1) who is also the (Reporting Party), from the previous matter. There were no health and safety concerns or issues observed during the time of this visit. The facility was clean and well maintained there were no obstructions to the inside or outside passageways. LPA Mixson reviewed several resident files and made observations to the other matter being investigated. LPA Mixson reviewed the daily notes written pertaining to Resident Number 1 (R1). LPA Mixson requested and received pertinent documentation pertaining to R1. An exit interview was conducted a copy of this report was discussed and given to Med-Tech, Maria Valenciathe state’s words, verbatim · CDSS document, Sep 24, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility with LPA identification and business card. There are 42 residents and 10 staff on shift at the time of inspection. Hospice waiver approved for 20; currently 6 on hospice. Infection Control on file. Resident record review began- Ten (10) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 110.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, not all foods were dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued on from page 1) LPA began review of employee records- Ten (10) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure has been changed according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 10/06/2023. The facility could not provide dates of drills per LPA's request. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are six (6) deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC 809D, Appeal Rights was reviewed with and a copy provided to the facility representative. LPA has requested updates to the following documents to be submitted to the CCL by 08/09/2024: LIC 200, Updated facility sketch.the state’s words, verbatim · CDSS document, Jul 26, 2024

Allegation investigated: Staff sexually assualted resident

Licensing Program Analyst (LPA), Yolanda Delgado made an unannounced visit to the facility to investigate a complaint investigation into the allegation listed above. During the investigation, LPA conducted interviews and reviewed documents pertaining to the allegation. It was alleged staff sexually assaulted resident on the night of June 17, 2024, “inserted gauze into their rectal cavity 10 to 15 times”. Interviews with facility staff and Reporting party revealed R1 was hospitalized from June 16th through June 18, 2024. The LPA interviewed R1 and R1 denied that they were sexually assaulted while hospitalized. LPA also reviewed R1’s admitting documents and discharge documents from the hospital to corroborate the time frame of R1’s hospitalization and no facility staff could not have sexually assaulted R1 at the facility as R1 was hospitalized when the allegation was made. This agency has investigated the complaint alleging "staff sexually assaulted resident". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Efren Rillo. Unfoundedthe state’s words, verbatim · CDSS document, Jun 20, 2024 · control 18-AS-20240619112634

Allegation investigated: Staff did not conduct a preadmissions assessment

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to deliver findings regarding the allegation listed above. LPA was granted entry and met with Administrative Assistant Yamberly Genesis Garcia, who was Informed of the purpose of the visit. Regarding the allegation “Staff did not conduct a preadmissions assessment”, it was alleged Administrator Efren Rillo did not conduct a preadmissions assessment for Resident One (R1) that reflects R1's level of care. R1 was admitted to the facility on 04/24/2014. R1's Resident Appraisal form was signed and dated on 04/25/2014 revealing prior to R1's admission, a determination of the prospective resident's suitability for admission and appraisal of R1's individual service needs, feeding, toileting, transferring, and grooming was not completed. Based on records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided to Garcia. Substantiatedthe state’s words, verbatim · CDSS document, May 15, 2024 · control 18-AS-20240305095021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: May 24, 2024

87457 Pre-Admission Appraisal – General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs...with the admission ...This requirement has not been met as evidenced by: Based on record review, the licensee did not comply with the section cited above completeing R1's preadmission appraisal prior to the resident being admitted to the facility which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: The licensee agreed to send a self certified statement stating that the licensee has read and reviewed the section cited here. This shall be sent to the LPA by the POC due date.

Allegation investigated: Staff left residents alone without adequate supervision Staff did not keep the facility clean or sanitary Staff did not ensure that residents were adequately fed

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Administrator, Efren Rillo who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations, and conducted records reviews. It was alleged that "Staff left residents alone without adequate supervision", and there was no staff at the facility. It was alleged that on 4/22/2024 at 10:30am there were no staff at the facility. LPA conducted a records review of the staff schedule for Monday 4/22/2024 and found there were (9) staff working at the facility. Unsubstantiated LPA conducted interviews with (4) staff scheduled on Monday 4/22/2024, who denied there was no staff working on this date. Around 10:30am, staff reported activities are taking place at the facility, and staff are walking around to ensure residents in their rooms are supervised. LPA conducted (4) resident interviews which revealed that staff come and assist the residents and check on them. During today’s visit LPA was at the facility from 8:40am to 11:30am and observed staff was present in the kitchen, resident rooms, and common areas. Therefore, based on interviews, records review and observation the allegation that no staff were present at the facility on Monday 4/22/2024 is unsubstantiated. It was alleged that "Staff did not keep the facility clean or sanitary". LPA conducted a walk through of the facility, including common areas, kitchen, resident rooms, bathrooms, and outdoor area. LPA observed the facility was clean and sanitary. LPA observed the cleaning supplies the facility utilizes to conduct regular cleaning of the facility, as well as hygiene and incontinent supplies for residents. LPA conducted (6) staff interviews, which revealed conflicting information. (1) staff interview revealed housekeeping staff do not always keep the facility clean, however (5) staff reported the facility is kept clean and all staff work together to help keep it clean. LPA conducted (4) resident interviews which revealed that staff keep their rooms clean and conduct laundry regularly. Therefore, based on interviews and observations LPA found that the allegation is unsubstantiated. It was alleged that "Staff did not ensure that residents were adequately fed", and facility residents appeared to be malnourished and “drugged”. LPA conducted a tour of the facility including the common areas, resident rooms and bathrooms, and outdoor areas. LPA found observed residents engaging in activities, and in their rooms. No health or safety issues were observed concerning the care of the residents. LPA also reviewed the facility menu, and conducted a walk through of the facility kitchen and found the facility meets the required food supply. LPA conducted (6) staff interviews who denied that residents are malnourished and being fed. LPA conducted (4) resident interviews which revealed that residents are being fed and there is enough food for the residents. Therefore, based on interviews, records review and observations, LPA found the allegation is unsubstantiated. Findings that are unsubstantiated mean that although the allegation is valid, the preponderance of the evidence standard has not been met. An exit interview was conducted with Administrator, Efren Rillo where this report was reviewed and provided to them.the state’s words, verbatim · CDSS document, Apr 26, 2024 · control 18-AS-20240422165732

Allegation investigated: Staff did not provide responsible party 60 day notice of fee increases

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to deliver findings regarding the allegation listed above. LPA was granted entry and met with Administrative Assistant Yamberly Genesis Garcia, who was Informed of the purpose of the visit. Regarding the allegation “Staff did not provide responsible party 60-day notice of fee increases”, it was alleged a verbal, not written, notice was given to Resident 1 (R1) and/or their Power of Attorney (POA) regarding an increase in the monthly rate for R1. Interview with Administrator (AD) Efren Rillo revealed an increase in the level of care was needed for R1, and their monthly rate was adjusted to reflect the increase. AD Rillo also revealed he only provided a verbal notice concerning the increased rate. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6), are being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided to Rillo along with LIC811- Confidential Names list and Appeal Rights. Substantiated Level of care Assessment is modeled off the Assisted Living Waiver Program Assessment Tool. Scores are categorized as Tier 1: Independent, Tier 2: Supervision, Tier 3: Limited Assistance, Tier 4: Extensive Assistance, and Tier 5: Total Dependence. The written notice sent to R1’s POA had a “ADL Self Performance Assessment” attached scoring R1’s “Level of Care” as “Tier 5: Total Dependence” for categories “Bed Mobility”, “Transfer”, “Dressing”, “Eating”, “Toilet Use”, “Personal Hygiene”, and “Bathing” . Pricing for Level of Care is modeled off the Assisted Living Waiver Program 2023 rates for Level of Care with Tier 1: $88.60 per participant per day, Tier 2: $105.86 per participant per day, Tier 3: $123.12 per participant per day, Tier 4: $166.27 per participant per day, and Tier 5: $250.00 per participant per day. The last page of the ADL Self Performance Assessment has a note signed by Administrator Efren Rillo stating R1 was assessed at Tier 5 level of care but will be charged at Tier 4 rates of $166.27 per day. Interview with Administrator Rillo revealed they lowered the level of care Tier rate for R1 due to R1 living at this facility for 10 years. Therefore based on interviews and records review, the allegation "Staff did not provide responsible party with an itemized list" has been deemed UNFOUNDED at this time. Regarding the allegation “illegal eviction”, it was alleged Pico De Loro is now in the process of evicting R1 due to not being able to afford the adjusted rate of care. Interview with Administrator Rillo stated they have not started the process of evicting R1 and they had no intention of evicting R1. Administrator stated R1’s Power of Attorney (POA) is delinquent in payment and has not paid for the months of January 2024 and February 2024. Interview with R1’s POA revealed that R1 was currently at the facility, R1 had not been evicted, and POA did not receive an eviction notice. Record review of text messages revealed POA was aware of the delinquent of payments for two months and informed Administrator Rillo they understood due to their delinquency in payment R1 may be evicted. This agency has investigated the complaint alleging “illegal eviction. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Garcia.the state’s words, verbatim · CDSS document, Mar 21, 2024 · control 18-AS-20240305095021

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Mar 29, 2024

Increase in fee rates for elderly residents...: (a)If a licensee of a residential care facility for the elderly increases the rates... the licensee shall provide no less than 60 days' prior written notice to the residents... This requirement was not bet as evidenced by: Based on interviews, Licensee failed to give R1's Power of Attorny a 60-day written notice regarding the fee increase and only gave the POA a verbal notice. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Mar 21, 2024

Plan of correction: Licensee will review Health and Safety Code 1569.655 and send a statement of understanding to CCL by POC date.

Allegation investigated: Staff are barricading the residents while in care

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to the facility to investigate and deliver findings to the above allegation. LPA was granted entry and met with Administrator Efren Rillo. Regarding the allegation "Staff are barricading the residents while in care" LPA conducted staff and resident interviews that do not corroborate the allegation listed above. Resident interviews revealed they do not feel that they are barricaded while in care at the facility and can leave to go out to the community if needed. Interviews with Staff interviews reveal residents are able to go out into the community if they are physically and mentally capable. LPA conducted a tour of the facility and observed and inspected the exit doors leading outside the facility. The facility doors were unlocked and residents had access to the courtyard and shaded seating area outside. LPA noticed a gate along the outside perimeter that was locked. LPA observed the front door of the facility to be locked as well. (CONTINUED LIC9099-C) Unsubstantiated During file review LPA found the facility was approved for a locked perimeter due to admissions of residents with dementia served. LPA's record review, observation, and interviews provided no information that could corroborate or refute validity of the allegation. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was reviewed with and provided to Administrator Efren Rillo.the state’s words, verbatim · CDSS document, Nov 13, 2023 · control 18-AS-20231020110520