Real Care

Allegation investigated: Staff falsified medication records.

On 08/04/2026, Licensing Program Analyst (LPA) J. Duarte and Licensing Program Analyst A. Walton met with Licensee Benjamin Donel and delivered findings. During the course of investigation, LPA reviewed medication for R1. LPA reviewed the acetaminophen medication for the afternoon and four out of the five pills in the bubble pack should have been dispensed. The MARs was signed to show medication was administered; however, the medication remained in the bubble pack. Staff did not have documentation to indicate or state a reason why the medication was not dispensed to R1. The MARs for R1 also indicated that on 04/06/2026, R1 refused medication with reason being that R1 was asleep. Staff interviews revealed R1 was asleep during the medication pass and staff did not want to wake up R1, so a refusal was indicated in the MARs log. However, per the administrator, the facility policy is to attempt to wake up residents and make three attempts to administer medication if a resident refuses medication Based on interviews and documentation, the preponderance of evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 6, chapter 8, on the attached 9099D. An exit interview was conducted. A copy of this report was discussed and provided Licensee Benjamin Donel, whose signature on this form confirms receipt of this document. A plan of correction was developed and a copy of this report and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 4, 2026 · control 24-AS-20260408103446

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 19, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed This requirement was no met as evidenced by: LPA reviewed the acetaminophen medication for the afternoon and four out of the five pills in the bubble pack should have been dispensed. The MARs was signed to show medication was administered; however, the medication remained in the bubble pack. Staff did not have documentation to indicate or state a reason why the medication was not dispensed to R1. The MARs for R1 also indicated that on 04/06/2026, R1 refused medication reason being is that R1 was asleep. Staff interviews revealed R1 was asleep during the medication pass and staff did not want to wake up R1, so a refusal was indicated in the MARs log, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: Licensee agrees to review section 87465 and train staff on the requirements of section 87465. Licensee will submit a copy of training topics and attendance to the Fresno CCL office by the POC due date.

Allegation investigated: Staff did not notify resident's authorized representative of an unusual incident involving the resident. Staff mismanaged medication, resulting in resident suffering a fall that caused injuries. Licensee did not ensure staffing was adequate to meet residents' needs.

On 08/04/2026, Licensing Program Analyst (LPA) J. Duarte met with Licensee Benjamin Donel and delivered findings. The Department conducted interviews and reviewed records. Per the incident reports, R1's authorized representative was made aware of the incident. LPA was unable to determine if staff mismanaged medication, resulting in a resident suffering a fall. Based on staff schedule, the facility has adequate staffing to meet the residents needs. In review of interviews conducted and records, the allegations are unsubstantiated. 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 allegations are Unsubstantiated. An exit interview was conducted. A copy of this report was discussed and provided Licensee Benjamin Donel, whose signature on this form confirms receipt of this document. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 4, 2026 · control 24-AS-20260408103446

Type of visit: Case Management - Other

On 08/04/2026, an informal meeting was held at the Fresno Regional Office. The purpose of this meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during this meeting. The following were in attendance at this meeting: Licensee, Benjamin Donel Licensing Program Manager I, Alexandria Walton Licensing Program Analyst (LPA), Jimmy Duarte During this meeting the following items were discussed: · Fire Clearance · Staffing · Physical Plant · Safeguarding Personal Belongings · Food Service Licensee will submit a plan for items discussed to CCLD by 08/19/2026. During this meeting LPA Duarte delivered findings to complaint number 24-AS-20260408103446. Exit interview was conducted. A copy of this report was discussed and provided to the Licensee, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 4, 2026

Allegation investigated: Facility did not ensure that staff are properly trained.

On 07/23/2026, Licensing Program Analyst (LPA) J. Duarte arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and met with Director of Operations, Gemma De La Cruz. LPA contacted Licensee Benjamin Donel and he authorized staff Gemma to sign this report. During the course of this investigation, LPA conducted a facility tour, reviewed records, and interviewed staff. Staff interviews revealed that staff were not fully trained and the facility did not have record of the initial and annual trainings for staff. Based on interviews, the preponderance of evidence standard has been met; therefore, the allegation: Facility did not ensure that staff are properly trained, is SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 6, chapter 8, on the attached 9099D. An exit interview was conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Gemma De La Cruz, whose signature on this form confirms receipt of this document. Substantiatedthe state’s words, verbatim · CDSS document, Jul 23, 2026 · control 24-AS-20260427110441

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Aug 3, 2026

87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement was not met as evidenced by: Staff interviews revealed that staff were not fully trained and the facility did not have record of the initial and annual trainings for staff, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2026

Plan of correction: Facility will ensure that all staff are fully trained and provide documentation to CCLD by POC due date of 08/03/2026.

Allegation investigated: Staff do not ensure resident is allowed to leave the facility for personal activities. Staff does not ensure resident is treated with dignity and respect in their personal relationships in the facility. Staff do not ensure resident is dispensed medications as prescribed.

On 06/26/2026, Licensing Program Analyst (LPA) J. Duarte met with Administrator Crystianna Robinson to deliver findings for the above allegations. The Department conducted interviews and reviewed records. Based on the interviews conducted and records reviewed, the allegations are unsubstantiated. 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 allegations are Unsubstantiated. An exit interview was conducted. A copy of this report was discussed and provided to Administrator, Cystianna Robinson, whose signature on this form confirms receipt of this document. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 26, 2026 · control 24-AS-20260403081500

Allegation investigated: Staff do not ensure resident is offered a well balanced variety of food choices.

On 06/26/2026, Licensing Program Analyst (LPA) J. Duarte arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and met with Administrator Crystianna Robinson. During the course of this investigation, LPA conducted a facility tour, reviewed records, and interviewed staff. Based on interviews and records, the facility did not have a nutritional menu for residents in care. The preponderance of evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A deficiency was cited on 05/08/2026 in complaint control number 24-AS-20260219094132, in accordance to California Code of Regulations, Title 22, Division 6, chapter 8, and a plan of correction was developed and the facility and the facility hired a nutritionist. A copy of this report and appeal rights were discussed and provided to Administrator Crystianna Robinson, whose signature on this form confirms receipt of this document. Substantiatedthe state’s words, verbatim · CDSS document, Jun 26, 2026 · control 24-AS-20260403081500

Allegation investigated: Staff are not serving nutritional meals to residents in care.

On 06/02/2026, Licensing Program Analyst (LPA) J. Duarte arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and met with Administrator Crystianna Robinson. During the course of this investigation, LPA conducted a facility tour, reviewed records, and interviewed staff. Based on interviews and records, the facility did not have a nutritional menu for residents in care. The preponderance of evidence standard has been met; therefore, the allegation is SUBSTANTIATED. A deficiency was cited on 05/08/2026, in complaint control number 24-AS-20260219094132, in accordance to California Code of Regulations, Title 22, Division 6, chapter 8, and a plan of correction was developed. An exit interview was conducted and a copy of this report was provided to Administrator Crystianna Robinson, whose signature on this form confirms receipt of this document. Substantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2026 · control 24-AS-20260327004403

Allegation investigated: Staff are not allowing a resident to see a physician. Staff are coercing a resident to sell their personal belongings.

On 06/02/2026, Licensing Program Analyst (LPA) J. Duarte arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator Crystianna Robinson. The Department investigated the above allegations. Interviews with staff revealed that the facility contracts with a doctor; however, if requested, residents may see their own physician. In addition, LPA conducted interviews and was unable to be determined if the facility is coercing residents to sell their personal belongings. 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 allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator Crystianna Robinson, whose signature on this form confirms receipt of this document. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2026 · control 24-AS-20260327004403

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) J. Duarte and Licensing Program Manager (LPM) A. Walton, arrived unannounced to conduct the Annual Inspection. LPA and LPM met with and explained the reason for the visit with Administrator (AD) Crystianna Robinson. During this visit, LPAs toured the facility inside and out. Resident rooms were observed to have required furnishings and adequate lighting. LPAs observed required items in bathrooms to include shower mats and grab bars. The hot water in resident bedrooms measured between 107 and 110 degrees F. Multiple resident rooms were observed to have stained carpet, dirty toilets, and a strong urine odor. The kitchen was toured. LPAs observed a two-day supply of perishable and a seven-day supply of nonperishable food, emergency food, water, and paper products. Refrigerator, freezers, prep stations and appliances were organized with food properly stored and labeled. The kitchen area was observed to have dead water bugs. Medications are centrally stored in locked medication carts in a medication room. Doors and passageways are unobstructed throughout the facility. LPAs toured the outdoors to find the grounds well-kept with clear walkways, and seating available. The in ground pool was gated and locked as required. The facility utilizes delayed egress in memory care; however, the facility does not have fire clearance for delayed egress. The fenced patio in memory care has an exit; however, the exit was secured closed with a padlock. Fire extinguishers were serviced on 09/26/2025. A fire drill was conducted on 03/04/2026, per staff records. Continued on LIC809-C Continued from LIC809. LPA conducted resident and staff file reviews as well as a medication audit. Emergency/ Disaster and Infection Control procedures and requirements were reviewed during the inspection. Deficiencies were cited on the attached LIC 809D. A civil penalty was assessed in the amount of $1,000 for a fire clearance repeat violation, See LIC 421IM. A civil penalty was assessed in the amount of $250 for building and grounds repeat violation, See LIC 421FC. For a total amount of $1,250. An exit interview was conducted and Plan of Corrections (POC) developed. A signed copy of this report and Appeal Rights were provided. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 06/04/2026the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) J. Duarte and Licensing Program Manager (LPM) A. Walton, arrived unannounced to conduct the Annual Inspection. LPA and LPM met with and explained the reason for the visit with Administrator (AD) Crystianna Robinson. During this visit, LPAs toured the facility inside and out. Resident rooms were observed to have required furnishings and adequate lighting. LPAs observed required items in bathrooms to include shower mats and grab bars. The hot water in resident bedrooms measured between 107 and 110 degrees F. Multiple resident rooms were observed to have stained carpet, dirty toilets, and a strong urine odor. The kitchen was toured. LPAs observed a two-day supply of perishable and a seven-day supply of nonperishable food, emergency food, water, and paper products. Refrigerator, freezers, prep stations and appliances were organized with food properly stored and labeled. The kitchen area was observed to have dead water bugs. Medications are centrally stored in locked medication carts in a medication room. Doors and passageways are unobstructed throughout the facility. LPAs toured the outdoors to find the grounds well-kept with clear walkways, and seating available. The in ground pool was gated and locked as required. The facility utilizes delayed egress in memory care; however, the facility does not have fire clearance for delayed egress. The fenced patio in memory care has an exit; however, the exit was secured closed with a padlock. Fire extinguishers were serviced on 09/26/2025. A fire drill was conducted on 03/04/2026, per staff records. Continued on LIC809-C Continued from LIC809. LPA conducted resident and staff file reviews as well as a medication audit. Emergency/ Disaster and Infection Control procedures and requirements were reviewed during the inspection. Deficiencies were cited on the attached LIC 809D. A civil penalty was assessed in the amount of $1,000 for a fire clearance repeat violation, See LIC 421IM. A civil penalty was assessed in the amount of $250 for building and grounds repeat violation, See LIC 421FC. For a total amount of $1,250. An exit interview was conducted and Plan of Corrections (POC) developed. A signed copy of this report and Appeal Rights were provided. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 06/04/2026the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) J. Duarte, conducted a Case Management regarding deficiencies observed during the complaint investigation in control number 24-AS-20260219094132. LPA introduced self and allowed entrance by Facility staff. LPA met with Director of Operations, Maria Gemma Dela Cruz, and discussed the purpose of today's visit. During the course of investigation, LPA, LPM, and S1 observed R2's mattress linens to be stained and the bedroom had a urine odor. S1 stated that she sees the stains and can smell it too. Based on the review conducted by the Department and information gathered, the following deficiency was cited on LIC 809-D per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8. An exit interview was conducted, and a copy of this report and appeal Rights were provided to Maria Gemma Dela Cruz, whose signature below confirms receipt of these reports.the state’s words, verbatim · CDSS document, May 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 22, 2026

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: LPA, LPM, and S1 observed R2's mattress linens to be stained. S1 stated that she sees the stains and can smell it too. The bedroom linens were stained and the bedroom had a urine odor, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Facility agrees to train staff to ensure client bedrooms are maintained clean and odorless. The schedule and training completed to be submitted to CCLD by POC due date of 05/22/2026.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) J. Duarte, conducted a Case Management regarding deficiencies observed during the complaint investigation in control number 24-AS-20260219094132. LPA introduced self and allowed entrance by Facility staff. LPA met with Director of Operations, Maria Gemma Dela Cruz, and discussed the purpose of today's visit. During the course of investigation, LPA, LPM, and S1 observed R2's mattress linens to be stained and the bedroom had a urine odor. S1 stated that she sees the stains and can smell it too. Based on the review conducted by the Department and information gathered, the following deficiency was cited on LIC 809-D per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8. An exit interview was conducted, and a copy of this report and appeal Rights were provided to Maria Gemma Dela Cruz, whose signature below confirms receipt of these reports.the state’s words, verbatim · CDSS document, May 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 22, 2026

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: LPA, LPM, and S1 observed R2's mattress linens to be stained. S1 stated that she sees the stains and can smell it too. The bedroom linens were stained and the bedroom had a urine odor, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Facility agrees to train staff to ensure client bedrooms are maintained clean and odorless. The schedule and training completed to be submitted to CCLD by POC due date of 05/22/2026.

Type of visit: Case Management - Deficiencies

On 04/02/2026, Licensing Program Analyst (LPA) J. Duarte and Licensing Program Manager (LPM) A. Walton, arrived unannounced to conduct a Case Management visit. LPA introduced self, stated the purpose of the visit and met with Administrator Jessica Pelaya. During the investigation of complaint control number 24-AS-20260327004403. The following was observed: The gate on Real Rd was observed secured closed with a chain and a lock. Another exit gate from the walkway on Chester Lane was observed with a lock; however, the gate was unlocked, this gate leads to another gate that exits to the parking lot, the area between both gates was observed being utilized to store plastic gasoline cans, lawn and gardening supplies and tools. The four gates to the pool were observed unlocked and one gate was observed with the key inside the lock. Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. A repeat Civil Penalty was assessed in the amount of $1,000 for fire clearance. An exit interview was conducted with the Administrator Jessica Pelaya. A plan of corrections was developed and reviewed. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Apr 3, 2026

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. This requirement was not met as evidenced by: Based on observation and interview, the gate on Real Rd was observed secured closed with a chain and a lock. Another exit gate from the walkway on Chester Lane was observed with a lock; however, the gate was unlocked, this gate leads to another gate that exits to parking lot, the area between both gates was observed being utilized to store lawn and gardening supplies and tools.the state’s words, verbatim · CDSS document, Apr 2, 2026

Plan of correction: The administrator agreed to make corrections and submit photographs of correction by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87307(e)(2)(A) · Plan of correction due date: Apr 3, 2026

87307 Personal Accommodations and Services (e) The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: (2) Fishponds, wading pools, hot tubs, swimming pools, or similar larger bodies of water. (A) The licensee shall ensure that the bodies of water specified above are inaccessible through fencing, covering, or other means when not in active use by residents. This requirement was not met as evidenced by: Based on observation and interview, the four gates to the pool were observed unlocked and one gate was observed with the key inside the lock, making the pool accessible to residents.the state’s words, verbatim · CDSS document, Apr 2, 2026

Plan of correction: The administrator agreed to make corrections and submit photographs of correction by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Apr 3, 2026

87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on observation and interview, exit gate from the walkway on Chester Lane was observed with a lock; however, the gate was unlocked, this gate leads to another gate that exits to parking lot, the area between both gates was observed being utilized to store plastic gasoline cans, lawn and gardening supplies and tools.the state’s words, verbatim · CDSS document, Apr 2, 2026

Plan of correction: The administrator agreed to make corrections and submit photographs of correction by POC due date.

Allegation investigated: Facility did not assist resident with medical needs prior to leaving community. Resident's bedroom is not clean.

On 11/07/2025, Licensing Program Analysts (LPA) J. Duarte arrived at the facility unannounced to continue the investigation and deliver findings on the above allegations. LPA was greeted by Administrator (AD) Jessica Pelaya and LPA explained the reason for today's visit. Based on observation and interviews, although the allegations may have happened, there is not a preponderance of evidence to prove that the alleged violations occurred; therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left with the administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 7, 2025 · control 24-AS-20251024095250

Allegation investigated: Staff locks resident’s bathroom door. Staff not refilling residents medication prescription in timely manner.

On 10/27/2025, Licensing Program Analysts (LPAs) J. Duarte and M. Medina conducted an unannounced initial 10-day complaint visit. LPAs introduced self, stated purpose of visit, and allowed entrance by Administrator Jessica Pelaya. This department investigated the above allegations. During the facility tour, LPAs observed the bathroom door in R1's room to be unlocked. During interviews and records review, it was stated that R1's family is obtaining newly prescribed medications and refilling medications from the pharmacy and delivering them to the facility. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 27, 2025 · control 24-AS-20251023155115

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility is in disrepair Unfingerprinted individuals on premises Reporting requirements

On 09/25/2025, Licensing Program Analysts (LPAs) J. Duarte and L. Salazar arrived at the facility unannounced to continue the investigation and deliver findings on the above allegations. LPAs were greeted by current Administrator (AD) Jessica Pelaya. LPAs stated the purpose of the visit. LPAs toured facility with AD, reviewed facility records, interviewed residents and staff, reviewed residents files, and observed two individuals not on the facility schedule as employees, had personal belongings in rooms 166 and 269 and staff reported that they reside there. A Civil Penalty in the ammount of $500 for Criminal Record Clearance is here by assessed. LPA J. Duarte observed room 174 to be floaded and with an industrial fan operating to air out the room. LPAs also observed multiple resident rooms and hallways throughout the facility with dirty and/or stained carpet, toilets, and showers. In addition the kitchen tiles have dirt built up in the groute. LPAs reviewed resident records and interviewed R1, who stated went to the hospital on two occassions. A review of facility files, shows no incident report was submitted for R1's hospital visit. Based on the information received, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D. A Civil Penalty in the ammount of $500 per individual totaling, $1,000 for Criminal Record Clearance is here by assessed on LIC421BG. An exit interview was conducted with AD and a plan of correction was developed by 10/02/2025. A copy of this report and appeal rights were discussed and provided at the time of visit. Substantiatedthe state’s words, verbatim · CDSS document, Sep 25, 2025 · control 24-AS-20250912104637

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b) · Plan of correction due date: Sep 26, 2025

87355 Criminal Record Clearance (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by LPAs observation of two individuals not on the facility schedule as employees, had personal belongings in rooms 166 and 269 and staff reported that they reside there. A Civil Penalty in the ammount of $500 per individual for Criminal Record Clearance is here by assessed. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal righs of persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator is immediately removing I1 & I2 from the property. I1 & I2 will not reside at the facility until a Livescan is completed and fingerprints are cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 2, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidenced by LPA observed room 174 to be floaded and with an industrial fan to air out the room. LPAs also observed multiple resident rooms and hallways throughout the facility with dirty and/or stained carpet, toilets, and showers. In addition the kitchen tiles have dirt built up in the groute.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator has completed a cleaning schedule and task binder to ensure facility remains clean. POC cleared during this visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 2, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days... (D)Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by LPAs interview with R1, who stated went to the hospital on two occassions. A review of facility files, shows no incident was submitted for R1's hospital visit.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: In addition, administrator stated they will provide training with staff on reporting requirements by POC due date of 10/02/2025.

Type of visit: Case Management - Deficiencies

On 09/25/2025, Licensing Program Analysts (LPAs) J. Duarte and L. Salazar arrived at the facility unannounced to conduct a case management visit based on deficiencies found during a complaint investigation. LPAs conducted a facility tour and and observed R1's room to have five unsecured Oxygen tanks. R1 was observed in a wheelchair. While R1 was moving around the room, the wheelchair wheels were observed to be rolling over the canula tube that measured approximately 20 ft in length, causing possible obstruction to oxygen flow. LPAs conducted interviews with R1 and R2 and observed both residents to not have a signal system to call for assistance. A review of records reveal, Business Office Manager does not have a criminal background clearance. Based on observations and records review, and per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 809-D. A Civil Penalty in the amount of $500 for Criminal Record Clearance is hereby assessed on LIC421BG. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of persons in care. An exit interview was conducted with AD and a plan of correction was developed by 09/26/25. A copy of this report and appeal rights were discussed and provided at the time of visit.the state’s words, verbatim · CDSS document, Sep 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(a) · Plan of correction due date: Sep 26, 2025

87355 Criminal Record Clearance (a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. This requirement was not met as evidenced by LPAs observed S1 to not be on the personnel roster and not finger print cleared. A Civil Penalty in the amount of $500 for Criminal Record Clearance is here by assessed. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that she will contact S1 and advise that until a Criminal Background Clearance is completed and finger prints are completed, S1 is not to return to the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87618(b)(3)(E) · Plan of correction due date: Sep 26, 2025

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following:(3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. This requirement was not met as evidenced by LPAs observation of 5 unsecured Oxygen tanks in Resident R2s room. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that oxygen tanks not in use will be removed from the R2's room and the one's in use will be secured. Administrator stated that she will send photos to CCLD and email LPA J. Duarte of the secured oxygen tanks by 09/26/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(i)(1)(A) · Plan of correction due date: Sep 26, 2025

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: (A) Operate from each resident's living unit. This requirement was not met as evidenced by LPAs observation of Resident R1 and R2 did not have a signal system. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal righs of persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator assigned a call pendant to R1 and R2 and stated that all resident will be assigned a pendant by POC due date of 09/26/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87618(b)(3)(F) · Plan of correction due date: Sep 26, 2025

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following:(3) Ensuring that the use of oxygen equipment meets the following requirements:(F)Plastic tubing from the nasal canula or mask to the oxygen source shall be long enough to allow the resident movement within his/her room but does not constitute a hazard to the resident or others. R1 was observed in a wheelchair. The wheelchair wheels were observed to be rolling over the canula tube while moving around the room. The canula tube was observed to measure approximately 20 ft in length causing possible obstruction to oxygen flow.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator stated that she will contact hospice to order a portable oxygen machine for R1. Administrator will email request to LPA J. Duarte by POC due date of 09/26/25.

Type of visit: Case Management - Health Checks

On 09/12/25, Licensing Program Analysts (LPA) J. Duarte conducted an unannounced Case Management visit for the purpose of Health and Safety of the residents in care. LPA introduced self, stated the purpose of the visit and allowed entrance by Administrator (AD) Jessica Pelaya. LPA toured the facility with AD and S1. LPA toured the resident rooms. LPA observed one resident room with wet carpet near the entrance of the restroom. AD and S1 stated that the restroom flooded last night. S1 and AD stated that there was a clog; however, the system was unclogged this morning and the water system is now functioning. The resident room was observed to have a fan blowing air. S1 stated that the carpet in that room was washed and the carpet was drying. This resident room and the rest of the occupied resident rooms were observed to have operating sinks and toilets with running water. LPA observed residents throughout the facility watching TV in the lobby, reading books, eating, and socializing with each other. LPA toured the kitchen. The kitchen was observed to have running water. LPA observed a two day supply of perishable and a seven day supply of non-perishable food available. S2 stated that the kitchen was not affected and has had running water at all times. All common areas observed to have adequate seating available for residents in care. No deficiencies cited during case management visit. Information obtained during this visit will need further review. A follow up will be conducted at a later date and any citations will be addressed at that time if warranted. An exit interview was conducted with AD and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 12, 2025

Allegation investigated: Staff did not re order residents medications timely.

Licensing Program Analysts (LPAs) J. Duarte and S. Doucette conducted a visit to commence a complaint investigation. LPAs identified themselves and discussed the purpose of the visit, the elements of the allegations and delivered findings with Administrator (AD), Jessica Pelaya. LPAs reviewed and obtained copies of the Centrally Stored Medication, MARS, medication in Memory Care for R1 and R2. LPAs requested R2's hospice records; however, facility did not have records of R2's hospice care. Based on interviews with AD, R1 did not have a seizure. LPAs did not locate an IR or any documentation indicating R1 had a seizure. Based on records review and MARs log, medication was administered as prescribed. However, facility did not have a centrally stored medication log for R1 and R2 for August 2025. LPAs were unable to determine if medications for R1 and R2 were ordered in a timely manner. Continued on LIC 9099C. Unsubstantiated Continued from LIC 9099. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided to AD Jessica Pelaya.the state’s words, verbatim · CDSS document, Sep 11, 2025 · control 24-AS-20250905110736

Type of visit: Case Management - Deficiencies

On 09/11/2025, LPA J. Duarte and S. Doucette arrived at the facility unannounced to conduct a compliant investigation. During the course of the investigation, LPAs observed deficiencies. LPAs met with Administrator (AD) Jessica Pelaya. LPAs reviewed resident records including: Centrally Stored Medication, MARS, medication in Memory Care for R1 and R2, hospice records, admission agreements, and physician reports. During the course of the investigation, LPAs observed the Centrally stored medication log for R1 has a start date of 09/01/2025; however, medication bubble pack has a label indicating Date Opened is 09/05/25. Medication bubble pack shows eight pills out of 28 were administered for the evening and the bubble pack for the morning shows seven out of 28 were administered for the morning. In addition, a medication that indicates to be administered at Noon by pharmacy was crossed out and above was hand written "2 PM." Facility was unable to provide a centrally stored medication log for R1 and R2 for the month of August of 2025. Facility was unable to provide hospice records for review for R2. During the tour of the facility, LPAs observed latch locks on the outside of the main building, on top of the door, preventing residents from exiting the facility. LPA took photos. An exit interview was conducted and a copy of this report was provided with plan of correction and appeal rights. Civil penalty was issued for fire clearance.the state’s words, verbatim · CDSS document, Sep 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(4) · Plan of correction due date: Sep 12, 2025

87465(h)- The following requirements shall apply to medications which are centrally stored:(4) -All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement was not met as evidenced by: Licensee did not ensure prescription labels remained unaltered. LPAs observed the time for R1 to take a prescribed medication at noon was altered to indicate to take at 2 PM, which poses an immediate health, safety, and/or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: Licensee agrees to submit an agenda and date training will be conducted by the pharmacy to LPA by POC due date (09/12/25).

From the deficiency page — Deficiency type: Type A · Section cited: CCR87202(a) · Plan of correction due date: Sep 11, 2025

87202(a) - (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 was not met as evidenced by: Licensee did not ensure approved fire cleareance was maintained by attaching latch locks on the outside of the main builiding, on top of the door, locking residents in facility which poses an immediate health, safety, and/or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: Licensee agrees to immediately remove outisde latch locks. POC was cleared during the visit. A Civil Penalty was issued.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 12, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Licensee did not ensure R1's medication were issued as prescribed. LPAs observed the Centrally stored medication log for R1 has a start date of 09/01/2025; however, medication bubble pack has a label indicating Date Opened is 09/05/25. Medication bubble pack shows eight pills out of 28 were administered for the evening and the bubble pack for the morning shows seven out of 28 were administered for the morning,which poses an immediate health, safety, and/or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: Licensee agrees to submit an agenda and training date for admininstering medication to LPA by POC due date of 09/12/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(6) · Plan of correction due date: Sep 25, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by: Licensee did not ensure R1 and R2 had a centrally stored log for August of 2025, which poses a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: Licensee agrees to conduct a training on centrally stored logs by POC due date of 09/25/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87633(a)(4) · Plan of correction due date: Sep 25, 2025

(a)The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met:(4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s). This requirement was not met as evidenced by: Licensee did not ensure R2 had a Hospice Care Plan, which poses a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: Licensee agrees to submit a Hospice Care Plan for a resident that meets regulations to LPA by POC due date of 09/25/25.

Allegation investigated: Staff rely on egress devices for memory care residents as a substitute for staff Staff are not maintaining the facility free of odor Staff do not ensure that residents are provided with activities

On 8/12/2025, Licensing Program Analysts (LPAs) J. Duarte and M. Medina conducted an unannounced subsequent complaint visit to conduct facility tour, interviews, gather documentation and deliver findings. LPA introduced self and stated purpose of visit and allowed entrance by direct care staff. Administrator, Jessica Pelaya present and conducted facility tour with LPAs along with Maintenance Supervisor, Nathan Villela. . During the course of the investigation, facility was toured, interviews conducted and information gathered. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred;therefore, the allegations are UNSUBSTANTIATED. No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 12, 2025 · control 24-AS-20250620140053

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct a subsequent Pre-Licensing Inspection. LPA met with Licensee (LIC) Benjamin Donel and Administrator (AD) Jessica Pelaya. LPA, LIC and AD toured the facility grounds inside and out. LPA observed the following requirements to be met: -Toilet grab bars in all resident restrooms installed, -All resident apartments were useable and move in ready including clean or replaced carpets. -The delayed egress doors were found to be in working order. The COMP III was conducted during this visit. Contact information for the facility was confirmed. The facility phone number is (661) 760-7610 The applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.the state’s words, verbatim · CDSS document, Apr 30, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Licensee Benjamin Donel and Administrator Jessica Pelaya. The facility has capacity for 300 residents. Per Fire Clearance, 290 Non-Ambulatory and 10 Bedridden. A hospice waiver has been granted for 10. The Independent (IND) and Assisted Living (AL) residents will reside in a mixed setting. The Memory Care (MC) is a designated portion of the building. The facility has designated 67 rooms as AL, 36 rooms as IND and 32 as MC. LPA began the tour by entering through the main entrance/lobby of the 2-story building. Required postings were observed and hung as required. Common areas throughout the facility were well lit with clear walkways. Furniture was observed to be properly spaced and in good condition. Flooring found to be intact throughout. Resident apartments (IND, AL and MC) were randomly selected and toured. LPA observed operating AC/Heating units, Smoke/Carbon Monoxide detectors. Bathrooms were in good repair with faucets delivering hot water. The facility currently has apartments “move in ready” on the first floor AL and IND living. In these rooms contained, required furniture, furnishings and linens were observed. There is a signal system in place which was operational. Hot water in rooms toured measured between 107 – 114 degrees Fahrenheit. LPA observed supply of paper products, bed linens, towels and personal hygiene/grooming products. The kitchen was observed to have both walk in and stand-alone freezers and refrigerators which were maintained at required temperatures. LPA observed supply of dishes, plates, utensils, and cooking items. Cleaning supplies and chemicals as well as knives and sharp items are properly stored. Appliances were found to be in working order. The kitchen was clean with floors and storage areas intact. LPA observed medication rooms on first and second floors. The facility has three locking medication carts which will be utilized in medication pass throughout the facility. The First aid kits contained the required items. Emergency food and water supplies were observed. The Fire Extinguishers were serviced 6/24/2024 by Independent Fire & Safety. Doors and passageways are unobstructed throughout the inside of the facility common areas. The elevators were tested and in working order. A laundry room was observed with new appliances and room for storage. Outside of the facility was toured. The grounds are well maintained with clear and defined walkways. There is a gated pool which was gated and locked as required. The following requirements have not been met at the time of this inspection: 1. Toilet grab bars need to be installed in resident bathrooms 2. All apartments were not found to be useable during the visit 3. Carpets were soiled in some areas. Carpet cleaning was in process during the visit 4. Delayed Egress system was not operable and under repair during the visit An exit interview was conducted with LIC and AD. It was explained that once the items above were complete and resolved, LIC will notify LPA Brown, and a subsequent inspection will be scheduled. The COMP III was not conducted during this visit. A copy of this report was signed and emailed to ben@sunsetequitygroup.comthe state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 300 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Jessica Pelaya, Administrator; Benjamin Donel, Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 9, 2025