Rossmoor Sunshine Villa-Ruth Elaine

Type of visit: Required - 1 Year

On May 20, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee (LI) Ricardo Banos was notified via telephone and later arrived to assist with the inspection. LPA observed that Ricardo Banos has a valid Administrator certificate which expires on January 11, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for four. The facility is a single story home which consist of six private resident bedrooms, seven bathrooms, a living room, a dining room, a kitchen, a family room, and an attached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six residents in care and two care giving staff present. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the six resident bedrooms and observed them to be clear of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in hallway cabinets. LPA inspected the six resident bathrooms and observed them to be clean. Resident bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 111.3 and 116 degrees Fahrenheit. LPA observed the facility has a two day perishable and a seven day non-perishable food supply on hand in the kitchen. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. CONTINUED ON LIC809-C LPA observed fire extinguishers to be mounted on the wall in the kitchen and in the resident hallway. Fire extinguishers were observed to be charged and serviced as of February 27, 2026. LPA tested the wired smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their most recent emergency disaster drill on May 12, 2026. LPA observed the centrally stored medication to be kept in a locked pantry located in the kitchen. LPA observed a first aid kit to be stored in the locked pantry and it has all the required components. LPA inspected the attached two car garage and observed it to be free of any hazards. LPA observed chemicals and toxins to be stored in a locked cabinet located in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the LI, conducted a tour of the exterior portions of the facility. LPA observed the exterior to be clear of any obstructions or hazards. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. All the required documentation was present and current in the resident files reviewed. LPA reviewed the residents' medication and medication administration records. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Ricardo Banos and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, May 20, 2026

Allegation investigated: Staff yells at or belittles resident Facility did not arrange for medical care appropriate to resident needs

On January 26, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Licensee (LI) Flormine Resurreccion was notified via telephone and later arrived to assist with the inpsection. During the course of the investigation, LPA interviewed residents, interviewed staff, reviewed and obtained pertinent documents to this complaint. Regarding the allegation, staff yells at or belittles resident, the following has been concluded: It was alleged that staff yelled at or belittled Resident #1 (R1). LPA conducted an interview with R1 who confirmed the allegation. LPA conducted an additional five resident interviews. Two out of the five residents interviewed were unable to be qualified for an interview. However, three out of the five residents interviewed denied the allegation and stated that staff have never mistreated them. LPA conducted four staff interviews. Four out of the four staff interviewed denied the allegation. Staff interviewed also denied ever observing a staff yell at or belittle a resident. CONTINUED ON LIC9099-C Unsubstantiated Regarding the allegation, facility did not arrange for medical care appropriate to resident needs, the following has been concluded: It was alleged that the facility did not arrange for medical care appropriate to R1's needs. LPA conducted an interview with R1 who confirmed the allegation. LPA conducted four staff interviews. Four out of the four staff interviewed denied the allegation. Staff interviewed stated that medical care was also sought for R1 when it was necessary or when it was requested from R1. Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the two allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Licensee Flormine Resurreccion and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 26, 2026 · control 22-AS-20240919092048

Type of visit: Required - 1 Year

On May 19, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Assistant Administrator (AD) Maria Tavarez arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents, One (1) may be bedridden, with approved hospice waiver for four (4) residents. Currently, there is one (1) Hospice resident present during today’s visit. This is a single story home with attached two-car garage facility. The facility has six private resident bedrooms, six full bathrooms and one half bathroom. At around 8:30 AM, LPA conducted a tour of the physical plant accompanied by Assistant Administrator Maria Tavarez, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 110.1 to 114.8 degrees F. A comfortable temperature of 73 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning products and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed two fire extinguisher’s were fully charged and mounted. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on May 12, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 8/1/2024 – 8/1/2025. A review of five residents (R1-R5) service files and four staff (S1-S4) personnel files revealed to be complete. The facility has the current administrator's certification on file for Robert Dale Kalagayan # 6067291740 - Expiration 08/07/2025. No deficiencies during this inspection visit. An exit interview was conducted with Assistant Administrator Maria Tavarez, and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 19, 2025

Type of visit: Case Management - Deficiencies

On August 16, 2024, at 1:31pm, Licensing Program Analysts (LPA) Edward Kim and Jenifer Tirre conducted a Case Management Deficiencies while on a complaint visit for Case #22-AS-20240812095815. LPAs Kim and Tirre were granted entry and met with Licensee (LI) Flormine Resurreccion and explained the purpose of the visit. During an inspection visit, LPAs Kim and Tirre observed the following: the facility did not maintain personnel records of verification of required staff training and orientation for six (6) out of the twelve (12) records reviewed. Based on the observations made during today's visit, a deficiency is being cited as per the Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted and a copy of this report and the appeal rights were provided to Licensee Flormine Resurreccionthe state’s words, verbatim · CDSS document, Aug 16, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Aug 26, 2024

87412 Personnel Records (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. Based on observation, interview, and record review, LPAs Kim and Tirre observed the facility did not maintain personnel record verification of staff training in six out of twelve staff files. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 16, 2024

Plan of correction: Licensee states they will make records into compliance by giving additional trainings and send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date August 26, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA’s) Bernadette Allen made an unannounced visit to the facility to conduct a required comprehensive annual inspection. LPA met with Maria Tavarez who granted entry into the facility. LPA observed 4 staff and 5 residents during the inspection. Facility has a capacity of six (6) residents, ages sixty (60) and above. The facility is operating in the capacity and conditions approved by CCL. Physical Plant: LPA observed there are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms: they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. The hot water temperature tested within regulation at 104-124 degrees F. The facility is equipped with operating smoke detectors, carbon monoxide alarms and fully charge fire extinguishers. Posters such as personal rights, CCL complaint poster, and the disaster plan were posted in a common area. All sharps are locked in a cabinet under the kitchen sink. There was a designated place for client/staff files locked in pantry. Overall, the facility appeared to be clean, in good repair, and operating in safe conditions. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed two (2) client files for admission agreements, updated physician reports, and Medication Administration Records (MAR’s) which appeared to be administered as prescribed by their physicians. LPA also reviewed two (2) staff files for First Aid/CPR certification, training's, and health screenings and appeared to be current. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Maria Tavarez support staff at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 15, 2024