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Allegation investigated: facility not providing itemized bill for increase rent/care facility not providing reassessment for increased care costs Administrator failed to required notice regarding increase care costs

Licensing Program Analyst Hiratsuka, conducted the investigation into the allegation above. LPA spoke to Administrator via the phone and then reviewed the resident's file. Administrator stated she did increase the rate and didn't give the proper notice. There was verbal increase notifications but not written. LPA left a copy of the CA Health and Safety Code for two types of rate increases with this report. Based on the interview, the allegation is substantiated. Based on the information gathered through interviews, LPA was able to determine that the allegation is substantiated. Therefore, the Department finds the allegation to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Please see 9099-D for the deficiency sited Substantiatedthe state’s words, verbatim · CDSS document, Jul 15, 2026 · control 59-AS-20260709162518

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Aug 5, 2026

Increase in fee rates for elderly residents; 90 days’ written notice standing amount of reasons for increase; application of section. If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase and the reason or reasons for the increase, including a description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident.This requirement not met as evidence by the facility based on interview adn review of resident's file, the rate increase was done incorrectly which poses a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 15, 2026

Plan of correction: By 08/05/2026, the licensee shall submit in writing how they shall ensure the rate increases are issued per the California Health and Safety Code.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hiratsuka arrived at the facility to conduct an unannounced annual visit. LPA toured the facility with Caregiver Yanique Dobson. LPA and Caregiver conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: four private and one shared bedroom, a common bathroom, kitchen, laundry room, garage, backyard, and the common areas. LPA observed rooms to have the required furnishing. LPA observed designated space for locked medications, toxins and sharps. LPA observed facility to have seven days of nonperishable foods. LPA observed carbon monoxide detectors to be present and operating. LPA reviewed three of six resident files. LPA found that two of the three resident files are missing completed and signed admission agreements and completed and signed personal rights forms. As a result of today's visit, deficiencies cited. Please see LIC 809-D. Exit interview and a copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 22, 2026

Type of visit: Case Management - Other

On October 29, 2025 at approximately 12:30 PM, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to continue the post-licensing inspection conducted on September 19, 2025. LPA met with Administrator and explained the purpose of the visit. During today's inspection, LPA and Administrator discussed the pending referral from technical support program. Administrator stated initiation has been accepted. In areas toured, no immediate health, safety, and personal rights violation was observed. LPA observed facility to be clean and sanitary. LPA and Administrator discussed health conditions and conducting thorough care plans. LPA provided Administrator a copy of: - LIC 625 APPRAISAL/NEEDS AND SERVICES PLAN - CCR 87612 Restricted Health Conditions - CCR 87615 Prohibited Health Conditions - CCR 87628 Diabetes At this time, no deficiencies cited. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a case management visit regarding a deficiency LPA observed. LPA met with staff and explained the purpose of the visit. The purpose of the phone call was regarding LPA and Licensee's phone conversation on October 6, 2025 when Licensee stated a new administrator has started at the facility, which LPA informed Licensee that a fingerprint transfer was needed prior to new administrator working at the facility. Today's visit, LPA conducted an audit via Guardian and confirmed that S1 has not been associated to the facility. LPA met with S1 and informed S1 that Licensee is to submit a written notice of appointing a new administrator along with the copy of the Administrator Certificate within 30 days of employment. Additionally, LPA and new Administrator discussed if facility needs to transfer a criminal record clearance to the facility roster, they are to submit a copy of LIC 9182 along with a copy of individual's identification card and/or driver's license to sacasctransferrequest@dss.ca.gov New Administrator completed LIC 9182 to transfer S1's criminal record clearance to the facility. LPA completed the transfer on Guardian. LPA provided new Administrator a copy of LIC 9182 and CCR 87355 Criminal Record Clearance. As a result of today's visit, deficiencies cited. Please see LIC 809-D. Exit interview and a copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 16, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(c)(1) · Plan of correction due date: Oct 17, 2025

87355 Criminal Record Clearance (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another... (1) A signed Criminal Background Clearance Transfer Request, LIC 9182 (Rev. 4/02). This requirement is not met as evidenced by: Based on file review and interview, Licensee did not comply as S1 was working at the facility for approximately two weeks without a criminal record clearance transfer to the facility which poses an immediate risk for residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: LIC 9182 was completed during LPA's visit. LPA transferred S1's clearance to the facility. Additionally, Licensee is to submit a statement of understanding of regulation 87355 Criminal Record Clearance, acknowledging that prior to residing, volunteering, or working at the facility, all individuals need a criminal record clearance and association to the facility. Plan of Correction is due October 17, 2025 to LPA Cassie Yang via email. Failure to provide plan of correction by due date will result to a $100 civil penalty per day until received.

Type of visit: Post Licensing

On September 16, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a post licensing inspection. LPA met with staff who contacted Administrator who arrived to the facility shortly afterwards. Today's visit, LPA and Administrator discussed submitting a referral to technical support program for support with staff records and training. A referral will be submitted today. LPA and Administrator discussed resident observations and the residents level of care. At this time, LPA was unable to complete post licensing inspection. LPA will continue inspection at a later day. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Prelicensing

On February 27, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a pre-licensing inspection utilizing the inspection tool. LPA met with Applicant Raman Preet and explained the purpose of the visit. LPA and Applicant conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: four private and one shared bedroom, a common bathroom, kitchen, laundry room, garage, backyard, and the common areas. LPA observed rooms to have the required furnishing. LPA observed designated space for locked medications, toxins and sharps. LPA observed facility to have seven days of nonperishable foods. LPA observed carbon monoxide detectors to be present and operating. LPA observed PUB 475 present, LPA has informed Applicant poster shall be 20 x 26. LPA observed fire extinguisher present with no service tag. Applicant was informed by Sacramento City Fire that a receipt was adequate. LPA has request Applicant to get it serviced and submit proof to LPA. LPA provided facility with a copy of the following: - LIC 311F - 87411 Personnel Requirements - General - 87307 Personal Accommodations and Services - 87211 Reporting Requirements - 1569.625 Staff training; legislative findings; contents - LIC 9182 Based on today's inspection, the pre-licensing inspection has passed. Comp III was conducted with Applicant. Applicant has satisfied all requirements in accordance to per Title 22, California Code of Regulations. CAB will be notified accordingly of licensure. Exit Interview and copy of report provided to Applicant.the state’s words, verbatim · CDSS document, Feb 27, 2025