Silver Oaks Country Estates I

Allegation investigated: Staff are not preventing resident from engaging in physical behavior with other residents in care. Staff leave residents unsupervised for an extended periods of time.

On April 03, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility and met with the Administrator, Sarah Mckenzie. LPA explained the reason for the visit was to provide findings for the complaint investigation. During the investigation, LPA conducted interviews, record reviews, and made observations pertaining to the listed allegations. On March 12, 2026, Community Care Licensing received a complaint alleging, Staff are not preventing resident from engaging in physical behavior with other residents in care, and Staff leave residents unsupervised for extended periods of time. It was reported that there is a Resident # 1 (R1), who has been physically abusive towards staff and residents. The administrator and the owner are aware of R1’s behavior and have told residents, "If you cannot handle it, this facility is not for you." It was reported that R1 will push, kick, pull hair and slap staff and residents. Information obtained did not identify any specific date or time. Information obtained from interview with Administrator, Sarah Mckenzie, denied the allegation and stated any behaviors out of the baseline are reported to the relevant parties. Regarding the allegation staff are not preventing resident from engaging in physical behavior with other residents in care, the Administrator advised that all incidents and behaviors displayed by the residents are recorded, documented, and reported to the relevant parties. Unsubstantiated The Administrator stated that there have not been any incidents brought to the attention of the management team regarding physical behavior with other residents in care. Information obtained from interviews with the facility staff confirmed information provided by the administrator, that behaviors are documented and reported. Additional information obtained from interviews with staff advised that most of the residents are elderly and require assistance to ambulate, with walker or wheelchair. Additionally, several of the residents, including R1, may have cognitive challenges therefore if they are rude or upset with another resident or staff they usually do not recall or know why they are upset. Information obtained from interview with R1 was not reliable due to R1’s cognitive comprehension and mental decline due to their diagnosis of Alzheimer, Dementia. Additional information obtained from additional resident interviews was not reliable due to similar diagnosis. Information obtained from interview with the Witness advised that there were no concerns with how the facility staff attend to the daily needs of R1. There were no noticeable accounts that R1 was unsupervised or concerns with physical behavior with other residents on the dates and times they were out to visit with R1. Regarding the allegation, Staff leave residents unsupervised for extended periods of time, it was reported that staff will leave the facility three to four times during the day for about 30 minutes at a time to go to assist at other homes, and at this time the residents are left without supervision. When interviewed by the Administrator, Sarah Mckenzie denied the allegation. The Administrator advised that when staff leave to take their scheduled breaks the Administrator and two caregivers come to relieve the staff for breaks. Residents are never left without supervision. Information obtained from interviews with staff indicated that they are being released for their break by the Administrator and two caregivers. Additional staff interviews indicated that they do not leave residents unattended when they take their breaks or to assist at other homes. Information obtained from interviews with R1 was not reliable due to R1’s cognitive decline. Additional interviews with additional residents were not dependable due to their diagnosis of dementia and or Alzheimer’s. Information obtained from interviews with witness indicated there was no concern regarding the staff leaving the residents unattended to work in other homes. LPA’s review of the records including a R1’s medical assessment dated 12/21/2025, revealed R1’s cognitive abilities, between aging and dementia. Additional record reviews including staff schedules of staff breaks, and facility daily sign in and out, dated for March 2026, confirmed sufficient staff present to provide care and supervision during staff scheduled breaks. LPA’s observations during several unannounced visits confirmed there were sufficient staff present to provide supervision and care to the residents in care. Based on interviews, record reviews, and observations, the allegations Staff are not preventing resident from engaging in physical behavior with other residents in care, and staff leave residents unsupervised for extended periods of time, has been deemed unsubstantiated. An allegation determined unsubstantiated means although the allegation may have occurred, there is not sufficient evidence to support the listed allegation. An exit interview was conducted. A copy of this report was explained and given to Administrator, Sarah Mckenzie.the state’s words, verbatim · CDSS document, Apr 3, 2026 · control 18-AS-20260312091301

Type of visit: Required - 1 Year

On March 13, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Required Inspection and met with the Resident Services Director, Sarah McKezie. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for six adult residents and is currently operating at the capacity of five Elderly Residents, for a facility type of (740). LPA Mixson toured the facility along with the Resident Services Director and made observations pertaining to the required annual visit. LPA inspected the facility inside and outside. There were no obstructions or debris to the indoor or outdoor passageways observed. Additionally, there were no bodies of water seen on the premises at the tie of this visit. The facility is a single-story home located at 138 Sun Villa Court, Vista Ca 92084. Physical Plant: The facility phone number is (760) 415-8216 and it is operable. LPA Mixson observed the residents’ bedrooms, and each was furnished as per Regulations and Title 22. LPA Mixson inspected the facility bathrooms, and the hot water temperature tested within regulations, and was logged. The bathrooms were clean, and appliances were operating appropriately currently. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the LTCO poster. The cleaning supplies and sharp items were locked and inaccessible to the residents in care presently. There were designated storage spaces for the residents’ and staff’s files, and it was locked and inaccessible to residents in care at present. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. There were no documented errors observed on the centrally stored medication forms, and medications were stored in their original containers at the present. The facility has a locked medication cart and it is stationed in the right hand corner of the kitchen at the time of this visit. Food Service& furniture: The non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents at this time. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The overall facility is clean; the furniture is in good condition and arranged in a manner which provides space for residents to move safely. The facility cooling system and other appliances were operable at present. Licensee informed LPA there were safety lights for night throughout the facility. Care & Supervision/Administration: There were adequate staff present for the supervision of residents in care. The floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Henry Showah has a current administrator’s certificate with an expiration date of 04/26/2026, and it is posted in the facility. All documents mailed and training is completed for next years certification. Sarah provided the online portal print out. Records Reviewed and Resident/Staff Files: LPA Mixson reviewed the staff files and the facility's staff schedule. The staff files reviewed had the criminal clearances, updated training's, along with current First Aid certifications. The resident files reviewed possessed the required paperwork as per Regulations at the present time and forms updated as required by Regulations. Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as the disaster training binder. LPA observed the last fire drill met the Department standards and was conducted as required per standards. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to conduct regular cleaning of the facility. LPA reviewed the facility's infection control plan and found required infection control measures met the Department requirements. An exit interview was conducted. A copy of this report was reviewed and given to the Residents Services Director, Sarah McKenziethe state’s words, verbatim · CDSS document, Mar 13, 2026

Type of visit: Case Management - Other

On December 05, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility in order to conduct a case management visit following receipt of a death report of Resident Number 1 (R1), and met with the Director, Sarah McKenzie. On November 26, 20205, Community Care Licensing received a Death Report via the Riverside Officer of the Day (OD) desk. The death report was indicating that R1 passed away on November 19, 2025. During todays visit LPA conducted a tour of the facility along with the Director, and made observations. LPA conducted interviews and conducted a review of the records. Based on information obtained during todays visit there were no observable Health and Safety violations cited during today's visit. An exit interview was conducted and a copy of this report was explained and given to the Director Sarah Mckenzie.the state’s words, verbatim · CDSS document, Dec 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with caregiver Scarlett Brewer who was informed of the purpose of the visit. Director of Patient Services Sarah McKenzie arrived shortly after LPA's arrival. At the time of the visit there was three (3) staff and four (4) residents present. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Detergents, cleaning solutions, and sharp and dangerous objects were observed to be locked and inaccessible in a closet. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. 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 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed two (2) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid. Two (2) resident files were reviewed and possessed all required paperwork. The listed administrator possesses a current administrator's certificate. Resident medication was centrally stored and locked in a medication cabinet located in the kitchen. LPA reviewed medications prescribed to the residents and found all medication with required labeling found to be in place. Facility has the emergency and disaster plan and infection control plan. All facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items. Fire extinguishers were fully charged and inspected. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Director McKenzie.the state’s words, verbatim · CDSS document, Jul 12, 2024