Spanish Vines Assisted Living and Memor

Type of visit: Case Management - Other

On September 11, 2026, at 1:00 PM, Licensing Program Analyst (LPA) Avelina Martinez arrived unannounced at the facility to conduct a case management inspection. LPA Martinez met with Kaitlynn Eagleson and explained the purpose of today’s visit. The purpose of the visit today, is in response to follow up on Administrator qualification and duties, and certification requirements, and inspection Authority. During today's visit, LPA Martinez requested to review facility records. LPA Martinez was not provided the records due to facility staff not having access. In addition, LPA Martinez conducted a phone call to North Star Management Group-Regional Manager during today visit. However, the North Star Management Group-Regional Manager was not available. LPA Martinez left a voicemail and requested a return phone call. LPA Martinez also, conducted a phone call with the interim facility administrator during today's visit. However, the interim facility administrator was not able to attend today's facility visit or provide records. LPA Martinez also conducted an interview with the Marketing Director, and they do not have access to facility files. LPA Martinez conducted an interview with the Resident Care Coordinator, and they reported they have limited access to facility records, and LPA Martinez was not able to obtain facility records. Continued... For Administrator changes, the Regional Office requests the following documentation to be submitted by September 14, 2026, by 5:00 PM · A letter from the licensee and/or Board appointing the individual as the Administrator · LIC 308 Designation of Responsibility · Copy of current Administrator Certificate · LIC 200 signed by the licensee or designee · LIC 500 to indicate the days/hours the administrator is in the facility · LIC 501 Personnel Record-(And any documentation that meets the education and/or experience requirements. 87405 (f) Administrator - Qualifications and Duties As a result of this visit, the following deficiencies were cited 87405 (a) Administrator - Qualifications and Duties) and 87755 (c) Inspection Authority of the Licensing Agency, per Title 22 Regulations. The deficiencies can be found on 809-D Page. An exit interview was conducted, and a copy of this 809 report, 809 D-Page, and appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Sep 11, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Sep 25, 2026

87405(a): All facilities shall have a qualified and currently certified admin...When the admin is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section.This requirement was not met as evidence by: based on observation/interviews, on 09/11/26 the Licensee did not ensure that a substitute admin had ability to access records and manage the facility. This posed a potential health/safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Facility staff agrees to update LIC 308 designation of responsibility and designate a substitute Administrator that has qualifications adequate to be responsible and accountable for management and administration of the facility by POC date 09/25/2026. Facility staff agrees to email LPA Martinez LIC 308 and appointed substitute administrator documentation by POC date 09/25/2026 by 5:00 PM

From the deficiency page — Deficiency type: Type B · Section cited: CCR87755(c) · Plan of correction due date: Sep 25, 2026

87755(c): The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. This requirement was not met as evidence by: based on observation and records request, the Licensee did not ensure that facility records were made available to inspect and be reviewed on the 09/11/26 inspection visit. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Facility staff agrees to implement a plan to make facility records available to CCLD during normal business hours by POC date: 09/25/26. Facility staff agrees to email plan to LPA Martinez by 09/25/26 by 5:00 PM.

Allegation investigated: Resident's room is in disrepair. Facility does not have an evacuation plan. Staff did not adhere to the resident's admission agreement.

On July 17, 2026, at 9:30 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Arlene Moreno-Figueroa during today’s visit and explained the purpose of the visit. Throughout the course of this investigation, LPA Martinez conducted interviews, reviewed records, and inspected the facility. Based on information provided it was learned that resident's 1 (R1) en suite bathroom shower was leaking. It was also learned that R2's en suite bathroom ceiling was effected by the leak in R1's en suite bathroom. The facility addressed the leaks and repaired both bathrooms. Facility staff also provided invoice repair documentation. The facility also has an emergency evacuation plan, and was provided to LPA Martinez. LPA Martinez also inspected the emergency exit stairwell. The emergency exit stairwell has an evacuation chair. In addition, the facility has evacuation sketches throughout the first and second floor of the building. Continued... Unsubstantiated Moreover, LPA Martinez reviewed R1's admission agreement, which only states level one base rate. The admission agreement does not reflect assistive feeding device services. LPA Martinez also reviewed R1's February 12, 2026, and March 27, 2026, Needs and Service plans (NSP). The February 12, 2026, NSP did not indicate R1 required assistive feeding device services. The March 27, 2026, NSP included assistive feeding device services. Based on the information gathered from file reviews and interviews, there is not sufficient evidence to show that R1 moved into the facility with an assistive feeding device and that the facility agreed to provide this service to R1 when they moved into the facility. Additionally, R1's property inventory list document was not dated and did not include a feeding device. Due to the above noted information, 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, and therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 17, 2026 · control 27-AS-20260407131508

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Avelina Martinez arrived at this facility unannounced on June 17, 2026, at 12:00 PM to conduct a case management visit. LPA Martinez met with Arlene Moreno-Figueroa and explained the purpose of the visit. The purpose of the visit today, is in response to a learned Incidental Medical and Dental Care deficiency. On the June 17, 2026, facility visit, LPA Martinez found a large white bag filled with multiple medication bottles, Lorazepam syringes, multiple medication bubble packs, and morphine bottles. The large white bag filled with medications was stored in an unlocked and unsecured office. The found accessible controlled medications pose an immediate health and safety risk to resident in care. An immediate health and safety civil penalty shall be assessed on June 17, 2026, in the amount of $500.00. The immediate health and safety civil penalty can be found on the LIC421IM form. Moreover, the following deficiency was cited 87465(h)(2) Incidental Medical and Dental Care, per Title 22 Regulations. The deficiency can be found on the 809-D Page. An exit interview was conducted, and a copy of the 809 report, 809-D Page, LIC 421IM Form, and Appeals Rights were provided to the facility.the state’s words, verbatim · CDSS document, Jun 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jun 17, 2026

87465(h)(2) Incidental Medical and Dental Care: The following requirements shall apply to medications which are centrally stored:Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on observation and inspection, the licensee did not ensure medications and controlled medications were kept safe and locked. This pose an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 17, 2026

Plan of correction: Facility staff removed the medication from the unlocked room. In addition, facility staff agrees to conduct an in-service training on medication storage and proper medication destruction. By POC Date: June 24, 2026. In-service training documents shall be emailed to LPA Martinez by POC date: June 24, 2026 by 5:00 PM.

Type of visit: Prelicensing

On March 23, 2026, at 10:00 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Avelina Martinez met with Arlene Moreno-Figueroa, and explained the purpose of the visit. Facility has a fire clearance for 101 non-ambulatory residents and four bedridden residents. LPA Martinez inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. Hospice waiver is pending. LPA Martinez reviewed two resident files and two staff files. All files were complete. LPA Martinez reviewed Disaster preparedness plan, infection control plan, staff training, activities calendar, and menu. The facility temperature measure at 73 degrees. The facility water temperature measured at 106 degrees. The exterior of the facility and courtyard are in good repair. The facility has call system. The elevator certificate is current. Facility smoke detectors were inspected in May 2025. The facility kitchen had an adequate food supply and sanitary. Last fire drill was in March 2026. The hospice waiver is pending, once hospice waiver has been approved LPA Martinez will return to the facility to complete the pre-licensing visit. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 23, 2026

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 105 Interview Method: Virtual interview (Teams Meeting) On 1/15/2026, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. 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, Jan 15, 2026