Springwell Haven

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on citations issued on 04/27/2026 as well as issue an amended report. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA delivered an amended report to reflect a change in citation. LPA toured the facility and observed there are no longer sleeping quarters in the garage and a vehicle is parked there. The door to the room is unlocked and the lock has been removed. Exit interview conducted and a copy of this report as well as the amended report was provided.the state’s words, verbatim · CDSS document, Sep 3, 2026

Allegation investigated: Staff live in the garage Staff unpermitted partition/dwelling in the garage

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff. Regarding the allegations that staff live in the garage and staff unpermitted partition/dwelling in the garage, the investigation revealed the following: LPA observed a room created in the garage with a bed and furniture separated from the rest of a garage by a makeshift partition of items such as a large door (photos). Staff confirmed that staff reside in the makeshift room. Upon review of facility floor plan on file with the department, the floor plan does not match the physical plant of garage. LPA observed alterations made that are not depicted on floor plan. Based on observation and interviews conducted, the preponderance of evidence standard has been met. Therefore the above allegations are found to be SUBSTANTIATED as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. Deficiencies are being cited on the attached LIC-9099D. An exit interview was conducted and a copy of this report as well as the appeal rights were provided at exit. *amended report to amend the "D" page. Substantiatedthe state’s words, verbatim · CDSS document, Apr 27, 2026 · control 22-AS-20260420144134

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a) · Plan of correction due date: Apr 28, 2026

Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility... This req is not met as evidenced by: *amended report Based on observation and interviews conducted, Licensee failed to ensure there is no sleeping/ residing in garage by resident or staff. This poses an immediate health and safety risk to residents in care. *Resident refers to anyone residing at the facility.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: Licensee to remove the sleeping area in garage and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87305(a) · Plan of correction due date: Apr 28, 2026

Prior to construction or alterations, all facilities shall obtain a building permit. This req is not met as evidenced by: Based on observation, Licensee failed to obtain a building permit for changes made to the garage floor plan which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: Licensee to initiate process for building permit and forward proof to LPA by POC due date.

Allegation investigated: Staff live in the garage Staff unpermitted partition/dwelling in the garage

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff. Regarding the allegations that staff live in the garage and staff unpermitted partition/dwelling in the garage, the investigation revealed the following: LPA observed a room created in the garage with a bed and furniture separated from the rest of a garage by a makeshift partition of items such as a large door (photos). Staff confirmed that staff reside in the makeshift room. Upon review of facility floor plan on file with the department, the floor plan does not match the physical plant of garage. LPA observed alterations made that are not depicted on floor plan. Based on observation and interviews conducted, the preponderance of evidence standard has been met. Therefore the above allegations are found to be SUBSTANTIATED as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. Deficiencies are being cited on the attached LIC-9099D. An exit interview was conducted and a copy of this report as well as the appeal rights were provided at exit. Substantiatedthe state’s words, verbatim · CDSS document, Apr 27, 2026 · control 22-AS-20260420144134

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a)(2)(B) · Plan of correction due date: Apr 28, 2026

Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide... living accommodations.. for the residents, staff.. who may reside in the facility...No room commonly used for other purposes shall be used as a sleeping room...This req is not met as evidenced by: Based on observation and interviews conducted, Licensee failed to ensure there is no sleeping/ residing in garage by resident or staff. This poses an immediate health and safety risk to residents in care. *Resident refers to anyone residing at the facility.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: Licensee to remove the sleeping area in garage and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87305(a) · Plan of correction due date: Apr 28, 2026

Prior to construction or alterations, all facilities shall obtain a building permit. This req is not met as evidenced by: Based on observation, Licensee failed to obtain a building permit for changes made to the garage floor plan which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: Licensee to initiate process for building permit and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20260420144134. LPA was greeted and granted entry into the facility and explained the reason for the visit. While conducting the complaint investigation, LPA observed there is a locked door in the garage leading to another room. Both staff present stated having no access to the key to the room. LPA unsuccessfully attempted contact with Licensee to obtain key. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Apr 27, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(f)(2) · Plan of correction due date: May 11, 2026

A facility shall have both of the following in place: A set of keys available to facility staff on each shift for use during an evacuation that provides access to all of the following... Based on interviews conducted, Licensee failed to ensure staff have keys to all locked areas which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: Licensee to provide key access to all staff and forward proof to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Springwell Haven. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 2 residents on hospice. Licensee Ramil De Los Santos and Administrator Cristy Valerio arrived during the visit. Upon entry, facility appears clean and sanitary. LPA Lyman along with Caregiver Romeo Pegedped toured the facility at 8:50 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. The home consists of five resident bedrooms, 2 common restrooms, 1 resident restroom, caregiver room, staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident rooms are single and double occupancy. LPA observed five residents with bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 115.8 and 118.8 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards. First aid kit had all the elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked and operational. LPA observed ample emergency food and water. Facility does not have documentation of required quarterly emergency drills. LPA reviewed the emergency disaster plan and infection control and plans are thorough and complete. CONTINUED ON LIC 809C DATED 10/16/2025 Facility provides activities in the form of exercise and music therapy. LPA reviewed five resident files and three staff files. Resident files contained required documents including admission agreements, physician reports, resident appraisals and physician orders for bed rails. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance as well as required training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Oct 16, 2025

Allegation investigated: - Licensee did not ensure resident's electric bed was safeguarded

On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conduct a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Licensee (LE), Ramil Delos Santos and Administrator (AD) Cristina Valerio arrived shortly to assist with the visit. The department received a complaint on August 18, 2025 and LPA Tea conducted the initial 10-day visit a few days later on August 21, 2025. It was alleged that the licensee did not ensure resident’s electric bed was safeguarded. LPA Tea toured the facility and interviewed facility staff and collected pertinent documents such as staff and resident rosters, copies of Resident 1 (R1)’s file. The investigation determined the following: A former resident, Resident 1 (R1) moved to another facility. R1 stated the electronic hospital bed is not (Report continued on LIC9099-C) Unsubstantiated the original one they had at the former facility. R1 moved on August 6, 2025. It took two trips to move the resident. The first trip had R1 in a gurney. The second trip was their bed, Hoyer lift, wheelchairs and personal belongings. R1 assumed the bed was swapped during moving day. Per review of resident records, every resident at the facility has their own hospital bed that has been ordered from their physician. LPA verified all residents had doctor’s orders for the beds. R1 received a serial number from the medical equipment company SG Home Care for the bed – Code #15033-833-383-180328. LPA verified all the beds at the facility, and it does not match R1’s serial number. LPA toured the entire facility and checked the garage and storage shed and discovered there are no extra hospital beds, all hospital beds in the facility have a resident that occupies it, a total of four beds for the four residents currently at the facility. The extra empty beds in the facility are regular beds, not hospital beds that are used for display for vacant beds. They currently have two vacancies here. Five out of five staff interviewed similarly stated that residents have been staying in their own hospital beds and have never changed beds at all. It is difficult and heavy to disassemble the beds, let alone in a short time span when a resident was transported not far from the facility. One care staff interviewed stated that families of new residents can use the regular beds or they can order a special hospital bed. The facility does not provide hospital beds for the residents. LPA spoke to care staff regarding safeguarding residents’ personal belongings and property. All the staff similarly answered that there have never been any issues with theft or missing items. They do their best to ensure that residents’ personal belongings are safeguarded. LPA reviewed resident records and noticed the Client/Resident Personal Property and Valuables forms were blank for residents and did not list any items. LPA interviewed Licensee Ramil Delos Santos, and he explained for every resident that moves in, he tells the family to not bring anything of value to the facility. LE Delos Santos tells them not to bring jewelry or expensive stuff to avoid any issues with expensive personal property or items. LPA spoke to the transportation coordinator from AMA Transport who transported R1 and their personal property and belongings on August 6, 2025. The coordinator stated that 100 percent that is the same bed the resident had. It was never touched, moved or swapped. They had to make two trips because the transport van was not big enough for everything, and they did not want R1 waiting in the gurney for a long time. They tried to move R1’s stuff as quickly as possible. The coordinator said the distance from the facility to R1’s new facility is not far. Once they dropped off R1 at the new facility, they came back to pick up the rest of the items. It was not easy, the coordinator said they had to dissemble the bed. One of the caregivers (Report continued on LIC9099-C) helped the movers dissembled it. R1 shares the room so there is not ample room to disassemble a heavy hospital bed and swap it within an hour with a different bed due to the lack of time and space. Three caregivers interviewed witnessed a caregiver staff from the facility help the transport movers disassembled R1’s original bed. All care staff interviewed that were there on moving day confirmed that R1’s original bed was disassembled and transported with all of R1’s belongings that day. Nothing was left on moving day. The facility has in writing and a record that R1 signed a statement stating they received all their items during the move, dated and signed on August 6, 2025. Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegation that the licensee did not ensure residents electric bed was safeguarded has been determined to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies cited at this time and an exit interview was conducted with the facility and a copy of the report and confidential names list was provided to the facility.the state’s words, verbatim · CDSS document, Aug 21, 2025 · control 22-AS-20250818150104

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced plan of correction visit to follow up on citations issued on 10/07/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. At 12:05 PM, LPA toured the facility and observed the following: *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. Medications are secured during today's visit. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87608(a)(5)(A) pertaining to Postural Supports has been cleared. Licensee removed rails. Licensee has complied with the POC. *Deficiency cited under Health and Safety Code 1569.695(c) pertaining to Emergency Drills has been cleared. Licensee conducted drill. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87628(a) pertaining to Diabetes has been cleared. Licensee provided proof of correction. Licensee complied with the POC. Licensee addressed items on advisory note issued on 10/07/2024. Licensee has been advised to maintain all items in compliance. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 24, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Springwell Haven. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 1 resident on hospice. Administrator Cristy Valerio arrived during the visit. Upon entry, LPA observed two residents medications on the dining room table unsecured. LPA Lyman along with Caregiver Nenita Hernandez toured the facility at 7:30 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. The home consists of five resident bedrooms, 2 common restrooms, 1 resident restroom, caregiver room, staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident rooms are single and double occupancy. At 7:40 AM, LPA observed Resident 3 (R3) has bed rails at head and foot of bed. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.2 and 118 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards. First aid kit had all the elements including thermometer, tweezers and scissors. LPA observed toxins are secured during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 7:45 AM, LPA observed unsecured medications in the unlocked caregiver room. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there are no safety concerns noted. Exit gates are unlocked and operational. LPA observed ample emergency food and water. Facility does not have proof of required quarterly emergency drills. LPA reviewed the emergency disaster plan and infection control and plans are thorough and complete. CONTINUED ON LIC 809C DATED 10/07/2024. Facility provides activities in the form of exercise, and music therapy. LPA reviewed six resident files and three staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance as well as required training. LPA reviewed medication storage and administration. LPA observed facility staff are checking R1's blood sugar. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Oct 7, 2024