Sunny Beach Villa

Type of visit: Required - 1 Year

On 4/9/26 at 9:00am Licensing Program Analyst (LPA) Kevin Gould and Department Representative Leigh Ann Rogers arrived at Sunny Beach Villa for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Dessi Dimitrova and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be malodorous and in need of a more thorough cleaning program. LPA observed that all rooms are equipped with the required furniture. LPA observed several areas in the facility with insufficient lighting with missing or inoperable light bulbs.. LPA measured the water temperature, temperature measured at 112 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed insufficient seven day non-perishable food supply as the facility has no canned/non-perishable food supplies in cases of emergency. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed medications in resident's possession and a physician's note indicating they are able to manage own medications. However, LPA did observe medications pre poured and not stored in their original containers provided by pharmacy. facility was unable to provide current liability insurance LPA observed liability insurance that expired November 2025. Report Continued on LIC 9099-C LPA conducted review of staff files and observed no documented training since 2019. LPA observed there is currently only one staff member/primary caregiver in addition to the licensee and administrator that based on LPA observations is no longer able to effectively provide care and supervision and maintain the facility in a clean state. LPA observed the facility has a carbon monoxide detector but observed it is not functioning as designed and is in need of replacement. Per administrator one has been ordered and has not yet arrived. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: POC

On 5/20/25 Licensing Program Analyst (LPA) Holly Williams arrived unannounced to conduct a plan of correction visit. LPA Williams met with facility designated administrator (FDA) Dessilava Dimitrova and explained the purpose of the visit. A brief interview was conducted with the FDA. The census is 2 and the facility has a hospice waiver for 2 residents. As of 5/20/25 Upon touring the facility the LPA observed that the carpet has been replaced two of the brand new laminate flooring and they painted the bedrooms.The rest of the facility looks clean and free of hazards. Plan of correction is cleared. An exit interview was held with FDA. A copy of this report was left with the FDA.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: POC

On 5/6/25 Licensing Program Analyst (LPA) Holly Williams arrived unannounced to conduct a plan of correction visit. LPA Williams met with facility designated administrator (FDA) Dessilava Dimitrova and explained the purpose of the visit. A brief interview was conducted with the FDA. The census is 2 and the facility has a hospice waiver for 2 residents. As of 5/5/25 LPA Williams have not received all proof of corrections as agreed in the plans of correction. Upon touring the facility the LPA observed that the carpet has not been replaced or taken out in two of the bedrooms. LPA granted an extension until 5/20/25 to take out or replace carpets in the 2 rooms. The rest of the facility looks clean and free of hazards. Civil penalties were assessed in the amount of $100 for failure to correct the previously issued citation that was issued on 4/10/2025. An exit interview was held with FDA. Appeal rights and a copy of this report was left with FDA.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Required - 1 Year

On 4/10/2025 a unannounced annual visit made at this facility by Licensing Program Analyst (LPA) Holly Williams and Licensing Program Manager (LPM) Czarrina Camilon-Lee. This LPA and LPM was met by the Facility Designated Administrators (FDA) Dessislava Dimitrova's mother S1 and father S2. The FDA Dessislava Dimitrova came to the facility and a brief interview was held with Dimitrova. Current census was 2 residents. It was learned that there were (0) residents under the care of hospice at this time. It was learned that there was (0) resident receiving services through home health at this time. It was learned that there were (1) residents diagnosed with dementia at this time. Facility staff files were supplied by the Licensee for review at this time. This LPA also requested for the facility resident files at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture [Continued on 809-C] and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. LPA observed grime, grease, and a sticky floor through out the kitchen. LPA observed in the drawers in the kitchen an excess amount of napkins, plastic, and the drawers had not been cleaned. Based on facility sketch room #3 designated as a client room has been changed to a staff room. Similarly, the master bedroom approved for resident room has been changed to a staff room. LPA advised the FDA to correct facility sketch and obtain new fire clearance. Facility resident bedrooms were toured. LPA observed in R1's room unlocked medications and it states in the LIC 602 that the resident is not allowed to handle their own medication. Facility resident restrooms were toured. Grab bars and non-skid mats in bathroom were observed to be present and in good repair at this time. Kitchen drawers and cabinets were opened and reviewed. Knives were observed to be unlocked in the kitchen drawers. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed and were adequate. Food in the refrigerator was not covered. Laundry area, located in the walkway leading to the outside, was toured. Bleach, detergent, and all other cleaning supplies were observed to be unlocked and accessible to the residents. Medication cabinet, was observed to be unlocked and accessible to the residents. First aid kit, located in the medication area, was reviewed and requested the items to be provided including a manual and scissors. Fire extinguishers (2), located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company Jorgensen, and found to be in compliance at this time. LPA observed bedroom 2 and the staff room did not have smoke detectors. LPA advised the administrator that the 2 smoke detectors need to be replaced because they are missing. Overall the LPA observed the facility needs a major deep cleaning to include; floor surfaces need to be washed, carpet needs to be replaced, walls, cabinets, windows, and baseboards need to be wiped down. [Continued on 809-C] Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. LPA observed tools, rakes, and ladders that were accessible to resident's. A review of (2) facility resident files was conducted and noted on the following LIC 858. A review of (2) facility staff file was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted to CCL: LIC 500 LIC 308 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Apr 10, 2025

Allegation investigated: ) Questionable Death. Neglect/Lack of Supervision: 2) Staff did not ensure resident received adequate nutrition while in care. 3) Staff did not ensure resident received sufficient fluid intake while in care.

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to Sunny Beach Villa RCFE on 8/16/24 at 2:25pm to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Licensee, Dessi Dimitrova and together discussed the investigation details. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, the department was unable to corroborate the allegations. Per the allegation of questionable death, the department could not corroborate the allegations as the determined cause of death was determined to cardiopulmonary arrest. Department review of medical records determined alleged victim had multiple comorbidities that contributed to the resident’s cause of death. Due to the resident’s medical history and medical records, the department has determined the cause of death was not suspicious or was a result of neglect/lack of supervision by facility staff. Report continued on LIC 9099-C. Unsubstantiated Additionally, the department conducted interviews with facility staff and residents who all denied resident was not provided or denied adequate nutrition and fluid intake while in care at the facility. Residents interviewed all denied and provided statements to the department that residents were provided and encouraged to drink fluids and eat balanced nutritious meals while in care at the facility. Documentation obtained by the department indicates resident made independent choices in regard to food and fluid intake. Resident would often order and have food delivered to the facility while declining food prepared by facility staff and consumed by other residents in the home. The department has determined the allegations that the facility did not provide nutritious meals and did not provide adequate fluid intake to meet resident’s needs has been unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of questionable death and neglect/lack of supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 16, 2024 · control 27-AS-20231120141425

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to Sunny Beach Villa RCFE on DATE at TIME to conduct a case management inspection to address deficiencies observed during a complaint investigation. LPA Gould met with Licensee, Dessi Dimitrova and together discussed the details of the case management. The department has determined, while conducting a complaint investigation, that the facility did not seek timely medical attention for a former resident. The department reviewed former resident’s medical records and observed the resident was admitted to the hospital on 5/18/23 with open wounds and bone protrusion on bilateral toes. Two primary caregivers interviewed denied ever witnessing resident’s toes/feet being in the condition shown and described by investigators. Previous statements obtained from caregivers stated that they assisted resident with putting on shoes without socks the date resident was admitted to the hospital and assisted the resident with bathing twice a week. Medical records indicate the resident or facility staff did not seek medical attention from the last visit in February 2023 until resident was admitted to the hospital and passed away on 5/18/23. The department has determined the facility staff did not to seek medical attention in a timely manner for resident’s foot injury. Per the California Code of Regulations, Title 22 the following deficiency is cited. Due to the injury and subsequent deficiency, an immediate civil penalty is issued today. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties. Exit interview conducted and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 16, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 19, 2024

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by Photographic evidence and statements from medical personnel that R1 was admitted to the hospital with two open wounds on toes with bone protrusion and did not seek medical attention for R1’s wounds in a timely manner which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 16, 2024

Plan of correction: The Licensee has agreed to incorporate a body/skin check to be filled out during each resident's showering day where staff will inspect and document any changes in condition. Licensee will provide a written plan of correction detailing how the facility will implement the body checks and when to contact physician or seek medical attention.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced 1 Year Required Annual Inspection Visit. LPA met with the Administrator and explained purpose of the visit. Administrator Certificate expires . LPA toured the facility and inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. LPA measured the hot water temperature in resident's bathroom at 109.8 degrees Fahrenheit which is within the required range of 105 to 120 degrees. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire Extinguisher last inspected 1/18/2023 and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present and in working order. The facility conducts fire/disaster drills with residents on 3/19/2024. LPA observed centrally stored medications, knives and toxins locked and not accessible to residents. First aid/CPR certificates are current. First aid kit was checked and is complete. LPA reviewed two resident files and two staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents for community care licensing to be submitted via email by April 10, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies observed or cited today. Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.the state’s words, verbatim · CDSS document, Apr 7, 2024

Allegation investigated: Licensee financially abused resident in care

Licensing Program Analyst (LPA) Jamie Ivey Canady arrived unannounced to deliver complaint findings. LPA Ivey Canady met with staff and later with Administrator Dessi Dimitrova. LPA Ivey Canady explained the reason for the visit. The Department has determined the following as it relates to the complaint allegation: Licensee financially abused resident in care Cont 9099-C Unsubstantiated On 2/22/2024 Licensing Program Analyst (LPA) Jamie Ivey Canady investigated current facility allegations. According to interviews with facility staff and residents, credit cards and funds have not been utilized by facility staff after 5/18/2023, the date R1 deceased. Based on facility record review, witness statements and financial institution records, R1 funds have been accessed after 5/18/2023. It was learned from facility residents and staff, that R1 shared a food deliver account with R2. Based on witness record review, there are payments that were accessed from R1 credit account; however those are payments that had been set on an automatic withdrawal and as of date of complaint, R1 estate had not stopped the automatic payments. Based on staff and resident interviews, R1 purchased a meal with the use of a food delivery account one day prior to R1 deceased. According to R1 financial records there are insurance premiums being withdrawn from R1 account. It was learned a life insurance policy was purchased by R1 with the facility administrator named as the beneficiary. However according to facility staff and facility resident statements, R1 was asked not to purchase the insurance policy. Based on facility staff statement and facility records, facility staff administrator has declined the option to file a claim for insurance payout and the insurance account has been closed by R1 insurance company. Therefore, the allegation Licensee financially abused resident in care is Unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22 no deficiencies cited. Exit interview was held and a copy of report was given to facility administratorthe state’s words, verbatim · CDSS document, Feb 27, 2024 · control 27-AS-20231120141425