The Hills of Gowdy

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert arrived unannounced for a Case Management visit. LPA was greeted and granted entry by Staff at 10:20am. LPA met with Administrator Shaleemar "Shy" Balignasay and explained the purpose of the visit. LPA was informed the facility has a new owner as of August 15, 2026. LPA confirmed with the Regional Office that there were no new applications on file for this facility. The prospective business buyer is associated with the facility but the Department did not receive any notification or documentation; thus the facility is not under new ownership at this time. The prospective buyer is stating they are the new owners to incoming residents and families. The facility will be cited for False Claims and the current licensee must continue to operate the facility. There are currently five residents in care with two staff members. LPA observed the facility was 73 degrees Fahrenheit and was clean with no odors detected. The hot water temperatures were inspected in two of three bathrooms and ranged between 105.0 to 109.4 degrees Fahrenheit. The utilities have remained on and there were two days of perishables and seven days of non perishables on hand. One resident recently moved from another facility and a new resident will be moving in on Wednesday, August 19, 2026. There is an additional staff member who started work on August 16, 2026 and is background cleared and associated to the facility. Staff were currently paid for the last pay period but staff are still owed back wages. Deficiencies will be cited for the period of 7/31-8/18/2026 at $100 per day X 19 days for the amount of $1900. An exit interview was conducted with AD Shy Balignasay and a copy of this report, LIC 809-D, LIC421FC and Appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Aug 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: Sep 17, 2026

87207 False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: (cont'd) LPA was informed verbally by staff and family members that there is a new owner for the facility as of August 15, 2026. There is no application filed. This poses a potential health and safety risk for five of five residents in care.the state’s words, verbatim · CDSS document, Aug 18, 2026

Plan of correction: AD and Licensee are to provide information to residents, staff, vendors and families that are not misleading statements that misrepresent the facility. Currently there are no applications received by the Department regarding a change of ownership )cont'd) Therefore there is no new owner at this time. Facility operations and responsibilities remain with the Hills of Senior Living.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert arrived unannounced for a Case Management Deficiencies Visit. LPA was greeted and granted entry at 8:15am by Administrator (AD) and LPA explained the purpose of the visit. The facility has four residents in care. One resident recently moved in on July 28, 2026 and one resident receives hospice services. LPA toured the facility and the temperature was 73 degrees Fahrenheit. LPA tested hot water temperatures in three of four bathrooms and the hot water temperature ranged from 107.0 to 109.5 degrees Fahrenheit. The facility was clean and there were no odors detected. Utilities have remained on. LPA observed the facility had two days of perishable food supplies and seven days of non-perishable food on-hand. During the tour, LPA observed two of four residents had bed rails but did not have bedrail orders on file. A deficiency will be cited and bed rails will be removed by staff. LPA interviewed two of four residents and two of two live-in staff. At this time, staff have not been paid for the pay period of 7/1-7/15/2026 and were to be paid on July 22, 2026. Staff continued to be owed back pay. A penalty will be assessed for the dates of 7/10-7/30/2026 for the lack of a financial plan to ensure that staff receive their pay that is due, and for pay periods moving forward. The amount assessed on this date is $100 per day X 21 days = $2100. LPA spoke with Administrator regarding $1,237 of licensing fees that are due and provided documentation for facility. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Shaleemar Balingnasay, Administrator and a copy of this report was given to the facility along with a copy of the LIC 809-D, LIC421FC and Appeal Rights.the state’s words, verbatim · CDSS document, Jul 30, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(3) · Plan of correction due date: Jul 31, 2026

87608 (a) Based on the individual's preadmission appraisal...the facility shall provide assistance and care for the resident...which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating (Cont'd) the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidenced by: Based on LPA observation and record review, two of four residents did not have orders which poses an immediate risk to persons in care.the state’s words, verbatim · CDSS document, Jul 30, 2026

Plan of correction: Administrator stated they will obtain half bed rail orders from the physician and will remove the bed rails by the POC due date. AD will email or text photos to LPA.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management visit and to amend a report from June 18, 2026. LPA was greeted and granted entry by Administrator (AD) at 8am and explained the purpose of the visit. The facility is a seven bedroom, four bathroom residential home in which one bedroom and one bathroom is used for live-in staff. The facility is approved for six non-ambulatory residents in which one may be bedridden in bedroom #3. Currently there are three residents in care and none of the residents are on hospice. At time of entry LPA observed the facility temperature was 76 degrees Fahrenheit. Two of three residents were observed having breakfast at the dining table. A third resident was in their bedroom and had just finished breakfast. LPA toured the kitchen and observed the refrigerator had two days of perishable items and there were seven days of non perishable items available. Utilities have remained on and operational. During the tour LPA observed the house was clean and resident bedrooms had the required furnishings. The hot water temperatures ranged from 112.4 to 118.9 degrees Fahrenheit in three of four bathrooms. LPA advised Administrator to update resident Admissions Agreements and paperwork to reflect that they reside at the Hills of Gowdy. Residents have moved to this location from another property and are in the process of updating Medical Assessments to reflect the location change. LPA interviewed three of three residents and observed all were dressed and ready for the day. LPA interviewed two of two staff. Staff were fully paid on July 7, 2026 but continue to be owed back pay. (Continued on LIC 809-C) (Continued from LIC 809) A Civil Penalty will be assessed for CCR 87213 Finances for 21 days X $100 per day, from 6/18-7/9/2026 due to employees not being paid timely. Total Assessment is $2100. An exit interview was conducted with Administrator (AD) Shaleemar Balingnasay and a copy of this report, the amended report from 6/18/2026, the LIC 421FC and LIC 858 was provided at the time of visit.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management Deficiencies Visit at 8am to observe the health and safety of residents in care LPA was greeted and granted entry by Staff #1 (S1) and LPA explained the purpose of the visit. There are currently three residents in care. Two new residents were relocated from the Hills of Tree Top. Residents were moved into the facility on June 16, 2026. One additional resident already resided at the facility. LPA interviewed three of three residents regarding their quality of care and three of three residents did not have issues with care. LPA was informed two residents had passed away and Death Reports will be sent to the Department. S1 has an administrator's certificate that expires on January 29, 2027 but has not been assigned as the Administrator for this location. A second Administrator lives in the Additional Dwelling Unit (ADU) who has a current Administator's Certificate. Two of two staff members reside in the facility and are associated per Guardian report LPA interviewed staff who are currently being paid but are owed back pay. A citation will be given for Finances CCR 87213. A Civil Penalty will be assessed from 5/30-6/18/2026 at $100 per day X 20 days. Total assessed $2000. LPA toured the facility and observed there were two-days of perishable food and seven-days of non- perishable food on the premises. The facility was clean and there were no odors detected. For the two new residents who were relocated, bedrooms were put together with beds having the required linens and required furnishings were in place. LPA tested the hot water temperature in three of three bathrooms. The hot water temperature was between 105.0 to 105.2 degrees Fahrenheit. (Continued on LIC 809-C) (Continued from LIC 809) LPA obtained copies of the Certified Letter the Licensees have sent to families notifying them of legal proceedings by the Department. Letters were sent out on May 29, 2026. LPA confirmed the legal proceedings by the Department were also posted on a bulletin board by the facility's front door. Based on LPA's interviews and observations, the facility will be assessed a Civil Penalty for Finances CCR 87213 for $2000. An exit interview was conducted with Staff #1 (S1) for AD Cuyson and copy of this report was provided to the facility along with a copy of the LIC 421FC. ***THIS IS AN AMENDED REPORT.***the state’s words, verbatim · CDSS document, Jun 18, 2026

Allegation investigated: Facility did not adequately address resident's catheter.

On June 4, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to the facility to initiate the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Eleazar Cuyson was notified via telephone but was unable to assist with today's inspection. During the course of the investigation, LPA interviewed a resident, interviewed staff, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, facility did not adequately address resident's catheter, the following has been concluded: It was alleged that the facility did not adequately address Resident #1 (R1's) catheter. LPA conducted a file review for R1. Per R1's medical assessment dated May 29, 2026, R1 is diagnosed with senile dementia and is unable to manage any of his treatment, medication, or medical equipment. Per R1's after visit summary from the hospital dated March 2, 2026, it states that the facility staff are responsible for cleaning the area around R1's catheter every day. CONTINUED ON LIC9099-C Substantiated LPA conducted an interview with R1, but was unable to qualify R1 for an interview due to his current cognitive condition. LPA conducted four staff interviews. Four out of the four staff interviewed denied the allegation and stated that the area around R1's catheter has been cleaned everyday. However, based on the file review for R1, LPA observed that the facility currently does not have a care plan that addresses R1's catheter needs. LPA observed that the most recent care plan on file for R1 is dated August 3, 2023, and it does not state how the staff will be assisting R1 with his needs regarding his catheter. Per California Code of Regulation Section 87612, a catheter is categorized as a restriction health condition. Per California Code of Regulation Section 87613(a)(2), it states: (a) Prior to admission of a resident with a restricted health condition, the licensee shall: (2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs. During the investigation, the Licensee was unable to provide any documented training that demonstrated that the facility staff were provided with specialized training from a licensed professional for R1's catheter needs. Three staff interviewed also corroborated that they did not receive any training from a licensed professional for R1's catheter needs. Based on the evidence gathered during this investigation, the Department obtained sufficient evidence to substantiate the allegation that, facility did not adequately address resident's catheter. The preponderance of evidence standards has been met; therefore, the above allegation is SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D page. An exit interview was conducted with Administrator Eleazar Cuyson via telephone. A copy of the report and appeal rights were provided to the facility at time of visit.the state’s words, verbatim · CDSS document, Jun 4, 2026 · control 22-AS-20260601091902

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87613(a) · Plan of correction due date: Jun 19, 2026

87613 General Requirements for Restricted Health Conditions: (a) Prior to admission of a resident with a restricted health condition, the licensee shall: This requirement is not evidenced by: Based on records reviewed and interviews conducted, the Licensee did not ensure that the facility had an adequate plan to address Resident #1's (R1) catheter needs. R1's care plan does not address his catheter and staff did not receive any training for R1's catheter needs. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: The Administrator stated that he will update the care plan for R1 to address his catheter needs and will have a licensed professional train the facility staff who assist with R1's catheter needs. The Administrator agreed to provide LPA the updated care plan and proof of training via email or fax by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit for a Case Management Deficiencies Visit. LPA was greeted and granted entry by staff at 8am. LPA spoke with Administrator Eli Cuyson regarding the purpose of the visit. LPA toured the facility and observed the Department's Legal Accusation with legal proceedings was not posted in a prominent place within the ten days of Licensee notification. LPA contacted families of five of five residents who confirmed they were not notified of the legal proceedings by the Department. LPA spoke with Administrator on Friday, May 15th, regarding the requirement to post legal proceedings in a prominent place and to notify families by the tenth day. Civil penalties will be assessed. LPA interviewed two of two staff members and one family member and staff were not paid as of 5/28/2026. Staff were to be paid on the 7th and 22nd of each month. Two of two staff members shared they have given resignation for non-payment. Civil Penalties for Finances will be assessed. Upon touring the facility, utilities remained on and there were two-days of perishable items and seven days of non-perishable items on hand. Facility appliances were in working order. The facility was clean and no odors were detected. The hot water temperatures range between 105.9 to 107.1 degrees Fahrenheit. Three of four residents were resting comfortably at time of visit and one resident was being bathed by home health. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Total Civil Penalties assessed is $1250. An exit interview was conducted with Staff #2 for Administrator Eli Cuyson and a copy of this report was given to the facility along with a copy of the 809-D, LIC 421IMs and Appeal Rights.the state’s words, verbatim · CDSS document, May 29, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b)(1) · Plan of correction due date: May 30, 2026

§1569.38. Posting of licensing reports; disclosure to new residents. (b) A licensed residential care facility for the elderly shall provide written notice to a resident, the resident’s responsible party, if any, and the local long-term care ombudsman, within 10 days from the occurrence of either of the (cont'd) following events: (1) The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: Licensee was notified on 5/15/2026 of posting requirements by the 10th day which was May 18th and was instructed to inform Responsible Parties by this date. LPA contacted five of five resident families to notify families of legal proceedings.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(e) · Plan of correction due date: May 30, 2026

§1569.38 (e) Upon providing the notice described in subdivision (b), the licensed residential care facility shall also post a written notice, in at least 14-point type, in a conspicuous location in the facility, that may include where the mail boxes are located, where the facility license (cont'd) is posted, or any other easily accessible location in the facility. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: Licensee was notified on 5/15/2026 of posting requirements by the 10th day which was May 18th. LPA printed Accusation report for facility staff to post ASAP on front door bulletin board.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: May 30, 2026

87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records...This req is not met as evidenced by Based on interviews conducted, the Licensee did not ensure employees are receiving their paychecks timely or the full amount. This poses an immediate health and safety risk for persons in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: The Licensee to submit a financial plan to ensure that staff receive their pay that is due, and for pay periods moving forward. The financial plan shall bere- submitted via email or fax by POC date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management deficiencies visit and was greeted and granted entry by staff at 8am. LPA spoke with Administrator (AD) Eli Cuyson via phone and explained the purpose of the visit. The facility currently has five residents in care. Upon entry, two residents had eaten breakfast and were resting on the couch in the living room. LPA toured the kitchen and observed the facility had the required two days of perishable food items and seven days of non-perishable food items. The facility temperature was 70 degrees Fahrenheit and the facility was clean. During the tour, LPA tested the hot water temperatures in two of two resident bathrooms. The hot water temperatures ranged from 105.0 to 113.0 degrees Fahrenheit. Additionally, three residents were sleeping comfortably in their rooms. LPA greeted one alert resident but was informed by staff that the resident has a cold. All bedrooms had the required furnishings and linens and no odors were detected. LPA was unable to interview residents since four of five of the residents were sleeping. LPA observed they were clean, dressed and comfortable. The exterior of the property is maintained. Utilities have remained operational. LPA interviewed two of two staff who shared they have been paid and no back pay is owed. LPA shared with AD, via phone, that legal notices sent by certified mail from the Department must be posted in the facility and families notified within ten days. AD acknowledged this and will follow-up with Licensees. Based on LPA's interviews and observations, the facility is in Compliance with Title 22 Regulations and no deficiencies will be cited on this date. An exit interview was conducted with Staff #1 (S1) for AD Cuyson and copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 15, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management visit. LPA was greeted and granted entry at 8am and spoke to the Administrator (AD) Eleazar "Eli" Cuyson regarding the purpose of the visit. LPA observed the exterior of the property has been cleared of weeds and palm fronds and is being maintained. The Plan of Correction from 3/30/2026 has been cleared. The facility currently has a census of five residents. LPA observed three residents eating breakfast and one resident being bathed by a hospice agency. One resident was asleep. Upon touring the facility, the facility was 70 degrees Fahrenheit, clean and odorless. Staff were assisting with feeding residents and preparing them for the day. LPA observed the pantry and freezer had seven days of non-perishable items and the refrigerator had two day of perishable food items. LPA tested the hot water temperature in two of two bathrooms. The temperatures ranged from 105.4 to 111.0 degrees Fahrenheit. LPA interviewed two of two staff members who stated they have been paid weekly. LPA asked if any back pay was owed by both staff members and both staff members stated they have been paid. Staff shared that Friday, May 8th, is the last Friday staff will be paid weekly and that payroll will return to bi-monthly on the 7th and 22nd. The Department received a financial plan for operations from the Licensees on May 9, 2026 and currently has liability insurance. Based on LPA's interviews and observations, the facility is in Compliance with Title 22 Regulations and no deficiencies will be cited on this date. An exit interview was conducted with Staff #1 (S1) for AD Cuyson and copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management Visit and conducted a resident health and safety check. LPA was greeted and granted entry at 8:15am by Staff #2. LPA spoke with Administrator (AD) Eli Cuyson via phone and explained the purpose of the visit. Upon entry LPA observed one resident eating breakfast and another just finishing breakfast and reclining on the sofa. There were five residents in care and three staff members on site. LPA observed the facility temperature to be 70 degrees Fahrenheit and staff was preparing breakfast for the other residents. The exterior of the property was not maintained but has been cited. The Plan of Correction is due at the end of the month. During the visit, LPA toured the kitchen and observed the freezers and pantries had seven days of non-perishable supplies and the refrigerator had two days of perishable food items. Staff was cooking breakfast and feeding residents. Utilities have remained on and appliances are in working order. LPA measured hot water temperatures in two of three resident bathrooms. The hot water temperatures ranged between 105.0 to 105.2 degrees Fahrenheit. LPA was informed the water heater has been replaced and observed a hot water temperature log in bathrooms. LPA checked on the additional three residents. One was drinking their breakfast shake in their room, another resident was in the bathroom and the third resident was asleep in their bedroom. Residents were being cleaned and dressed for the day. LPA interviewed two of five residents and three of three staff. Three of three staff members reported they are paid timely and are not owed any back pay. Staff are now paid on a weekly basis. (Continued on LIC 809-C) (Continued from LIC 809) LPA spoke with Administrator (AD) and relayed that, although staff are now being paid timely and are current, the Plan of Correction states that the Licensee is to submit a financial plan to ensure that staff receive their pay that is due, and for pay periods moving forward. On this date, a financial plan has not been received by the Department. A civil penalty is assessed for the dates of 3/31/26 to 4/21/2026 for a total of 22 days X $100 per day. Total assessed for 87213 Finances is $2200. The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #3 for AD Eli Cuyson, and a copy of this report was given to the facility along with a copy of the LIC421-FC,the state’s words, verbatim · CDSS document, Apr 21, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit to do a health and safety check on residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 8am. LPA spoke with Administrator (AD) Eleazar "Eli" Cuyson regarding the purpose of the visit. Upon entering the facility two of five residents were observed at the dining room table for breakfast. One resident was tied to a wheelchair with a sweater. LPA brought this to staff's attention and staff immediately untied the resident. An immediate Civil Penalty of $500 will be assessed for using a sweater as a restraint LPA toured the kitchen and noted there were two-days of perishable food supplies and seven-days of non-perishable food on-hand. The facility was 71 degrees. LPA inspected hot water temperature and the hot water temperature was 140.7 degrees Fahrenheit. A Civil Penalty of $250 will be assessed for a Repeat Violation. The exterior of the property is not maintained and has been cited on March 30, 2026 with a Plan of Correction date of April 30, 2026. Total amount assessed is $750. LPA interviewed two of five residents and two of two staff. Two of two staff report they are being paid timely and were paid from 3/30-4/5/2026. Staff are now paid on a weekly basis. AD confirmed the facility has liability insurance. Awake residents were clean and dressed. One resident was sleeping at time of visit. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Eleazar "Eli" Cuyson, Administrator (AD) and a copy of this report was given to the facility along with a copy of the LIC 809-D, LIC421-FC, LIC 421-IM, and Appeal Rights.the state’s words, verbatim · CDSS document, Apr 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5) · Plan of correction due date: Apr 10, 2026

Postural Supports. a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself...(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement was not met as evidenced by: LPA observed one of four residents tied to a wheelchair using a sweater. This poses an immediate health and safety risk to residents in care. Civil penalty is assessed.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Staff immediately untied the sweater. AD will conduct a training for all staff members regarding resident personal rights and use of restraints Documentation to be sent to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(e)(2) · Plan of correction due date: Apr 10, 2026

87303 (e) Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained.. to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).This requirement is not met as evidenced by: Based on LPA observations and interviews Licensee failed to ensure water temperature is between 105 and 120 degrees F which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: AD immediately turned down the water heater from the measured hot water temperature of 140.7 degrees Fahrenheit. AD will send temperature log to document water temperatures daily and adjust as needed. AD to email LPA water log by POC due date

Type of visit: Case Management - Deficiencies

LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management Visit and a resident health and safety check. LPA was greeted and granted entry by Staff #1 (S1) at 8am. The facility has a census of four residents. The exterior of the facility is overgrown with weeds and palm tree fronds. LPA inquired if a gardener was maintaining the property but at this time, there is no gardener. A Type B deficiency will be given for 87303(a) Maintenance and Operation. The facility temperature was 73 degrees and all utilities are in working order. LPA toured the kitchen and observed the refrigerator has a two day supply of perishable items and there is seven days of non-perishable items on hand. LPA inspected the hot water temperature of two of three bathrooms. The hot water temperature ranged from 92.7 to 93.2 degrees Fahrenheit. A Type A deficiency and $250 Immediate Civil Penalty will be assessed for 87303(e)(2) Maintenance and Operation for hot water temperatures not being within range of 105 to 120 degrees Fahrenheit. LPA interviewed three of four residents and LPA observed residents were clean, dressed and were eating breakfast, or waiting for breakfast. LPA interviewed two of two staff members who both have been partially paid from 2/19-3/15/2026. Staff are not sure when the second half will be paid from this pay period since the pay periods are now weekly. Two of two staff confirmed they were paid from 3/3-3/18/2026. One staff member's check has cleared, the second staff member stated the check is pending in the bank and will clear on 3/30/2026. A Civil Penalty has been issued for 87213 Finances from March 12, 2026 to March 30, 2026. The amount assessed is $100/day X 19 days for a total amount of $1900. (Continued on LIC 809-C) (Continued from LIC 809) The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and Health and Safety Code. Civil Penalties are being assessed for Failure to Correct/Repeat Violation at $100 per day X 19 days for finances and a $250 Immediate Civil Penalty for hot water temperatures Total assessed is $2150. An exit interview was conducted with Staff #1 and AD via phone. AD gave permission for Staff #1 (S1) to sign licensing reports. A copy of this report was given to the facility along with a copy of the LIC 809-Ds. LIC 421-FCs and Appeal RIghts.the state’s words, verbatim · CDSS document, Mar 30, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Mar 31, 2026

87303 (e) Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained.. to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).This requirement is not met as evidenced by: Based on LPA observations and interviews Licensee failed to ensue water temperature is between 105 and 120 degrees F which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: Licensee to adjust water temperature and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 30, 2026

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA observations and interviews, the facility exterior is overgrown with weeds and palm tree fronds obstruct walkways. This poses a potential health and safety risk for residents, staff and visitors visiting the facility.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: Administrator will follow-up to obtain gardening services by POC due date. LPA will continue to monitor.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management Health Check. LPA was greeted and granted entry by the Administrator (AD), Eleazar "Eli" Cuyson at 8:20am. LPA explained to AD the purpose of the visit. The facility temperature was 72 degrees. Upon touring the kitchen LPA observed the refrigerator had two-days of perishable supplies and the freezers and pantry had seven days of non-perishable supplies on-hand. LPA measured two of two resident bathroom temperatures which ranged from 106.7 to 110.3 degrees Fahrenheit. All utilities were operational and have not been shut off. LPA observed one of three residents getting a daily bed bath, and two of three residents sleeping during the visit. LPA interviewed three of three staff. Three of three staff confirmed they were fully paid on Saturday, March 21, 2026 for the pay period of 2/19-3/18/2026. It was shared that staff will now be paid weekly and the next pay period will be from 3/19-3/25/2026 and will be paid on April 1st. Three of three staff confirmed no back pay is owed. Staffing is adequate at this time. A Technical Advisory has been provided regarding the facility's water heater. Currently the water heater resides in an Additional Dwelling Unit (ADU) with a separate address. Licensees (LE) were advised to provide a dedicated water heater to 23981 Gowdy Ave., or to include the ADU on 23697 Dune Mear to the facility's fire clearance. LEs and AD were also informed that tenants in the ADU, if under the facility plan, will need to be fingerprinted. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with AD Cuyson and a copy of the report and LIC 9102-TA were given at the time of the visit.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a health and safety Case Management visit. LPA was greeted and granted entry by Staff #1 at 8am and spoke to the Administrator (AD) via phone regarding the purpose of the visit. AD gave permission for Staff #1 to sign the licensing reports. LPA toured the facility and there were no odors detected and the facility was clean. The temperature was 73 degrees and comfortable. Cable and internet were on and operational. LPA observed the refrigerator had two-days of perishable items and seven-days of non-perishable items on-hand. LPA tested the hot water temperature in two of two resident bathrooms and the temperature ranged from 105.1 to 106.8 degrees Fahrenheit. LPA observed staff providing a bed bath for one resident. One resident was dressed and seated at the table for breakfast. A third resident was still sleeping. LPA confirmed with three of three staff that they have been paid for the prior pay period and were current. Staff will be paid on the 22nd for the pay period of 2/18-3/15/2026. It was explained to LPA by AD and Licensee that the pay period is longer due to adjusting the pay period back to the Hills paying staff on the 7th and 22nd of each month. The facility currently has liability insurance. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Staff #1 and a copy of the report were given at the time of the visit.the state’s words, verbatim · CDSS document, Mar 19, 2026

Type of visit: POC

On March 13, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced Plan of Correction visit. LPA is following up on a deficiency cited on a case management visit on January 8, 2026. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and provided verbal approval that lead caregiver can sign the report on his behalf. On today's visit, LPA observed three residents in care and two staff present. LPA observed one resident sleeping in the living room and two residents watching television in their rooms. LPA observed residents to be in clean clothes. LPA observed all internet connected television sets in the facility were working. LPA requested to view caregiver's mobile phone device to ensure it is connected to the facility's Wi-Fi. During the POC visit, LPA interviewed three staff and two residents. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. The previous citation issued during the case management visit was cleared at time of visit. An exit interview was conducted with an authorized facility representative and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 13, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management Visit. LPA was greeted and granted entry by Staff #1 (S1) at 8am. LPA spoke with the Administrator (AD) via phone regarding the purpose of the visit. The facility has three residents in care. LPA toured the kitchen and observed the refrigerator had two-days supply of perishable items. The freezer had a seven-day supply of non-perishable items. LPA observed the utilities were operational. The facility temperature was 70 degrees. The hot water temperature in two of two resident bathrooms was 105.9 to 109.2 degrees Fahrenheit. The facility has current liability insurance. LPA spoke to three of three staff who stated they were paid for the prior pay period of 2/4-2/18/2026 on March 5. 2026. Staff have not been paid for the current pay period. Staff were unsure what the pay period is currently since it recently changed so that pay dates are on the 7th and 22nd of each month. A Civil Penalty has been issued for 87213 Finances from March 6, 2026 to March 11, 2026. The amount assessed is $100/day X six days for a total amount of $600. The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Staff #1 and a copy of this report was given to the facility along with a copy of the LIC 421-FC.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety case management visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and observed the following: Facility is a one story home that appears clean, safe and sanitary. There are three residents present. LPA observed the residents relaxing in their rooms. LPA observed ample two day perishables and seven day non-perishables as well as ample emergency food and water. Utilities are operational and staff deny any interruption in services. LPA observed ample linens and hygiene supplies. Water temperature measured between 97.8 and 105.8 degrees F in facility restrooms. Smoke detectors are operational. Fire extinguishers are fully charged. LPA observed secured toxins and sharps as well as a first aid kit. Facility staff confirm payroll was delayed and are still owed wages. Facility does not have proof of current liability insurance. No health or safety concerns noted during today's visit. Based on observations and interviews conducted, Deficiencies are being cited, as per Title 22 Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator and a copy of this report as well as appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 27, 2026

87213 The licensee shall have a financial plan that [...] assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records...This req is not met as evidenced by Based on interviews conducted, the Licensee did not ensure employees are receiving their paychecks timely or the full amount. This poses an immediate health and safety risk for persons in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: The Licensee to submit a financial plan to ensure that staff receive their pay that is due, and for pay periods moving forward. The financial plan shall be submitted via email or fax by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 27, 2026

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests...This requirement is not met as evidenced by: Based on interviews conducted, the licensee did not comply with the section cited above. Licensee currently does not have liability insurance for the facility. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: Licensee to obtain liability insurance and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Mar 12, 2026

Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained.. to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).This req is not met as evidenced by: Based on observation, Licensee failed to ensue water temperature is between 105 and 120 degrees F which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: Licensee to adjust water temperature and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct a Case Management Health and Safety Check. LPA was greeted and granted entry by Staff #1 (S1) at 8am. LPA spoke with Administrator (AD) Eli Cuyson, via phone, and explained the purpose of the visit. LPA requested utility bills and liability insurance documentation from AD. AD stated he will email LPA with documentation, which is in a central location, once provided. AD was unable to meet LPA at the facility. LPA did not receive a current liability of insurance document by the end of the visit. During the visit, LPA observed the facility was clean and there were no odors. Electricity, water, trash, gas, cable/internet and phones were in working order. Both Staff #1 and Staff #2 reside in the facility and confirmed utilities have not been shut off. LPA inspected the kitchen and noted there was a minimum of two-days of perishable food and seven-days of non-perishable food on site. Groceries are delivered weekly and LPA observed the pantry was stocked. LPA observed staff feeding residents breakfast. LPA conducted a health and safety check on the three residents in care. Two of three residents interviewed stated they are happy with the care provided and that there is plenty of food. Two of the three residents have not observed any utility shut-offs and they do not have any issues. One of three residents was unable to respond to interview questions. LPA interviewed two of two staff members who confirmed they have not been paid for an entire month (two pay periods) but that they are being patient and giving the licensees time. Two of two staff stated they are good employers. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the property and noted debris on the outside perimeter of the property. LPA was told the gardener has not come in two months. Residents do not go outside but pathways in the backyard are not obstructed. LPA attempted to contact the landlord of the property but was unable to contact landlord at the phone number provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and Health and Safety Code. An exit interview was conducted via phone with Eli Cuyson, Administrator. AD gave permission for Staff #1 (S1) to sign licensing reports. A copy of this report was given to the facility along with a copy of the LIC 811, LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Feb 20, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Feb 21, 2026

87213 Finances. The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents. This requirement is not met as evidenced by: Based on LPA observation and staff interviews, the facility staff have not been paid for two pay periods: 1/7-1/20/2026 and 2/21-2/3/2026. This poses an immediate health and safety risk for all residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: Licensee (LE) was currently creating employee accounts in the new payroll account opened with US Bank. LE stated employees should be paid by Monday, 2/23/2026.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.605 · Plan of correction due date: Feb 21, 2026

§1569.605 Liability insurance; coverage requirements: On and after July 1, 2015, all residential care facilities for the elderly... shall maintain liability insurance covering injury to residents and guests in the amount of at least...($1,000,000)...per occurrence and...($3,000,000)... caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Based on LPA file review the facility does not have current liability insurance. This poses an immediate health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, Feb 20, 2026

Plan of correction: Licensee (LE) stated new insurance contracts were obtained on Wednesday, 2/18/2026 and that once all contracts are paid, LE will forward all documentation to LPM Santos and LPA Lopez.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced Case Management visit to conduct a health and safety check for the residents in care. LPA was greeted and granted entry by Staff #1 (S1) at 8:30am. LPA met with Administrator (AD) Eleazar "Eli" Cuyson and explained the purpose of the visit. The facility currently has three residents in care. LPA toured the facility kitchen and observed sharps and knives are secured. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. The facility was clean and no odors were detected. All utilities were in working order and appliances were operational. While touring the facility, LPA visited and interviewed three of three residents regarding care provided. Two of three residents stated they were doing fine and there were no issues with care provided. One resident was unable to speak but was clean and dressed and was being fed during the visit. LPA also interviewed three of three staff members regarding care provided. LPA obtained copies of the resident and staff rosters and the following documents for three of three residents: Identification and Emergency Information forms (LIC 601), Physician's Reports (LIC 602A), Resident Appraisals (LIC 603A) and Admissions Agreements. LPA provided payment information documentation to AD for licensing fees due. (Continued on LIC 809-C) (Continued from LIC 809) Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with AD Eli Cuyson and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Case Management - Health Checks

On January 8, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced case management visit for a Health & Safety check. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Eleazar Cuyson was notified via telephone and provided verbal approval that caregiver Leslie Aguilar can sign the report on his behalf. On today's visit, LPA observed two residents in care and one staff present. LPA observed one resident sleeping and one resident listening to the news on a cellphone device. LPA observed residents to be in clean clothes. LPA, accompanied by the caregiver, conducted a tour of the physical plant. LPA inspected the six private resident bedrooms and observed them to be free of hazards. LPA observed residents' bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed the lights in each of the resident bedrooms to be operational. The water and toilets in each of the resident bathrooms were operational. The hot water temperature measured between 107.4 to 108.5 degrees Fahrenheit. LPA observed the facility has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed the facility has a three day emergency food and water supply stored in the kitchen. No health or safety concerns were observed. LPA additionally conducted interviews with one staff and one resident. Per staff interview, it was reported that the facility has not had internet for at least six days. LPA reviewed the Admission Agreements and obtained the Identification and Emergency Information sheet for all residents. Continued on LIC 809-C. Based on the observations made during today's visit, a deficiency is being cited per Title 22 of California Code of Regulations. An exit interview was conducted with caregiver Leslie Aguilar and a copy of the report was reviewed and provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)1 · Plan of correction due date: Jan 16, 2026

87468.2 (a) In addition to the rights listed in [...] Personal Rights of Residents in All Facilities, residents in [...] residential care facilities for the elderly shall have [...]: (1) To have [...] use of the Internet, and meetings of resident and family groups. This requirement is not evidenced by: Based on observation and interviews, the Licensee did not ensure residents have access to an internet connection. Based on interviews conducted, there has not been a working internet connection for at least six days. This poses a potential health and safety risk for persons in care.the state’s words, verbatim · CDSS document, Jan 8, 2026

Plan of correction: The Licensee will provide proof that they have paid their internet provider in full. The Licensee that will provide CCLD with proof of payment via email or fax by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced required visit to the facility for the purpose of conducting the required annual inspection. LPA Rodriguez explained reason for visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted facility administrator (AD) Eleazar Cuyson about visit. For this visit, there are 2 staff members on duty, of which are background cleared and associated. The PUB475 "See Something, Say Something" poster was observed to be located at the entrance of the facility. LPA observed the Administrator's Certificate for Eleazar Cuyson, which expires on 5/7/2026. LPA toured the interior and exterior portions of the facility with staff on duty (S1). The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 1 may be bedridden and 5 may be on hospice. For this visit, there are a total of 3 residents in care, of which 0 are on hospice and 0 are bedridden. There are a total of 6 private resident bedrooms, and 1 staff room. LPA toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 4 restrooms, of which were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature was measured to be at 107.2 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguishers were dated and tagged for the date of 2024. LPA observed the emergency disaster and evacuation plan, which is posted at the entrance. Facility had back-up emergency food and water supply, located in the kitchen. LPA observed that First Aid Kit had all the required components. Medications and toxins were also observed to be locked and inaccessible to residents in care. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. LPA observed that the garage is used as an additional dwelling unit which is permitted, and is separated by a locked gate and has an empty swimming pool. For today's visit, deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Cuyson. A copy of this report and appeal rights were explained and provided.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a health and safety check of the residents at the facility. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. Administrator Eleazar Cuyson arrived during the vsiit. LPA observed the facility has electricity, water, gas and telephone service. LPA observed that the air conditioner turned on during the visit. LPA observed all the resident rooms had the required furnishings. LPA observed all bathrooms are clean and operational. LPA observed the fire extinguisher in the kitchen is fully charged. LPA interviewed staff and residents. The Administrator reported that as far as he knows all of the facility utility bills are up to date. LPA observed a 2 day perishable food supply on hand in the kitchen. LPA observed there is not a 7 day non-perishable food supply on hand in the facility. LPA observed a 3 day emergency supply of food and water on hand in the kitchen. LPA observed the first aid kit did not contain a first aid manual. Smoke detectors/carbon monoxide detectors tested operational. No obstacles or hazards observed in the facility. LPA consulted with the Administrator regarding reporting requirements. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations (CCR). An exit interview was conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Jun 23, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Jun 30, 2025

Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not being met as evidenced by, LPA observed there is not a one week supply on nonperishable foods on hand at the facility. This poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 23, 2025

Plan of correction: Licensee agrees to purchase a one week supply of nonperishable foods and to always have on hand at the facility a one week supply of nonperishable supply of food. Licensee to forward proof to LPA by the POC due date.

Type of visit: Office

On today's date, Licensing Program Managers (LPM) Alisa Ortiz and Licensing Program Analysts (LPAs) Michael Tea and Brandon Lopez met with Licenseeon this day for the purpose of discussing financial operations and distress and reporting requirements The following was discussed: Licensee's responsibilities of facility oversight Licensee's requirement to maintain control of facility and property Licensee’s responsibility to maintain financial solvency Licensee’s responsibility to communicate with the department Report of suspected dissolution of partnership Report continued on LIC809-C The following was agreed upon during today's meeting: The Licensee has clarified the dissolution of partnership is not related to license, but rather a separate business deal. The dissolution of partnership will not impact licensee’s facilities. The Licensee has reported they are in communication with landlords for properties leased and will maintain a valid lease and control of property. The Licensee will maintain payment of all facilities bills and ensure sufficient staffing to meet residents needs, the Licensee will communicate any health and safety concerns related to residents in care to the department immediately. The following items are to be provided to the Department: Updated LIC 500 Personnel Report identifying all current working staff and their agreed upon schedules by close of business May 29, 2025. Updated lease agreements with letters from landlords voiding any outstanding evictions or unlawful detainers by close of business May 23, 2025. A copy of loan contract to support financial solvency by close of business May 29, 2025. An exit interview was conducted Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy. A copy of this report, LIC 809, was provided to Licensee Allen Medina, Maricel Nepomuceno, and Keak Vongphakdy.the state’s words, verbatim · CDSS document, May 22, 2025

Allegation investigated: Staff is not providing a refund upon resident’s death.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit regarding a complaint. LPA was greeted and granted entry at 9:33am. LPA met with Carla Ward, Administrator. The facility has six residents in care. LPA explained to Administrator that the purpose of the visit was to amend an LIC 9099-D delivered on February 20, 2025 regarding a substantiated finding. An exit interview was conducted with Administrator Carla Ward and a copy of the reports were provided to the facility. Substantiatedthe state’s words, verbatim · CDSS document, Apr 24, 2025 · control 22-AS-20250220103503

Allegation investigated: Staff left resident in soiled clothes/diapers for a period of time.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to deliver findings for a complaint visit conducted on February 20, 2025. LPA was greeted and granted entry and spoke with Carla Ward, Administrator via phone. LPA met with Allan Manimbo, Administrator Designee. LPA interviewed staff and residents regarding care provided and the length of time it took for staff to respond for toileting needs. Two residents stated staff come timely and check on them when they call. One resident toileted independently. LPA reviewed resident file and spoke with home health who visited twice a week. Home health nurse stated there is a resident log that shows how often residents are changed or turned and that it is being followed. Staff stated if residents call, they attend to them within fifteen minutes. Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that the resident was left in soiled clothes/ diapers for a period of time is unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 14, 2025 · control 22-AS-20250220103503

Allegation investigated: Staff did not provide assistance in meeting necessary medical and dental needs

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA was greeted and granted entry by staff. LPA met with Administrator Carla Miranda and explained the reason for the visit. LPA toured the facility and interviewed staff and residents. The investigation revealed the following. Resident 1 (R1) was scheduled for an appointment on February 20, 2025. The Administrator arranged for a staff member (S1) to take R1 to the appointment. S1 reported they were provided the address and took R1 to the appointment. R1 verified they were taken to the appointment but didn't make it inside, R1 reported that S1 didn't assist them out of the car and they ended up going back to the facility. S1 reported that R1 told him they were at the wrong location and refused to get out of the car. S1 stated they called the Administrator to speak to R1 but she couldn't convince R1 to get out of the car. The Administrator reported that the appointment was scheduled at a specialist, not R1's primary care physician (PCP) and that is why R1 didn't know the location and refused to get out of the car. The Administrator reported she was on the phone with R1 and they tried to convince R1 to attend the appointment. Unsubstantiated R1 reported she did talk to the Administrator but reported she was taken to the wrong location. A review of records shows R1's PCP is at a different location than the location of the specialist were the appointment was scheduled. R1 missed their appointment on February 20, 2025. The Administrator scheduled a new appointment after R1 missed their appointment. The witnesses involved reported conflicting information. Based on the evidence gathered the allegation is deemed unsubstantiated, 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. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Mar 17, 2025 · control 22-AS-20250310165438

Allegation investigated: Staff is not providing a refund upon resident’s death.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office on February 13, 2025. LPA was greeted and granted entry by staff and met with Administrator (AD) Carla Ward and explained the purpose of the visit. LPA requested Register of Facility Residents for facility #306006369, which was a Change of Ownership (CHOW) effective October 29, 2024. The resident resided at this facility and passed away on December 13, 2024 and personal property and effects were also removed on December 13, 2024. Documentation obtained include: ID and Emergency Information, Admissions Agreement which included the facility's refund policy and copies of the check written on February 13, 2025 by the Licensee company with the letter sent to Resident's Responsible Party; also dated February 13, 2025. (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) Based on LPA's observations, record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. The following deficiency is being cited per Health and Safety Code 1569.652(c) on the LIC 9099-D. An exit interview was conducted with Carla Ward, Administrator (AD) and a copy of this report was given to the facility along with Appeal Rights.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 22-AS-20250220103503

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Feb 28, 2025

(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual...responsible for the fees... within 15 days after the personal property is removed. This requirement was not met as evidenced by: Based on LPA record review and interviews, one of one resident did not receive a timely refund. This poses a potential health and safety risk for residents in care. ***This is an amended report***the state’s words, verbatim · CDSS document, Feb 20, 2025

Plan of correction: Licensee and Administrator to provide LPA with training inservice or letter of understanding of the CCR Title 22 and HSC regulations regarding refunds for residents.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Nancy Guillen, Brandon Lopez and Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Bryant So and Licensees Maricel Nepomuceno and Allen Medina. An application to operate a Residential Care Facility for the Elderly (RCFE) for six non- ambulatory, with one bedridden resident in bedroom #3 and five residents on hospice was received by Community Care Licensing (CCL) on August 14, 2024. The facility is a one-story house with six resident bedrooms, one staff bedroom, four bathrooms, a living room/dining room, and a kitchen. LPAs observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is a backyard with an exit gate on each side of the house. There is an Additional Dwelling Unit (ADU) which is permitted and a locked gate which has an empty swimming pool. There is a shaded seating area and LPAs did not observe any obstacles or hazards in the backyard. LPAs toured the facility at 9:15 AM and observed all private resident bedrooms had the required furnishings of beds, lamps, chest of drawers and chairs. Each bedroom also has a ceiling fan and a television. LPAs greeted residents and inquired about their quality of care. LPAs inspected the physical plant and observed the centralized dual smoke alarm and carbon monoxide detector were in working order. LPAs tested hot water temperatures in four of four resident bathrooms, and auditory devices worked for all exits. The hot water temperature measured between 106.7 and 109.5 degrees Fahrenheit The fire extinguishers were charged and were serviced in February and April 2024. LPAs inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPAs observed sharps and knives were in a locked drawer and chemicals were secured under the sink. The medication storage and resident files were locked and a First Aid kit was observed with the required elements. (Continued on LIC 809-C) (Continued from LIC 809) LPA confirmed that administrator has a current administrator certificate which expires on May 15, 2025. Administrator and Licensees waived the Component III presentation and were notified that the final application approval will be issued by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted and a copy of this report was provided to the Administrator and Licensees.the state’s words, verbatim · CDSS document, Oct 28, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 5 COMP II Participants: Allen Medina, CEO; Bryant So, Administrator Interview Method: Telephone interview On 9/16/24, 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, Sep 16, 2024