The Legacy Collection at Marian

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10:00 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator. LPA met with Administrator, Carthel Mercado and the reason for the visit was explained. Entrance interview. The facility is a single-story home located in a residential neighborhood. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes two (2) living rooms, and a dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 2:18 p.m., hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 05/01/2026. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted at the entrance. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 03/09/2026 and are conducted quarterly. Activities were observed in the common areas. At 11:12 a.m. LPA observed residents engaged in a group activity. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility. The Administrator presented the live monitoring screen to the LPA, confirming that all cameras were functioning properly and that none of them were equipped with audio capability. INTERVIEWS: Starting at 10:09 a.m. one (1) staff and three (3) resident interviews were conducted. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are six (6) total bedrooms in the facility; All six (6) bedrooms are designated as private, single occupancy, resident rooms. There is no staff room and Administrator stated that staff remain awake at night. Five (5) of Six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Each bedrooms have its own supply of linens stored in the closet. RESTROOMS: There are seven (7) total restrooms of which four (4) are designated as private en-suite resident restrooms, three (3) half-baths of which two (2) are designated for resident use and one (1) is for staff and guest use. The facility also contains a separate shower room for resident use. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 109.2-112.5 degrees Fahrenheit, all within the required range. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 112.8 degrees Fahrenheit. Cleaning supplies and other chemicals are kept locked under the sink area. GARAGE /LAUNDRY ROOM: LPA observed the locked garage /laundry room adjacent to the kitchen. Laundry room has a washer and dryer. LPA observed a sufficient supply of emergency food and water. LPA observed a staff / office area. Medications are stored in the locked cabinets inside the garage. LPA observed an extra refrigerator with food. Refrigerator was checked for proper labels and expiration dates. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including tables and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. LPA observed a swimming pool that was properly fenced and locked at the time of the visit. Resident Records: were reviewed beginning at 11:35 a.m. four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order.Personnel Records were reviewed beginning at 12:23 p.m. Six (6) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 1:30 p.m. Medications are locked, centrally stored in cabinets located in the garage adjacent to the kitchen. Medications for four (4) residents were reviewed. Medications are labeled and checked for expiration dates. Medications reviewed were found to be self-administered as prescribed. No errors observed during review. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator made changes to facility phone number and confirmed that all information is accurate. No citations issued at this time. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, May 11, 2026

Allegation investigated: Alterations made to the facility without permits

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above-listed allegation. The purpose of this visit is to deliver findings for the above listed allegation. Upon arrival at 1:45 p.m., LPA Mosley was greeted by staff and Administrator / Designee Carthel Mercado and the reason for the visit was explained. On 09/11/2025 the Department received a complaint regarding the following allegation: Alterations made to the facility without permits. To investigate this complaint on 09/16/2025 LPA Mosley conducted the unannounced initial 10-day complaint visit. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 10:30 a.m. LPA conducted an in person interview with the Licensee Representative and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099-C... Substantiated (PAGE 2) Report continued from LIC 9099... On 09/15/2025 at 3:29 p.m.; 3:41 p.m., 09/16/2025 at 4:08 p.m., 10/14/2025 at 1:26 p.m., and 11/3/2025 at 3:50 p.m., LPA corresponded telephonically with the creditable Witness #1 (CW). On 9/16/2025 corresponded via email with CW. During today's visit at 1:55 p.m. LPA and Administrator briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. On the allegation Alterations made to the facility without permits, it is the concern of the Reporting Party (RP) that the facility has undergone major interior changes, including reconfigured bedrooms, added bathrooms, and electrical upgrades without proper permits. To investigate this complaint, LPA conducted an in person interview, telephonic interviews, corresponded via email, and obtained copies of pertinent documentation relevant to the investigation. Interview with Licensee Representative revealed that they are unfamiliar with any specific alterations made to the home. Construction was completed shortly after the home was purchased in March of 2024. They have no knowledge in regard to permits. Interviews with the CW revealed that the property is officially recorded as 5 bedrooms with 3.5 bathrooms. However, the following un-permitted structural and interior modifications have been made including the living room, originally sunken, and has been leveled to match the rest of the house. Bedroom #6 incorporating a portion of the former laundry room and an existing bathroom that was previously accessed through the laundry area. Walls and plumbing were removed and reconfigured to create a new bathroom within the bedroom. The kitchen was remodeled, reconfigured, and expanded using part of the laundry room. The stove and hood were relocated. A new door was added from the dining room into the garage. Bedrooms 2, 3, and 5 have had their windows replaced with doors. Bedroom 4 had its window converted to a door, and the interior door was relocated. Originally, Bedrooms 4 and 5 were a single open space separated by a folding partition; a permanent wall has been erected to create two rooms. Bedroom #6, which was the original master suite, included a walk-in closet and a large bathroom. The walk-in closet has been converted into a hallway-accessible bathroom, while the original bathroom has been downsized and reconfigured. The original full and half bathrooms have been modified, with the full bathroom now featuring only a walk-in shower. Additionally, the property has also undergone a complete electrical system upgrade. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099-C PAGE 2... It was noted that that there are no immediate health and safety risk or concerns. The facility has since been compliant with the requests and are in the process of submitting all the required permits for the home’s alterations. As of now there is not a specific deadline for the permits to be made as they are actively working on the request that have been made. Based on information gathered during the course of the investigation, interviews and a credible source there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Alterations made to the facility without permits is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 29-AS-20250911081240

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Dec 12, 2025

(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on information gathered during the course of the investigation, interviews and a credible source there is sufficient evidence to support the allegation occurred.the state’s words, verbatim · CDSS document, Dec 5, 2025

Plan of correction: The Licensee and Administrator are in the process of actively submitting the requested documentation to the City of TO for permits. The Licensee agrees to update CCLD throughout the process and submit the permits once the process is complete.

Allegation investigated: Licensee does not allow resident to have visitors at facility

Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival approx. at 10 a.m., LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. At 10:30 a.m. LPA met with Administrator Designee Carthel Mercado and Licensee Representative, Joan Buck-Plassmeyer and the reason for the visit was explained. Entrance interview conducted. On 10/28/2025, the Department received a complaint regarding the following allegation, Licensee does not allow resident to have visitors at facility. During today's visit at 10:12 a.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 10:30 a.m. LPA conducted in person interviews with the Executive Director, three (3) staff, two (2) residents including Resident #1 (R1), three (3) visitors, the Licensee Representative, a record review and obtained copies of pertinent documents relevant to the investigation. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC 9099... On the allegation Licensee does not allow resident to have visitors at facility, it is the concern of the Reporting Party (RP) that R1 is not allowed to have visits at the facility as they please. To investigate this complaint, LPA Mosley conducted a telephonic interview with Visitor #1 (V1) of R1 on 11/3/2025 at 2:20 p.m. and 11/4/2025 at 8:07 a.m. On 11/4/2025 starting at 10:30 a.m. LPA conducted in person interviews with the Executive Director, three (3) staff, Two (2) residents including R1, three (3) visitors, the Licensee Representative, a record review and obtained copies of pertinent documents relevant to the investigation. Interview with Visitor #1 (V1) revealed concerns that the Licensee has imposed limitations on visitation, including restrictions on timing and location. Interviews with facility staff revealed that V1 was initially permitted to visit without specific guidelines. Over time, staff reported that V1 engaged in behavior perceived as disruptive, including raising their voice, making demands while staff were assisting other residents, and expressing negative opinions about staff to other residents and visitors. Staff described feeling intimidated by V1 and noted that the environment became increasingly tense during V1’s visits. Interview with R1 revealed that they were unable to communicate verbally or in writing. Interview with Resident # 2 (R2) revealed that V1 visited daily and frequently voiced complaints about staff. R2 stated they had observed V1 yelling at staff and expressed feeling unsafe during V1’s visits, choosing to remain in their room to avoid interaction. R2 also communicated these concerns to facility staff. Interviews with other visitors indicated that they had not experienced any issues with visitation procedures. However, they did report challenges related to V1’s behavior, including instances of V1 raising their voice at staff. Interview with the Licensee representative acknowledged difficulties in ensuring V1’s adherence to facility policies and respectful conduct toward staff, residents, and visitors. In response, the facility requested that V1 visits with R1 to be designated in areas such as outdoor spaces and R1’s room to accommodate the staff and other residents’ requests. V1 remains permitted to visit the facility while being reminded to comply with facility rules and maintain respectful interactions with all individuals on site. Facility record review revealed that V1 visited on 11/3/2025 around 3:30 p.m.,10/31/2025 at 4:35 p.m and on multiple occasions and has the opportunity to visit R1 in their room and patio privately. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Licensee does not allow resident to have visitors at facility is deemed unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Nov 4, 2025 · control 29-AS-20251028150448

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a post licensing visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by staff and Administrator. LPA met with Administrator, Carthel Mercado and the reason for the visit was explained. Licensee Representatives Joan Buck-Plassmeyer and Molly Buck arrived during the visit. Entrance interview. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes two (2) living rooms, and a dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 2:53 p.m., hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 03/30/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted at the entrance. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 08/22/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. INTERVIEWS: Starting at 10:19 a.m. one (1) staff and two (2) resident interviews were conducted. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. Residents stated they were pleased with the facility. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are six (6) total bedrooms in the facility; All six (6) bedrooms are designated as private, single occupancy, resident rooms. There is no staff room and Administrator stated that staff remain awake at night. All six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are seven (7) total restrooms of which four (4) are designated as private en-suite resident restrooms, three (3) half-baths of which two (2) are designated for resident use and one (1) is for staff and guest use. The facility also contains a separate shower room for resident use. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 109.2-120.0 degrees Fahrenheit, all within the required range. KITCHEN: The LPA inspected the kitchen/food service area at 10:23 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 116.8 degrees Fahrenheit at 10:24 a.m. Cleaning supplies and other chemicals are kept locked under the sink area. GARAGE /LAUNDRY ROOM: LPA observed the locked garage /laundry room adjacent to the kitchen. Laundry room has a washer and dryer. LPA observed a sufficient supply of emergency food and water. LPA observed a staff / office area. Medications are stored in the locked cabinets inside the garage. LPA observed an extra refrigerator with food. Refrigerator was checked for proper labels and expiration dates. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including tables and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. LPA observed a swimming pool that was properly fenced and locked at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... Resident Records were reviewed beginning at 10:35 a.m. four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:45 a.m. Four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures, as they pertain to infection control and emergency planning, adhere to the standard. MEDICATIONS: Medication review began at approximately 2:43 p.m. Medications are locked, centrally stored in cabinets located in the garage adjacent to the kitchen. Medications for two (2) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster , LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Aug 22, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kelly Dulek conducted an announced Pre-Licensing inspection at the facility today and met with Licensee Representatives/Applicants Joan Buck-Plassmeyer and Molly Buck. Entrance interview conducted. The facility obtained a fire clearance on 01/30/2025 for 5 (five) non-ambulatory and 1 (one) bedridden (in bedroom #1, 3 or 5), with a total capacity of 6 (six) residents. The Licensee Representatives submitted a hospice waiver request for 2 (two) residents, which is pending at this time. The facility also has a dementia care plan pending. Component II was completed telephonically with the assigned CAB Analyst. Component III was completed on 10/10/2024 with the Applicant Representatives. The facility is a single-story home in the Thousand Oaks area, which consists of 6 (six) bedrooms and 7(seven) bathrooms. There is no staff room and Applicant stated that staff will remain awake at night. Beginning at 11:47AM, the LPA, along with Applicant Representatives, conducted a physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with regulation. The following was observed: RESIDENT BEDROOMS/BATHROOMS: The resident bedrooms were observed. All 6 (six) bedrooms are fully furnished for resident use. The resident bathrooms were observed to be clean and sanitary with non-slip surfaces. There are 4 (four) private en-suite restrooms designated for resident use. There are an additional 3 (three) half-baths, 2 (two) of which are designated for resident use and 1 (one) is for staff and guest use. The facility also contains a separate shower room for resident use. Hot water was measured in a sample of resident restrooms and measured within the required range. The facility has a sufficient supply of linens and towels. Facility has a call button system for resident use. Report continued on LIC 809-C COMMON AREAS: The 2 (two) living rooms and dining area are furnished appropriately. A fireplace was observed in the living room to be inaccessible to residents. Paint, windows, window coverings, and floors are in good repair. The LPA observed the required postings in the common areas. Representatives stated they plan to install auditory devices on all exits, should any potential residents present a risk of exiting. Common areas maintained a comfortable temperature during the visit. Hardwired combination smoke alarms and carbon monoxide detectors and fire doors were tested at 12:43PM and were operational at the time of the visit. Fire extinguishers were observed to be fully charged and purchased on 12/31/2024. First aid supplies were reviewed and observed to be in compliance. KITCHEN/FOOD SERVICE AREA: The facility has a sufficient supply of non-perishable foods, emergency food and water. Knives and sharp items will be stored in a locked drawer in the kitchen island. Cleaning supplies and disinfectants will be stored underneath the locked kitchen sink and in the locked garage. The facility has a sufficient supply of plates, cups and utensils. GARAGE: LPA observed the locked attached garage to contain laundry area, staff/office area, emergency food and water supply, and storage. Medications will be stored and prepared in a locked cabinet inside the garage. OUTDOOR SPACE: The back yard area is enclosed. The exit gate was observed to be self-closing and self-latching. The backyard contains a shaded seating area and appropriate outdoor furnishings, as well as outdoor activity supplies. The backyard does have a pool, which was properly enclosed and locked. All passageways were observed to be free of obstructions. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 11, 2025