Timers Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 05/12/2026 and was greeted by Administrator Shaunda Williams. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected three (3) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip mat in showers. Video surveillance was observed in common areas. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. See 809-C Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate (7026420740) for Shaunda Williams 10/26/2027. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for one (1) out of the one (1) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for one (1) out of the one (1) personnel record reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory residents and may retain three (3) hospice residents. There are currently zero (0) residents on hospice during inspection. Resident Records/Incident Reports: LPA reviewed resident records for four (4) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided..the state’s words, verbatim · CDSS document, May 12, 2026

Allegation investigated: Personal Rights/Conduct inimical- S1's conduct poses a health and safety concern.

Licensing Program Analysts (LPAs) Elizabeth Irra and Nune Margaryan conducted a subsequent visit to deliver findings for the above allegation. LPA was allowed entry by Shaunda Williams (Administrator). LPAs discussed the purpose of today’s visit. On 07/18/25, LPA Nune Margaryan conducted the initial visit. During this visit, LPA Margaryan conducted a tour of the living room, dining area, kitchen, outside of facility, common areas and resident rooms. The kitchen had sufficient perishable and non-perishable food. Resident rooms and common areas were properly furnished. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA Margaryan requested copies of staff and resident roster along with other pertinent documentation. Refer to LIC 9099C for the continuation of this report. Substantiated During this investigation, Michele Salant (Department of Social Services Community Care Licensing Investigation Branch) interviewed Individual #1 (I-1) through Individual #3 (I-3), Resident #1 (R-1) and Resident #2 (R-2), S1, obtained police reports from the Pomona Police Department, obtained video footage and photos of S1 pertaining to this incident, obtained a copy from the Pomona Courthouse. Allegation: Personal Rights/Conduct inimical- S1's conduct poses a health and safety concern. It has been alleged that on 07/15/25, S-1 was involved in a physical altercation at a park with other individuals and was observed to use a baseball bat with the intent of hitting the individuals involved and also used a baseball bat to vandalized a vehicle. Interviews revealed that on 07/15/25, S1, was involved in a physical altercation with a group of individuals at a park. S1 confirmed participating in this fight. Reports and interviews revealed that S1 arrived at the park, instigated the fight, returned to their car and returned back to the park with a baseball bat and ski mask. Reports and interviews revealed that S1 was observed to be swinging the baseball bat with force towards the individuals in the fight and was observed to be intentionally vandalizing a vehicle with the baseball bat. Reports and interviews revealed that S1 fled the scene and was apprehended by Pomona Police Department shortly after. Reports revealed that S1 had the baseball bat on the back seat of their vehicle with glass still lodged on it and observed to have a ski mask as well. Reports, interviews and documentation corroborate this allegation. This case may be referred to CCLD’s Legal Division. Such referral may result in the filing of administrative action before the Office of Administrative Law. Deficiency cited. Refer to LIC 9099D. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeals rights were provided to XXXXXX.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 28-AS-20250717092352

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.50(a)(3) · Plan of correction due date: Oct 8, 2025

(a) The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: (3) Conduct that is inimical to the health, morals, welfare, or safety of eithr an individual in or receiving services from the facility or the people of the State of California. This standard is not met as evidence by: Evidence collected via interviews, records, video footage and photos corroborate the alleged incident that occurred at the park as noted on this report.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Licensee shall develop a written plan of correction to ensure compliance with Health and Safety Code 1569.50 (a)(3) and submit to LPA Irra by POC due date of 10/08/25.

Allegation investigated: Personal Rights/Conduct inimical- S1's conduct poses a health and safety concern.

Licensing Program Analysts (LPAs) Elizabeth Irra and Nune Margaryan conducted a subsequent visit to deliver findings for the above allegation. LPA was allowed entry by Shaunda Williams (Administrator). LPAs discussed the purpose of today’s visit. On 07/18/25, LPA Nune Margaryan conducted the initial visit. During this visit, LPA Margaryan conducted a tour of the living room, dining area, kitchen, outside of facility, common areas and resident rooms. The kitchen had sufficient perishable and non-perishable food. Resident rooms and common areas were properly furnished. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA Margaryan requested copies of staff and resident roster along with other pertinent documentation. Refer to LIC 9099C for the continuation of this report. Substantiated During this investigation, Michele Salant (Department of Social Services Community Care Licensing Investigation Branch) interviewed Individual #1 (I-1) through Individual #3 (I-3), Resident #1 (R-1) and Resident #2 (R-2), S1, obtained police reports from the Pomona Police Department, obtained video footage and photos of S1 pertaining to this incident, obtained a copy from the Pomona Courthouse. Allegation: Personal Rights/Conduct inimical- S1's conduct poses a health and safety concern. It has been alleged that on 07/15/25, S-1 was involved in a physical altercation at a park with other individuals and was observed to use a baseball bat with the intent of hitting the individuals involved and also used a baseball bat to vandalized a vehicle. Interviews revealed that on 07/15/25, S1, was involved in a physical altercation with a group of individuals at a park. S1 confirmed participating in this fight. Reports and interviews revealed that S1 arrived at the park, instigated the fight, returned to their car and returned back to the park with a baseball bat and ski mask. Reports and interviews revealed that S1 was observed to be swinging the baseball bat with force towards the individuals in the fight and was observed to be intentionally vandalizing a vehicle with the baseball bat. Reports and interviews revealed that S1 fled the scene and was apprehended by Pomona Police Department shortly after. Reports revealed that S1 had the baseball bat on the back seat of their vehicle with glass still lodged on it and observed to have a ski mask as well. Reports, interviews and documentation corroborate this allegation. This case may be referred to CCLD’s Legal Division. Such referral may result in the filing of administrative action before the Office of Administrative Law. Deficiency cited. Refer to LIC 9099D. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeals rights were provided to Shaunda Williams.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 28-AS-20250717092352

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.50(a)(3) · Plan of correction due date: Oct 8, 2025

(a) The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: (3) Conduct that is inimical to the health, morals, welfare, or safety of eithr an individual in or receiving services from the facility or the people of the State of California. This standard is not met as evidence by: Evidence collected via interviews, records, video footage and photos corroborate the alleged incident that occurred at the park as noted on this report.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Licensee shall develop a written plan of correction to ensure compliance with Health and Safety Code 1569.50 (a)(3) and submit to LPA Irra by POC due date of 10/08/25.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Elizabeth Irra conducted a case management visit. LPA met with Shaunda Williams and discussed the purpose of today's visit. LPA conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. During this visit, LPA requested Ms. Williams for an updated Designation of Facility Responsibility (LIC 308) document as the most recent on file does not reflect a designee and states "To be hired". Additionally, LPA obtained a copy of the staff roster and resident roster. Exit interview conducted and a copy of this report was provided to Shaunda Williams.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Elizabeth Irra and Blanca Gonzalez conducted an annual inspection visit. LPAs met with Shaunda Williams (Administrator) and discussed the purpose of today’s visit. This is a 2- story home which consist of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area, office (upstairs) and an attached garage with the laundry unit. All resident bedrooms are located downstairs. This facility is approved for (6) non-ambulatory residents (3 of which may be under hospice). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Policy in place. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detector observed and tested. The fire extinguisher observed and appeared to be full (located near the kitchen area). Last drill was conducted on 05/01/25. Bedrooms have the required furniture. Supply of food (perishable and non-perishable) observed. Bathrooms have non-skid surfaces and grab bars. Hot water temperature (hallway bathroom) measured at 130.4*. Deficiency cited. Refer to LIC 809C for the continuation of this report. Staffing: Facility is adhering to staffing requirements. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for S-1 through S-4. Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Resident Rights-Information: Resident rights are posted and are included in Resident files. Planned Activities: Activity provides planned activities. This facility also provides internet access to the clients. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #4 (R-4). Resident files are maintained at the facility. Resident file has the required documents. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment and Preplacement Appraisal Information, Resident Pre-Appraisal. Resident Rights were observed. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Last drill was conducted on 05/01/25. Health Related Services/Incidental Medical Services: The medications are stored and locked. R-2 has (2) over the counter medications (Zyrtex 10 mg and PreserVision AREDS 2 formula) without a physician’s order. Deficiency cited. Deficiencies cited. Refer to LIC 809D. Exit interview conducted, copy of appeal rights and a copy of this report was provided to Shaunda Williams.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Elizabeth Irra conducted an annual inspection visit. LPA was allowed entry by Shaunda Williams. LPA discussed the purpose of today’s visit. . This is a 2- story home which consist of (3) bedrooms, (2) bathrooms, living room, kitchen, dining area, office (upstairs) and an attached garage with the laundry unit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility does has an Infection Control Plan in place. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms tested and operable. Carbon Monoxide is located near the kitchen and it was tested and is operable. The fire extinguisher is located in the kitchen and appears to be full. Hot water temperature measured within regulations. The hot water supply measured at the following temperatures: 108.0*. Bathrooms had non-skid surfaces and grab bars. Staffing: Facility is adhering to staffing requirements. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator/S-1 through Staff #3 (S-3). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. **Refer to LIC 809C for the continuation of this report.** Resident Rights-Information: Resident rights are posted and included in Resident files. Planned Activities: Activity schedule is posted. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #4 (R-4). Resident files are maintained at the facility. Resident files have the required documents. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Residents with Special Health Needs: Per Administrator, there are no residents with postural supports and no residents with prohibited health conditions. Per Administrator, there is (1) resident utilizing oxygen equipment and there is (1) resident under hospice care. Health Related Services/Incidental Medical Services: The medications are stored and locked inside the closet near the dining area. Exit interview conducted, copy of appeal rights and a copy of this report was provided to Shaunda Williams.the state’s words, verbatim · CDSS document, May 24, 2024

Allegation investigated: Staff did not safeguard resident's personal items

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Shaunda Williams who assisted with today's visit. Regarding the allegation that : Staff did not safeguard resident's personal items. The investigation consisted of interview(s) with Administrator, review of resident #1's file, including Resident Personal Property and Valuables list, and interviews with residents #2-#4. Resident #5 refused to be interviewed. Administrator stated that Resident #1 moved out of the facility on 1/13/24. Administrator stated that resident #1's personal items were taken to the hospital on about 1/23/24 and were given to resident #1's case manager. LPA observed that administrator has a video of items that were given to case manager. Administrator stated that the remainder of resident #1's items were picked up by occupational therapist from Department of Health Services on about 1/26/24. Administrator spoke to Occupational therapist during today's visit, and LPA observed that the Occupational therapist confirmed that they picked up resident #1's items from the facility. Unsubstantiated Administrator stated that she does not have any of resident #1's belongings and all the belongings have been returned. Resident #2 - Resident #4 were unable to corroborate the allegation. Three out of three residents interviewed stated that facility staff do safeguard their personal belongings. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, and a copy of the report was provided to Ms. Williams.the state’s words, verbatim · CDSS document, Apr 18, 2024 · control 28-AS-20240412164359

Allegation investigated: Facility staff do not treat residents with respect. Facility staff are not providing adequate food service to residents. Facility staff discarded residents meals. Facility staff left resident on the floor nfor a prolonged period of time.

Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Shauna Williams/S-1 and discussed the purpose of today's visit. LPA conducted the initial investigation visit on 01/03/24. During this visit, LPA obtained a copy of the staff and resident rosters. LPA also reviewed files for Resident #1 (R-1) and Resident #2 (R-2) and requested relevant documentation. Ms. Williams provided the requested documentation. During today's visit, LPA reviewed the food supply, interviewed Staff #1 (S-1) and Staff (S-2) and interviewed Resident #2 (R-2) through Resident #5 (R-5). R-1 is no longer residing at this facility. Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Facility staff do not treat residents with respect. Resident interviews revealed that staff treat residents with respect. Interviewed residents indicated that staff are respectful and helpful. Interviewed residents indicated staff do not yell, bully nor harass anyone. Interviewed residents indicated they do not have any concerns pertaining to this matter. Interviewed staff indicated staff treat residents with respect. Interviewed staff indicated that staff do not nor have they witnessed any staff yelling, bullying or harassing anyone. Interviewed staff indicated that R-1 has a history of fabricating stories. Interviewed staff indicated they are trained on resident rights and mandated reporting. Resident and staff interviews do not corroborate this allegation. Allegation: Facility staff are not providing adequate food service to residents. Resident interviews revealed that staff provide adequate food service to residents. Interviewed residents indicated that they enjoy the meals that are provided at this facility. Interviewed residents indicated that they do not have any concerns pertaining to this matter. Interviewed staff indicated staff provide adequate food service to residents. Interviewed staff indicated they have not received any complaints/concerns in regards to the food service from anyone. Interviewed staff indicated that R-1 has a history of fabricating stories. LPA also observed the facility’s food supply. Resident and staff interviews do not corroborate this allegation. Allegation: Facility staff discarded resident's meal. Resident interviews revealed that staff do not discard residents meals prior to residents finishing their meal. Interviewed residents indicated that food that is provided by staff is not expired. Interviewed residents indicated that staff offer a variety of food. Interviewed residents indicated that they do not have any concerns pertaining to this matter. Interviewed staff indicated that staff do not discard residents meals prior to residents finishing their meal. Interviewed staff indicated they have not received any complaints/concerns in regards to this matter. Interviewed staff indicated that R-1 has a history of fabricating stories. Resident and staff interviews do not corroborate this allegation. Allegation: Facility staff left resident on the floor for a prolonged period of time. (1) out of (4) interviewed residents indicated that they have not experienced nor witnessed any residents left on the floor by staff. (2) out of (4) interviewed residents moved into this home after the alleged incident. (1) out of the (4) interviewed residents was unable to provide an answer due to a cognitive impairment. Interviewed staff indicated staff do not leave residents on the floor. Interviewed staff indicated that R-1 has a history of fabricating stories. Interviewed staff indicated they have not witnessed nor received any complaints/concerns in regards to this matter. Resident and staff interviews do not corroborate this allegation. Refer to LIC 9099C for the continuation of this report. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report and appeal rights were provided to Shaunda Williams.the state’s words, verbatim · CDSS document, Mar 4, 2024 · control 28-AS-20231227121532

Allegation investigated: Staff are illegally evicting resident from the facility.

Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced visit to investigate the above allegation. LPA met with Shaunda Williams and discussed the purpose of today’s visit. During this investigation, LPA obtained a copy of the staff and resident rosters, reviewed file for R-1 and obtained relevant documentation and interviewed Shaunda Williams/S-1. LPA was unable to interview R-1 as R-1 was taken to the hospital and is unavailable for an interview. Refer to LIC 9099C for the continuation of this report. Substantiated Allegation: Staff are illegally evicting resident from the facility. It is alleged that staff illegally evicted R-1 from this facility. The latest 30-day eviction notice allegedly provided to R-1 was sent to LPA via e-mail on 01/05/24 which was missing required elements as per Health and Safety Code 1569.683. R-1’s 30-day eviction notice was missing the correct phone number for Department of Social Services-Community Care Licensing, reasons relied upon the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons and information about resources to assist the resident in identifying alternative housing and care options, including public and private referral services and case management organizations. On 01/10/24, LPA sent an email to Shaunda Williams inquiring on numerous eviction notices (revisions) that were sent to LPA via e-mail pertaining to R-1 as the 30-day eviction notice was incomplete. As of today, LPA has not received an updated 30-day eviction notice for R-1. Allegation is corroborated. Based on interview conducted and emails received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency is being cited. Refer to LIC 9099D. A copy of the Health & Safety Code 1569.683 was provided to Ms. Williams/Administrator. An exit interview was held. A copy of this report along with appeal rights were provided to Shaunda Williams.the state’s words, verbatim · CDSS document, Jan 18, 2024 · control 28-AS-20240111113802

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683 · Plan of correction due date: Jan 22, 2024

Eviction notices; reasons for eviction contents; service. (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This standard is not met as evidence by: R-1 was provided with an incomplete 30-day eviction notice. The details of the missing elements are noted on this report.the state’s words, verbatim · CDSS document, Jan 18, 2024

Plan of correction: Administrator to rescind the most recent eviction notice as it is missing required elements (as noted on this report) and reissue a new 30-day eviction notice. Administrator to provide a copy of the revised eviction notice and proof of delivery to R-1 to LPA by POC due date. Note: A copy of the Health & Safety Code 1569.683 was provided to Ms. Williams/Administrator.