Treasure Heritage

Allegation investigated: Unqualified staff providing care to residents. Facility does not have adequate staffing.

On 04/15/2026 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the Administrator, Sunday Olowosagba and stated their reason for their visit was to deliver the findings of the complaint. To investigate the allegation(s), on 04/02/2026 at approximately 10:30 AM, LPA conducted a physical plant tour. By 11:00 AM, LPA requested relevant documentation. From 11:00 AM to 1:30 PM, LPA attempted interviews with three (3) residents (R1-R3), two (2) staff members (S1-S2) and conducted record review. (Contiue to LIC 9099-C) Substantiated Regarding the allegation: Unqualified staff providing care to residents. It was alleged that S2 lacked the skills and competence to provide care and supervision to the residents. To investigate the allegations, LPA conducted interviews with two (2) staff members. LPA’s interview with S2 revealed they are the live-in staff member who cares for the residents and S1 will arrive in the mornings and evenings to assist with medications. When questioned if they could provide information regarding the residents’ diagnosis and needs/services, S2 could not answer. Additionally, upon LPA’s arrival on 4/02/2026, LPA observed S2 to be walking around the neighborhood’s curved sidewalk, away from the facility leaving all three (3) residents alone. Further record review of S2’s file revealed that S2’s First Aid/ Cardiopulmonary Resuscitation (CPR) certification was expired (01/2026). LPA’s interview with S1 revealed they would have to seek a new replacement for S2 due to them lacking the compression needed to fulfill their position. When questioned if they could provide S2’s proof of training via documentation showcasing dates and hours of training completed, S1 could not provide LPA with the information requested but instead a sheet dated 10/11/2025 with topics such as: Resident Personal Right, Elder Abuse and Hand washing and Infection Control. The documentation provided documented the length of training to be “2.5 hours”. When questioned where the remainder of S2’s training hours were reflected via documentation showcasing dates and hours of training completed, again S1 could not provide LPA with the information requested. Based on interviews, observations and record review, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time. Regarding the allegation: Facility does not have adequate staffing. It was alleged that the facility had failed to provide an appropriate level of supervision to ensure resident’s needs are met. To investigate the allegation, LPA conducted interviews with two (2) staff members. LPA’s interview with S1 revealed they arrive both mornings and evenings to assist with residents’ medications. When questioned if they could provide the LIC 500 Personnel Report showcasing staff and their schedule, S1 could not provide LPA with the information requested. LPA’s interview with S2 confirmed they are the only staff member working. S2 stated they receive, “No Breaks”. Additionally, upon LPA’s arrival on 4/02/2026, LPA observed S2 to be walking around the neighborhood’s curved sidewalk, away from the facility leaving all three (3) residents alone. During LPA’s initial visit, LPA observed R3 to call out for assistance from their room while both S1 and S2 were in the kitchen. LPA observed S1 to tell S2 to go assist R3. During LPA’s physical plant tour, LPA observed R3’s bedroom to not have any auditory alarms to communicate when they need assistance. LPA’s interview with S1 revealed they have not placed such alarms yet but would. (Continue to LIC 9099-C) Based on interviews, record review and observations, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time. Citations issued, please refer to LIC 9099-D. No other immediate health and safety issues observed during the day of the visit. Exit interview was conducted, appeal rights given, and a copy of this report was provided to the Administrator. Regarding the allegation: Staff are mismanaging resident’s medication. It was alleged that facility are withholding R1’s medication. To investigate the allegation, LPA attempted interviews with three (3) residents and two (2) staff members. LPA’s interview with R1 revealed they only care to take two (2) of their medications due to them not knowing what their other medications are for. R1 stated that both S1 and S2 do not give them their medication upon their request and keep their medications locked away with the other residents. R1 stated they can manage their own medication. LPA’s interview with R2 revealed that they have had no issues with their medications being given to them. LPA attempted to interview R3 but due to their inability to validate the questions being asked, LPA terminated the interview. LPA’s interview with S1 revealed that they follow the physician’s orders of R1’s medication and R1 will argue that they need more. S1 stated they were not aware of R1’s addiction to their medication upon their arrival to the facility. S1 stated they have tried to have R1 see their primary doctor but R1 refuses to go. LPA conducted a record review of R1’s medication. The medication in question was reviewed and compared to the Medication Administration Records (MARs) from 3/1/2026 to 4/01/2026. LPA observed the physician’s orders to be prescribed as needed (PRN) and ordered to, “Take 1 tablet by mouth twice daily as needed for pain. May take an additional 1 for breakthrough”. LPA observed R1’s MARs to have morning, afternoon and evening listed for their medication pass. Additional record review of R1’s Physician’s Report documented that they could not store their own medication and needed “supervision” with medication administration. LPA’s supplementary web search on 4/08/2026 of said medication was reviewed to be, “…a controlled substance (Schedule II) with high risk of addiction, dependency…” Further record review of R1’s medication in question was filled on 3/13/2026 and was observed to have been prescribed for a quantity of 75 pills. LPA’s medication count conducted with S1 observed there to be a remainder of 38 pills accounted for. LPA’s review of R1’s MARs (3/13/2026 to 4/01/2026) accounted for 35 pills administered. R1’s medication was not documented as taken for the afternoon and evening of 4/01/2026. R1’s medication was not documented as taken for the morning of 4/02/2026. During LPA’s physical plant tour, LPA observed R1’s medication to be centrally stored within the locked medication cabinet. LPA did not observe any discrepancy of R1’s medication. Based on interviews, record review and observation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. (Continue to LIC 9099-C) Regarding the allegation: Facility is in violation of Fire Safety regulations. It was alleged that the fire alarm pull station was not functioning. To investigate the allegation, LPA conducted a physical plant tour. LPA observed two (2) fire extinguishers to be fully charged and dated 5/29/2025. LPA observed the fire alarms to be interconnected. LPA along with S1 tested the alarms where LPA observed the alarms to be working and in proper condition. LPA observed the carbon monoxide to be in proper condition. LPA along with S1 tested the carbon monoxide and observed it to be working. LPA observed the fire alarm pull station to be intact with business cards located on top of the alarm with electrical contractor’s information. Additional record review of the facility’s Emergency Disaster Plan revealed S1 had reviewed and updated the plan on 2/14/2026. LPA reviewed the plan to entail emergency names and telephone numbers such as: Fire Department and Ambulance/Paramedics. Based on observations and record review, the facility’s fire alarms/carbon monoxide and fire extinguishers were observed to be working and in proper condition. Therefore, the allegation is UNSUBSTANTIATED at this time. Regarding the allegation: Staff did not ensure facility was kept clean, safe and sanitary. It was alleged the facility did not have adequate pest control. To investigate the allegation, LPA conducted interviews with two (2) residents and one (1) staff member. LPA’s interview with both residents confirmed the facility has not had any issues with pest such as roaches or rats. During LPA’s physical plant tour, LPA observed the facility to be in proper condition. LPA did not observe any pest. However, LPA did observe R1’s bedroom to appear unorganized with an odor omitting from said quarters. LPA’s interview with R1 revealed they do not like the staff entering their room nor do they allow the staff to clean their room. LPA’s interview with R2 correlated R1’s interview. LPA’s interview with S1 confirmed R1 has made it difficult for staff to clean and maintain R1’s bedroom within compliance. Based on interviews and observations, the facility was not observed to have any pest and R1’s confirmation of not allowing staff to clean their room, therefore the allegation is UNSUBSTANTIATED at this time. No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 31-AS-20260323090432

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 16, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met evidence by: Based on interviews, record review and observations, S2's CPR is expired, training documentation could not be provided and LPA observed S2 to have left all (3) residents alone which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: The Licensee/Administrator will review the regulation and email LPA Segovia a statement of understanding additionally a copy of S2's renewed CPR by POC due date. POC due date: 4/16/2026

Allegation investigated: Staff refused to accept the resident back to the facility.

On 04/15/2026 at approximately 09:30 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced initial complaint visit to the facility to investigate the above allegation(s). LPA was greeted by the Administrator, Sunday Olowosagba and stated the reason for their visit. At 09:45 AM, LPA requested census, resident, and staff roster. At approximately 09:50 AM, LPA conducted a physical plant tour, to ensure the health and safety of the residents. At 10:00 AM, LPA requested pertinent documentation pertaining to the investigation such as but not limited to: Admission Agreement, Re-Appraisals and Physician’s Report. In between 10:30 AM – 12:30 PM, LPA attempted interviews with one (1) resident (R1), one (1) staff member (S1) and conducted record review. (continue to LIC 9099-C) Substantiated Regarding the allegation: Staff refused to accept the resident back to the facility. It was alleged that S1 refused to accept R1 back to the facility after being discharged from the hospital. To investigate the allegation, LPA attempted to interview one (1) resident and one (1) staff member. LPA attempted to interview R1, but they no longer reside at the facility and were not present during LPA’s visit. LPA’s interview with S1 revealed on 4/04/2026, R1 was transported to the hospital due to severe pain. S1 stated they refused to allow R1 to return to the facility due to them, “needing a higher level of care”. When questioned as to what higher level of care R1 needed, S1 stated that R1’s chronic pain is too severe, and they do not have nurses such as “LVNs” (Licensed Vocational Nurses) employed at their facility. S1 stated, R1 needs a rehabilitation center. When questioned if they had provided R1 with a 3-day or 30-day eviction notice, S1 stated, “No”. When questioned if they had submitted R1’s eviction notice to Community Care Licensing Division (CCLD), S1 stated, “No”. LPA conducted a record review of R1’s file. LPA’s record review of R1’s Admission Agreement revealed that, “…a written notice that includes specific facts concerning the date, place, witnessed, and circumstances for eviction will be provided to the resident”. Further record review of R1’s Pre- Appraisal documented R1 to have episodes of anxiety, but no documentation of the severity of their chronic pain and/or alcohol abuse were notated. LPA’s record review of R1’s Interdisciplinary Discharge Summary paperwork on 6/14/2025, prior to moving into the facility on 6/19/2025 disclosed various diagnosis relating to R1 such as, “…Alcohol abuse with withdrawal with perceptual disturbance…”. Additionally, LPA did not observe there to be any documentation of Re-Appraisals having been done regarding R1’s change in conditions leading to R1’s hospitalization on 4/04/2026. During LPA’s physical plant tour, LPA observed R1’s bedroom to be empty. Based on interviews, record review and observations, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time. Citations issued, please refer to LIC 9099-D. No other immediate health and safety issues observed during the day of the visit. Exit interview was conducted, appeal rights given, and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 31-AS-20260406160332

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Apr 16, 2026

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed...Thirty (30) days written notice to the resident is required... This requirement is not met by: Based on interviews, the Licensee/administrator failed to ensure Resident 1 (R1) was given the proper 30 (thirty) day notice for eviction. R1 was not allowed back to the facility after hospitalization discharge. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: Licensee/Administrator will ensure to send Community Care Licensing Division a proper thirty (30) day notice regarding R1. The POC due date: 04/16/2026

Type of visit: Required - 1 Year

On 01/05/2026 at 9:30 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual Inspection at this facility. LPA was greeted by caregiver who granted access. LPA explained the reason for the visit. Caregiver sent the administrator, Sunday Olowosagba a message and informed him LPA was at the facility to conduct an annual visit. A physical plant tour was initiated at approximately 10:00 a.m., and the following was observed: Entrance: LPA observed required postings at the facility's entrance and a sign in sheet for visitors. LPA observed a fully charged fire extinguisher with service date 05/29/2025. Common Areas: These include the two (2) dining areas, living area and a sitting/office area. All common areas were observed clean. There is a television and board games available to residents in the living room. Facility files are kept locked in filing cabinets in the dining area. Kitchen: LPA observed the kitchen to be clean and clear of clutter. LPA observed a fire extinguisher with a service date of 05/29/2025, fully charged. LPA observed, centralized medications locked in a kitchen cabinet. LPA observed a small refrigerator for medication that requires refrigeration locked. LPA observed a 2 day perishable and 7 day non perishable supply of food in the facility. Surrounding Grounds: There is appropriate outdoor seating for residents. Auditory alarms on exit doors were observed on and functioning. Laundry Room/Garage: LPA observed a washer, dryer detergents and cleaning products locked in the laundry room. Through the laundry room is the door to the garage. Garage is used for facility storage. LPA observed a second refrigerator. (Continued to LIC809-C) (Continued from LIC809) Bedrooms: The facility has three (3) bedrooms that may be shared for a total capacity of six (6) residents. Bedrooms are cleared for one (1) bedridden resident each. All resident rooms are furnished with required lighting, dresser, chair, bed, linens, and storage space. Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in a shared bedroom for private use. All bathrooms were clean, had grab bars, with non skid flooring. LPA observed a sufficient supply of hand soup, toilet paper, and paper towels. Hot water temperature has been measured at approximately, 119 degrees Fahrenheit. Resident file: At approximately 10:52 a.m. to 12:30 p.m., LPA conducted a file review of five (5) out of five (5) resident records. LPA reviewed resident record to insure compliance of licensing forms. LPA's review of Resident #2's (R2's) records revealed from 09/02/25 to 12/24/25 the facility had documented ongoing behavioral concerns and medical concerns. On one occasion on 08/18/25 R2 left the facility without assistance. LPAs review of Community Care Licensing (CCL) records revealed no unusual incident/injury reports regarding R2 have been submitted by the facility. LPA's review of Resident #3's (R3's) records revealed no TB results on file. Staff Files / Facility records: At approximately 12:30 p.m. LPA also conducted a file review of two (2) staff records to insure forms and training are up to date and in compliance with licensing forms. At 12:45 p.m., LPA met with the administrator. LPA reviewed infection control plan, liability insurance and emergency disaster plan (LIC610E). LPA observed smoke detectors through out the facility, they are interconnected and hard wired. LPA observed a functioning carbon monoxide detector on a wall by the bedrooms. At approximately 12:47 p.m. the administrator tested the smoke alarms and they were observed operational. LPA observed fire doors close automatically. Deficiencies were observed during todays visit (refer to LIC809-D). Exit interview conducted. Appeal Rights provided. A copy of this report provided.the state’s words, verbatim · CDSS document, Jan 5, 2026

Type of visit: Required - 1 Year

On 12/09/2024 at 12:40 p.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual Inspection at the facility mentioned above. LPA was greeted by the administrator, Sunday Olowosagba who granted access. LPA explained the reason for the visit. The facility is licensed for six (6) non ambulatory residents of which three (3) may be bedridden with a total capacity of six (6) residents. Facility has a Hospice wavier for 2. The inspection care tool was used to complete the visit. A physical plant tour was conducted at approximately 12:50 p.m. along with the administrator and LPA observed the following: Entrance: LPA observed proper postings by the facility entrance. Common Areas: These include the dining areas, and living rooms. All common areas were observed, clean and clear of clutter. Furniture appeared clean and in good repair. There is an electric fire place not in use properly secured with a screen. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked under the kitchen sink, inaccessible to residents in care. Cleaning supplies were observed locked under the kitchen sink. LPA observed there to be sufficient supply of 7-day non-perishable foods and 2-day perishable foods; properly stored. LPA observed a fire extinguisher with a service date of 06/08/2023, fully charged. LPA observed, resident medications will be locked in a kitchen cabinet inaccessible to residents. LPA observed a small refrigerator for medication that requires refrigeration. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is appropriate outdoor seating for residents. Auditory alarms were on and functioning at time of visit. Bedrooms: There are four (4) bedrooms three (3) are designated for resident use. Resident bedrooms are shared. (Continued to LIC809-C) (Continued from LIC809) All resident rooms are furnished with required lighting, dresser, chair, bed, linens, and closets for storage. LPA observed a hallway closet with extra linens. Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in resident's' bedroom for private use. All bathrooms were clean, had grab bars, and trash bins with lids. LPA observed a sufficient supply of hand soup, toilet paper, and paper towels. Hot water temperature has been measured at approximately, 116 degrees Fahrenheit within regulation. Laundry Room/Garage: Laundry room is kept locked. LPA observed a washer and dryer that appeared operative. LPA observed detergent locked in the laundry room. Through the laundry room is the door to the garage. Garage is used for facility storage. LPA observed smoke detectors through out the facility, they are interconnected and hard wired. LPA observed a carbon monoxide detector on a wall by the bedrooms. At approximately 12:55 p.m. the administrator tested the smoke alarms and they were observed operational. Resident file: At approximately 1:02 p.m. LPA conducted a file review of one (1) out of one (1) resident record. LPA reviewed resident record to insure compliance of licensing forms. New resident was admitted Saturday, 12/07/2024. LPA discussed pre-admission procedures, appraisal and needs and services, safeguards for property and valuables and centrally stored medication destruction records (CSMDR) with administrator. Staff Files / Facility records: At approximately 1:20 p.m. LPA also conducted a file review of one (1) staff record to insure forms and training are up to date and in compliance with licensing forms. LPA found administrator's name on pending administrator certificate list. LPA reviewed infection control plan, liability insurance and emergency disaster plane (LIC610E) with administrator. No deficiencies were observed during todays visit. Exit interview conducted. Copy of this report provided.the state’s words, verbatim · CDSS document, Dec 9, 2024

Type of visit: Required - 1 Year

On 03/04/2024 at 1:15 p.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual Inspection at the facility mentioned above. LPA was greeted by staff #1 (S1) who granted access. Administrator Sunday Olowosagba met LPA shortly after. LPA explained the reason for the visit. The facility is licensed for 6 non ambulatory residents of which 3 may be bedridden with a total capacity of six (6). Facility has a Hospice wavier for 2. The inspection tool was used to complete the visit. A physical tour was conducted at approximately 1:40 p.m. along with the administrator and LPA observed the following: Entrance: LPA observed proper postings by the facility entrance. LPA observed hand sanitizer and masks were available. Common Areas: These include the dining areas, and living rooms. All common areas were observed well lit, clean and clear of clutter. Furniture appeared clean and in good repair. There is an electric fire place not in use properly secured with a glass screen. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen drawer inaccessible to residents. Cleaning supplies were observed locked under the kitchen sink. LPA observed there to be sufficient supply of 7-day non-perishable foods and 2-day perishable foods. LPA observed a fire extinguisher with a serviced date of 06/08/2023. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is appropriate outdoor seating for residents and a large umbrella is used to provide shade. Bedrooms: There are four (4) bedrooms three (3) are designated for resident use. Residents' bedrooms are shared. All resident rooms are furnished with required lighting, dresser, chair, bed, linens, and closets for storage. LPA observed a hallway closet with extra linens and PPE. (Continued to LIC809-C) Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom for private use. All bathrooms were well lit, clean, had grab bars, and trash bins with lids. LPA observed a sufficient supply of hand soup, toilet paper, and paper towels. At approximately 1:48 p.m. hot water temperature in one (1) out of the two (2) bathrooms was measured at 117.1°F. Laundry Room/Garage: Laundry room is kept locked. LPA observed a washer and dryer that appeared operative. LPA observed detergent and extra water for the facility. Through the laundry room is the door to the garage. The garage door was observed locked. LPA observed smoke detectors through out the facility, they are interconnected and hard wired. LPA observed a carbon monoxide detector on a wall by the bedrooms. At approximately 1:50 p.m. the administrator tested the smoke alarms and they were observed operational. Resident file: At approximately 1:51 p.m. LPA conducted a file review of three (3) out of three (3) resident records. LPA reviewed resident records to insure compliance of licensing forms. LPA observed one (1) out of three (3) residents was missing examination for communicable tuberculosis. Administrator requested from Hospice Nurse who was present at the time to provide documentation of TB exam for resident #2 (R2) as soon as possible. Hospice nurse said they would. Resident record review also revealed resident #1 (R1) with hearing impairment documented on physician's report did not have the Telecommunication Device Notification on file. Staff Files: At approximately 2:49 p.m. LPA also conducted a file review of two (2) staff records to insure forms and training are up to date and compliance with licensing forms. Medications: At approximately 3:00 p.m. LPA observed, resident medications locked in a kitchen cabinet inaccessible to residents. Facility keeps medical administration records (MAR) for residents. Deficiencies were observed during todays visit. Exit interview conducted. Copy of this report and appeals provided.the state’s words, verbatim · CDSS document, Mar 4, 2024