Umbrella Residential Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to amend a report issued on 07/31/2026. LPA Rai met with Staff, Susan Cunan and stated the purpose of today’s visit. LPA Rai spoke with Administrator Anabelen Vallarta over the phone and stated the purpose of today's visit. LPA Rai obtained verbal confirmation from Administrator Anabelen for Staff, Susan Cunan to sign the report on Anabelen's behalf. During today's visit, LPA Rai amended the report dated on 07/31/2026 due to additional information provided to the Department. LPA Rai spoke with Administrator and stated Title 22 regulations do not address accepting cash advance from resident and/or resident's responsible parties. Administrator understood the concern of accepting rent advances from residents for future services as services may change and/or resident may no longer be part of the facility. Administrator understood charging resident for services and accepting payment for services rendered to the resident. Long Term Care Ombudsmans were present in the facility. Exit interview conducted with Staff, Susan Cunan and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 20, 2026

Allegation investigated: Facility staff is financially abusing resident in care.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator, Anabelen Vallarta and stated the purpose of today’s visit. This report has been amended. On 05/01/2026, the Department received a complaint with the above allegations. On 05/08/2026, the Department conducted an initial investigation at the facility. On 07/13/2026, the Department conducted a follow up investigation at the facility. It was alleged that the Administrator asked to borrow $22,500 from resident (R1)’s funds in September 2025 and November 2025. Continuation on LIC 9099-C, page 1 of 2. Unfounded Page 2 of 2. On 05/08/2026, LPA Rai interviewed 2 staff, S1 and Administrator (ADM) Anabelen Vallarta. S1 stated is not aware of R1’s financial situation and is involved in the care and supervision of R1. ADM stated R1 is not managing their finances and R1’s responsible party (RP) is R1’s Durable Power of Attorney for Finance and Medical (DPOA). ADM stated R1’s DPOA is managing R1’s medical and financial responsibility. ADM stated R1’s POA is responsible to making payments for R1’s care and rent. ADM stated R1’s POA authorized three months advance payment to the facility for the rent invoices for October 2025, November 2025 and December 2025. ADM stated R1’s POA provided a signed letter to stated their intention to pay in advance for the rent invoices for the three months. ADM stated she did not request for an advance nor did ADM request for the rent invoices to be paid in advance. ADM stated R1's DPOA initiated the conversation of paying the facility in advance and provided the letter and check to cover for R1's expenses at the facility. ADM denied allegation and stated her staff and herself are not financially abusing R1 and she had not heard or informed of any of the facility staff taking any unauthorized money from R1. On 07/13/2026, LPA Rai interviewed 5 residents (R1-R5). 4 Out of 5 residents (R2-R5) refused to be interviewed. R1 stated he/she was not aware of anything related to the allegation. R1 stated his/her POA and ADM take care of things on their behalf, such as arranging for medical care/appointments, following up on ordering medications, but not related to any financial issues as R1 has a DPOA. Based on review of R1’s Admission Agreement, on 06/27/2025 signed by R1 and R1’s DPOA on page 5, it states under Payment Provision: “The resident will be billed by the first day of the month for processing month’s room and services charges. Payment is due by the 1st day of the month. The method payment will be by check or money order.” Based on review of R1’s Physician’s Report dated 10/4/2025, R1 is not able to manage own cash resources and R1 has a neurocognitive disorder. Based on the review of R1’s DPOA signed letter dated October 23, 2025, R1’s DPOA stated they authorized the three month’s advance payment to the facility for a total of $22,500. Based on review of the invoice of October 2025, November 2025 and December 2025, the total amount R1’s DPOA’s payment to the facility staff was $22,500. During this investigation, LPA Rai attempted to reach out to R1’s DPOA three times but was not successful. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator Anabelen Vallarta and a copy of the report was provided. On 08/20/2026, the report was amended due to additional information provided during the investigation.the state’s words, verbatim · CDSS document, Jul 31, 2026 · control 26-AS-20260501145914

Allegation investigated: Facility is not arranging, or assisting resident, for medical and/or dental care appropriate wherein resident missed his/her appointments.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator (ADM) Anabelen Vallarta and stated the purpose of today’s visit. On 07/13/2026, the Department received a complaint with the above allegations. On 07/13/2026, the Department conducted an initial investigation at the facility. It was alleged that resident (R1) had a medical appointment on 07/10/2025 which was missed by facility staff. Continuation on LIC 9099-C, Page 1 of 2. Substantiated Page 2 of 2. On 07/13/2026, LPA Rai and Licensing Program Manager (LPM) Romeo Manzano conducted an interview with Administrator (ADM) Anabelen Vallarta. ADM stated resident (R1) had a scheduled appointment on 07/10/2026 which R1’s Power of Attorney (POA) informed ADM about three weeks prior to the appointment. ADM stated she forgot about the appointment after ADM had noted the medical appointment on the facility calendar. ADM stated the appointment was for 07/10/2026 and ADM called R1’s medical office to reschedule the appointment for a later date in the month. The Department has investigated the above allegation. Based on interview, record review and observation of the above allegation the preponderance of evidence standard has been met, therefore, the above allegation is substantiated. Deficiency was cited per California Code of Regulations, Title 22. See LIC9099-D. This report was reviewed with Administrator, Anabelen Vallarta and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 31, 2026 · control 26-AS-20260713113340

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87456(a)(2) · Plan of correction due date: Aug 1, 2026

87465 Incidental Medical and Dental Care (a)(2) The licensee shall provide assistance in meeting necessary medical and dental needs… This was not met as evidenced by: Based on record review and interview, R1 was not provided assistance in meeting necessary medical needs wherein R1 missed their medical appointment due to ADM forgetting about the appointment which pose/posed a potential health, safety and/or Personal Right’s risk to residents in care.the state’s words, verbatim · CDSS document, Jul 31, 2026

Plan of correction: Administrator (ADM) stated to submit a written plan of action understanding regulations and ensuring facility staff provide assistance in meeting resident’s necessary medical needs by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to following up on the deficiencies cited on 07/13/2026. LPA Rai met with Administrator (ADM) Anabelen Vallarta and stated the purpose of today's visit. LPA Rai observed 2 staff and 5 residents at the facility. During visit, LPA Rai observed resident (R2) in the living room watching tv with another resident. LPA Rai observed R2 was free from restraint and did not observe the gait belt tying resident to the wheelchair. LPA Rai observed the office area and the garage area was not being using as habitual space. ADM stated staff are no longer using the garage as habitual space. LPA Rai observed cleaning solutions such as laundry detergents in the garage with an locked door and were not accessible to residents in care. On 07/23/2026, the facility was approved by the Fire Department for 5 rooms to be occupied by residents for 5 non-ambulatory residents and 1 bedridden resident for room #2. LPA Rai provided Administrator the Letter of Deficiency Citations Cleared for deficiencies issued during today's visit. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator Anabelen Vallarta and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 31, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced complaint investigation visit. LPA Rai met with Administrator, Anabelen Vallarta and stated the purpose of today's visit. LPA Rai observed 5 residents and 2 staff at the facility. During visit, LPA and LPM observed resident (R2) tied to the wheelchair. There was a thick grey and black gait belt that tied the resident's torso with the back of wheelchair. The buckle of the gait belt was at the back of the wheelchair which was inaccessible to resident. Staff (S1) stated they use the gait belt to make sure R1 does not slide down on the wheelchair. ADM stated R2's family requested facility staff to use the gait belt to tie against the wheelchair. ADM and staff stated that R2 slides from the wheelchair. During visit, LPA and LPM observed the office area and the garage area was being observed as a living space. Staff S1 stated they sleep in the office area and two other staff sleep in the garage area. ADM confirmed 2 staff use the garage as habitual space. The facility does not have a building permit for the garage to be used as a habitual space. LPM observed 5 residents' beds except 1 hospice had half-bed rails attached to the bed. ADM stated resident's have physician's order for half-bed rail for mobility. LPM and LPA reviewed 2 resident files and ADM needs to be aware of resident's responsible party and/or resident has been signed and dated. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPM and LPA addressed ADM needed to ensure staff had access to resident's file at all times. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator, Anabelen Vallarta and a copy of the report was provided. Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jul 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a)(2)(B) · Plan of correction due date: Jul 14, 2026

87307 Personal Accommodations and Services (a) (2) (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building. This requirement is not met as evidence as: Based on observation, S1 and ADM admitted to staff living in the garage and hallway leading towards exit which poses/posed an immediate health, safety and/or Personal Rights to residents in care.the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee/Administrator stated to submit a written plan of action to ensure garage and hallway are not being used as habitual space by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(3) · Plan of correction due date: Jul 14, 2026

87468.1 Personal Rights of Residents in All Facilities (a)(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence as: Based on observation, R2 was tied to the wheelchair with a gait belt wherein R2 was not able to go to restroom on their own without staff removing the gait belt around the torso which poses/posed an immediate health, safety, and/or Personal Rights tothe state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee/Administrator stated to submit a written plan of action to ensure resident is not being held against the wheelchair with a gait belt by POC due date. (con't) residents in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jul 14, 2026

87309 (a)...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, LPA and LPM observed cleaning solutions such as laundry detergents in the garage with an unlocked door which was accessible to residents in care which poses/posed an immediate health, safety and/or Personal Rights to residents in care.the state’s words, verbatim · CDSS document, Jul 13, 2026

Plan of correction: Licensee/Administrator stated to submit a written plan of action to ensure cleaning solutions such as laundry detergents is in locked storage and not left attended by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Anabelen Vallarta. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and observed there to be locked drawers and cabinets for sharp objects and cleaning supplies. LPA observed the first aid kit was complete. LPA toured five out of five bedrooms. Each bedroom had working lights and available bedding and clothing storage areas. LPA toured 3 out of 3 bathrooms. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathrooms ranged from 110 F to 112 F. LPA tested two out of two carbon monoxide detectors and the smoke detectors in the hallways and resident bedrooms. All carbon monoxide and smoke detectors functioned properly when tested. LPA toured the outside area and found the exits were clear of obstruction. LPA reviewed the Centrally Stored Medication and Destruction Records for residents R1-R5. Resident R1 had five medications missing. R2 had three medications missing. R3-R5 did not have any medications missing. See LIC809-C page for more information. Page 1 of 2. LPA reviewed the resident records of R1-R5 and found them to be complete. LPA reviewed two staff records and found them to be complete. The emergency disaster drill log indicates the last drill occurred on 09/03/2025. LPA Marrufo requests that updated copies of the following records be submitted to the department within seven calendar days: LIC500 Personnel Report LIC308 Designation of Administrative Responsibility Liability Insurance LIC610E Emergency Disaster Plan A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Administrator Anabelen Vallarta and a copy of this report and appeal rights were provided. Page 2 of 2. END REPORTthe state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Simi Rai and Marcella Tarin arrived announced to conduct the facility's pre-licensing visit. LPAs met with Applicant, Anabelen Vallarta. There are no clients present on site. This facility address is not currently licensed. During visit, LPAs toured the inside and outside of the facility to include the kitchen, dining, living room, garage, activity room, 3 resident rooms, 1 staff room, 1 office room and 3 bathrooms. All fire exit routes were free and clear of obstruction. LPAs observed 2 sheds in the backyard which will be used for storage and not habitual space. Toxins observed secured. Facility has an approved fire clearance for 3 ambulatory, 2 non ambulatory residents and 1 bedridden resident in Bedroom #2. Bathrooms supplied with hygiene products and paper supplies. LPAs observed the smoke and carbon monoxide detectors to be in working condition. Hot water temperature maintained between 108.9 - 109.4 degrees Fahrenheit. Facility temperature maintained at 70 degrees Fahrenheit. First aid kit supplied with tweezers, bandages, gauze, scissors, and thermometer. Medications will be stored in a locked cabinet. The facility will lock sharp supplies in a locked cabinet in the kitchen. The following posters observed to include the emergency telephone numbers, personal rights, and facility sketch. Fire extinguisher was inspected on 08/28/2024. No issues noted during this pre-licensing inspection. COMP III was reviewed during visit. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. This report was reviewed with Applicant, Anabelen Vallarta. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 18, 2024

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Anabelen Vallarta, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. 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, Aug 12, 2024