Villa Teresa Residential Care

Allegation investigated: Staff did not provide resident 90-day notice of rent increase

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 approx. 10:40 a.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with George Yazbek, Licensee Representative, and Tina Martinez, Administrator, and reason for the visit was explained. Entrance interview conducted. On 05/07/2025, the Department received a complaint regarding the following allegation, Staff did not provide resident 90-day notice of rent increase. On 05/08/2025 LPA’s Esther Cortez and Erica Mosley conducted the initial unannounced complaint visit conducted a physical plant tour, interviewed the Licensee Representative, Administrator, one (1) staff and collected pertinent documents relevant to the investigation. On 02/25/2026 LPA Mosley conducted a subsequent visit, LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, conducted interviews with two (2) staff, two (2) residents Report continued on LIC 9099-C PAGE 2... Substantiated (PAGE 2) Report continued from LIC 9099... A family visitor, the Licensee representative, the Administrator, and obtained copies of pertinent documentation relevant to the investigation. During today's visit starting at 10:45 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 the facility is in compliance with title 22 regulations. On the allegation, Staff did not provide resident 90-day notice of rent increase, it is the concern of the Reporting Party (RP) that the facility Licensee Representative (LR) did not provide Resident #1 (R1) the required 90-day notice of rent increase before increasing their rent. To investigate this complaint, LPA’s conducted in person interviews, telephonic interviews, file and record review, and obtained copies of pertinent documentation relevant to the investigation. Interview with R1 revealed that in the beginning of May 2025 the facility owner informed them that they were going to increase the rent by $2,500 noting they were “too much trouble”. R1 stated they were not given the 90-day notice of the rent increase as required. An interview with the facility’s Licensee Representative (LR) revealed that R1’s rate increase was based on a change in condition. It was noted that when R1 was admitted, they were ambulatory and required minimal assistance. Over time, R1 gained approximately 70 pounds, became non-ambulatory, and required one-on-one care and full assistance. LR stated that they communicated regularly with R1’s Emergency Contact/Power of Attorney for Health Care and Living Will (EC) regarding R1’s condition and informed the EC that a rate increase would be necessary if the decline continued. A formal text message was reportedly sent to the EC regarding the increase; however, the exact date is unknown. LR confirmed that R1 was not provided with a 90-day notice; however, the rate change was due to a change in condition, which the EC had been made aware of. It was also noted that no additional documentation was available. LR was unable to provide any documentation sent to R1 or to R1’s EC. LR further reported that they no longer have access to the text messages and therefore have no proof of communication. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099 PAGE 2... Additionally, a detailed explanation of the additional services to be provided at the new level of care, along with an accompanying itemization of the charges, was not provided or made available. R1 moved out on May 18, 2025. During the 05/08/2025 visit, LPA's Cortez and Mosley observed the Facility Administrator documenting R1’s updated needs and service plan back dated to 05/01/2025. Record review revealed that R1’s appraisal dated 04/10/2022 noted that R1 is alert, unable to ambulate independently, requires one-person assistance with a walker, is able to eat independently, and is dependent for showers and bathing. R1 has weak legs and arms, uses a walker with one-person assistance, and requires assistance getting up and out of a chair and bed. R1 is alert and oriented but non-ambulatory. R1’s needs and service plan dated 03/06/2023 notes R1 as friendly and sociable, incontinent (using a urinal and needing assistance with toileting), and at risk for falls. R1’s needs and service plan dated 05/16/2024 reflects minimal changes, noting that R1 required assistance with scheduling medical appointments. R1’s needs and service plan back dated to 05/01/2025, notes that R1’s PTSD continues to present challenges, resulting at times in manipulation of caregivers. R1 is a fall risk with an unstable gait, uses a CPAP for sleep, and is incontinent of bowels but uses urinals to urinate. R1 has COPD and uses an inhaler. R1 requires assistance during transfers and needs encouragement to use the toilet for bowel movements instead of relying on briefs. R1 is described as friendly but may become easily irritated if not receiving continuous attention from staff and does not adjust easily to changes in staff. R1 requires maximum assistance with all Activities of Daily Living (ADLs), including the use of a Hoyer lift for transfers. Documentation revealed a rent increase notice dated 08/24/2023 indicating a rent increase from $4,700 to $5,000, effective 09/01/2023. LPA attempted to contact EC on 02/09/2026 at 2:42 p.m. ,02/25/2026 at 11:10 a.m., 3/5/26 – 9:26 a.m., 3/20/26- 3:28 p.m. Report continued on LIC 9099-C PAGE 4... (PAGE 4) Report continued from LIC 9099 PAGE 3.. The facility was unable to provide proof of written notice of the rate increase within two business days after initiating services at the new level of care, as required, and did not provide the required detailed explanation of the additional services or the accompanying itemization of charges. Based on information gathered during the course of the investigation there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Staff did not provide resident 90-day notice of rent increase 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. (PAGE 2) Report continued from LIC 9099... On 02/10/2026 LPA subpoenaed hospital records and home health records for Resident #1 (R1). On 02/25/2026 LPA Mosley conducted a subsequent visit, LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, conducted interviews with two (2) staff, two (2) residents, a family visitor, the Licensee representative, the Administrator, and obtained copies of pertinent documentation relevant to the investigation. During today's visit starting at 10:45 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 the facility is in compliance with title 22 regulations. On the allegation, Staff did not properly assist resident, resulting in resident falling and obtaining a fracture, it is the concern of the Reporting Party (RP) that a few years ago the exact date is unknown Resident #1 (R1) fell due to Staff #1 (S1) not properly assisting R1 resulting in a fracture. To investigate this complaint, LPA’s conducted in person interviews, telephonic interviews, file and record review, reviewed hospital records, hospice records and obtained copies of pertinent documentation relevant to the investigation. Documentation revealed that R1’s physician report dated 02/26/2023 lists neuropathy deconditioned as their primary condition and non-ambulatory. Hospital records dated 05/10/2023 revealed that R1 was admitted to the hospital due to edema and cellulitis changes left leg and foot above knee, ulcer medial foot and ankle noted. The assessment plan noted that the cellulites developed erythema and an ulcer, R1 was seen by the wound RN and edema is better and cellulitis lateral leg and foot better. Incident report submitted to the department on 08/28/2023 reported that R1 was being assisted to their room by staff and began to become unbalanced and slowly rolled their ankle and were on the floor. 911 was called and R1 was transported to the hospital. Hospital records revealed that on 08/27/2023 R1 was admitted to the hospital due to 1. COPD exacerbation, 2. Trimalleolar fracture of right ankle, noting rolled ankle while ambulating with walker. Hospital records note that R1 refused to be discharged to a skilled nursing facility and was discharged with home health. Hospice records revealed that R1 was referred to hospice on 08/30/2023 and admitted on 08/31/2023. R1 was admitted with a primary diagnosis of chronic obstructive pulmonary disease with acute exacerbation and a list of secondary diagnoses of severe sepsis with septic shock, pneumonia, unspecified organism, essential primary hypertension, cellulitis of unspecified part of limb, gastro-esophageal reflux disease with esophagitis with bleeding, depression unspecified, spinal stenosis site unspecified, history of falling, heart failure unspecified, post-traumatic stress disorder unspecified. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099 PAGE 2... Interview with S1 revealed that on the night of 08/27/2023 they were assisting R1 to their room from the living room. R1 was using their walker and S1 was directly behind R1 holding on to their pants as they were walking towards their room. R1 became unbalanced and dropped directly down, rolling on their ankle with all of their body weight. S1 immediately called 911 and noted they were unable to help R1 up due to their weight. R1 was transported to the hospital. At the time of the incident R1 was not required to use a gait belt nor were they actively using the gait belt at the time of the incident. Documentation supports that at the time of the incident a gait belt was not included in the care plan or included in a suggested care option. Interview with R1 revealed that they are unfamiliar with the exact date of the incident when they rolled their ankle. They recall one night using their walker, S1 was behind them as they walked to the room. The walker slipped and they rolled their ankle but did not fall to the ground. They remembered feeling a pop and their ankle began throbbing. The staff called 911 and they were transported to the hospital. They believe S1 should have been holding on to them better to avoid the fall. They believe the staff should have been using the emergency belt for assistance. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violations did or did not occur, therefore the allegation of “Staff did not properly assist resident, resulting in resident falling and obtaining a fracture” is deemed UNSUBSTANTIATED at this time. On the allegation, Staff did not elevate resident’s feet resulting in pressure sores, it is the concern of the Reporting Party (RP) that facility staff do not elevate R1’s feet resulting in pressure sores. To investigate this complaint, LPA’s conducted in person interviews, telephonic interviews, file and record review, reviewed hospital records, hospice records and obtained copies of pertinent documentation relevant to the investigation. Documentation revealed that R1’s physician report dated 02/26/2023 lists neuropathy deconditioned as their primary condition and non-ambulatory. Hospital records dated 05/10/2023 revealed that R1 was admitted to the hospital due to edema and cellulitis changes left leg and foot above knee, ulcer medial foot and ankle noted. The assessment plan noted that the cellulites developed erythema and an ulcer, R1 was seen by the wound RN and edema is better and cellulitis lateral leg and foot better. Hospice records revealed that R1 was referred to hospice on 08/30/2023 and admitted on 08/31/2023. R1 was admitted with a primary ... Report continued on LIC 9099-C PAGE 4... (PAGE 4) Report continued from LIC 9099 PAGE 3.. diagnosis of chronic obstructive pulmonary disease with acute exacerbation and a list of secondary diagnoses of severe sepsis with septic shock, pneumonia, unspecified organism, essential primary hypertension, cellulitis of unspecified part of limb, gastro-esophageal reflux disease with esophagitis with bleeding, depression unspecified, spinal stenosis site unspecified, history of falling, heart failure unspecified, post-traumatic stress disorder unspecified. On 09/06/2023 it was noted that R1 has impaired skin integrity (redness) and is at risk of skin breakdown. On 10/04/2023 notes indicate that R1 had a left malleolus open sore, on 10/11/2023 it was noted that R1 had left outer malleolus sore and two (2) new pressure sores on right inner and outer malleolus. R1 was receiving continuous wound care. Records do not indicate that R1 was ordered to elevate their legs. Additionally, documentation notes that “however, even with proper treatment, a wound infection may occur.” Interview with R1 revealed that the facility staff occasionally assisted them with elevating their legs, however on occasion staff did not assist them. Interviews with facility staff revealed that whenever the residents require assistance, they are there to help them. When residents require assistance with their legs being elevated, they will do so. Staff would encourage R1 to elevate their feet as recommended by hospice, however R1 will refuse or will choose not to. S1 stated “all they can do is encourage the residents and recommend it, we cannot force residents to comply”. It was further noted that R1 would elevate their legs most of the time. The facility purchased special pillows for R1 to support proper elevation and always made sure they were elevated when R1 allowed it. Interviews with the Licensee representative revealed that staff consistently encouraged and elevated R1’s feet noting that they purchased equipment specifically for the purpose. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violations did or did not occur, therefore the allegation of “Staff did not elevate resident’s feet resulting in pressure sores” is deemed UNSUBSTANTIATED at this time. On the allegation, Staff did not schedule a follow-up appointment for resident, it is the concern of the Reporting Party (RP) that facility staff failed to schedule a follow-up appointment for R1 after R1 fractured their leg. To investigate this complaint, LPA’s conducted in person interviews, telephonic interviews, file and record review, reviewed hospital records, hospice records and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099-C PAGE 5... (PAGE 5) Report continued from LIC 9099 PAGE 4... Interview with R1 revealed that they had an incident where they fractured their foot, were sent to the emergency room and they were instructed to schedule a follow up appointment. R1 stated that the Administrator #1 (A1) at the time did not schedule the follow-up appointment for them. R1 noted that the facility helps with arranging, scheduling and transporting them to appointments. Interviews with staff revealed that the Administrator is typically the individual who assists residents with scheduling appointments. Staff may assist as needed; however, the Administrator is primarily responsible for that task. An interview with the current Administrator #2 (A2) revealed that they have served as the Administrator of the facility since June 2024. During the time frame of the complaint, A2 was not employed at the facility and therefore could not speak to whether R1’s appointments were scheduled during that period. A2 stated that R1 is vocal and independent in managing their own appointments and ordering medications. Staff would occasionally assist R1 with scheduling appointments; however, this occurred only on rare occasions. It was noted that throughout 2023, R1 did not receive assistance from the facility with scheduling appointments, as documented in their care plan. During facility visit 02/25/2026 at 11:28 a.m. LPA Mosley observed A2 assisting a family with scheduling a doctor’s appointment for a resident. Documentation revealed that R1 was placed on hospice care immediately following their discharge from the hospital. R1 was admitted to the hospital on 08/27/2023. Hospice records revealed that R1 was referred to hospice on 08/30/2023 and admitted on 08/31/2023. R1’s care plan dated 03/06/2023 does not list assistance with scheduling appointments from the facility. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violations did or did not occur, therefore the allegation of “Staff did not schedule a follow-up appointment for resident,” is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 29-AS-20250507120138

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: May 6, 2026

1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 90 days' prior written notice...the amount of the increase...This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above when they stated they increased the rent due to change in condition however documentation does not support the statement, which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: Administrator agrees to submit a written statement of acknowledgement and understanding of HSC 1569.655 to CCLD by POC due date.

Allegation investigated: Staff does not respond to resident's request for assistance.

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 approx. 10:40 a.m. LPA was greeted by staff who called the Administrator and the reason for the visit was explained. The LPA met with George Yazbek, Licensee Representative, and Tina Martinez, Administrator, and reason for the visit was explained. Entrance interview conducted. On 04/16/2025, the Department received a complaint regarding the following allegation, Staff does not respond to resident's request for assistance. On 04/17/2025 LPA Esther Cortez conducted an unannounced initial complaint visit conducted a physical plant tour, interviewed the Administrator, owner, one (1) staff, two (2) residents, two (2) family members of a resident and tested staff response call time. On 02/09/2026 LPA Mosley conducted one (1) telephonic interview and attempted three (3) telephonic interviews from the responsible parties of the residents who resided in the home during the time frame of the complaint. On 02/10/2026 LPA Mosley conducted one (1) and attempted two (2) telephonic interviews. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC 9099... During today's visit starting at 10:44 a.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, conducted two (2) staff interviews, two (2) residents, and a family visitor and obtained copies of pertinent documentation relevant to the investigation. On the allegation, Staff does not respond to resident's request for assistance, it is the concern of the Reporting Party (RP) that Resident #1 (R1) rings their bell for assistance and staff do not respond and tends to other residents. To investigate this complaint, LPA’s conducted in person interviews, telephonic interviews, file and record review, call response time and obtained copies of pertinent documentation relevant to the investigation. Call response time revealed that on 04/17/2025 at 4:20 p.m. LPA Cortez observed a call from room #3 and residents were assisted by staff. At 4:36 p.m. and 4:37 p.m. LPA tested the call button and staff responded at 4:50 p.m. Resident interviews revealed that during the time frame of the complaint staff assisted with resident call requests, however during night hours response times were delayed, however all calls were addressed. At times residents will shout for assistance if their calls are not addressed immediately. R1 noted that staff typically take 10 minutes or so to respond to resident calls. On one occasion R1 alleged that they requested staff assistance, however staff assisted other residents and did not assist them. Staff interviews revealed that they respond to all resident calls. Staff who hear the call first will typically respond to the request first. During night hours Staff #1 (S1) is typically responsible for addressing resident calls, however, all staff will respond. The residents use two (2) forms to call for staff, they use a manual bell and an electronic bell. Witness interviews from 04/17/2025 revealed that concerns were raised regarding the possibility that staff could not hear the calls. The concerns were addressed to the administrative staff and were being addressed. Witness interviews from 02/09/2026 revealed that to their knowledge from April 2025 to now they have had no concerns regarding the facility staff response time. To their knowledge staff response time to requests for assistance has not been a concern. Residents have not addressed any concerns regarding staff response time. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violations did or did not occur, therefore the allegation of “Staff does not respond to resident's request for assistance” is deemed UNSUBSTANTIATED at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 25, 2026 · control 29-AS-20250416123155

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:15 AM. LPA met with facility staff who contacted the facility Administrator Tina Marie Martinez and Licensee Representative George Yazbek. The Licensee Representative arrived to the facility at 11:22 AM and the Administrator arrived to the facility at 11:25 AM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 11:23 AM the LPA, along with the Licensee Representative and later the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This includes the living rooms, hallway, and dining area. LPA observed the living rooms to be clean and properly furnished at the time of the visit. The living rooms contained activities for resident use including a television. The living rooms contained an appropriately screened fireplace, locked cabinets, and drawers which contained resident medications and resident, staff, and facility files. LPA observed the living rooms to contain a complete first aid kit and the facility’s telephone. The hallway was observed to be clean and free from any obstructions. The hallway contained closets that contained storage for linens and care supplies. The dining area was observed to be equipped with adequate seating for resident use. The common areas contained all required postings. The facility’s fire and carbon monoxide alarms were tested between 12:35 PM and 12:37 PM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. Continued on LIC 809C. COMMON AREAS CONT: LPA observed an unsecured bottle of Mucus Relief medication stored in a hallway drawer. LPA informed the Administrator who immediately secured the medication. BEDROOMS: There are five (5) bedrooms in the facility; two (2) are dual occupancy resident rooms, two (2) are single occupancy resident rooms, and one (1) is a staff room. LPA, the Licensee Representative, and the facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #1 contained a direct exit to the outdoors of the facility that was observed to be blocked by a chair. LPA informed the Licensee Representative who removed the obstruction at the time of the visit. LPA observed Resident #1 (R1)’s bed to contain full bed rails. LPA observed the screen door of room #1 to contain two (2) small tears in the screening material. LPA informed the Licensee Representative who performed repairs to the material at the time of the visit. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured under-sink cabinet to contain cleaning chemicals. LPA observed secured drawers to contain knives and other sharp objects. LPA observed the kitchen to contain a wall mounted fire extinguisher to be fully charged and purchased on 02/14/2025. BATHROOMS: There are two (2) bathrooms at the facility. One is designated as a shared/common resident bathroom and one (1) is a private resident bathroom. Both resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 116.4 and 118.0 degrees Fahrenheit, which is in compliance with regulation. Both bathrooms contained secured storage which contained grooming supplies and cleaning supplies. GARAGE: The garage was observed to be locked and inaccessible to clients in care. LPA observed the garage to contain the facility’s washer and dryer, extra care supplies, sufficient emergency water supplies, an extra refrigerator/freezer, and locked cabinets which contained cleaning supplies and laundry supplies. Additionally, the garage was observed to contain a locked staff break room. Continued on LIC 809C. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the outdoors of the facility to contain a locked storage shed which contained gardening supplies and extra care supplies. LPA observed a camera located at the entrance of the facility. RECORD REVIEW: Record review began at 12:25 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. LPA observed staff trainings to be missing the name of the instructor who performed the training and the number of hours per training subject. Additionally, LPA observed one (1) staff file to be missing the twenty (20) hours of required annual training. LPA informed the Administrator of the missing trainings and the Administrator agreed to conduct trainings with staff members on the topics required by regulations. Six (6) resident files were reviewed. LPA observed R1’s bed to contain full bed rails. During file review LPA observed that R1 was not enrolled with hospice care. LPA informed the Licensee Representative that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Licensee Representative expressed understanding and removed the full length bed rails from R1’s bed at the time of the visit. LPA observed Resident #2 (R2)’s Appraisal Needs and Services plan to be dated 10/03/2024. LPA informed the Administrator that resident appraisals shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first. The Administrator expressed understanding and completed an updated Appraisal Needs and Services plan for R2 at the time of the visit. MEDICATION REVIEW: Medication review began at 02:05 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Continued on LIC 8809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last logged emergency disaster drill was conducted on 09/03/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that they had no recommendations for improvement for the facility. LPA interviewed two (2) staff members. One (1) staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. One (1) staff member interviewed was unable to appropriately identify the different forms of abuse but was knowledgeable on their roles and responsibilities, the resident’s rights, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued. LPA experienced technical difficulties while printing appeal rights. Appeal Rights will be emailed to Licensee at a later date.the state’s words, verbatim · CDSS document, Dec 15, 2025

The state marks this report as 25 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection at the above-named facility. Upon arrival, LPA met with two staff members and explained the purpose of the visit. At the time of arrival, there were two (2) staff on duty and five (5) residents in care. Licensee George Yazbek arrived at approximately 12:33 pm. Administrator Tina Marie Martinez arrived at approximately 12:35 pm. Entrance interview conducted. The facility is a one-story Residential Care Facility for the Elderly (RCFE). Currently, there are no residents on hospice and no residents are bedridden. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The facility was seen to be in good repair inside and outside. There is one fire extinguisher located in the kitchen and dining area and last serviced on 6/12/2024. There is one carbon monoxide detector and six (6) smoke alarms throughout the facility. At approximately 12:41 pm, Licensee tested the detector and alarms. All are in good working order. The kitchen area was sufficiently stocked with seven days of non-perishables and two days of perishables. Snacks and beverages are readily available for Residents. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Please continue to 809-C, Pg 2. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet. First aid kit was observed to be complete. Residents participate independently in activities such as arts and crafts, watch game shows, conduct conversations, listen to music, go out on outings with friends and family and medical appointments, and outdoor visitations. The front yard consists of walkway and landscaping. The backyard has walkways and an outdoor visiting area. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. A locked garage is located at the front of the home used for storing supplies. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Bedrooms 1 and 2 are private bedrooms and Bedroom 3-4 is a shared bedroom. Bedrooms 1, 2, and 3-4 share a bathroom off the hallway located near the bedrooms. Bedroom 5-6 is a shared bedroom with a private bath. The bathrooms have secure grab bars and no skid flooring. Medication inventory revealed an unexplainable under count of one (1) medication for Resident 1 (R1) and an over count of one medication for R1. Medication inventory revealed Resident 2 (R2) had an over count of one medication. Residents’ files were reviewed. LPA noted that on file for each resident was the following: Physician’s Reports, Admission Agreements, Health Screenings, Medical Assessments, Identification and Emergency information, Appraisals/Needs Service Plan, and Centrally Stored Medication Administration Records. Staff files were reviewed. LPA noted that staff files are current with health screenings, First Aid & CPR certifications, trainings, and background clearances. All persons associated with the facility have criminal record clearance. Administrator certificate is valid. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Copy of report and Appeal Rights issued at the time of the visit.the state’s words, verbatim · CDSS document, Dec 18, 2024

Allegation investigated: Licensee is not providing comfortable accommodations Facility staff is unable to meet resident's needs

Licensing Program Analyst (LPA) Kelly Dulek conducted an unnanounced subsequent complaint visit to the facility with the purpose of delivering findings for the above allegations. LPA initially met with facility staff Emerson del Monte. Licensee George Yazbek was contacted via telephone and arrived at the facility at 02:43PM. Entrance interview conducted. During today's visit, LPA briefly toured the facility at 02:25PM and observed the residents. LPA also interviewed staff and reviewed Resident #1 (R1)’s file at 02:27PM. During an initial complaint visit conducted on 05/16/2024, LPA interviewed Administrator and Assistant Administrator at 12:40PM, conducted a physical plant tour at 12:47PM, reviewed resident files and took photographs of pertinent documents, and interviewed residents and staff from 01:17PM to 02:15PM. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated The complaint alleges that facility staff cannot meet R1’s needs, as R1 is awake and screaming all day and night, which then makes an uncomfortable environment for other residents in care. During the initial visit, LPA interviewed residents and staff. Additionally, LPA observed R1 and attempted to interview R1. R1 stated their room is nice and quiet and R1 enjoys spending about half their time in the common spaces of the facility and the other half in their room. During the interview, R1 was pleasant, but tired, so staff brought R1 to their room to rest. LPA did not hear any noise from R1’s bedroom throughout either the initial or subsequent visit. Other residents interviewed indicated they have not heard any screaming at night or during the day. Residents stated the facility is calm and quiet. Staff interviewed indicated that R1 did yell on Tuesday 05/14/2024 in the early morning hours upon waking at about 06:00 or 06:30AM. Interview revealed that R1 awoke asking for their son, after their son visited for Mother’s Day. Staff did calm R1 and tend to R1’s needs. On that day, they were able to call R1’s son on the phone to allow for a telephone visit. Staff interviewed indicated this has only ever happened “once in a blue moon” and R1 has been residing at the facility without issue since 2021. Staff were aware another resident in the facility is unhappy that R1 did yell that one morning, so staff had been communicating with R1’s family, as well as the family of a different resident in an attempt to move R1’s room farther away from the other resident. At the time of the initial visit, the move was pending. LPA confirmed during the subsequent visit that R1 had been relocated to another room. All residents interviewed indicated the facility is comfortable, their needs are met and that the staff are great. 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 at this time. No citations issued. Exit interview conducted. A copy of today’s report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20240515140759

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 9:39 a.m. The LPA initially met with two caregivers. The administrator Marilou Rojas and licensee/administrator George Yazbek arrived approximately 20 minutes later. LPA explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher appeared fully charged and was last inspected on 1/23/2023. KITCHEN: Caregivers were preparing breakfast so some locks on cabinets were open. LPA observed knives are stored in a locked drawer and chemicals are stored in a locked cabinet under the sink. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPA observed two double-occupancy bedrooms and two single-occupancy bedrooms, appropriately furnished. RESTROOMS: Restrooms are clean and sanitary and in operating condition. Hot water temperature was 114*F. COMMON SPACES: The living room, family room and dining room furniture was observed to be in good condition. The LPA observed the required postings throughout the facility. The backyard patio is equipped with furniture for residents' use. The garage and staff room were locked. Medication is stored in a locked cabinet in the hall/desk area. Medications were reviewed and appear to be given as prescribed. The administrator and two staff records, including training records, were reviewed and appear to be complete. Two resident files were reviewed and appeared complete.INFECTION CONTROL: LPA observed an adequate supply of Personal Protection Equipment (PPE) and licensee can obtain additional supplies as needed. The facility has appropriate plans in place in the event clients and/or staff show symptoms of or test positive for COVID. Cleaning protocols were sufficient. No deficiencies were observed at the time of the visit. Exit interview conducted. Report provided to administrator.the state’s words, verbatim · CDSS document, Dec 1, 2023