Wildomar Senior Assisted Living

Allegation investigated: Staff do not allow resident to have access to personal property. Staff uses emergency services on resident as form of punishment.

On 8/4/2026, Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Administrator Melissa Polendo and Regional Director Keyna Calton explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record reviews. For the allegation, Staff do not allow resident to have access to personal property. During staff interviews six out of the six staff stated that residents have access to their personal property. During residents’ interviews, six out of the six residents stated that they have access to their personal property. For the allegation, Staff uses emergency services on resident as form of punishment. During staff interviews six out of the six staff stated that the facility does not use emergency services on residents as form of punishment. During resident interviews, six out of the six residents stated that the staff do not use emergency services as a form of punishment. Unsubstantiated Based on the evidence found during the investigation, the two (2) allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melissa Polendo and Regional Director Keyna Calton.the state’s words, verbatim · CDSS document, Aug 11, 2026 · control 56-AS-20260610125423

Allegation investigated: Staff do not ensure that resident's showering needs are met.

On 8/4/2026, Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Administrator Melissa Polendo and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record reviews. For the allegation, Staff do not ensure that resident's showering needs are met. During staff interviews, six staff members stated that R1 showers have not been completed. Four staff memebers stated that R1’s showers are scheduled in the afternoon on Monday and Thursday. In addition, two staff were unaware R1 was schedule two showers per week. During residents’ interviews, R1 confirmed their shower needs were not being met. During record review, LPA Rico observed R1 is scheduled for two showers per week. Based on record review, for the months of April 2026 and June 2026 residents was only receiving a shower once a week and for certain weeks there was no documentation shower was completed. Substantiated Furthermore, for the month of May 2026 there was no documentation that showers were completed and no documentation of refusals. Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because of the preponderance of evidence the standard has been met. During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Melissa Pardo, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 56-AS-20260601113657

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Aug 19, 2026

Additional Personal Rights of Residents in Privately Operated Facilities 87468.2(4) To care, supervision, and services that meet their individual needs and are delivered by...meet their needs.This requirement was not met as evidenced by; Based on interviews and records review, the licensee did not ensure (R1) shower needs were not being met. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: The Administrator stated that an in-service will be provided for all staff regarding resident showers. Proof of completion will be provided to LPA Rico. POC due date 8/19/2026

Allegation investigated: Staff do not ensure resident's cash resources are safeguarded.

On 8/4/2026, Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegation listed above. LPA met with Administrator Melissa Polendo and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record reviews. For the allegation, Staff do not ensure resident's cash resources are safeguarded. During staff interviews, two staff indicated that R1 had moved out in May 2026. During record reviews, LPA Rico observed R1 handles their own finances. In addition, outside parties related to R1 indicated the individual in question is a family member not the facility. Unfounded Based on the evidence gathered, the allegation is deemed UNFOUNDED. A finding that the complaint allegation is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the allegation was dismissed. An exit interview was conducted where this report LIC 9099 was discussed and provided to Administrator Melissa Polendo.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 56-AS-20260707162227

Type of visit: Case Management - Other

On 7/8/2026, Licensing Program Analysts (LPAs) Eldin Serrano, Mary Rico and Matthew Aguilar conducted an unannounced case management visit. LPAs met with Regional Director Kenya Carlton and explained the purpose of the visit. The visit pertained to the complaint control number AS-20250613162316. Based on the observations made during today’s visit, no deficiencies cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was provided, and a copy of this report was given to Regional Director Kenya Carlton.the state’s words, verbatim · CDSS document, Jul 8, 2026

Type of visit: Case Management - Other

On 6/24/2026, Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit. LPA Rico met with Assistant Executive Director Theresa Gamez and explained the purpose of the visit. The visit pertained to the complaint control number 56-AS-20260116121012. LPA Rico conducted interviews with staff, residents, toured the facility and reviewed facility documents. Based on the observations made during today’s visit, no deficiencies cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was provided, and a copy of this report was given to Assistant Executive Director Theresa Gamez.the state’s words, verbatim · CDSS document, Jun 24, 2026

Allegation investigated: Staff threatened residents. Staff forced residents to eat in their bedroom. Staff did not provide adequate food service to residents. Staff are not providing a safe environment for residents in care. Staff did not respond to residents’ call button in a timely manner. Staff did not meet residents’ incontinent needs. Staff did not allow residents to participate in activities.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Assistant Executive Director Theresa Gamez . On January 16, 2026, it was alleged staff threatened residents, staff forced residents to eat in their bedroom, staff did not provide adequate food service to residents, staff did not provide a safe environment for residents in care, staff did not respond to residents’ call button in a timely manner, staff did not meet residents’ incontinence needs, and staff did not allow residents to participate in activities. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews. [Continued on LIC9099-C] Unsubstantiated According to the allegations received Resident #1 (R1) was threatened with being evicted from the facility by staff, R1 was forced to eat their meals in their room after complaining about the quality of the food because the food at the facility was under cooked or over cooked and the portion sizes have decreased. It was alleged that R1 was harassed by Resident #2 (R2), staff did not interfere, and the facility was unsafe environment for the residents. It was also alleged that staff do not respond to residents’ call buttons and residents’ who require assistance with incontinence management were limited to only six (6) incontinence briefs a day. It was also alleged that R1 was not allowed to participate in activities. Interviews with staff and residents did not reveal that staff threatened residents. Interviews with staff and residents provided conflicting statements as to whether R1 was required to eat in their bedroom. Review of the facility’s menu and interviews with staff and residents did not reveal that the food service was inadequate. Interviews with staff and residents did not reveal that staff did not respond to residents’ call button in a timely manner, staff did not meet residents’ incontinence needs, nor did it reveal that staff did not allow residents to participate in activities. Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude staff threatened residents, staff forced residents to eat in their bedroom, staff did not provide adequate food service to residents, staff did not provide a safe environment for residents in care, staff did not respond to residents’ call button in a timely manner, staff did not meet residents’ incontinence needs, and staff did not allow residents to participate in activities. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Assistant Executive Director Theresa Gamez and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 8, 2026 · control 56-AS-20260116121012

Allegation investigated: Staff mismanaged resident's medication.

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper and Assistant Executive Director Theresa Gamez. On March 20, 2026, it was alleged that staff mismanaged resident's medication. According to the allegation received, on March 19, 2026, Resident #1 (R1) was not given two of their prescribed medications and since that incident R1 no longer receives their medications on time. It was also alleged that staff place resident’s medications in their bedrooms and leave the room before the medications were consumed by the resident. The Department’s investigation consisted of an unannounced facility visit, records review, and staff and resident interviews. [CONTINUED ON LIC9099-C] Unsubstantiated Review of R1’s medical assessment dated August 13, 2024, revealed that R1 was unable to administer their own prescription medications, unable to administer their own PRN medications, and unable to store their own medications. Review of R1’s Medication Administration Record (MAR) for March 19, 2026, revealed that R1 refused two morning medications. Furthermore, review of the MAR did not reveal that R1 received their medications late following the incident. Interviews with staff and residents provided conflicting statements as to the reasoning of R1 not taking two of their medications. Interviews with staff did not reveal that staff leave medications in residents’ bedrooms nor do staff give medications late. Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude staff mismanaged resident's medication. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director Karen Roper and Assistant Executive Director Theresa Gamez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 27, 2026 · control 56-AS-20260320143116

Allegation investigated: Staff are mismanaging resident's medications Staff do no ensure resident's hygiene needs are being met Staff does not answer resident's call button in a timely manner

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Karen Roper, Executive Director and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and residents. The allegation that Staff are mismanaging resident's medications. LPA randomly review three (3) residents medications, the medications are being administered as prescribed. The Medtechs do take the parameters for the residents blood pressure before administering medications to the residents. They use a medication management system called August Health that records when medication is being administered to residents. August Health also records the parameters for the residents. LPA observed the blood pressure logs for those residents who are required to have their parameters done before administering their medications. Unsubstantiated The allegation that Staff do no ensure resident's hygiene needs are being met. LPA interviewed five (5) residents and they stated that their scheduled shower schedule is good and there are no issues. LPA interviewed three (3) caregivers, they stated that they do follow the shower schedule for the residents and have not missed a shower schedule for the residents. The allegation that Staff does not answer resident's call button in a timely manner. LPA interviewed seven (7) residents, they stated that staff does answer their call buttons and assist in a timely manner. LPA interviewed three (3) staff, they stated that they do answer the residents call buttons in a timely manner. LPA randomly tested three (3) residents call button and it took staff between 3 to 7 minutes to assist the residents. Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy of this report was provided to Karen Roper, Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 56-AS-20250811092601

Allegation investigated: Staff did not allow resident to use assistive devices

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper. On December 2, 2025, it was alleged that staff did not allow resident to use assistive devices. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews. According to the allegations received, Resident #1 (R1) was informed by facility staff that they were no longer permitted to use their motorized wheelchair. It was alleged that R1 hit two staff members with their motorized wheelchair on two separate occasions and was thus prohibited from using their motorized wheelchair. [CONTINUED ON LIC9099-C] Substantiated Interviews with staff, residents, and outside sources revealed that staff verbally informed R1 that they were no longer permitted to use their motorized wheelchair. Review of R1’s medical assessment dated July 10, 2025, revealed that R1 had a motor impairment/paralysis. Review of R1’s needs and service plan dated July 14, 2025, revealed that R1 required standby assistance with mobility and needed an electric wheelchair / motorized cart. Review of R1’s admissions agreement revealed that there is not a motorized scooter/wheelchair policy nor addendum in the agreement. Interviews with staff corroborated that the facility does not currently have a written motorized scooter/wheelchair policy. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of evidence exists to support the allegation that staff did not allow resident to use assistive devices. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Karen Roper, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Jan 14, 2026 · control 56-AS-20251202132657

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(27) · Plan of correction due date: Feb 11, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) ... residents... shall have all of the following personal rights: (27) To keep, have access to, and use their own personal possessions... This requirement was not met as evidence by: Based on interviews and records review, the licensee did not comply with the section cited above in that Resident #1 (R1) was prohibited from using their motorized wheelchair which posed a potentional personal rights risk to one (1) out of one hundred nine (109) residents in care.the state’s words, verbatim · CDSS document, Jan 14, 2026

Plan of correction: Licensee agrees to conduct an in-house training on personal rights and submit sign-in sheet and training agenda to the Department by POC due date of 2/11/2026.

Allegation investigated: Staff did not treat resident with dignity

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper. On January 12, 2026, it was alleged that staff did not treat resident with dignity. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews. According to the allegations received, on January 12, 2026, Client #1 (C1) attempted to enter Staff #1 (S1)’s office to ask a question. S1 responded by yelling and speaking rudely to S1. Interviews with staff, residents, and outside sources did not reveal that S1 yelled nor spoke rudely to C1. [CONTINUED ON LIC9099-C] Unsubstantiated Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude staff did not treat resident with dignity. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director Karen Roper, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jan 14, 2026 · control 56-AS-20260112213235

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Becky Mann made an unannounced visit to the facility to amend the finding of Complaint Control Number 56-AS-20250812162509. During the facility visit, LPA Mann toured the facility and observed 5 window screens on one side of the building to be in disrepair. LPA Mann informed Theresa Gamez, Assistant Executive Director that deficiency will be issued as this pose potential health, safety and personal rights risks to residents in care. An exit interview was conducted where this report was discussed and provided to Karen Roper, Executive Directorthe state’s words, verbatim · CDSS document, Nov 20, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80088(b) · Plan of correction due date: Dec 4, 2025

80088 Furniture, Fixtures, Equipment, and Supplies (b) All window screens shall be in good repair and be free of insects, dirt and other debris. This requirement is not met as evidenced by: Based on LPAs observations, the Licensee did not comply with the section cited above by having the window screens in the facility in disrepair which pose potential health, safety and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Nov 20, 2025

Plan of correction: Licensee stated to replace torn window screens in the facility and submit proof to LPA by Plan of Correction (POC) due date. Licensee stated to submit signed Statement of Understanding on CCR 80088(b) and submit to LPA by POC due date.

Allegation investigated: Neglect/Lack of Supervision resulted in resident's hospitalization Licensee did not ensure resident received wound care Facility staff are not allowing resident to use wheelchair Facility staff are not allowing resident to leave bedroom

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper and Assistant Executive Director Theresa Gamez. On October 17, 2025, it was alleged that neglect/lack of supervision resulted in resident’s hospitalization, licensee did not ensure resident received wound care, facility staff are not allowing resident to use wheelchair, and facility staff are not allowing resident to leave bedroom. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews. According to the allegations received, Resident #1 (R1) was hospitalized due to staff neglect and R1 did not receive wound care on October 15, 2025, as was planned to. It was alleged that R1 was confined to their bedroom and not allowed to leave and that facility staff took away their wheelchair. [Continued on LIC9099-C] Unsubstantiated Review of R1’s medical records revealed that on October 13, 2025, R1 had an emergency room visit due to inflammation of their wound. Review of facility records revealed that the Executive Director of the facility self-reported R1’s emergency room visit to the Department. Per record review and interviews, R1 was on home health services for wound care and on October 13, 2025, R1 was receiving wound care from the home health nurse when R1 had complaints of pain. R1 was then sent out to the hospital via emergency services. Records review and internal and external source interviews did not reveal that neglect/lack of supervision resulted in R1’s hospitalization, as R1 was on home health services for wound care and R1 returned back to the facility from the emergency department on the same day. Review of R1’s medical records revealed that R1 was home health services for wound care and outside source interviews confirmed that R1 was being seen by a home health nurse three times a week for wound care. Review of R1’s home health notes revealed that R1 was seen by the home health nurse on October 16, 2025. Outside source interviews and records review did not reveal that R1 was scheduled for wound care on October 15, 2025. Also, interviews with internal and external sources did not reveal that R1 was confined to their bedroom nor did the facility staff take away R1’s wheelchair. Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude that neglect/lack of supervision resulted in resident’s hospitalization, licensee did not ensure resident received wound care, facility staff are not allowing resident to use wheelchair, and facility staff are not allowing resident to leave bedroom. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director Karen Roper and Assistant Executive Director Theresa Gamez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Nov 5, 2025 · control 56-AS-20251017143416

Allegation investigated: Licensee overcharged resident. Staff did not ensure that residents were accorded privacy.

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper and Assistant Executive Director Theresa Gamez. On October 30, 2025, it was alleged that the licensee overcharged resident, and staff did not ensure that residents were accorded privacy. The Department’s investigation consisted of an unannounced facility visit, records review, and staff and resident interviews. According to the allegations received, Resident #1 (R1) has been overcharged by the facility for the last seven months. It was also alleged that staff members have entered R1’s and Resident #2 (R2)’s bedroom without permission. [CONTINUED ON LIC9099-C] Unsubstantiated Review of R1’s facility admission records revealed that R1 was admitted to the facility on June 18, 2024, with the Assisted Living Waiver (ALW) program. Interviews and records reviewed did not reveal that R1 was overcharged for the last seven months. Review of R1’s monthly invoice did not reveal that R1 was overcharged. Also, interviews provided inconsistent information and did not reveal that staff enter resident’s bedrooms inappropriately. Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude that the licensee overcharged resident, and staff did not ensure that residents were accorded privacy. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director Karen Roper and Assistant Executive Director Theresa Gamez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Nov 5, 2025 · control 56-AS-20251030143729

Allegation investigated: Facility does not ensure that staff are awake on the premises Facility staff inappropriately speak to residents Facility pipes are in disrepair

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Theresa Gamez, Assistant Executive Director and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and residents. The allegation that facility does not ensure that staff are awake on the premises. Ten (10) residents stated that they have not seen staff asleep on the premises. One (1) resident stated that a few months ago, they seen 2 night staff sleeping on the premises. Four (4) staff interviewed denied sleeping on the premises during work hours. Seven (7) staff interviewed stated that they have not seen a staff sleeping on the premises during work hours. Unsubstantiated The allegation that facility staff inappropriately speak to residents. Eight (8) out of ten (10) residents stated that staff have not spoken to residents inappropriately. Seven (7) staff denied speaking to residents inappropriately. The allegation that facility pipes are in disrepair. Based on LPA observations, the facility have fixed the pipes that are in disrepair. LPA observed and did a record review of receipts and invoices of repairs for the pipes from the company Apex Plumbing Services Inc. The facility has continued to repair the pipes in a timely manner. Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that 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. An exit interview was conducted where this report was discussed and a copy of this report was provided to Theresa Gamez, Assistant Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 56-AS-20250812162509

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87625(b)(3) · Plan of correction due date: Oct 30, 2025

87625 Managed Incontinence (b)addition Section 87611, General Requirements for licensee shall be responsible for: (3)Ensuring incontinent residents are kept clean, dry and facility remains free of odors from incontinence. Requirement has not been met: Based on LPA interviews, Licensee did not ensure that residents are being changed in a timely manner. Which poses a potential health and safety concern for residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee will submit a Statement of Understanding and training with staff signatures to LPA by Plan of Correction (POC) due date

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87303(a) · Plan of correction due date: Nov 27, 2025

87303 Maintenance and Operation (a) facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors…this requirement is not met as evidenced by: Interviews with staff, residents, and document reviews reveal that the facility did have bed bugs. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Licensee shall provide training on how to treat and prevent bed bugs to all staff. Licensee shall submit proof of training to the LPA by Plan of Correction (POC) due date.

Allegation investigated: Staff do not give resident medication as prescribed Staff do not ensure that resident's needs are met Staff did not have resident's medication records available for emergency medical care Staff illegally evicted resident

On 10/03/2025 at 1:30PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Executive Director, Karen Roper. The investigation consisted of interviews and record review. In regards to the allegation of staff do not give resident medication as prescribed : LPA interviewed seven (7) staff and (10) residents. Staff stated that they have sufficient training in medication and denied the allegation. Residents stated that they receive their medication(s). LPA reviewed the Medication Administration Record (MAR) for R1 and did not observe any discrepancies. Based upon interviews and record review, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff do not ensure that resident's needs are met: LPA reviewed Resident 1 (R1) Service Plan which confirmed that R1 mainly needed assistance with Unsubstantiated medication administration. Staff stated that R1 was independent and did not require assistance with their Activities of Daily Living (ADL). Based upon interviews and record review, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff did not have resident's medication records available for emergency medical care : Staff stated that the facility's policy is to provide residents' Face Sheet and Medication list when residents are sent out of the facility. The facility has a folder readily available with this information. Staff denied the allegation. The Reporting Party (RP) did not recall the details of this allegation. Based upon interviews, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff illegally evicted resident: Staff stated that R1 voluntarily left the facility on 06/16/2025 because R1 would be moved to a Skilled Nursing facility. Staff denied the allegation. LPA did not observe any documentation regarding eviction in R1's file. Based upon interviews and record review, this allegation is UNSUBSTANTIATED. LPA made several attempts to reach R1 but their contact numbers were disconnected. R1 was self-responsible. The RP stated that they did not observe or witness any of the above allegations but the family of R1 shared these concerns. UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to Executive Director, Karen Roper.the state’s words, verbatim · CDSS document, Oct 3, 2025 · control 56-AS-20250617192330

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Karen Roper and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (200) current census (118). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside staff office inaccessible to residents in care. LPA observed an in-ground pool; the perimeter of pool is gated and locked. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Karen Roper.the state’s words, verbatim · CDSS document, Sep 18, 2025

Allegation investigated: Staff did not safeguard resident's personal property Staff refused resident their medication Resident was not allowed to leave the facility with family

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrative Assistant, Theresa Gamez, and informed the purpose of the visit. Regarding the allegation, staff did not safeguard resident’s personal property, Resident #1 (R1) is no longer at the facility and was not interviewed. Administrator Rooper and four (4) staff interviewed deny not safeguarding resident’s personal belongings. Five (5) out of six (6) residents interviewed deny that staff have not safeguarded their personal belongings. Regarding the allegation, staff refused resident their medication, R1 is no longer at the facility and was not interviewed. The Administrator and four (4) staff interviewed deny that they refused to give residents their medications. Six (6) residents interviewed deny that staff refused to give them their medications. Regarding the allegation, resident was not allowed to leave the facility with family, R1 is no longer at the facility and was not interviewed. **Continued on LIC9099-C*** Unsubstantiated Interview with the Administrator reveal R1 was admitted to the facility as an emergency placement by Adult protective services (APS); however, the Administrator and four (4) staff interviewed deny not allowing residents to leave the facility with family. Six (6) residents interviewed deny that staff refused to allow them to leave the facility with family. Based on record review, interviews with Administrator, staff and residents, the allegations are Unsubstantiated. An Unsubstantiated finding means that 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. An exit interview was conducted with where this report was discussed and a copy provided with appeal rights to Administrative Assistant Gamez at the conclusion on the visit.the state’s words, verbatim · CDSS document, Sep 5, 2025 · control 56-AS-20250723085142

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced facility visit to conduct a Case Mangement Incident Visit. LPA met with Administrator Karen Roper and explained the purpose of today's visit. The visit is in response to an incident that may have occurred with Staff #1 (S1) and Resident #1 (R1). During today's visit, LPA requested resident roster and staff roster, and staff phone numbers. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809 was discussed and provided to Administrator Karen Roper.the state’s words, verbatim · CDSS document, Sep 3, 2025

Allegation investigated: Staff do not ensure the facility is kept in sanitary conditions for residents in care Staff do not ensure facility is kept free of mal odors Staff do not ensure residents receive clean linens Staff do not ensure residents are provided with adequate eating utensils Licensee does not ensure staff are adequately trained to perform care for residents Staff do not ensure required posters are placed prominently in the facility

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met Executive Director Roper and discussed the elements of the complaint. Allegation #1 - The facility is a 2 story, 4 wing facility. LPA toured facility hallways, library, common areas, med tech room, linen and storage rooms, laundry room, dinning area, kitchen and common bathrooms. LPA also toured the facility grounds. LPA found these areas to be clean and sanitary. Allegation #2 - The facility is a 2 story, 4 wing facility. LPA toured facility hallways, library, common areas, med tech room, linen and storage rooms, laundry room, dinning area, kitchen and common bathrooms. LPA also toured the facility grounds. LPA found these areas to be from odors. Unsubstantiated Allegation #3 - LPA toured facility hallways, library, common areas, med tech room, linen and storage rooms, laundry room, dinning area, kitchen and common bathrooms. LPA observed facility storage room to have more than an ample supply of linen or resident use. Executive Director Roper states the rooms are supplied with fresh linens, as well as cleaning of the rooms, once a week and changing of linens when necessary. Allegation #4 - LPA toured facility hallways, library, common areas, med tech room, linen and storage rooms, laundry room, dinning area, kitchen. LPA arrived to the dinning area, during a meal time, and found the kitchen to be clean and organized with an adequate amount eating utensils. Allegation #5 - LPA obtained sample training documents from Executive Director Roper showing proper training for direct care staff in the topics of resident rights, meals, cleaning, activities of daily living, bedridden clients, lifting and transferring. Other topics include, incontinence, communicating, positioning and personal care, UTI and preparing for end of life. Medical staff are trained in the topics of medications, person centered care plans, catheter and perineal care, cognitive impairment and specialized diets and nutrition. Allegation #6 - LPA observed, during facility tour, posting of required posters such as Licensing required Complaint Poster and the poster for the Long Term Care Ombudsman each posted in prominent locations at the facility. Based on the information obtained there is not enough evidence to support the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Roper and a copy was left with the facility.the state’s words, verbatim · CDSS document, Aug 1, 2025 · control 56-AS-20250728122130

Allegation investigated: Licensee is not ensuring that the facility elevator is in good repair. Staff member does not accord dignity to residents in care.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Karen Roper and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records. First allegation: Licensee is not ensuring that the facility elevator is in good repair. Regarding allegation LPA conducted a tour of the facility and LPA observed that facilities elevator is fully functioning. LPA went over the allegation with facility administrator and the administrator informed LPA that the elevator has always been working and that they have not had any issues or complaints pertaining to their elevator. LPA informed facility administrator that the elevators in building numbers 1-3 on the independent living side have not been working for the past week. Facility Administrator informed LPA that Wildomar Senior Assisted Living is not affiliated with the independent living side. Administrator further explained that both properties are managed by two different owners. Unfounded LPA walked over to the side building (32325) and spoke to Property Manager Wendi Jennings who informed LPA that (Wildomar Senior Apts), is managed by Positive Investments, INC. and that they are not a licensed facility but rather low-income independent living apartments. In addition, Wendi informed LPA that they are aware about the concerns pertaining to the elevators and that a work order has been initiated. Second allegation: Staff member does not accord dignity to residents in care. Regarding the allegation listed above LPA conducted an interview with facility administrator LPA went over the allegation with administrator pertaining to the staff listed facility administrated informed LPA that Wildomar Senior Assisted Living does not have any staff member listed under the name provided. Facility Administrator further explained to LPA that Senior Assisted Living and Wildomar Senior Apts are not affiliated with one another and both buildings are managed by different owners along with different staffing. Based on corroborating evidence, LPA found that the allegation[s] are Unfounded. Unfounded: A find of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted where this report was discussed, and a copy provided to Facility Administrator Karen Roper.the state’s words, verbatim · CDSS document, Jul 18, 2025 · control 56-AS-20250716101004

Allegation investigated: Facility has mold Facility allows drugs on premises

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit for the delievering findings of allegations listed above. LPA met with Business Office Manager Maggie Prado and explained today's visit. Investigation consisted of resident and staff interviews. For the allegation, facility has mold. LPA Hernandez conducted (2) staff interviews. 2 out of the 2 staff indicated the facility has never had mold. Staff #2 stated the facility is cleaned everyday and has a housekeeping schedule. LPA Hernandez conducted (6) resident interviews. 6 out of the 6 indicated they have not observed mold at the facility and the facility is kept clean. Unsubstantiated For the allegation, Facility allows drugs on premises. LPA Hernandez conducted (2) staff interviews. 2 out of the 2 staff indicated the facility does not allow drugs on the premises. LPA spoke with Staff #1 (S1) who stated if drugs are found on the premises facility staff will issue 30-day eviction and reiterated to LPA that drugs are never allowed on the premises. LPA Hernandez conducted (6) residents interviews. 6 out of the 6 residents stated the facility does not allow drugs on the premises and have not witnessed any drugs at the facility. Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Business Office Manager Maggie Prado.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 56-AS-20250403160500

Allegation investigated: Staff neglect/lack of supervision resulting in a resident being physically abused.

On June 18, 2025, at 8:45 a.m., Licensing Program Analyst (LPA) Eldin Serrano, conducted an unannounced visit to investigate and deliver the findings for the above allegation. LPA met with Executive Director Karen Roper and explained the purpose of the visit. The investigation included interviews with facility staff and residents, a review of facility records, resident records, and facility procedures, as well as observations made during the visit. On June 12, 2025, there was a physical altercation between Resident 1 (R1) and Resident 2 (R2) while they were in the room they shared. Interviews revealed that facility staff responded to R1's room and found R1 sitting on the bed in need of medical assistance. Facility staff immediately contacted 911, and paramedics and law enforcement responded to assess both residents. R1 was transported to the hospital due to injuries sustained during the incident, and R2 was detained by law enforcement. *** Continuation in LIC9099C *** Unsubstantiated During the Department's investigation, LPA requested and reviewed facility records, the police report, resident records, and the residents' most recent appraisals. R1 has a diagnosis of dementia. R2 did not have a documented diagnosis of cognitive impairment. The records reviewed did not identify a history of aggressive or assaultive behavior for either R1 or R2. R1 and R2 had been roommates for more than one year, and there were no prior Special Incident Reports (SIRs) or other documentation indicating previous physical altercations involving either resident. During interviews, five (5) residents and four (4) staff members stated they had never witnessed physical altercations between residents at the facility. One staff member reported that the allegation mentioned was the first physical altercation to occur at the facility and stated that staff immediately intervened to separate the residents. Staff consistently stated that when verbal disagreements occur between residents, staff intervene by redirecting the residents and attempting to de-escalate the situation. The facility also provided its written policies and procedures regarding resident behavior management. The investigation did not reveal evidence that the facility had prior knowledge that R2 exhibited aggressive behaviors toward residents requiring additional supervision before the incident. No documentation reviewed identified a pattern of aggressive behavior or other information indicating the incident was foreseeable. R1 and R2 were not interviewed because R1 remained hospitalized during the investigation, and R2 remained in police custody. Therefore, neither resident was available for interview. Based on interviews, record reviews, and other information obtained during the investigation, there is insufficient evidence to corroborate that staff neglect/lack of supervision resulted in a resident being physically abused. The evidence obtained did not establish that the residents required additional preventive interventions or that staff failed to respond appropriately once the altercation occurred. Therefore, the allegation is Unsubstantiated. An exit interview was conducted with Regional Director Kenya Carlton.The amended LIC 9099 and LIC 9099C were discussed and provided.the state’s words, verbatim · CDSS document, Jun 18, 2025 · control 56-AS-20250613162316

Allegation investigated: Facility staff did not assist resident with medications as needed

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Karen Roper and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records. First allegation: Facility staff did not assist resident with medications as needed. Regarding the allegation stated above. LPA conducted an interview with Facility Administrator who informed LPA that Resident #1 was discharged from a Skilled Nursing Facility and was admitted at Wildomar Senior Assisted Living on 5/23/2025. Administrator further explained that R#1 arrived at the facility with only four (4) pain medication (Hydrocodone-Acetaminophen 10-325), and that a refill order was placed however, medication was delayed due to a documentation error by R#1 primary physician. Administrator informed LPA that R#1 was transported to local hospital due to severe pain on 5/28/2025. Unsubstantiated LPA conducted an interview with Resident #1 pertaining to the allegation stated above. Resident #1 informed LPA that facility is not at fault and that the facility has been attentive to R#1 care needs. Resident #1 informed LPA that R#1 has been having ongoing issues with delayed medication prior to being admitted to Wildomar Senior Assisted Living, and that is due to residents’ primary physician and not the facility. Resident #1 informed LPA that resident has received the medication and that the facility has been doing a good job to ensure that R#1 receives the medication on a timely manner and according to R#1 medication order. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated. Unsubstantiated: meaning that 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. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Karen Roper.the state’s words, verbatim · CDSS document, Jun 4, 2025 · control 56-AS-20250528164240

Allegation investigated: Licensee is not providing resident's records to their representative as necessary.

On 05/28/2025 at 09:00 AM, Licensing Program Analyst (LPA), Melody Brown, met with Executive Director (ED) Karen Roper at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office to deliver complaint investigation findings for the above allegation. LPA Brown explained the purpose of the requested Office Visit to ED Roper. The investigation was conducted by LPA Melody Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicates that Licensee is not providing resident's records to their representative as necessary. LPA Brown obtained evidence to corroborate the allegation. During the facility visit in 02/13/2025, Staff #1 (S1) reported to LPA Brown that S1 did not receive a records request from Resident #1 (R1) representative. Records review indicated that R1 records request was sent to the facility in 01/16/2025 via email with R1 Authorized Representative authorization and R1 records were not obtained. In addition, investigations revealed that R1 records request was sent again in 02/04/2025 with attached Access to facilities and Records and ***Continuation in LIC9099C*** Substantiated the request has not been honored as well. Based on the information and interviews gathered, the allegation Licensee is not providing resident's records to their representative as necessary is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Please see LIC9099D for deficiency cited. An exit interview was conducted where this report (LIC9099), LIC9099D and Appeal Rights were discussed, and a copies were provided to ED Karen Roper at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 28, 2025 · control 56-AS-20250210145138

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Jun 3, 2025

87506 Resident Records (c) All information and records obtained from or regarding residents...(1)The Licensee... The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidenced by: Based on interviews and records review, the Licensee did not comply with the section cited above by not ensuring that Resident #1 (R1) records were provided to R1 Authorized Representative which poses a potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, May 28, 2025

Plan of correction: Licensee stated to train all staff on CCR 87506(c)(1) and submit proof of all staff training log to LPA Brown by the Plan of Correction (POC) due date.

Allegation investigated: Staff did not prevent resident from developing a pressure injury. Staff did not ensure resident’s room was free from odors. Staff did not ensure that a resident is using clean linen at all times. Staff did not adequately assist resident with care needs.

On 05/28/2025 at 09:00 AM, Licensing Program Analyst (LPA), Melody Brown, met with Executive Director (ED) Karen Roper at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office to deliver complaint investigation findings for the above allegations. LPA Brown explained the purpose of the requested Office Visit to ED Roper. After introducing and identifying self, LPA Brown discussed the findings to ED Roper. The investigation was conducted by LPA Melody Brown. The investigation consisted of file review, observation and interviews with relevant parties. The first allegation indicates that staff did not prevent residents from developing a pressure injury. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with four (4) of four (4) residents indicated that staff at the facility are checking on them five (5) times a day to determine if they needed a change, they needed assistance or to rotate them. LPA Brown unable to interview Resident #1 (R1) as R1 unable to answer LPA Brown's questions. Four (4) of four (4) residents interviewed denied developing or having a pressure injury. Eight (8) of eight (8) staff interviewed reported that **Cont.in LIC9099C*** Unsubstantiated they are checking on their residents every two (2) hours to change a resident if needed, to rotate a resident or if resident need assistance. Interviews with eight (8) of eight (8) staff indicated that there's no incident at the facility that they neglected R1, and they did not prevent R1 from developing pressure injury. Records review revealed that R1's on hospice care and receiving wound care. Interview with R1 hospice nurse on 05/22/2025 revealed that it was not due to staff neglect because R1 developed pressure injury but due to R1's change of condition and gradually decline in addition to R1 refusing care and severe agitation. Moreover, R1 hospice nurse stated that due to R1 declining health condition that started few weeks ago, they put R1 on comfort care medications. The second allegation indicates that staff did not ensure resident’s room was free from odors. During the investigation, LPA Brown was not able to obtain sufficient evidence to corroborate the allegation. Four (4) of four (4) residents interviewed reported that staff at the facility clean their room every week and they stated that all staff at the facility ensure that their room was free from odors. LPA Brown unable to interview R1 as R1 unable to answer LPA Brown's questions. Interviews with nine (9) of nine (9) staff indicated that housekeeping staff are cleaning residents’ rooms once a week and care staff make sure that trash, food trays, leftover food are picked up daily to ensure that residents’ rooms are free from odors. Nine (9) of nine (9) staff interviewed said that there's no incident at the facility that they did not ensure that R1's room was free from odors. Records review showed that all housekeeping staff have a schedule to clean all residents’ rooms weekly. During the facility visit on 05/22/2025, LPA Brown observed that R1's room was clean and free from odors. The third allegation indicates that staff did not ensure that a resident is using clean linen at all times. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with four (4) of four (4) residents indicated that all staff at the facility make sure that they always have clean linens. LPA Brown unable to interview R1 as R1 unable to answer LPA Brown's questions. Nine (9) of nine (9) staff reported that there's no incident at the facility that they did not ensure that their residents are using clean linens. Interviews with nine (9) of nine (9) staff revealed that they are changing their residents’ linens weekly and if they observed that a resident linen is dirty, they immediately change it. Nine (9) of nine (9) staff denied not ensuring that R1 always has clean linen. During the facility visit on 05/22/2025, LPA Brown observed R1 linens clean. The fourth allegation indicates staff did not adequately assist resident with care needs. During the investigation, LPA Brown was not able to obtain sufficient evidence **Continuation in LIC9099C** to corroborate the allegation. Four (4) of four (4) residents interviewed reported that all staff at the facility are adequately assisting them with their care needs as all staff are regularly checking on them if they need assistance and assisting them with their activities of daily living (ADLs). Interviews with four (4) of four (4) residents revealed that staff at the facility are meeting their care needs. LPA Brown unable to interview R1 as R1 unable to answer LPA Brown's questions. Interviews with eight (8) of eight (8) staff indicated that they all make sure that they are adequately assisting all their residents to meet their care needs. Eight (8) of eight (8) staff interviewed reported that there's no incident at the facility that staff did not adequately assist R1 with R1's care needs. An interview with R1 hospice nurse on 05/22/2025 indicated that all staff at the facility are providing the appropriate care for R1 to meet R1's needs. During the facility visit on 05/22/2025, LPA Brown observed staff at the facility working with R1 hospice nurse to ensure that they are adequately assisting R1 to meet R1's needs. Therefore, based on the evidence obtained during tLPA Brown's investigation, there is insufficient evidence to prove that staff did not prevent resident from developing a pressure injury (Allegation #1), staff did not ensure resident’s room was free from odors (Allegation #2), staff did not ensure that a resident is using clean linen at all times (Allegation #3), staff did not adequately assist resident with care needs (Allegation #4) are UNSUBSTANTIATED at this time. Although the allegation of staff did not prevent resident from developing a pressure injury (Allegation #1), staff did not ensure resident’s room was free from odors (Allegation #2), staff did not ensure that a resident is using clean linen at all times (Allegation #3), staff did not adequately assist resident with care needs (Allegation #4) 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. An exit interview was conducted where this report (LIC9099), was discussed and provided to ED Karen Roper.the state’s words, verbatim · CDSS document, May 28, 2025 · control 56-AS-20250519145753

Allegation investigated: Licensee is not providing resident's records to their representative as necessary.

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit for the delievering findings of allegation listed above. LPA met with Administrator Karen Roper and explained today's visit. Investigation consisted of request of documentation. For the allegation, Licensee is not providing resident's records to their representative as necessary. LPA Hernandez spoke with Administrator Karen Ruper who stated facility did not receive request from authorized reprensentative until a later date then one stated. LPA Hernandez observed resident's representative request of doucmentation letter which stated request of resident documentation was requested via fax with date 02/07/2025. Administrator Karen stated documentation will be sent over to legal team and resident representative today 05/05/2025. Substantiated Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met. During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Karen Roper, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, May 5, 2025 · control 56-AS-20250430111009

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: May 9, 2025

87506 Resident Records (c).. (1) The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. Based on observation and record review, the licensee did not comply with section cited above by not ensuring residents records are provided to residents representative, which poses a potential health, safety, and personal rights risks to those in care.the state’s words, verbatim · CDSS document, May 5, 2025

Plan of correction: Licensee stated to submit resident records to resident representative today 05/05/2025.

Allegation investigated: Staff do not keep the facility clean & sanitary Facility dining room has been closed for an extended period of time Staff prohibit resident from making phone calls Staff isolate residents in their rooms Staff do not assist resident with medical appointments Staff did not obtain medical assistance for resident in a timely manner

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit for the delievering findings of allegations listed above. LPA met with Administrator Karen Roper and explained today's visit. Investigation consisted of staff and resident interviews along with request of documentation. For the allegation, Staff do not keep the facility clean & sanitary LPA Hernandez conducted (8) resident interviews. 8 out of the 8 stated the facility is kept clean and sanitary everyday. Addtionally, LPA Hernandez observed Housekeeping schedule. LPA Hernandez conducted (8) staff interviews. 8 out of the 8 staff stated the facility is kept clean and sanitized everyday. Unsubstantiated For the allegation, Facility dining room has been closed for an extended period of time Administrator Karen Roper stated the facility dining room was closed between a three week time period due to a stomach flu outbreak. Administrator stated food trays were taken up to residents rooms and residents were asked to stay in their bedrooms to avoid getting sick. For the allegation, Staff prohibit resident from making phone calls LPA Hernandez conducted (8) resident interviews. 8 out of the 8 stated they are not prohibited from making phone calls. Additionally, Resident #6 (R6) stated phone call services are offered at the facility if resident doesn't have a personal cell phone. For the allegation, Staff isolate residents in their rooms LPA Hernandez conducted (8) resident interviews. 8 out of the 8 stated they are not isolated in their bedrooms. Resident #4 (R4) stated activities are offered and depends on the resident if they would like to attend activity. LPA Hernandez conducted (8) staff interviews. 8 out of the 8 stated residents are not isolated in their bedrooms. 8 out of the 8 stated residents are encouraged to come out of their rooms and participate in the various amount of activities that the facility offers. For the allegation, Staff do not assist resident with medical appointments LPA Hernandez conducted (8) resident interviews. 8 out of the 8 stated the facility does offer assistance with medical appointments. However, 6 out of the 8 residents are able to make their own appointments or a family member makes them and provides transportation to medical appointments For the allegation, Staff did not obtain medical assistance for resident in a timely manner. LPA Hernandez conducted (8) resident interviews. 4 out of the 8 stated facility staff assist with medical assistance when needed. The additional 4 residents stated they have not needed medical assistance but facility staff do assist others with such. Administrator Karen Roper stated all residents are helped in a timely manner with medical assistance. Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit pertaining to the allegation listed, no deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Karen Roper.the state’s words, verbatim · CDSS document, Apr 29, 2025 · control 56-AS-20250110161617

Type of visit: Case Management - Deficiencies

On 04/04/2025 at 12:15 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a Case Management - Deficiency. LPA was greeted and granted entry by a staff and met with Executive Director (ED) Karen Roper. LPA Brown identified herself and discussed the purpose of the visit and the elements of the allegation with ED Roper. During the facility visit on 03/13/2025, and facility visit today, 04/04/2025 LPA Brown was unable to obtain Resident #1 (R1) Admission Agreement as ED Roper cannot find R1's Admission Agreement at the facility and unavailable for review. LPA Brown informed ED Roper that deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D and Appeal Rights were discussed and provided to ED Karen Roper.the state’s words, verbatim · CDSS document, Apr 4, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Apr 10, 2025

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not ensuring that Resident #1 (R1) Admission Agreement is available to licensing agency staff to inspect, audit and copy on 03/13/2025 and 04/04/2025 which poses a potential health, safety and personal rights risks to resident in care.the state’s words, verbatim · CDSS document, Apr 4, 2025

Plan of correction: Licensee stated to obtain and provide a copy of R1 Admission Agreement to LPA Brown by the Plan of Correction (POC) due date.

Allegation investigated: Staff did not ensure light was fixed properly in resident bathroom. Staff did not ensure the aluminum threshold ramp was fixed/replaced to meet the residents needs.

On 03/13/2025 at 01:15 PM, Licensing Program Analyst (LPA) Melody Brown arrived unannounced at the facility commence and deliver the findings of a complaint investigation. LPA was greeted and granted entrance by a staff and met with Executive Director (ED) Karen Roper. LPA Brown explained the purpose of the visit with ED Roper. The investigation consisted of observation and interviews with relevant parties. First allegation: Staff did not ensure light was fixed properly in a resident bathroom.The investigation was conducted by LPA Melody Brown which consisted of observation and interviews with relevant parties. The first allegation indicates staff did not ensure light was fixed properly in a resident bathroom. During the investigation, LPA Brown was able to obtain sufficient evidence to corroborate the allegation. LPA Brown interviewed Resident # 1 (R1) and R1 indicated that the light in R1's bathroom at the center of the ceiling will not turn on and the busted one (1) bulb on top of R1's bathroom mirror and that makes it hard for R1 due to R1's falling eyesight. Interview with Staff #3 (S3) indicated that the light at the center of R1's bathroom ceiling was busted, and will not turn on. ***Continuation in LIC9099C*** Substantiated During the facility visit today, 03/13/2025, LPA Brown together with ED Roper observed that there's one (1) busted bulb in R1's bathroom and LPA Brown noted the the center of R1's bathroom ceiling will not turn on as well. During the facility visit today, the facility's Maintenance Director replaced the busted bulb and repaired the light at the center of R1's bathroom ceiling. Second allegation: Staff did not ensure the aluminum threshold ramp was fixed/replaced to meet a resident needs. The investigation was conducted by LPA Melody Brown which consisted of observation and interviews with relevant parties. During the investigation, LPA Brown was able to obtain sufficient evidence to support that staff did not ensure the aluminum threshold ramp was fixed/replaced to meet a resident needs. LPA Brown interviewed R1 and R1 indicated that it's difficult for R1 to go in and out of R1's room due to the aluminum threshold ramp on the entryway of R1's room. LPA Brown interviewed four (4) of four (4) residents on wheelchair and they revealed that it's hard for all of them as well to get in and out of their room due to the aluminum threshold ramp on their entryway. Interview with S3 indicated that S3 was aware and observed most of residents on wheelchair at the facility were having difficulty wheeling themselves in and out of their room due to the aluminum threshold ramp on their entryway.During the facility visit today, 03/13/2025, LPA Brown observed R1 having difficulty wheeling in and out of R1's room. LPA Brown noted that it is a safety hazard as well due to R1's failing eyesight. Therefore, based on the evidence obtained during LPA Brown's investigation, there's sufficient evidence to prove that staff did not ensure light was fixed properly in resident bathroom (Allegation #1), staff did not ensure the aluminum threshold ramp was fixed/replaced to meet a resident needs (Allegation #2), are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation of staff did not ensure light was fixed properly in resident bathroom (Allegation #1), staff did not ensure the aluminum threshold ramp was fixed/replaced to meet a resident needs (Allegation #2) are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report (LIC9099), LIC9099D and Appeal Rights were discussed and provided to ED Karen Roper.the state’s words, verbatim · CDSS document, Mar 13, 2025 · control 56-AS-20250311092303

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 21, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not ensuring that the light in R1's bathroom at the center of the ceiling and the one (1) bulb on top of bathroom mirror were working and not in disrepair which poses a potential safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Mar 13, 2025

Plan of correction: Licensee replaced the one (1) busted bulb on top of the bathroom mirror and repaired the light at the center of R1's bathroom ceiling during the visit todaty, 03/13/2025. Plan of Correction (POC) cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(4) · Plan of correction due date: Mar 21, 2025

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all...(4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not ensuring that the aluminum threshold ramp on the entryway of R1's room with failing eyesight was not hard to wheel in or wheel out or has sturdy hand railings which poses a potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Mar 13, 2025

Plan of correction: License ordered a flat aluminum threshold during the visit today, 03/13/2025 for R1 and stated that they will install a sturdy hand railing for R1 on R1's entryway and submit proof to LPA Brown by the POC due date.

Allegation investigated: Licensee is charging resident in excess of the rate allowed for Basic Services for SSI recipient.

On 02/13/2025 at 01:15 PM, Licensing Program Analyst (LPA) Melody Brown arrived unannounced at the facility to deliver findings for the allegation listed above. LPA Brown was greeted and granted entry by a staff and Executive Director (ED) Karen Roper was contacted and informed of the visit. LPA Brown explained the purpose of the visit to ED Roper. The investigation consisted of interviews and a review of pertinent documentation. The investigation was conducted by LPA Melody Brown. The investigation consisted of observation and interviews with relevant parties. The allegation indicates that Licensee is charging resident in excess of the rate allowed for Basic Services for SSI recipient. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with Resident #1 (R1) indicated that R1 is receiving Social Security Benefits as R1 indicated that R1 was working before as a part-time office staff and worked long enough and paid Social Security taxes. Per records review, R1 was receiving more than the Non-Medical Out-of Home Care (NMOHC) payment standard for Individuals in a Licensed Facility that receives ***Cont. in LIC9099C*** Unsubstantiated Social Security Income (SSI) and State Supplementary Payment (SSP). Moreover, interview with R1 family member confirmed that R1 was receiving more than the amount dispensed for SSI and SSP recipient as R1 family member provided a copy of Social Security Benefits that R1 was receiving from Social Security. In addition, R1 family member informed LPA Brown that R1 has other income source that R1 utilized to pay for total required fees at the facility. Based on the evidence, the allegation that Licensee is charging resident in excess of the rate allowed for Basic Services for SSI recipient is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 at this time. An exit interview was conducted and a copy of this report, LIC9099 was discussed and provided to ED Karen Roper.the state’s words, verbatim · CDSS document, Feb 13, 2025 · control 56-AS-20241217130651

Allegation investigated: Staff did not ensure resident’s call pendant was in good repair. Staff did not assist residents with care needs in a timely manner. Licensee did not maintain facility in good repair.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Administrator Karen Roper and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record review. For the allegation, Staff did not ensure resident’s call pendant was in good repair. During residents’ interviews, 9 out of the 10 residents stated their pendants are working. 1 out of the 10 residents was unable to collaborate on the allegation listed above. During staff interviews 6 out of the 6 staff stated resident’s pendants are working. During facility tour, LPA Rico tested residents’ pendants, all pendants observed to be working. Unsubstantiated For the allegation, Staff did not assist residents with care needs in a timely manner. During resident interviews, 8 out of the 10 residents stated staff provide assistance in a timely manner. 2 out of the 10 residents stated they are independent and do not require care assistance. During staff interviews 6 out of the 6 staff stated they assist residents in a timely manner. For the allegation, Licensee did not maintain facility in good repair. During resident interviews, 10 out of the 10 residents stated the facility is in good repair. During staff interviews, 6 out of the 6 staff stated that residents sinks are working, and the facility is in good repair. In addition, 6 out of the 6 staff stated maintenance staff will fix any repairs needed. During facility tour, LPA observed residents sinks to be working, and observed documentation of facility's repair log. Based on the evidence found during the investigation, the three (3) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Karen Roper.the state’s words, verbatim · CDSS document, Dec 26, 2024 · control 56-AS-20241224140916

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Paola Guerrero and Beena Singh conducted an announced pre-licensing visit to the facility. LPAs met with Facility Administrator Rose Yousefian. The pending application is for a Residential Care Facility for Elderly (RCFE). Capacity is (85) and current Census(109). The Administrator accompanied LPAs on a tour of the inside and outside of the facility. The physical plant, in general, was in good repair. The buildings and grounds are free from hazards. The indoor and outdoor passageways are free of obstruction. LPAs observed an in-ground pool at the facility, the perimeter of the pool was gated and locked. LPAs inspected bedrooms all bedrooms were furnished with a bed, nightstand, dresser, and chair. All bedrooms have adequate lighting for resident use. Bathroom's toilet, shower and tubs are in good repair. LPAs observed food storage and preparation areas to be clean and sanitary. LPAs inspected facilities freezer along with refrigerators logs all logs displayed appropriate temperatures according to Title 22 regulation. All appliances are clean and operating properly. The outdoor space is suitable for residents use. LPAs observed fully charged fire extinguishers present in the facility. Smoke alarms and carbon monoxide are present and functional. Facility has a designated area (2nd floor Med-Room) where medications are locked and stored. The facility had a designated area where staff and resident records are stored. Emergency disaster plans, personal rights, and complaint posters were posted in a common area. There is adequate seating in the common areas. Pre-licensing inspection is complete, and no corrections are needed to be made. Comp III presentation was completed. An exit interview was conducted, and a copy of this report was provided to Facility Administrator Rose Yousefian.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Paola Guerrero conducted an announced pre-licensing visit to the facility. LPA met with Facility Administrator Rose Yousefian. The pending application is for a Residential Care Facility for Elderly (RCFE). Current capacity is (85). The Administrator accompanied LPA on a tour of the inside and outside of the facility. The physical plant, in general, was in good repair. The buildings and grounds are free from hazards. The indoor and outdoor passageways are free of obstruction. LPA observed an in-ground pool at the facility, the perimeter of the pool was gated and locked. All bedrooms are furnished with a bed, nightstand, dresser, and chair. All bedrooms have adequate lighting for resident use. Bathroom's toilet, shower and tubs are in good repair and have non-skid mats. LPA observed food storage and preparation areas to be clean and sanitary. LPA inspected facilities freezer and Refrigerators logs all listed appropriate temperatures according to Title 22 regulation. All appliances are clean and operating properly. The outdoor space is suitable for residents use. LPA observed fully charged fire extinguishers present in the facility. Smoke alarms and carbon monoxide are present and functional. Facility has a designated area (Med-Room) where medications are locked and stored. The facility had a designated area where staff and resident records are stored. Emergency disaster plans, personal rights, and complaint posters were posted in a common area. There is adequate seating in the common areas. Facility had a supply of activities for the residents. During review of records LPA found that the facility has yet to complete an updated plan of operation, admission agreement, along with an updated facility sketch that indicates that the facility pool is not owned or part of the facility plan as indicated by the Facility Administrator. On April 24,2024 LPA observed that the facility is still promoting the pool as an amenity through their facilities website. In addition, residents records still listed swimming as part as facilities activities. Pre-licensing inspection is not complete, and doesn't meet the requirement to pass the inspection. LPA will initiate a second inspection when the facility completes the necessary requirements as stated. An exit interview was conducted, and a copy of this report was provided to Facility Administrator Rose Yousefian.the state’s words, verbatim · CDSS document, Apr 24, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Change of Ownership Capacity: 200 Census (if any clients in care): 79 COMP II Participants: Rose Yousefian Interview Method: Telephone interview On April 09, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 9, 2024

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Change of Ownership Capacity: 200 Census (if any clients in care): 85 COMP II Participants: Cristina Miller, Steven Atlas Interview Method: Telephone interview On February 06, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 6, 2024