Opal Care Llc

On 04/13/2026 at 3:15 PM, Licensing Program Analysts (LPA) David Doidge arrived unannounced to conduct a health and safety check. LPA met with Administrator Ferdinand Gutierrez and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. Administrator informed LPA that 2 residents have moved out since the first of April. Administrator called Licensee Victoria Puruganan. Victoria informed LPA by phone that the new buyer is signing the application today by 4:30 PM. Licensee informed LPA that the LPA observed residents to be appropriately groomed and attired with no visible bruising or marks. LPA observed no trash piled, electricity and gas operational. Water was running. One week supply of nonperishable and 2-day supply of perishable foods were available. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 03/13/2026 at 11:50 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check. LPA met with Administrator Victoria Puruganan and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. There was sufficient supply of perishable and nonperishable foods. LPA also verified with Administrator Victoria Puruganan that on March sixth the notices to all responsible parties and residents was sent out. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 02/17/2026 at 2:30 PM, Licensing Program Analysts (LPA) David Doidge arrived unannounced to conduct a plan of correction visit. LPA met with Administrator Victoria Puruganan and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. LPA observed residents to be appropriately groomed and attired with no visible bruising or marks. LPA observed no trash piled, electricity and gas operational. Water was running. One week supply of nonperishable and 2-day supply of perishable foods were available. LPA cleared all four deficiencies cited during the 02/11/2026 visit. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Licensing Program Analyst (LPA) Praveen Singh conducted this unannounced tele-visit with Administrator to address violations that were found during an investigation conducted by the Department. Due to the present shelter in place order by the Governor, this inspection was conducted via video-conference. As part of an investigation related to Complaint Control No. 15-AS-20200626085416 , filed on 6/26/20, the Department's Audit Division conducted a Trust Audit for this facility. The Auditor’s investigation revealed that Administrator financially abused R1. Administrator admitted using R1’s True Link debit card to make unauthorized purchases. The auditor obtained R1’s bank statements from April to June 2020 detailing the unauthorized purchases by Administrator. The auditor determined that the total unauthorized purchases on the resident’s card is $3,527.65. True Link has refunded $2,015.08 leaving a balance of $1,512.57 to be refunded back to the resident. In addition, Administrator did not have any Policies and Procedures in place to safeguard residents’ funds and did not follow or abide by her affidavit regarding client’s cash resources, which indicated cash resources will not be handled. Deficiencies are cited per California Code of Regulations, Title 22, and begins on the next page. Failure to correct deficiencies may result in civil penalties. Exit interview conducted and a copy of this report and Appeal Rights provided.

On this day at around 3:45 pm, LPAs Luisa Fontanilla and David Doidge conducted a case management visit and met with the Administrator. While conducting file reviews related to complaint #15-AS-20240820101350, LPAs observed the following: facility has an approved fire clearance for 3 non ambulatory but actual count of non ambulatory residents is 6 (one resident in a skilled nursing facility) facility converted the formal living room to a non ambulatory room with one non ambulatory resident occupant without an approved fire clearance staff does not have sufficient medication training Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D). Civil penalties are assessed for this visit. Exit interview was conducted with the Administrator and Appeal Rights was provided.

On 11/26/2025 at 11:45 AM, Licensing Program Analysts (LPA) Ardalan Gharachorloo arrived unannounced to conduct a health and safety check regarding an elopement as reported by the night staff (S2) on 11/24/2025 . LPA met with Administrator, Victoria Puruganan and explained the purpose of the visit. LPA spoke with the Licensee regarding the elopement of the resident (R1). R1, as previously reported, cannot leave unattended. LPA and Licensee/Administrator Victoria Puruganan spoke about the latest elopement. Licensee submitted the incident report to CCLD on 11/24/2025. On 11/24/25 at around 1:15 AM, R1 left the facility unattended. S2 stated that he attempted to prevent resident from leaving the facility but was not successful. S2 followed R1 as R1 went to Kaiser. S2 called 911 and filed the police report. LPA reviewed the facility’s LIC500 and obtained a copy of the resident roster. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 11/19/2025 at 09:10 AM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to conduct a health and safety check. LPAs met with Administrator Ferdinand Gutierrez and explained the purpose of the visit. LPAs toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. LPAs inspected the kitchen and pantry as well as refrigerators and freezers. LPA reviewed the facility’s LIC500 to confirm there is enough staff on duty to provide coverage for residents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 11/14/2025 at 10:20 AM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to conduct a health and safety check. LPAs met with Administrator Ferdinand Gutierrez and explained the purpose of the visit. LPAs toured the facility including but not limited to bedrooms, bathrooms, common area, and outdoor area. LPAs inspected the kitchen and pantry as well as refrigerators and freezers. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 10/31/2025 at 01:25 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check regarding an elopement. LPA met with Licensee/Administrator Victoria Puruganan and explained the purpose of the visit. While LPA was at the Center for Elders' Independence (CEI) PACE Temescal, investigating a previous elopement, LPA observed a resident (R1) from the facility walk unassisted into the driveway. R1, seemed upset, and informed LPA that R1 asked for a ride, but was not offered one. R1 decided to walk to CEI and was not assisted by the facility. LPA and Licensee/Administrator Victoria Puruganan spoke about the elopements and what steps are to be taken to prevent future elopements. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. An immediate and repeat civil penalty of $1,000 is hereby assessed. Exit interview conducted. A copy of this report, LIC421IM and appeal rights provided.

On 10/31/2025 at 02:06 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check regarding an elopement. LPA met with Licensee/Administrator Victoria Puruganan and explained the purpose of the visit. While LPA was speaking with staff regarding an elopement, S2 informed LPA that R2 walked up the street to a nearby café. LPA spoke with staff, W1, at the café who confirmed R2 had walked, unassisted, to the corner of the street, in front of the café. R2 sat on a nearby fire hydrant, was there for less than a half hour, then walked back down the street. S2 confirm R2 walked to the café as S2 watched, but S2 did not redirect nor follow R@ as S2 was the only one on shift and di not want to leave the other residents unattended in facility. LPA and Licensee/Administrator Victoria Puruganan spoke about the elopements and what steps are to be taken to prevent future elopements. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. An immediate and repeat civil penalty of $1,000 is hereby assessed. Exit interview conducted. A copy of this report, LIC421IM and appeal rights provided.

On 01/09/2026 at 02:20 AM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to conduct a health and safety check. LPAs met with Administrator Victoria Puruganan and explained the purpose of the visit. Administrator informed LPAs that a new resident moved in on 12/23/2025. LPAs reviewed resident’s file; it was complete. LPAs toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. LPAs inspected the kitchen and pantry as well as refrigerators and freezers. At: 2:15 PM, LPAs observed no toilet paper or paper towels in any of the four bathrooms. At 2:45 PM LPAs observed moldy cauliflower in the pantry. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted and a copy of this report provided.

On 10/31/2025 at 12:50 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check regarding an elopement as reported by Center for Elders' Independence (CEI) PACE Temescal to CCLD. LPA met with Licensee/Administrator Victoria Puruganan and explained the purpose of the visit. LPA spoke with the Licensee regarding the elopement of a resident (R1). R1, as previously reported, cannot leave unattended. LPA and Licensee/Administrator Victoria Puruganan spoke about the elopements and what steps are to be taken to prevent future elopements. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. An immediate and repeat civil penalty of $1,000 is hereby assessed. Exit interview conducted. A copy of this report, LIC421IM and appeal rights provided.

On 11/07/2025 at 12:50 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check. LPA met with Licensee/Administrator Victoria Puruganan and explained the purpose of the visit. LPA toured the facility LPA toured the facility including but not limited to bedrooms, bathrooms, common area, and outdoor area. LPA inspected the kitchen and pantry as well as refrigerators and freezers. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 10/28/2025 at 12:00 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check. LPA met with Licensee/Administrator Victoria Puruganan and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. LPA obtained copy of facility’s menu for the last month. LPA inspected the kitchen and pantry as well as refrigerators and freezers. The following deficiency was observed: · At 12:30 PM, LPA observed Inadequate food supply. Vegetables in the refrigerator were moldy. There was not enough cereal nor snacks for 9 residents. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. An immediate and repeat civil penalty of $1,000 is hereby assessed. Exit interview was conducted, a copy of this report and Appeal Rights provided.

On 09/24/2025 at 4:001 PM, Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to open a 10-day initial visit for complaint number 15-AS-20250917130441 . LPAs met with Licensee/Administrator Victoria Puruganan and explained the reason for the visit. During the complaint investigation, LPAs noted and cited for the following deficiencies: At 12:45PM, LPAs observed a resident (R1) in a room that is not fire cleared. LPAs evaluated the resident and came to the conclusion that the resident is bedridden. At 1:00PM, LPAs reviewed R1's file. The Appraisal Needs And Services Plan (ANS) had not been updated March 2023 while needs have clearly changed. At 1:15 PM, LPAs observed in the closet of bedroom 5 a blanket that had been soiled with urine, emitting a urine smell throughout the second floor of the facility. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights provided.

On 9/26/2025 at 12:15 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver a 10-day letter to correct. LPA met with Licensee/Administrator Victoria Puruganan and explained the purpose of the visit. LPA printed the letter and left it with the Licensee/Administrator. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 09/15/2025 at 12:00 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check regarding an elopement that occurred 08/24/2025 as reported by Oakland Police to CCLD. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. LPA interviewed staff and Licensee regarding the elopement of a resident (R1). R1 is back, was gone for three (3) to four (4) hours. Staff and Licensee/Administrator know R1 cannot leave unassisted. R1 left the facility for a walk after breakfast. 911 was called around 10:30 AM and R1 walked back to the facility while staff were on the phone with 911. While interviewing, LPA learned a new resident (R2) moved in on 09/09/2025. R2 is bedridden roomed in a non-fire cleared room. Licensee/Administrator did not submit the Unusual Incident Report (LIC624) to CCLD for the 08/24/2025 elopement. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. An immediate and repeat civil penalty of $1,500 is hereby assessed for elopement, not reporting elopement to CCLD, and having a bedridden resident in a non-cleared room. Exit interview conducted. A copy of this report, LIC421IM and appeal rights provided.

On 08/19/2025 at 11:15 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check of the facility. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. Three (3) staff and the Licensee/Administrator were present. LPA spoke with the Licensee/Administrator about staffing. New hire, S1, started 08/18/2025. Licensee/Administrator is going to make S1 the new administrator. S1 will be joined by S2, once cleared. One staff, S5, has put in a resignation letter with a last day of August sixteenth. No citations issued during visit. Exit interview conducted and a copy of this report provided Scan_20250821 (2).pdf

On 09/04/2025 at 11:15 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check of the facility. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. Three (3) staff and the Licensee/Administrator were present. LPA spoke with the Licensee/Administrator about staffing. Facility now has 7 staff total. Administrator/Licensee informed LPA that potential new hire, and potential new administrator, may not start after all. LPA obtained copy of new LIC500. No citations issued during visit. Exit interview conducted and a copy of this report provided.

On 08/15/2025 at 3:00 PM Licensing Program Analysts (LPAs) L. Alexander arrived unannounced to conduct a Plan of Correction (POC) visit. LPA met with Licensee/Administrator, Victoria Puruganan and explained the purpose of the visit. Deficiencies not cleared: CCR 87405(a)(b) Administrator - Qualifications and Duties $100.00 x 107 days = $10,700.00 (05/01/2025 thru 08/15/2025) CCR 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities = $100.00 x 128 days = $13,050.00 (Includes $250.00 repeat violation on 06/17/25) ) (04/10/2025 thru 08/15/2025) CCR 87621 (2)(b) Colostomy/Ileostomy $100.00 x 10 days = $1,000.00 (08/06/2025 thru 08/15/2025) HSC § 1569.605 Liability insurance; coverage requirements $100.00 x 10 days = $1000.00 (08/06/2025 thru 08/15/2025) LIC809-C Continued... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LIC809-C (Page 2) CCR 87608(a)(3) Postural Supports $100.00 x 10 days = $1,000.00 (08/06/2025 thru 08/15/2025) CCR 87628(a) Diabetes $100.00 x 17 days = $1700.00 (07/29/2025 thru 08/15/2025) CCR 80086(a)(c) Alterations to Existing Building or New Facilities $100.00 x 17 days = $1,700.00 (07/29/2025 thru 08/15/2025) Continuing Civil Penalties in the total amount of $6,900.00 is assessed today for failure to meet POC date for deficiencies. Civil penalties total as of today is $30,150.00 . Facility is subject to ongoing civil penalties until deficiencies is corrected. Exit interview conducted, LIC421FC, appeal rights and a copy of this report provided.

On 08/19/2025 at 11:15 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check of the facility. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. Three (3) staff and the Licensee/Administrator were present. LPA spoke with the Licensee/Administrator about staffing. New hire, S1, started 08/18/2025. Licensee/Administrator is going to make S1 the new administrator. S1 will be joined by S2, once cleared. One staff, S5, has put in a resignation letter with a last day of August sixteenth. No citations issued during visit. Exit interview conducted and a copy of this report provided.

On 08/15/2025 at 1:15 PM, Licensing Program Analyst (LPA) L. Alexander conducted a Health & Safety inspection as a result continuing Non-Compliance Conference meeting which was held 03/26/2025. LPA met with Licensee/Administrator, Victoria Puruganan and explained the purpose of the visit. Upon entry LPA observed three (3) residents and two (2) staff. The three (3) residents were sitting and walking in the front common area. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperatures was measured at 105.8 and 108.3 degrees F in the upstairs shared bathroom. LPA observed 7-day of non-perishable and 2-day of perishable food supplies were sufficient. LPA obtained a copy of current LIC 500 and Progress Report for Resident (R) R5. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 08/21/2025 at 2:30 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check regarding an elopement that occurred 08/19/2025. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. LPA interviewed staff and Licensee regarding the elopement of a resident (R1). R1 is not back and may not return. LPA obtained R1’s Physician’s report (602). Physician’s Report shows resident able to leave unassisted. Staff and Licensee/Administrator know resident cannot leave unassisted. Licensee/Administrator had the Unusual Incident Report (UIR LIC624) created, but had not yet sent in the report due to a computer issue. LPA obtained a copy. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. An immediate and repeat civil penalty of $1000 is hereby assessed. Exit interview conducted. Appeal Rights and a copy of this report provided.

On 08/06/2025 at 12:45 PM, Licensing Program Analyst (LPA) David Doidge unannounced to conduct 1-Year Annual Required Inspection. LPA met with Licensee/Administrator Victoria Puruganan, and explained the purpose of the visit. LPA toured the facility including but not limited to residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 75 degrees Fahrenheit. The hot water temperature was measured at 105.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/02/2024. Emergency Disaster Plan was last posted on 02/27/2025. Emergency disaster and fire drill are conducted quarterly; last conducted on 04/12/2025. First aid kit was observed to be complete. LPA reviewed five (5) residents records and five (5) staff records; all were complete. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 08/06/2025 at 02:00 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct case management to obtain documents on residents. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. LPA obtained records for all 10 residents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 08/11/2025 at 1:30 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check of the facility. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. During this visit, the LPA interviewed the Licensee/Administrator Victoria Puruganan regarding R1’a return from the hospital. R1 returned on 08/08/2025 in the evening with no new condition. Two staff and the Licensee/Administrator were present. LPA spoke with the Licensee/Administrator about staffing. New staff to join 08/19/2025, and another on 08/14/2025. S1 has left as of 08/10/2026. No citations issued during visit. Exit interview conducted and a copy of this report provided.

On 08/08/2025 at 2:30 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct a health and safety check regarding an elopement from an Unusual Incident Report (UIR) dated 08/04/2025. LPA met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. LPA interviewed staff and Licensee regarding the elopement and return of resident (R1). R1 is back with no injuries. LPA obtained R1’s after care report and spoke to R1. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.

On 08/06/2025 at 9:25 am, Licensing Program Analysts (LPAs) L. Alexander and D. Doidge arrived unannounced to conduct a Plan of Correction (POC) visit. LPAs met with Licensee/Administrator, Victoria Puruganan and explained the purpose of the visit. Deficiencies cleared: 87355(e)(3) 87555(b)(3)(26) 87307(a)(3)(D) 80075(k)(1) 87303(a) Deficiencies not cleared: 87621(2)(b) $100 x 1 day = $100.00 HSC 1569.605 $100 x 1 day = $100.00 87608(a)(3) $100 x 1 day = $100.00 87628(a) $100 x 8 days = $800.00 80086 (a)(c) $100 x 8 days = $800.00 Civil Penalties in the total amount of $1,900.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing civil penalties until deficiency is corrected. Exit interview conducted. Appeal Rights, Deficiency cleared letters, LIC421FC, and a copy of this report provided.

On 08/06/2025 at 9:25 AM, Licensing Program Analysts (LPAs) David Doidge and L. Alexander arrived unannounced to conduct case management inspection regarding an elopement from an Unusual Incident Report dated 08/04/2025. LPAs met with Victoria Puruganan, Licensee/Administrator and explained the purpose of the visit. LPAs obtained a copy of R1’s Physician’s report (602) and Appraisal Needs and Services Plan (ANS). LPAs interviewed Administrator about incident. Around 1PM, R1 was seen walking out the front door by S2. Previous Physician’s Report shows resident able to leave unassisted. Administrator said that R1 would walk to the local store on own, and per previous 602, R1 was able to do that. Upon learning of elopement staff walked the block to look for resident. Most recent 602, dated 05/02/2025 confirms resident is unable to leave the facility unassisted. A new Appraisal Needs and Services Plan was not created, and staff were going off of previous information. An immediate and repeat civil penalty of $1000 is hereby assessed. Exit interview was conducted with Licensee/Administrator, Victoria Puruganan, copy of this report and Appeal Rights provided.

On 07/29/2025 at 10:00 AM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct case management inspection as part of on-going monitoring plan from Non-Compliance Conference (NCC) held on March 26, 2025. LPA met with House Manager, Jezrael Pascual, and explained the purpose of the visit. Jezrael phoned Licensee/Administrator, Victoria Puruganan to inform. Victoria arrived approximately an hour later. On 06/17/2025 LPA's L. Alexander and D. Doidge conducted a Case Management visit in which deficiencies were cited with a Plan of Correction (POC) due date of 06/24/2025. LPAs were unable to return before 10 days POC visit. Deficiencies will be re-cited. LPA L. Alexander obtained copies of Residents (R) R1-R11 Medication Administration Records (MARs) for July 2025, Resident Registry List, Medical Assessment (LIC602-A) for R11, Emergency Disaster Plan (signed 02/27/2025) and screenshot print of building permit (filed 03/18/2024). THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:09 am LPA observed R4 in a hospital bed without a doctor's order At 10:09 am LPA observed unfinished wall constructions in bedrooms #9-12 including upstairs bedrooms. At 10:14 am LPA observed unlocked medications in refrigerator located in sun porch At 10:15 am LPA observed foods in containers, food bags/freezer bags unlabeled without dates located in refrigerators on sun porch that was expired and spoiled LIC809-C Continued... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LIC809-C Continued... (Page 2) At 10:20am LPA observed meats in rear refrigerator not contained in proper storage and freezer was not cleaned At 10:21 am LPA observed expired opened boxed Cherrios Cereal, salad dressing bottles, eggplants that was spoiled located in rear sunroom porch At 10:23 am LPA observed bottle Awesome Window Clean At 10:27 am LPA observed 1/2 bed rails on R5's bed without doctor's orders At 10:38 am LPA observed three (3) ladders, window screens, crutches, yard shovels, hoes, lawn mower, dolly, rakes, wood, sink, cooking pot in rear backyard At 10:39 am LPA observed laundry room door unlocked where Fabuloso Multi Cleaner, bleach, toxic chemicals were located At 10:39 am LPA observed screens, wheelchair in rear side backyard At 10:40 am LPA observed spoiled vegetables, expired gallons of milk, bottles of milk, unlabeled foods in refrigerator and freezers located on side back yards At 10:48am LPA observed four (4) boxes of laminate flooring upstairs, in which laminate flooring was unwrapped laying on hallway floor At 10:52 am LPA observed missing shower mats and no toilet paper in two (2) shared bathrooms located upstairs At 11:02 am LPA observed Lysol Disinfectant Spray located in locked closet with dried foods At 11:03 am LPA observed expired Velveeta Shells & Cheese, opened waffle cones and bagged brown rice At 11:05 am LPA observed toilet paper, bag of fruits, boxes of hot dog buns, Brownie Bars located in locked closet with fans, tool boxes, lotions, sprays, antiseptic rinse The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights, LI421BG, LIC421FC, LIC421IM and a copy of this report provided.

On 07/11/2025 at 10:45 AM Licensing Program Analysts (LPAs) David Doidge and Andrew Christy arrived unannounced to conduct a Case Management Incident due to an Unusual Incident Report submitted to CCLD on 07/08/2025 regarding a resident that eloped. LPAs met with Jezrael Pascual, House Manager and explained the purpose of the visit. Licensee/Administrator, Victoria Puruganan was called and informed of the visit, and arrived at 12:00 PM. LPAs interviewed Jezrael and another staff about incident. Neither saw R1 elope. Licensee/Administrator Victoria was present, but did not see R1 walk away. Staff reported that R1 had an appointment with Center for Elders Independence (CEDI) and was last seen waiting for the van in front of the house. Upon learning of elopement staff walked the block to look for resident. R1 was later found by the police. LPAs obtained a copy of R1’s Physician’s report (602) and a staff schedule for that day. The 602 confirms resident is unable to leave the facility unassisted. An immediate civil penalty of $250 is hereby assessed for a repeat violation Exit interview was conducted with Licensee/Administrator, Victoria Puruganan, copy of this report and Appeal Rights provided.

On 06/17/2025 at 3:30 PM Licensing Program Analysts (LPAs) L. Alexander and D. Doidge arrived unannounced to conduct a Case Management inspection as part of monitoring plan from Non-Compliance Conference (NCC) held on March 26, 2025. LPAs met with Licensee/Administrator, Victoria Puruganan, and explained the purpose of the visit. LPAs received and reviewed updated medical assessments for 5 (five) residents (R). During the review, LPAs observed R1 tested positive with Tuberculosis, and is currently taking a course of antibiotics for 4 months. Licensee did not have confirmation from R1's primary care physician if they were contagious or not. LPAs observed that R2's physician's report indicated that they can not administer their own insulin nor check their own blood glucose. LPAs observed that R4 had a recent Emergency Room visit of 06/07/2025 in which the After Visit Summary indicated that R4 was seen for a fall. During interview with S1, S1 stated that R4 had eloped and that the hospital called. S1 stated that they had notified CCLD but they did not have a copy of the Incident Report (LIC624). LPAs observed that R5 is diabetic on insulin and also has a ostomy bag. S1 stated that there is a nurse from Kaiser that comes to monitor R5 for the osotmy bag but S1 did not have care plan to address R5's insulin use for diabetes and ostomy. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPAs obtained copies of medical assessments for R1-R5, MAR for R3, Admission Agreement and Emergency Identification Form for R5. Civil penalties were assessed today of $500.00 for repeat violations. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report, LIC421FC and appeal rights provided.

On 05/13/2025 at 1:30 pm, Licensing Program Analysts (LPAs) L. Alexander and D. Doidge arrived unannounced to conduct a Plan of Correction (POC) visit. LPAs met with House Manager, Jezrael Pascual , and explained the purpose of the visit. Jezrael called Licensee/Administrator, Victoria Puruganan, to inform. On 03/26/2025, the Department held a Non-Compliance Conference (NCC) meeting with the Licensee, Victoria Puruganan. The Plan of Corrections (POC) was discussed with Licensee to get the facility in compliance. The due dates were 04/09/25, 04/30/25 and an extension was granted per the Licensee's request for 05/02/25. Deficiencies not cleared: 87405(a)(b) Administrator - Qualifications and Duties $100.00 x 13 days = $1,300.00 87788(h)(1)(A) Continuing Education Training Program Vendor Requirements $100.00 x 13 days = $1,300.00 87458(c) Medical Assessments $100.00 x 11 days = $1,100.00 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities $100.00 x 34 days = $3,400.00 Civil Penalties in the total amount of $7,100.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing civil penalties until deficiency is corrected. Exit interview conducted. Appeal Rights, LIC421FC, and a copy of this report provided.

On 05/09/2025 at 10:30 AM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct case management inspection as part of monitoring plan from Non-Compliance Conference (NCC) held on March 26, 2025. LPA met with Licensee/Administrator, Victoria Puruganan, and explained the purpose of the visit. LPA left the facility to complete the report and returned back for Licensee to sign documented report. Upon entry to the facility, LPA observed four (4) residents (R) sitting in the common area watching television. LPA was greeted by House Manager, Jezrael Pascual. LPA entered the office where Licensee/Administrator, Victoria Puruganan, was sitting at her desk. During the visit LPA reviewed six (6) current physician's reports out of eleven (11) residents. During the review, LPA observed two (2) of the residents are diabetic and need to take insulin daily. The physician's reports for both residents indicated that they are not able to administer their own injections nor take their own glucose readings. LPA left the facility to complete the report and returned back for Licensee to sign LPA observed the following deficiencies: At 12:36 pm a large bottle of bleach and a spray bottle labeled "Clorox" was unlocked under kitchen sink 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LIC809-C At 12:38 pm prescription insulin unlocked in refrigerator located on back sun porch At 12:40 pm wood planks laying out side in the side/back yards, buckets, ladder propped up against the outside exterior on the eastern side of house At 12:41 pm box mattress, top mattress and pillows stacked up against stairs in back yard At 12:42 pm doors, ladder, more wood, lawn mower, lawn rake, paint cans, buckets, dresser chest drawer with a missing top drawer At 12:44 pm glass window frame, buckets, boxes, bottle of bleach and spray bottles located on the western side of the house At 12:45 pm construction in Room #12 where there was a ladder, bottles of DAP repair, the floor was taped and wires were loose hanging out from the ceiling. At 12:50 pm R1 laying in a full hospital bed located in a bedroom not fire cleared for residents. Licensee stated that the room was for staff. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided

Continued from LIC9099 Allegation: Staff do not ensure that resident's hygiene needs are being met while in care. Findings: Per Physician's report and interviews, R1 is able to bathe self. R1 has preference to frequency of taking showers, and is able to take care of self. Allegation: Staff do not ensure that resident is provided with clean bedding while in care. Findings: Per interviews with resident and staff, bed are changed at least once a week, and more frequently as needed. Beds were observed by LPA to be clean and good repair. Facility has more than adequate linens for all beds. Allegation: Staff do not safeguard resident's personal possessions while in care. Findings: Facility maintains Client/Resident Personal Property and Valuables, LIC 621. R1 has reported missing an ATM card, however R1 admitted to placing ATM card in a book and not being able to remember which book it was placed in. R1 reported missing noise canceling headphones. LIC621 has headphones, but house manager mentioned that headphones was written by mistake, package that arrived had ear buds. Staff have not seen R1 with noise canceling headphones. R1 reported missing an Iphone. Staff found Iphone in R1's bed and was handed to R1 during visit. Allegation: Staff member harasses resident in care. Findings: During the visit, LPAs interviewed 3 residents. There was no disclosure of harassment made by staff against any resident. Resident denied harassment by staff. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegations are UNSUBSTANTIATED. No deficiencies were issued. Exit interview conducted and a copy of this report was provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC9099 Allegation: Licensee leaves resident(s) unsupervised while in care. Findings: Based on interview conducted with staff, when Licensee is on site, Licensee will monitor residents in the security cameras located in the office but will not interact with residents directly. Allegation: Staff are not seeking medical attention for resident in care as necessary. Findings: Based on interviews and record reviews conducted, R1 was admitted to the facility on January 12, 2025. LPAs were informed that R1 has not had any visit with a doctor because R1 does not have a primary doctor assigned yet. S1 states there is a medication that needs refill but has not been filled yet. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted. A copy of the appeal rights and , and this report provided.

On 02/02/2026 at 12:00 PM, Licensing Program Analysts (LPA) David Doidge and Licensing Program Manager (LPM) Jeremy Fong arrived unannounced to conduct a health and safety check. LPA and LPM met with Administrator Victoria Puruganan and explained the purpose of the visit. LPA and LPM toured the facility including but not limited to bedrooms, bathrooms, common area, kitchen, and outdoor area. LPA and LPM inspected the kitchen and pantry as well as refrigerators and freezers. LPA and LPM observed residents to be appropriately groomed and attired with no visible bruising or marks. LPA and LPM observed no trash piled, electricity and gas operational. Water was running, and five staff observed. One week supply of nonperishable and 2-day supply of perishable foods were available. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 12/30/2024 at 1:15pm Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Jazrael Pascual, House Manager and explained the purpose of the visit. While LPA L. Hall was conducting a complaint investigation 15-AS-20241221181547 on 12/30/2024, it was stated R1 had eloped from the facility. LPA toured the first level of the facility, obtained R1's physician's report (LIC602), appraisal needs and services plan, and identification and emergency information. LPA observed the following deficiencies during the visit. LPA observed during interview R1 had eloped. LPA observed during record review the elopement incident that occurred on 12/152024, had not been reported. LPA observed R1 did not have an current annual physician's report or appraisal needs and services plan. LPA observed during record review facility did not have a permit for the alterations of the facility. LPA observed plan the area called the solarium is blocked with a couch, 2 refrigerators, clothing, and other items. Continued on LIC809C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809. LPA observed facility did not have a s upplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. LPA observed the facility had four (4) refrigerator/freezer and all were unsanitary. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided

On 12/20/2024 at 2:45 PM, Licensing Program Analyst (LPA) D. Doidge conducted an unannounced Case Management visit based on information received by the agency on (the date of visit). LPA met with Jezrael Pascual, House Manager, and explained the purpose of the visit. LPA D. Doidge tried to obtain the following documents for R1. 1. Admissions Agreement (Opal) 2. Medical Assessments 3. Appraisal Needs and Services 4. Emergency & Identification 5. Any copies of Doctor’s Orders 6. Incident Reports if any The facility did not have any of the records available. One citation issued.. Exit interview conducted and a copy of this report was provided.

On 12/11/2024 at 6:00 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with House Manager, Jezrael Pascual, and explained the purpose of the visit. While LPA L. Alexander was conducting a complaint investigation (15-AS-20241113155956 ) on 12/11/2024. During interview and record review LPA observed that R1 was issued a 30-Day Eviction notice dated 11/21/2024. The reason for the eviction was due to "High Level of Care and Change of Medical Condition." LPA interviewed Administrator, Victoria Puruganan, and confirmed that no new re-assessments have been performed on R1. LPA observed that Licensee has a Plan of Operation that indicates Care of Dementia. Further, the eviction notice lacked all appropriate requirements. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.

On 07/29/2025 at 10:00 AM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct case management inspection as part of on-going monitoring plan from Non-Compliance Conference (NCC) held on March 26, 2025. LPA met with House Manager, Jezrael Pascual, and explained the purpose of the visit. Jezrael phoned Licensee/Administrator, Victoria Puruganan to inform. Victoria arrived approximately an hour later. Upon entry to the facility, LPA observed three (3) residents (R), which R1 was sitting outside front patio, and R2 and R3 were sitting inside the front living room area watching television. Deficiencies not cleared: 87405(a)(b) Administrator - Qualifications and Duties $100.00 x 77 days = $7,700.00 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities $100.00 x 77 days = $7,700.00 Civil Penalties in the total amount of $15,400.00 is a continuation of a daily penalty that was first assessed on 04/10/2025 for failure to meet Plan of Correction (POC) dates for deficiencies. Facility is subject to ongoing civil penalties until deficiency is corrected. Exit interview conducted. Appeal Rights, LIC421FC, and a copy of this report provided.

On 9/24/2024 at approximately 8:45 am, LPAs James Sampair and David Doidge conducted an Unannounced Case Management visit to deliver an amended civil penalty originally issued on 9/12/24, in the amount of $1,400. The LPAs met with Office Manager Jezrael Pascual and explained the purpose of the visit. The amended civil penalty issued today is in the amount of $400 and supersedes the previous civil penalty of 9/12/24. This report and the amended civil penalty were reviewed with the facility, and Appeal Rights were provided. .

...Continued from LIC 9099 Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.

On this day while at the facility conducting investigation in connection with complaint 15-AS-20250324113724, LPAs observed the following: R1 did not have completed preplacement and Appraisal Needs and Services Plan R2 eloped from the facility on January 14, 2025 and ended up at Kaiser Hospital for pneumonia and hypothermia the facility did not report incident to CCL Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted with Pascual and Appeal Rights was provided.

***report continues form LIC9099*** Allegation: Staff is overcharging resident for higher level of care that is not being provided. LPAs reviewed R5, R6 and R7’s files. All 3 residents are diagnosed with dementia. LPAs reviewed the admission agreements for all 3 residents. LPA’s found that there was no increase in the rate residents were paying for services and that the rate matches the services outlined in the agreement. This allegation is unsubstantiated. Allegation: Licensee does not ensure facility has basic supplies. LPA’s toured the entire facility including the kitchen, dining room, bedrooms, bathrooms and storage areas. Based on observation the facility has all the necessary basic supplies to care for the residents. This allegation is unsubstantiated. This agency has investigated the complaints alleging staff does not prevent resident from verbally and physically abusing other residents in care, staff is overcharging resident for higher level of care that is not being provided, and licensee does not ensure facility has basic supplies. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted, a copy of this report provided.