Country Rose Estate Memory Care.

On 01/28/2026, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Val Paraiso who was informed of the purpose of the visit. The facility is licensed to serve fifteen (15) non-ambulatory elderly residents and is approved for a secured perimeter. The facility also has an approved hospice waiver for six (6) residents and LPA was informed only one (1) resident is currently receiving hospice services at the facility. LPA toured the facility's interior and exterior with Administrator Paraiso. During the tour, LPA observed the facility is made up on a one-story building with eleven (11) resident bedrooms, two (2) showers, a kitchen, dining room, living room, and laundry room. LPA observed four (4) staff present in the facility. LPA conducted a record review and all four (4) staff present have a criminal record clearance and are associated with the facility. Resident bedrooms had the required bedding, furniture and lighting. Showers were equipped with grab bars and non-skid mats. LPA toured the kitchen and observed the facility has more than a two-day supply of perishable foods and seven-day supply of non-perishable food items. Knives are secured in a locked kitchen cabinet. Medications are secured in a locked cabinet inside the administrator's office. Disinfectants and cleaning solutions are secured in the locked laundry room. No bodies of water were observed on the premises. Indoor and outdoor passageways were free of obstruction. The outside area provides shaded seating available for resident use. Administrator tested one (1) of the smoke alarms/carbon monoxide detectors and LPA heard it to be operational. LPA also observed several charged fire extinguishers mounted throughout the facility that were last serviced on 09/11/2025. 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 Administrator reported they submitted a capacity increase request to Community Care Licensing and the San Marcos Fire Department (SMFD) has required the facility's driveway to be paved in order to facilitate fire department apparatus' access to the facility. Administrator added SMFD has allowed them to pave the facility's driveway by 2027 due to the financial cost of the project. LPA reviewed the facility's annual fire inspection dated 05/09/2024 conducted by SMFD noting the facility was cited for not having illuminated exit signs or a five (5) year fire sprinkler certification. During today's visit, LPA observed all exit signs to be illuminated and an inspection tag noting the facility's five (5) year sprinkler certification was completed in February of 2025. Residents' personal rights, complaint procedures, Long-Term Care Ombudsman's contact information, emergency disaster plan and facility sketch are visible posted near the front entrance. No issues or concerns were observed during today's visit. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Paraiso.

The investigation revealed the following: Allegation: Resident is being physically abused The detail of complaint alleges that R1 is being physically abused at the facility. On 10/7/25, the Department interviewed Administrator (A1), who denied the allegation stating that the above allegation is false and that R1 was never abused at the facility. He went on to state that R1’s father, conservator, psych nurse and Social Work can all attest to that. On 10/7/25, the Department interviewed 4 staff regarding the allegation, and of those interviewed, 3 out of 4 was not on staff during the time the allegation was made. However, 4 out of 4 stated that they have never abused a resident and have never witnessed any other staff abusing a resident in care. Additionally, 4 out of 4 state that they have received client’s right’s training. On 10/7/25, the Department interviewed 3 residents about their treatment at the facility and if they have ever been hit by a staff. Of those interviewed 3 out of 3 stated that they are treated well at the facility and have never been abused. The Department obtained, reviewed and evaluated the following documents: R1’s pre-placement appraisal (11/24/14), Needs and Services Plan ( 8/1/19), letter of conservatorship (5/3/24) and 30-day notice from facility outlining reason for eviction (dated 8/14/22) page 2 of 3 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 On 10/7/25 via telephone the Department interviewed Witness #1 (W1), who denied the allegation stating that it did not occur. W1 went on to state that the Department can “close the investigation, because the facility did not abuse R1.” Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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. There were no deficiencies cited during today's visit. Exit interview conducted and copy of report provided. page 3 of 3

On January 25, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and spoke with the Administrator, Val Paraiso, via the telephone. The facility file review was conducted in the Regional Office and additional records were requested and reviewed on site. The facility is licensed for 15 Elderly Adults and operating at a full capacity of 15. LPA met with Facility Manager, Janet Moster. LPA Mixson toured the facility along with the Facility Manager, Janet and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home, located at 1255 Adventure LN San Marcos, CA 92069. Physical Plant: The facility phone number is (760) 738-9391 and is operable. The LPA observed the resident's bedrooms. The bedrooms were equipped with required furniture as per Title 22, currently at the time of this visit. The LPA inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings were posted. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files and it was locked. Medications : were reviewed, locked and inaccessible to residents, and there was a 30 day supply. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, four staff at the time of this visit and the staff were engaging the resident in activities and snacks. Records Review: The LPA reviewed staff and resident files and conducted staff and resident interviews. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted and a copy of this report was given to the Facility Manager, Janet.