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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005934
Report Date: 07/28/2025
Date Signed: 07/28/2025 03:29:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230628144300
FACILITY NAME:ADULT CARE OC SATURNAFACILITY NUMBER:
306005934
ADMINISTRATOR:SCHOTT, BRIANFACILITY TYPE:
740
ADDRESS:24591 SATURNA DRIVETELEPHONE:
(626) 861-1124
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
07/28/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Brian Schott, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident sustained an unexplained fracture while in care.

Facility financially abused residents.

Facility overcharged resident for rent.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the three allegations listed above and delivering findings to the licensee. LPA was greeted and granted entry by facility staff after stating the purpose of the visit. Administrator Brian Schott was notified via telephone and presented with the allegations as well as the findings.

The initial investigation visit was conducted on June 29, 2023, by Licensing Program Analyst (LPA), Jerome Haley. During the visit, LPA toured the facility and conducted a health and safety check. Four residents were observed during the visit and records were obtained.

CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
VISIT DATE: 07/28/2025
NARRATIVE
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CONTINUED FROM LIC9099
Resident 1 (R1) was admitted to Adult Care OC Saturna on August 11, 2021. The Admission Agreement was reviewed and showed a monthly private pay rate of $4,250 for a double room, and no preadmission fee was charged. Resident 2 (R2) and an additional family member are listed as R1’s responsible parties. R1’s Physician Appraisal Report dated July 13, 2021, has an indication of a dementia diagnosis for R1 and shows that R1 was assessed as being unable to manage their own cash resources due to prior stroke. R1 was additionally assessed to be unable to independently transfer to and from bed. R2 paid R1’s monthly rent. The licensee’s email dated April 29, 2024, stated R1 passed away on December 24, 2022, at the facility. No death report was submitted to the Department or provided to the resident’s attorney-in-fact at the time.

R2 was admitted to Adult Care OC Saturna on June 11, 2021. The Admission Agreement was reviewed. R2 was listed as self-responsible with a monthly private pay rate in the amount of $4,250 for a double room. A preadmission fee in the amount of $500 was charged. R2’s Physician Appraisal Report dated June 24, 2021, identified R2 had dementia and was unable to manage their own cash resources. A later Physician Appraisal Report dated December 6, 2022, stated R2 was non-ambulatory and had mild cognitive impairment and was unable to manage their own cash resources.

Regarding the allegation that Resident sustained an unexplained fracture while in care, the following has been concluded: R2 was admitted at Adult Care OC Saturna on June 11, 2021. Prior to the last unwitnessed fall on October 06, 2022, R2 was ambulatory and able to walk with no assistance. After the fall and hip surgery, R2 used a wheelchair for mobility. R2 had a history of falls prior to becoming wheelchair bound.
On or about October 6, 2022, at about 6 AM, R2 had an unwitnessed fall in their room. Staff 1 (S1) and Staff 2 (S2) found R2 on the floor, assessed R2 and placed R2 back in bed. Later that evening R2 complained of pain to their hip and was unable to walk. It is unclear whether staff notified R2’s responsible party. Department did not receive any incident report regarding the fall. Charting notes provided indicate that R2 had been monitored following the initial fall. On October 7, 2022, at about 6:30 AM, staff S1 transferred R2 from their bed to a wheelchair because R2 was still unable to walk, and informed S2 that a bruise was present on the resident’s left hip. Per notes reviewed, S2 asked R2 if R2 was in pain and the resident confirmed. Per statement made by facility acting administrator (AA) May Kwok, on October 10, 2022, at approximately 10 AM, a Hope Hospice nurse visited the facility and assessed R2 and reported that R2 was okay.
CONTINUED ON FORM LIC9099-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
VISIT DATE: 07/28/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-C
On October 13, 2022, Dr. Homer Lew conducted a facility visit and assessed R2, Dr. Lew recommended staff call 911 to have R2 transported to Saddleback Medical Center for a full medical evaluation. Attending physician findings reported no acute fracture or dislocation is seen. R2 was discharged and returned to facility the same day with instructions to treat a decubitus ulcer on her pelvic area.
On November 04, 2022, at about 10 AM, R2 was transported again to Saddleback Hospital due to hip pain. Attending physicians reported that R2 had a fall and had not been able to ambulate or walk for two-three weeks since the fall. X-ray results revealed a closed displaced fracture of the right femoral neck. R2 underwent surgery and was discharged on November 9, 2022, to a skilled nursing facility with no complications. During R2’s stays at the hospital, R2 was receiving care for a decubitus ulcer and was referred to Hospice for wound care. R2 was discharged back to Adult Care OC Saturna on or about December 9, 2022, with no incident. Staff interviewed stated that R2 has no reported falls since R2 continues to use a wheelchair for mobility and is being treated for a pressure injury.
After R2 sustained an unwitnessed fall and was found on the floor on October 6, 2022, by staff, R2 verbalized repeated complaints of pain and discomfort as well as signs of injury. R2 who normally walked with no assisted device was utilizing a wheelchair. From October 13, 2022, until November 4, 2022, R2 continued to complain of pain and on November 4, 2022, was sent to Saddleback Hospital where a closed displaced fracture of the femoral neck was diagnosed. R2 underwent surgery and was discharged to a skilled nursing facility where R2 received physical therapy prior to being discharged back to Adult Care OC Saturna.

Upon the occurrence of the initial fall, facility staff failed to call 911 in order for R2 to be assessed by paramedics in spite of a continued complaint of pain following the fall. Immediate medical attention was therefore not requested and/or provided to R2.

Regarding the allegation that Facility financially abused resident, it was determined that: During the period of admission for residents R1 and R2, AA May Kwok fraudulently acquired durable Power of Attorney over residents’ finance, wrote residents’ personal checks for totaling $1,358, accessed resident’s bank account, and used residents’ funds paying her own business expenses including Southern California Gas Company for $3,871, Southern California Edison Company for $17,927, Orange County Tax Collection for $10,114, and Small Business Administration loan for $86,188.
CONTINUED ON FORM LIC9099-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
VISIT DATE: 07/28/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-C
Chase Bank financial records were reviewed and showed that AA added her name on residents’ bank account as attorney-in-fact on November 28, 2022. A bank signature card, which is a document that a bank keeps on file to authenticate a customer’s signature for their accounts, also showed AA’s signature. The residents’ cancelled checks reviewed and revealed that AA wrote and signed R2’s multiple checks for cash, memorial care, property records, and Tayani Institute for totaling $1,358. Residents R1 and R2’s bank statement showed an online payment was made out to Southern California Gas Company for $3,871.44 on January 3, 2023. The Department reviewed Southern California Gas Company transaction records which showed the payment had been made for a non-residential address for Pacific West Coin Laundry with AA listed as the customer.

Residents’ bank statement showed an online payment was made out to Southern California Edison Company for $17,927.24 on January 6, 2023. The Department reviewed Southern California Edison Company transaction records which evidenced that AA accessed the residents’ checking account and used residents’ funds to pay for a utility bill for the licensed facility Adult Care OC I – 306005939.
Residents’ bank statement showed an online payment was made out to Orange County Tax Collection for $10,114.22 on January 3, 2023. The Department reviewed Orange County Tax transaction records which evidence that the tax payment was made through the residents’ checking account ending 0356 in the amount of $10,114.22 for year 2021 – 2022 and year 2022 -2023 unsecured property tax including leased equipment tax and business assessments tax to an account with an associated email address MAYKWOK1416@GMAIL.COM for a taxed property located at 2626 Dupont Dr, Street, Ste A10, Irvine CA 92612. The taxed property is stated to belong to a business entity named Our Secret Place Medical Aesthetic Inc. with a listed business director as AA Kwok. Per the transaction records both Licensee Brian Schott and AA May Kwok are associated with Our Secret Place Medical Aesthetic Inc. Based on the transaction records review, both accessed residents’ bank account and used residents’ funds to pay their business assessment tax and leased property tax.

Finally, the residents’ bank statement showed an online payment was made out to a Small Business Administration (SBA) loan for $86,188.50 on February 1, 2023. The Department reviewed SBA transaction records which evidences the payment was made for a sole proprietorship business operated by AA at the address previously shown on a Southern California Gas Company payment also issued from the residents’ account.
CONTINUED ON FORM LIC9099-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
VISIT DATE: 07/28/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-C
Based on the transaction records reviewed, AA accessed residents’ checking account and used residents’ funds to pay for personal and business expenses unrelated to the residents’ facility fees.

Regarding the allegation that Facility overcharged residents for rent, it was determined that: the licensee financially abused the residents and overcharged residents’ rent for $97,038 based on the following discrepancies observed during the investigation: R1 and R2 had a joint checking account with Chase Bank. This checking account was used for paying rent.
Bank statements were reviewed for the period from June 2021 to April 2023. The following discrepancies were noted:
Residents’ check dated on 6/9/2021, check #1321, $1,000 was made out to Brian Schott, licensee for preadmission fees. Per R1’s Admission Agreement, no preadmission fees should be charged. R2’s Admission Agreement showed $500 preadmission fee needs to be charged. The licensee overcharged $500 preadmission fees.
In June 2021, residents’ check dated on June 11, 2021, check #1322, $8,500 was made out to New Home Senior Care. R1 was admitted to the facility on August 11, 2021. Licensee Schott should not charge R1’s rent for the month of June 2021. Licensee Schott overcharged R1 rent for $4,250.
In the month of July 2021, residents’ check dated on June 28, 2021, check #1326, $8,500 was originally made out to Licensee Schott, but then the payee’s name was changed to R2. This check was neither deposited to residents’ savings account nor checking account instead this check was cleared on June 28, 2021, from residents’ checking account. The amount of this check $8,500 is equal to R1 and R2’s monthly rent, $8,500 (R1 $4,250 + R2 $4,250). It appeared this check was paid for R2’s July 2021 rent. Licensee overcharged rent for $4,250 ($8,500-$4,250) because R1 was admitted to facility in August 2021.
In the month of August 2021, residents’ check dated on 8/20/2021, check #1325, $4,650 was made out to New Home Senior Care. Since R1 was admitted to facility in August 2021, R1 and R2’s rent payment should be $8,500 ($4,250+$4,250). The rent was undercharged for $3,850 ($8,500 - $4,650).
In the month of September 2021, residents’ one check dated on September 9, 2021, check #1424, $8,570 was made out to New Home Senior Care. Another check dated on September 9, 2021, check #1425, $1,700 was made out to Licensee Schott. Two checks were paid to licensee for totaling $10,270 resulting in $1,770 overpayment ($1,0270 - $8,500).
In the month of October 2021, residents’ check dated on October 14, 2021, check #1485, $9,000 was made out to New Home Senior Care resulting in $500 overpayment ($9,000-$8,500).
CONTINUED ON FORM LIC9099-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
VISIT DATE: 07/28/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-C
Starting in the month of November 2021, the rent was made through online payment. Two online payments were made out to New Home Senior Care on the date of November 9, 2021, and November 23, 2021, for totaling $17,200 resulting in $8,700 overpayment ($17,200-$8,500).
In the month of December 2021, one online payment was made out to New Home Senior Care on the date of December 24, 2021, for $8,600 resulting in $100 overpayment ($8,600 - $8,500).
In the month of January 2022, one online payment was made out to New Home Senior Care on the date of January 25, 2022, for $8,600 resulting in $100 overpayment ($8,600 - $8,500).
In the month of February 2022, three online payments were made out to New Home Senior Care on the date of February 15, 2022, and February 22, 2022, for totaling $18,383 resulting in $9,883 overpayment ($18,383 - $8,500).
In the month of March 2022, two online payments were made out to New Home Senior Care on the date of March 25, 2022, for $17,525 resulting in $9,025 overpayment ($17,525 - $8,500).
In the month of April 2022, two online payments were made out to New Home Senior Care on the date of April 22, 2022, for $17,525 resulting in $9,025 overpayment ($17,525 - $8,500).
In the month of May 2022, two online payments were made out to New Home Senior Care on the date of May 24, 2022, for $17,525 resulting in $9,025 overpayment ($17,525 - $8,500).
In the month of June 2022, two online payments were made out to New Home Senior Care on the date of June 24, 2022, for $17,525 resulting in $9,025 overpayment ($17,525 - $8,500). It should be noted after two payments were paid to facility on June 24, 2022, the residents’ account ending balance was “$0”.
In the month of July 2022, one online payment was made out to New Home Senior Care on the date of July 25, 2022, for $8,925 resulting in $425 overpayment ($8,925 - $8,500).
In the month of August 2022, one online payment was made out to New Home Senior Care on the date of August 25, 2022, for $8,925 resulting in $425 overpayment ($8,925 - $8,500).
In the month of September 2022, one online payment made out to New Home Senior Care on the date of September 23, 2022, for $8,925 resulting in $425 overpayment ($8,925 - $8,500).
In the month of October 2022, one online payment was made out to New Home Senior Care on the date of October 25, 2022, for $8,925 resulting in $425 overpayment ($8,925 - $8,500).
In the month of November 2022, one online payment was made out to New Home Senior Care on the date of November 23, 2022, for $8,925 resulting in $425 overpayment ($8,925 - $8,500).
CONTINUED ON FORM LIC9099-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
VISIT DATE: 07/28/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-C
Based on the evidence gathered, the allegations that Resident sustained an unexplained fracture while in care, Facility financially abused resident and that Facility overcharged resident for rent are all found to be Substantiated, meaning that the preponderance of evidence has been met.

See LIC9099-D for cited deficiencies and immediate civil penalty as per Title 22 Division 6 of the California Code of Regulations.

A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49 (f)

An exit interview was conducted with a facility representative and a copy of the present report along with appeal rights were provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2025
Section Cited
CCR
87468.2(a)(8)
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Per CCR87468.2(a)(8): "(...)residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, (...). This requirement is not met as evidenced by: Based on evidence reviewed, after activing administrator May
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Licensee stated they will refund to R2 or R2’s estate all misappropriated funds taken from their account which amounts to a total of $119,459.40.
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Kwok obtained attorney-in-fact status access to two residents’ bank accounts, multiple payments were evidenced to have been made from those accounts for unrelated business and personal expenses. This constitutes an immediate risk to the health, safety and personal rights of individuals in care. Immediate Civil Penalty Assessed.
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Type A
07/29/2025
Section Cited
CCR
87507(g)(3)(C)
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CCR 87507(g)(3)(C) regarding Admission Agreements: “Admission agreements shall specify the following: (C)Any fee that is charged prior to or after admission, shall be clearly specified.
This requirement is not met as evidenced by:
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Licensee stated that all excessive funds received in payment will be refunded to R2 or R2’s estate in the total amount of $97,038.
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Based on evidence reviewed, facility staff obtained payments in excess of the actual amounts due for R1 and R2 totaling $97,038 of overpayments. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 22-AS-20230628144300
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ADULT CARE OC SATURNA
FACILITY NUMBER: 306005934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2025
Section Cited
CCR
87465(g)
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CCR 87465 (g) “Incidental Medical and Dental Care. The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health appropriate to the conditions and needs of residents.” This requirement is not met as evidenced by:
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Licensee will conduct an in-service training to caregiving staff to ensure appropriate response to falls incidents resulting in potential injury.
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Based on the evidence gathered, despite the repeated pain complaints, it was confirmed that facility staff did not obtain adequate medical attention for the residents’ needs which constitutes an immediate risk to the health, safety and personal rights of individuals in care.
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Civil penalty assessed.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 9