Complaint·July 15, 2025

Four of these residents had signed admission agreements from this facility. R2 was admitted on 5/14/25, R3 was admitted on 10/8/24, R4 was admitted on 2/3/24, and R5 was admitted on 12/28/23, according to their respective admission agreements. Two current residents (R6-R7) who moved in recently had admission agreements from their prior placements, which are also owned and operated by the licensee of this facility. LPA Moleski reviewed medication administration records for R6 and R7. LPA Moleski observed signatures present for both of these residents from a certain staff member (S1) as early as 7/7/25. Vipulananda confirmed that S1 does not work at any other facilities owned or operated by the licensee of this facility. This indicates both R6 and R7 were moved in to this facility as of 7/7/25 at the latest. LPA Moleski interviewed two staff members who were working at this facility over the past two weeks (S1-S2). Both S1 and S2 confirmed that R1-R7 were living at the facility at the same time. Both S1 and S2 said that R1 was living in a staff room on a spare bed, along with the live-in staff member. This facility's license permits the licensee to provide care for no more than six residents at any given time. The department has determined the following as it relates to the allegation that the licensee is operating beyond the scope of license: Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. This facility is hereby cited per 22 CCR Section 87204(a). An exit interview was held with Vipulananda. Appeal rights and a copy of this report were left with Vipulananda.