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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850365
Report Date: 09/03/2026
Date Signed: 09/03/2026 12:13:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2026 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20260605145935
FACILITY NAME:FOUNTAIN SQUARE OF LOMPOCFACILITY NUMBER:
425850365
ADMINISTRATOR:MESHELL RAMOSFACILITY TYPE:
740
ADDRESS:1420 W NORTH AVENUETELEPHONE:
(805) 736-1234
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:130CENSUS: 56DATE:
09/03/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH: interim Administrator, Sarah KauTIME COMPLETED:
11:57 AM
ALLEGATION(S):
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Staff do not respond to residents’ pendant call.
INVESTIGATION FINDINGS:
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 At 9:00am on 09/03/2026, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings to all allegations to this complaint. LPA met with interim Administrator, Sarah Kau, announce who he is and the reasons for the visit.
As to the allegation of, “Staff do not respond to requests’ pendant call.” It was alleged that, “when (R1) presses their pendant, staff does not come assist or (R1) would have to wait 25 minutes to be assisted.” On 08/19/2026, LPA conducted an audit of R1’s pendant calls from the time frame of 03/01/2026 through 06/16/2026. Pendant call chart for R1’s room provide by facility shows that there was a total of 14 pendant calls from R1’s room, 3 of which took more than 16 minutes to address and clear. This is a 21% pendant call rate over 10 plus minutes to respond. Based on documentation provided by the facility, and substantiated allegations on separated reports within the last year, there is sufficient evidence to support the allegation of, “Staff do not respond to residents’ pendant call.” and is substantiated at this time.
Exit interview, report read, appeal rights and report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2026 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20260605145935

FACILITY NAME:FOUNTAIN SQUARE OF LOMPOCFACILITY NUMBER:
425850365
ADMINISTRATOR:MESHELL RAMOSFACILITY TYPE:
740
ADDRESS:1420 W NORTH AVENUETELEPHONE:
(805) 736-1234
CITY:LOMPOCSTATE:CAZIP CODE:
93436
CAPACITY:130CENSUS: 52DATE:
09/03/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH: interim Administrator, Sarah KauTIME COMPLETED:
11:57 AM
ALLEGATION(S):
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Staff do not put resident’s hearing aid on.
Staff do not meet resident’s grooming needs.
Staff did not properly address residents’ multiple falls at facility.
Staff left residents in soiled urine resulting in a rash.
INVESTIGATION FINDINGS:
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 At 9:00am on 09/03/2026, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to issue final findings to all allegations to this complaint. LPA met with interim Administrator, Sarah Kau, announce who he is and the reasons for the visit.
As to the allegation of, “Staff do not put residents hearing aid on.” It was alleged that, “first 6 months, staff were not putting (R1’s) hearing aid in.” It was discovered through documentation and interviews that on 06/15/2026 Licensing Program Analyst (LPA) conducted interviews with Staff (S1, S2, S2, S3, and S4) who all stated that they were familiar with R1 and R1 would have hearing aids to their recollection. S1-S4 stated that they don’t recall any issues with R1’s hearing aids. On 06/15/2026, LPA conducted interviews with Residents (R2, R3, R4, R5, and R6). R2-R6 all stated that the facility can use more staff. R1-R6 stated that the facility is providing for all care needs. R2-R6 all stated that they feel safe and are treated with dignity and respect at this facility. On 08/19/2026 LPA reviewed charting notes provide by the facility for the month of July 2025,
CONTINUED on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20260605145935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
VISIT DATE: 09/03/2026
NARRATIVE
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 LPA noted that there was not one reference to hearing aids, but there were 11 notations of “No issues” and 9 notations of R1 communicating with other residents in care. On 07/09/2026 LPA conducted an in-person interview with R1, R1 was not responding verbally to questions presented by LPA and no indication of negative or affirmative body language. R1 presented with smile and in good condition. At this time there is not enough evidence to support the allegation of, “Staff do not put residents hearing aid on.” And is unsubstantiated at this time.
As to the allegation of, “Staff do not met residents’ grooming needs.” It was alleged that, “in 10 months, the manicurist cut R1’s nails 3 times.” It was discovered through documentation and interviews that; On 06/15/2026, LPA conducted interviews with Residents (R2, R3, R4, R5, and R6). R2-R6 all stated that the facility can use more staff. R2-R6 stated that the facility is providing for all care needs. R2-R6 all stated that they feel safe and are treated with dignity and respect at this facility. On 07/09/2026 LPA conducted an in-person interview with R1, R1 was not responding verbally to questions presented by LPA and no indication of negative or affirmative body language. R1 presented with smile and in good condition. LPA reviewed facility documentation that included but not limited to R1’s pre-admission appraisal, R1 care plan, LIC602 Physicians Report, and facility charting notes which indicated that R1 required assistance with grooming. On 09/02/2026 LPC conducted a phone interview with Interim Administrator Sarah Kau who stated that the facility Hair Stylist and Manicurist whose schedule is every Tuesday and Thursday and all residents are notified of schedule and free to make appointments. On 06/05/2026 Reporting Party stated that R1 had nails manicured 3 times in 10 months. On 08/19/2026 LPA reviewed charting notes and noted no annotations pertaining to the need to manicure R1’s nails. At this time there is not enough evidence to support the allegation of, “Staff do not met residents’ grooming needs.” and is unsubstantiated at this time.
As to the allegation of, “Staff do not properly address residents’ multiple falls at facility.” It was alleged that R1 had an unreported fall in April or May of 2026. It was discovered through documentation and interviews’; On 06/15/2026, LPA conducted interviews with Residents (R2, R3, R4, R5, and R6). R2-R6 all stated that the facility can use more staff. R2-R6 stated that the facility is providing for all care needs. R2-R6 all stated that they feel safe and are treated with dignity and respect at this facility. On 07/09/2026 LPA conducted an in-person interview with R1, R1 was not responding verbally to questions presented by LPA and no indication of negative or affirmative body language. R1 presented with smile and in good condition. On 06/15/2026 LPA conducted in person interviews with S1-S4, all who stated they report all falls to medication technician, supervisor, and administrator on the date and time of fall regardless of injury.
CONTINUED on LIC9099-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 29-AS-20260605145935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
VISIT DATE: 09/03/2026
NARRATIVE
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 On 09/02/2026 LPA conducted an interview with Interim Administrator, Sarah Kau (IA) who stated that she recalls the alleged fall of R1 in the dining room and investigated after the fall was alleged. IA stated that there was a fall, however it was a different resident and that resident did not sustain any injury during that fall. IA stated that they reported those findings to the Reporting Party (RP) who alleged that R1 had fallen in the dining room and did not want to conflict with RP of fall allegation. On 08/19/2026 LPA reviewed R1’s full facility file and discovered that R1 did have two falls (05/15/2026, and 01/06/2026) both were documented, medical treatment provided and addressed by the facility. At this time there is not sufficient evidence to support the allegation of, “Staff do not properly address residents’ multiple falls at facility.” and is unsubstantiated at this time.
As to the allegation of, “Staff left residents in soiled urine resulting in rash.” It was alleged that, “R1 was left in soiled diapers resulting in a rash.” It was discovered through documentation and interviews; On 06/15/2026, LPA conducted interviews with Residents (R2, R3, R4, R5, and R6). R2-R6 all stated that the facility can use more staff. R2-R6 stated that the facility is providing for all care needs. R2-R6 all stated that they feel safe and are treated with dignity and respect at this facility. On 07/09/2026 LPA conducted an in-person interview with R1, R1 was not responding verbally to questions presented by LPA and no indication of negative or affirmative body language. R1 presented with smile and in good condition. On 06/15/2026 LPA conducted interviews with S1-S4, all staff stated that R1 did have a rash but would sometimes refuse to be assisted with toiling. S1-S4 all stated that R1 required at least two staff to assist with transfers and incontinence assistance. S1-S4 all stated that incontinence assistance is always addressed when identified. On 08/16.2026 LPA reviewed documentation of R1’s physician visit addressing rash in question. At this time based on interviews and documentation, there is not sufficient evidence to support the allegation of, “Staff left residents in soiled urine resulting in rash.” and is unsubstantiated at this time.
Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20260605145935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. … This requirement was not met by the number of call response that resulting in call button times exceeding
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Interim Admin/Administrator agree to conduct training will all staff on addressing call button calls, how recognize and write a procedure for staff to recognize, address, and clear call button calls in the facility. To be completed by 09/03/2026 and email LPA
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more than 10-minute response times as indicated in the complaint, which poses a potential danger to residents in care.
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documentation. LPA noted that this investigation was conducted in the same time frame as other investigations that address this specific complaint and POC has been met prior to final findings of this report. LPA will clear at singing. Repeat violation civil penalty waive by LPM (verbal).
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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.
SUPERVISOR'S NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5