Sequoia Springs Senior Living Community

Type of visit: Case Management - Incident

At approximately 8:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit to follow up on three incident reports submitted by the facility. LPA met with Executive Director Alma Peralta and reviewed records. On 08/11/2026, the Department received a report of another medication error that occurred at the facility. Staff, S1, accidentally gave resident, R1, another residents, R2, medication. The medication was prepared in advance and the wrong cup was given. S1 noticed the error immediately and attempted to have R1 spit the pills out, but all but two pills were swallowed. S1 contacted emergency personnel due to a possible allergic reaction. R1 was taken to the emergency room for observation and returned. On 08/15/2026, staff, S2, accidentally gave resident, R3, another residents, R4, medication. The medication was prepared in advance and the wrong cup was given. S2 noticed the error immediately and notified their supervisor. Medications were compared to allergy list and none were observed. Notification to the physician was completed and staff observed R3's vitals as instructed. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued in the amount of $250. On 08/20/2026, the facility received a telephone call from a resident's, R5, family member informing them the resident was currently at the post office. The facility staff were not aware R5 had left the building. LPA reviewed resident records and observed R5 has poor hazard awareness and is to be escorted when away from the facility. Facility escorted R5 back to the facility and enhanced their observation to ensure resident was safe. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given.the state’s words, verbatim · CDSS document, Aug 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 22, 2026

87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure resident received assistance with medication as ordered. This poses an Immediate Health, Safety or Personal Rights risk to residents in care. This is a repeat violation within a 12 month period. An immediate civil penalty of $250 is being issued today.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: Staff was removed from medication duties and facility no longer prepares medication in advance. POC cleared during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(d) · Plan of correction due date: Aug 22, 2026

87705 Care of Persons with Dementia:(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure staff were aware when resident left the building without assistance. This poses an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: Licensee agrees to review elopement plan and address frequency of elopement drills with all staff, regarding elopment and wandering behaviors. Proof of training with participants signature, trainer, & date of training; and elopement plan, as well as what is the facility plan for avoiding elopements, to be submitted to CCL by 09/18/2026. Date for scheduled staff training on Elopements shall be submitted to CCL by 08/22/2026.

Allegation investigated: Staff did not ensure that the facility is free of hazards. Staff did not prevent the facility from being in disrepair.

At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Fortuna Fire Inspector Jacob Basler and toured the building to review corrections that were noted on the Fire Inspection conducted on May 15, 2026. The items listed on the report were reviewed and appear to have been corrected. After the walk through LPA met with Executive Director Alma Peralta. During the course of this investigation, LPA tested all delayed egress doors and looked for areas containing hazards or in disrepair. The egress doors are operating as designed and open after 15 seconds of continuous pressure. An alarm is activated when the door is pressed and continues to sounds until reset by staff. LPA observed all exits were free from obstructions. LPA found items that were in need of repair but was informed they have been identified and repairs were already in progress. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 30, 2026 · control 21-AS-20260515122038

Type of visit: Case Management - Incident

At approximately 9:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a case management visit to follow up on two incident reports submitted by the facility. LPA met with Executive Director Alma Peralta and reviewed records. On 04/20/2026, staff, S1, assisted resident, R1, with medications. S1 gave R1 a medication that was supposed to be held in preparation of an upcoming medical procedure. S1 failed to verify medications before giving them to the resident. S1 caught the error and made the proper notifications. R1 was observed for changes and was fine. S1 was provided additional training and left employment at the facility. On 06/07/2026, staff, S2, was assisting residents with medications and accidentally gave resident, R2, another residents pill. The error was caught during the change of shift medication count. All notifications were made and R2 was observed for side effects with none occurring. S2 received refresher training to ensure future errors do not occur. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued in the amount of $250. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given.the state’s words, verbatim · CDSS document, Jul 30, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 31, 2026

87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure resident received assistance with medication as ordered. This poses an Immediate Health, Safety or Personal Rights risk to residents in care. This is a repeat violation within a 12 month period. An immediate civil penalty of $250 is being issued today.the state’s words, verbatim · CDSS document, Jul 30, 2026

Plan of correction: Staff have been retrained. POC cleared during visit.

Type of visit: Case Management - Incident

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to complete a pre-licensing inspection. During this inspection, LPA followed up on special incident report submitted by the facility. LPA met with Compliance and Training Coordinator Julissa Aguirre and reviewed records. On 03/28/2026, a staff, (S1) was training to become a medication technician and gave a medication to a resident that was prescribed to the different resident. The medication was prepared in advance with the room number written on the medication cup. S1 handed a cup to a resident and when the cup was returned, S1 realized it was the wrong cup. Staff assessed the resident and verified there were no known allergies. Residents physician was notified and resident was monitored for adverse reactions. LPA requested staff refresher training on medication procedures and an updated medication procedure. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued in the amount of $250. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Juliessa Aguirre and Appeal rights were given.the state’s words, verbatim · CDSS document, May 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 14, 2026

87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure resident received assistance with medication as ordered. This poses an Immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, May 13, 2026

Plan of correction: Licensee agrees to schedule refresher training for medication staff and submit date of training to CCL by 05/14/2026. Self certifiation of completed training shall be submitted to CCL by 06/12/2026.

Allegation investigated: Medication not given as ordered Personal rights

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to deliver the investigative findings from an investigation into the above allegations. LPA met with Compliance and Training Coordinator Julissa Aguirre. During the course of this investigation, LPA reviewed records and conducted interviews. Based on records reviewed and interviews conducted, LPA was not able to find evidence to support the allegations. LPA reviewed the medication records and observed R1 had two orders for a PRN medication that stated the medication was to be given by mouth three (3) times daily as needed. There were no restrictions placed on timing between doses. One prescription was for a 0.5 MG amount and the other for 1 MG. Documents show a 0.5 MG tablet was given on 2/18/2026, at 6:11AM and again at 2:15PM. The 1 MG medication was given at 4:01PM and again at 5:15PM. These amounts and timing are within the prescribed time frames. Based on interviews conducted, the allegation of Personal Rights was in regards to staff speaking in a loud, rude manner towards R1 and physically restraining them. LPA was not able to gather additional statements regarding these behaviors. Records reviewed showed documentation of bruising being found on R1's wrists and arms and a skin tear with a bandage that was not present the day before. LPA did not find documentation of the cause of the injuries. Continued on LIC9099-C. Unsubstantiated LPA reviewed R1's care plan and notes regarding staff observations. LPA observed R1 routinely walked around and was at times aggressive towards staff. R1 was also noted to be a high fall risk and there were several documented falls. LPA advised facility management to conduct refresher training on documenting injuries post fall and the have staff document the healing process of those injuries. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 21-AS-20260227110953

Type of visit: Required - 1 Year

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Compliance and Training Coordinator Julissa Aguirre and explained the purpose of the visit. Administrator certificate is current. Facility has a Hospice waiver for 10 residents. At approximately 8:30AM, LPA toured the facility to ensure the health and safety of residents in care. The facility was observed to be at a comfortable temperature. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and outdoor courtyards. In the areas toured no immediate health, safety, or personal rights violations were observed. Fire extinguishers were fully charged. Smoke detectors are all operational. Carbon Monoxide Detector was present. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. The kitchen equipment was clean and in good repair. Dishware appeared to be stored in a sanitary manner. Food appears to be stored and prepared properly. Refrigerators and freezers were maintained at the proper temperature. Facility has required seven-day non-perishable and two-day perishable supply of food. LPA observed several flies in the dinning room during this visit. Facility has EcoLab fly traps located throughout the facility, but the traps appeared to not have been maintained. Emergency food stores and water was present to ensure facility can be self-sufficient for 72 hours. Facility has a generator to supply power in an emergency. Emergency lighting devices were present. First aid kit was present. No pools/bodies of water are on the premises. Facility has been conducting Emergency drills every 3 months. At approximately 10:30AM, LPA reviewed 10 of 55 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of a physician visit within the last 12 months was present. Medication records were organized and contained orders for each medication. Medications were secured. Continued on LIC809-C… During this inspection, LPA followed up on several Unusual Incident Reports submitted by the facility. On 07/27/2025, Staff provided a resident with the wrong medication. The report states the staff misread the room number on a prepared medication cup. Staff notified residents physician of the error and resident was taken to the emergency room for observation. On 09/08/2025, staff discovered an error that occurred where a resident was given the wrong dose of a medication. Staff notified residents physician of the error and resident was monitored. On 09/28/2025, Staff provided a resident with the wrong medication. The report states staff did not verify what medication was in their hand before giving it to the resident. At approximately 1:30PM, LPA reviewed 10 staff files. Staff files reviewed did not contain evidence of completed annual training in 8 of 10 files. There was at least one staff on duty with CPR certification during this visit. All employees requiring background checks are cleared. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Evidence of control of Property, (Current Rental/Lease Agreement/Deed) LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Julissa Aguirre and Appeal rights were given.the state’s words, verbatim · CDSS document, Sep 30, 2025

The state marks this report as 17 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Administrator not responding timely to resident concerns

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Alma Peralta, interviewed staff and reviewed records. Based on records reviewed and interviews conducted, LPA observed resident council concerns have not been addressed in writing since January 2025. LPA reviewed regulation with Executive Director. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Aug 19, 2025 · control 21-AS-20250722165411

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.157 · Plan of correction due date: Aug 29, 2025

1569.157 Resident-oriented facility council:(c) If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days. This requirement is not met as evidenced by: Based on records reviewed, Licensee has not responded in writing to the resident council concerns. This poses a potential Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: Licensee agrees to review Health and Safety code 1569.157 and to develop a written plan that outlines how the facility will receive resident council concerns and how they will respond in writing. Written plan shall be submitted to CCLD by 08/29/2025.

Allegation investigated: Facility staff did not dispense medications as prescribed

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Alma Peralta, interviewed staff and reviewed records. Based on records reviewed and interviews conducted, Resident returned from hospital with a prescription for Antibiotics. The medication arrived at the facility on 07/19/2025 but did not start the medication until 07/21/2025. Physician orders stated the medication was to begin 07/19/2025 but was not entered into the facility system until 07/21/2025. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Aug 19, 2025 · control 21-AS-20250731094523

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 20, 2025

87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure resident received assistance with medication as ordered. This poses an Immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: Licensee updated procedures for entering medications into the system. POC cleared during visit.

Allegation investigated: personal rights

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Executive Director Alma Peralta, interviewed staff and reviewed records. Based on records reviewed, Resident, R1, went to the hospital on 07/25/2025 for a change in condition. R1 was admitted to the hospital. Based on records reviewed, R1 returned to baseline on 07/29/2025 and was to be discharged but facility refused to accept them back. R1 returned to the facility on 08/08/2025 receiving hospice care. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Aug 19, 2025 · control 21-AS-20250801164515

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(22) · Plan of correction due date: Aug 20, 2025

(22) To be protected from involuntary transfers, discharges, and evictions in violation of state laws and regulations... This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not accept resident back to the facility when they were discharged This poses an Immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: Licensee agrees to review Health and Safety code 1569.269. Resident returned to the facility. POC cleared during visit.

Type of visit: Case Management - Incident

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit regarding some incident reports submitted by the facility. LPA met with Executive Director Alma Peralta, interviewed staff and reviewed records. On 08/08/2025, staff observed Resident, R1, outside, walking towards the grocery store. Staff alerted other staff on the radio and resident was encouraged to come back to the facility. Resident returned with prompting from staff and was escorted to their room. LPA reviewed records and observed resident requires assistance when away from the facility. On 08/11/2025, a staff on their way to work observed Resident, R2, walking towards the grocery store. Staff alerted on duty staff and resident was encouraged to come back to the facility. Resident returned unharmed. LPA reviewed resident records and observed resident requires assistance when away from the facility. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given.the state’s words, verbatim · CDSS document, Aug 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Aug 20, 2025

87705 Care of Persons with Dementia:(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure the front exit door was monitored to ensure the safety of residents. This poses an Immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: Licensee agrees to develop a written plan that outlines how facility will monitor exits to ensure the safety of residents at risk of elopement. Written plan shall be submitted to CCLD by 08/20/2025.

Allegation investigated: Staff allows a minor to administer medications

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Alma Peralta, interviewed staff and reviewed records. Based on interviews conducted, children are often seen helping with activities during the summer months. The children are always supervised and participate with activities for the residents. Based on interviews conducted, children have never assisted with medications or assisting residents with activities of daily living. 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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 6, 2025 · control 21-AS-20250804121541

Allegation investigated: Facility not allowing resident visitors

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegation. LPA met with Executive Director Alma Peralta, Interviewed staff and residents, toured the building and reviewed records. LPA received copies of documents. Based on interviews conducted and records reviewed, a former staff who was visiting with residents in the dining room was escorted from the building. The reason given was former staff are not allowed to enter the building or visit with residents without prior permission from the Administrator. This policy violates Health and Safety code, preventing residents to have visitors of their choosing and without prior notice. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Jul 23, 2025 · control 21-AS-20250722165411

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(24) · Plan of correction due date: Jul 24, 2025

1569.269 Enumerated rights; severability:(24) To consent to have relatives and other individuals of the resident’s choosing visit during reasonable hours, privately and without prior notice. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, Licensee issued a visitor policy that prevented residents visiting with individuals of their choosing without prior notice. This poses an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: Licensee shall review Health and Safety Code section 1569.269 and submit self certification they have reviewed and will abide by the statute. Self Certification shall be submitted to the Department by 07/24/2025. LPA provided copy of Statute for review.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff do not enure the facility's alert system is properly operating Staff do not timely respond to the resident's alerts

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegations. LPA met with Executive Director Alma Peralta, interviewed staff and residents and reviewed documents. Based on interviews conducted and documents reviewed, the facilities call system is not operating fully. When a resident activates the system, the call is received at the front desk but does not directly notify caregivers as it should. During normal business hours, the front desk person receives the residents request for assistance who then radios the caregivers to relay where assistance is needed. After hours, caregiving staff are to check the computer system, at the front desk, frequently to provide assistance. This after hours process has resulted in many response times beyond 20 minutes to assist a resident. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Alma Peralta and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Jul 2, 2025 · control 21-AS-20250701142800

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 14, 2025

87303 Maintenance and Operation:(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Licensee did not ensure resident pendant alert system was fully operational. This poses a potential Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: Licensee shall develop a written plan to address repair options for call system and methods to ensure residents receive timely assistance from staff. Written plan shall be submitted to CCLD by 07/14/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Jul 14, 2025

87411 Personnel Requirements - General:(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure residents received timely assistance as noted in the Resident Hand Book. This poses a potential Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: Licensee shall develop a written plan to address repair options for call system and methods to ensure residents receive timely assistance from staff. Written plan shall be submitted to CCLD by 07/14/2025.

Type of visit: Case Management - Incident

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in regards to an incident report submitted by facility on 04/23/2025. LPA met with Executive Director Alma Peralta and reviewed records. On 04/19/2025, while assisting with resident medications, staff, S1, observed resident, R1, in their room at approximately 5:30AM. At approximately 5:40AM, S1 was assisting another resident when they heard a noise around a corner. S1 went to investigate and saw R1 looking at them through a window from the outside. S1 observed the door to be unlocked and the door alarm was turned off. S1 opened the door and escorted resident back to their room. The noise heard by S1 was the door closing and R1 yelling to be let back in. Based on records reviewed, the door alarm was left turned off by kitchen staff the day prior. Facility updated procedures to ensure exit alarms are monitored to ensure they are operational. No citations issued during today's visit.the state’s words, verbatim · CDSS document, May 14, 2025

Type of visit: Case Management - Other

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in regards to recent management changes. LPA met with Executive Director Alma Peralta and discussed various topics including reporting requirements. Former Executive Director Roger Endert's last day at the facility was 04/09/2025. LPA requested paperwork be sent to CCL to officially change the Administrator position to Alma. No citations issued during this visit.the state’s words, verbatim · CDSS document, Apr 16, 2025

Allegation investigated: Licensee did not ensure a refund was issued to residents responsible party in a timely manner

At approximately 10:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility uannounced to conduct an investigation into the above allegation. LPA met with Executive Director Roger Endert and reviewed records. Based on records reviewed and interviews conducted, Licensee did not issue a refund to residents responsible party within the timeframes provided in Title 22 regulation and the Health and Safety code. Resident passed away on 10/08/2024 and all personal belongings were removed from the premise on 10/14/2024. To date, responsible person has not received a refund. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Roger Endert and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Feb 12, 2025 · control 21-AS-20250117112835

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Feb 28, 2025

1569.652(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual..., to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not provide a refund within the 15 day timeframe in regulation. This poses a potential Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2025

Plan of correction: Licensee shall issue the refund to responsible party by POC date of 02/28/2025 and send self certification of completed payment to CCL by 02/28/2025.

Type of visit: Case Management - Other

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in regards to a report that facility was having difficulty acquiring food items and not being able to report incidents as required. LPA met with Jennifer Larue, toured the building and reviewed records. LPA was informed the facility has not had access to their computer records system since January 1, when the new management company took over. Jennifer has been completing hand written documentation for medications and incident reports. LPA observed the facility food stores to be within regulation at the time of this visit. Facility is in the process of securing food vendors for food deliveries. Food has been purchased at the local grocery stores in the mean time. No citations issued during this inspection.the state’s words, verbatim · CDSS document, Jan 13, 2025

Allegation investigated: Staff made an inappropriate comment regarding a resident Staff mishandled the residents pendants

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to open an investigation into the above allegations. LPA met with Executive Director Roger Endert, reviewed records and interviewed staff. Based on interviews conducted, LPA was not able to find evidence to support the allegation that staff made an inappropriate comment regarding a resident. LPA reviewed records regarding resident care and observed a recent meeting discussing an agreed upon risk assessment based on resident care needs. LPA interviewed individuals that attended the meeting and was not able to find evidence that staff made inappropriate comments. LPA reviewed records and interviewed staff regarding resident pendant procedures. LPA was informed that a staff had removed a pendant from a resident. The staff member was preparing resident for bathing and removed the pendant and placed it on a counter. After assisting the resident, staff forgot to return the pendant to resident. Resident was without their pendant for approximately 4 hours, until staff was alerted to the situation. There were no issues in this timeframe. LPA reviewed the previous 90 days of pendant logs and observed resident had access to their pendant. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 23, 2024 · control 21-AS-20241217090243

Type of visit: Required - 1 Year

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Executive Director Roger Endert and explained the purpose of the visit. Administrator certificate is current. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to resident rooms, common areas, bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. The common areas, bathrooms and kitchen were clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Cooking/dining equipment and utensils were present. Food appears to be stored and prepared properly. Facility has required seven-day non-perishable and two day perishable supply of food. Medication is locked and not accessible. The facility was observed to be at a comfortable temperature. First aid kits were present. Fire extinguishers were fully charged. Smoke detectors are all operational. Fire sprinklers were located throughout. Carbon Monoxide Detector was present. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. Facility has been conducting emergency drills every month. At approximately 9:45AM, LPA reviewed 10 Staff and 10 resident files. All resident files contained the required documentation. 7 of 10 staff files reviewed did not contain evidence of completed annual training. There was at least one person present with current First Aid/CPR certification. During this inspection, LPA followed up on an incident report submitted to CCL on 10/30/2024. The incident was reporting two medication errors that occurred on 10/24/2024 and 10/25/2024. Staff misread the orders for both of these incidents. An investigation was conducted by the Health and Wellness Director and staff were retrained. This is a repeat violation in a 12 month period. An immediate civil penalty is being issued in the amount of $1000. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Executive Director and Appeal rights were given.the state’s words, verbatim · CDSS document, Nov 5, 2024

Type of visit: Case Management - Other

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in order to amend a complaint investigation. On 8/21/2024, LPA delivered findings from a complaint investigation regarding the allegation that Staff are restricting access to the residents. LPA did not find evidence to support this allegation, but did learn that a code to an emergency gate was changed and staff nor the fire department were informed of the new code for approximately 2 days. LPA spoke with Executive Director Roger Endert about the code change and was informed the code was changed due to a staff using the gate as a convenient entry to memory care. Upon learning of this use, Roger had the code changed to prevent this use, but did not immediately pass the information on to staff or the Fire Department. During today's visit, LPA spoke with Roger and was informed the code was changed again and all staff were informed as well as the Fire Department. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Roger Endert and Appeal rights were given.the state’s words, verbatim · CDSS document, Oct 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Oct 8, 2024

87203 Fire Safety:All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure staff or Fire Department was informed of a new code for an emergency exit. This poses an immediate Safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 7, 2024

Plan of correction: Administrator made Fire Department and staff aware of the new code. POC cleared at time of visit.

Allegation investigated: Staff are restricting access to the residents Staff do not have planned activities for the residents

***Amended report to add information regarding LPA follow up for a fire code violation*** At approximately 8:05AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Executive Director Roger Endert, reviewed records and interviewed staff. LPA reviewed facility program design, evacuation plans and the fire clearance issued by the Fire Authority. Based on interviews conducted, the courtyard gate in the memory care section of the facility was locked with a key pad lock. Facility recently changed the code to the gate to prevent staff from causally using it as an exit and was in the process of retraining staff on the procedures to use the gate. Facility provided code to the Fire Department for use in an emergency. LPA will address this fire code violation on a case management visit. Continued on LIC9099-C... Unsubstantiated LPA reviewed the activity program used by the facility. The facility has an activity schedule for both assisted living and memory care, and LPA observed activities being conducted. LPA discussed with Executive Director the need to have a staff dedicated to be the activities director and not be responsible for other duties that would take away from that responsibility. LPA provided a copy of Regulation 87219, Planned Activities. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.the state’s words, verbatim · CDSS document, Aug 21, 2024 · control 21-AS-20240731114601

Allegation investigated: Staff did not seek timely medical attention for a resident Staff made unauthorized changes to a resident's medical needs Staff do not provide adequate care and supervision to the residents

At approximately 8:05AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Executive Director Roger Endert, reviewed records and interviewed staff. Based on interviews conducted, Resident was found on the floor of their apartment at approximately 5:00PM on 05/22/2024. Upon discovery, staff immediately contacted emergency personnel. Resident was admitted to the hospital. Resident was living in the assisted living area of the facility and was not under any close observation orders. Facility procedures are to check on residents approximately every 2 hours. Resident returned from the hospital under the care of a Hospice agency. Based on records reviewed, the physician at the hospital was in communication with the family and the facility regarding the care needs of the resident. Continued on LIC 9099-C... Unsubstantiated When resident returned back from the hospital, facility updated the care plan to reflect the new care needs of the resident. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.the state’s words, verbatim · CDSS document, Aug 21, 2024 · control 21-AS-20240605141038

Allegation investigated: Facility staff failed to meet residents care needs.

At approximately 8:05AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegation. LPA met with Executive Director Roger Endert, reviewed records and interviewed staff. Based on records reviewed and interviews conducted, resident was found in their room with feces on their body. While staff was assisting resident to clean up, they observed resident's ankle was swollen and they had bruising on their eye. Staff contacted medication technician to assist with an assessment. Medication technician contacted staff from the previous shift to see if there was anything to report. There were no incidents the previous day. Emergency personnel were contacted and resident was taken to the hospital. LPA reviewed resident care plan and observed resident was a low fall risk and did not require constant supervision. 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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 21, 2024 · control 21-AS-20240605153000

Type of visit: Case Management - Incident

At approximately 8:05AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in regards to several Unusual incident reports submitted by the facility. LPA met with Executive Director Roger Endert and reviewed records. LPA received two (2) reports that a medication error had occurred, and two (2) reports of residents leaving the facility without staff assistance. On 07/31/2024, staff noticed there were two different orders for the same medication and resident, R1, had received both. Facility notified responsible party, physician and pharmacy to correct the error. R1 was monitored for side effects due to the error and none were observed. On 08/11/2024, resident, R2, was given the wrong medication at the wrong times twice, once in the morning and at noon. Facility notified responsible party, physician and pharmacy to correct the error. R2 was monitored for side effects due to the error. R2 stated they were a little dizzy but was fine a short time later. ***This is the third violation in a 12 month period. An immediate civil penalty is being issued in the amount of $1000 for repeating the same code section in a 12 month period.*** On 06/22/2024, staff observed resident, R3, wandering around in the parking lot of the facility. Staff were able to redirect R3 back into the facility with no further incidents. Staff checked the doors and alarms and initiated more frequent checks for the resident. On 08/12/2024, staff was returning from their break and observed a resident, R4, across the street from the facility. Staff was able to assist the resident back to the facility. Facility has updated resident care plan to address this behavior. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.the state’s words, verbatim · CDSS document, Aug 21, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 22, 2024

87465 Incidental Medical and Dental Care:(4)The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed Facility did not assist with medications as prescribed. This poses an Immediate Health risk to residents. ***An immediate civil penalty is being issued in the amount of $1000 for this repeated violation.the state’s words, verbatim · CDSS document, Aug 21, 2024

Plan of correction: Staff responsible was given additional training on medication procedures and facility reviewed their process on entering new orders and verification of exsisting orders. POC cleared during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(k)(6) · Plan of correction due date: Aug 22, 2024

87705 Care of Persons with Dementia:(6) Without violating Section 87468, Personal Rights, facility staff shall ensure the continued safety of residents if they wander away from the facility.This requirement is not met as evidenced by:Based on records reviewed, 2 residents left the facility without staff knoweldge. This poses an immediate Safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 21, 2024

Plan of correction: A review of the physical alert devices was conducted and care plans were updated. Staff were retrained in the observation requirements for residents. POC cleared during visit.

Allegation investigated: Staff did not prevent a resident from wandering Staff do not provide adequate care and supervision to a resident Facility does not have a qualified administrator

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Administrator Erin Ortiz, reviewed records and interviewed staff. Based on records reviewed and interviews conducted, residents have the right to walk wherever they choose. Resident, R1, left the memory care area of the facility and was walking around the building. Staff were able to redirect resident and were aware of their location at all times. Based on records reviewed and interviews conducted, R1 has many behaviors and routinely refuses assistance. Staff document the refusals and try alternative methods to provide assistance. The facility administrator position was vacant for approximately 30 days, but facility oversight was being provided by corporate management and day to day operations were handled by heads of departments. Continued on LIC9099-C. Unsubstantiated All staff have received training on the emergency disaster plan. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.the state’s words, verbatim · CDSS document, Jul 3, 2024 · control 21-AS-20240506123737

Allegation investigated: Facility failed to meet resident's care needs Facility failed to observe and report changes in resident's condition

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct an investigation into the above allegations. LPA met with Administrator Erin Ortiz, reviewed records and interviewed staff. Based on records reviewed and interviews conducted, LPA did not find evidence to support the allegation that facility failed in meeting the needs of a resident, R1. Records showed R1 was able to manage their own needs and only needed assistance with bathing due to safety reasons. Facility records show numerous attempts by staff to assist resident but resident refused. Documentation showed R1 continued to go against physician orders by drinking alcohol to excess. Based on records reviewed, facility documented changes in R1's condition and notified responsible party of such changes. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 3, 2024 · control 21-AS-20240329143310

Allegation investigated: Staff left feces soiled linens in the resident's room for over a week. Facility is in disrepair.

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Administrator Charmin Bailey, interviewed staff and reviewed records. Based on interviews conducted and records reviewed, LPA observed the facility did not ensure laundry is done in a timely manner. LPA reviewed housekeeping records and observed resident laundry is not always completed as agreed to in the admission agreement. LPA observed several occasions where a residents laundry was not completed for more than 2 weeks. Based on records reviewed and interviews conducted, the facility windows are in disrepair. Many resident room windows are not operational. Some do not open correctly or do not close completely. Facility is aware and has a plan to replace the windows in the building but needs to wait for the weather. Continued on LIC9099-C... Substantiated The packet contains the required documents and was signed by a facility representative and responsible party. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator and Appeal rights were given.the state’s words, verbatim · CDSS document, Apr 5, 2024 · control 21-AS-20231229133708

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(F) · Plan of correction due date: Apr 26, 2024

87307 Personal Accommodations and Services:(F) Basic laundry service (washing, drying, and ironing of personal clothing). This requirement is not met as evidenced by: Based on interviews and records reviewed, Licensee did not ensure resident laundry was completed, leaving soiled items in resident rooms for long periods of time. This poses a potential Health risk to residents in care.the state’s words, verbatim · CDSS document, Apr 5, 2024

Plan of correction: Licensee to develop a written plan regarding how and when laundry is completed and documented in the building. Written plan to be submitted to CCL by POC date of 4/26/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 26, 2024

87303 Maintenance and Operation:(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on interviews conducted, Licensee did not ensure windows in the building were in good repair. Windows in several rooms are not in good repair which causes a potential Health or Safety risk to residents in care. This is a repeat violation, civil penalty of $250.00 is being issued.the state’s words, verbatim · CDSS document, Apr 5, 2024

Plan of correction: Licensee is aware of the condition of the windows and has a plan for replacement. Licensee to submit a written plan, including timelines for completion of this project. Plan to be submitted to CCL by POC date 04/26/2024.

Allegation investigated: Resident Medication was not administered per regulation

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Administrator Charmin Bailey interviewed staff and reviewed records. Based on records reviewed, Resident (R1) did not receive medication as ordered. Records show the medication was out of stock, but there was no documentation to show facility followed up. Facility does not have a written procedure to ensure oversight for re-ordering medications. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. This is a repeat violation, civil penalty of $250.00 is being issued. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator and Appeal rights were given. Substantiatedthe state’s words, verbatim · CDSS document, Apr 5, 2024 · control 21-AS-20240216124504

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 9, 2024

87465 Incidental Medical and Dental Care:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed Facility did not ensure medication was re-ordered in a timely manner. This poses an immediate Health or Safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 5, 2024

Plan of correction: Licensee to develop a written plan to ensure oversight of the re-ordering process for resident medications. Plan to be submitted to CCL by POC date 04/09/2024.

Allegation investigated: Staff are not properly trained Facility is not following infection control plan Facility is in disrepair

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to amend this report to add additional information regarding the above allegations. On 04/05/2024 at approximately 8:30AM, LPA met with Administrator Charmin Bailey and reviewed records. Based on a review of staff training records, facility has documentation of required staff training. LPA observed additional training for special circumstances as well. LPA reviewed facility infection control plan and observed precautions implemented to decrease the risk of infection. Facility was in daily contact with local public health, signs were posted and staff were wearing proper personal protective equipment (PPE). LPA toured facility and did not find evidence to support the allegation that facility is in disrepair. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 5, 2024 · control 21-AS-20240205165146

Allegation investigated: Facility failed to manage medication as prescribed by physician Staff did not meet residents care needs

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Administrator Charmin Bailey and reviewed records. Based on records reviewed and interviews conducted, the facility failed to manage medication as prescribed by physician. LPA reviewed medication records and found R1 did not receive medications that were prescribed to them on multiple occasions due to the facility being out of stock and not reordering on time or not being able to find the medications. ***This is a repeat violation in a 12 month period, an immediate civil penalty is being issued in the amount of $250.*** LPA reviewed care plans and after visit summaries related to R1. Based on records reviewed and interviews conducted, facility did not meet residents care needs. Continued on LIC9099-C... Substantiated Resident did not receive showering assistance or laundry assistance as outlined in facility care plan and Admission agreement. Care plan states staff will monitor and track certain aspects of resident care needs but there is no documentation showing it was done. Based on interviews conducted, resident handles care needs on their own, but care plan indicates care staff are responsible to ensure the needs are met. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Charmin Bailey and Appeal rights were given.the state’s words, verbatim · CDSS document, Mar 8, 2024 · control 21-AS-20231229133708

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 11, 2024

87465 Incidental Medical and Dental Care:(4)The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on records reviewed Facility did not assist with medications as prescribed. Facility did not have medications on hand for resident and did not re-order in a timely manner. This poses an Immediate Health risk to residents.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: Licensee to provide written procedure that outlines how medications are ordered and how accountability is achieved to ensure medications are available for residents. Written procedure to be submitted to CCL by POC date of 03/11/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Mar 29, 2024

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical functioning...and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by: Based on records reviewed, facility did not ensure the care needs of the resident were met. This poses a potential Health risk to residents.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: Licensee to conduct refresher training on how facility monitors and ensures residents are observed for changes. Self certification of completed training to be submitted to CCL by POC date of 03/29/2024.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility mismanages medications Residents care needs are not being met

At approximately 8:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to amend this report to add additional information regarding the above allegations. On 03/08/2024 at approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Administrator Charmin Bailey and reviewed records. Based on a review of records, facility did not reorder medications causing resident to be without needed medication as required. Based on a review of records and interviews conducted, resident care needs were not met, Resident did not receive showering assistance or laundry assistance as outlined in facility care plan and Admission agreement. These allegations are addressed and citations issued in complaint, 21-AS-20231229133708. Substantiatedthe state’s words, verbatim · CDSS document, Mar 8, 2024 · control 21-AS-20240205165146

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility is incorrectly charging resident for a pet they do not have at the facility.

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Charmin Bailey, interviewed staff and reviewed records. LPA received copies of documents. Based on a review of admission agreement and invoices of cost of care, the facility made an error by charging resident an additional sum of money one time. The error was caught and the money was refunded. The facility is not charging resident for the cost of a pet. This agency has investigated the above allegation. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Unfoundedthe state’s words, verbatim · CDSS document, Jan 23, 2024 · control 21-AS-20231229133708

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Resident is not receiving wound care as needed

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegation. LPA met with Executive Director Charmin Bailey, interviewed staff and reviewed records. LPA received copies of documents. Based on records reviewed, facility did not follow up on physician orders to provide care for residents wound. On 11/22/2023, facility was notified, via telephone, to clean, dry and apply a bandage to residents toe daily. On 11/27/2023, an order was faxed to the facility to provide the requested wound care. There is no documation of follow up after 11/22/2023 to obtain the written order. A review of residents care plan shows an update to provide care on 11/27/2023. The wound grew progressivly worse in that timespan. This lack of care resulted in resident being sent to the hospital due to an infection and surgical procedure. Continued on LIC9099-C... Substantiated Other times, resident did not notify facility of scheduled appointments. LPA reviewed transportation logs and interviewed staff responsible for driving. The logs did not provide information regarding individual resident appointments, only that the bus went to a location. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Charmin Bailey and Appeal rights were given.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 21-AS-20231130145710

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: Jan 24, 2024

87465 Incidental Medical and Dental Care:(2)The licensee shall provide assistance in meeting necessary medical and dental needs. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure wound care was provided to resident. This poses an immediate Health risk to residents in care.the state’s words, verbatim · CDSS document, Jan 23, 2024

Plan of correction: Licensee has implemented more frequent meetings with shareholders to ensure communication on the care of residents. POC cleared at time of visit.

Allegation investigated: Facility is in disrepair.

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Charmin Bailey, toured the building and grounds, interviewed staff and reviewed records. LPA received copies of documents. Based on interviews conducted and records reviewed, the facility became aware of several outside lights that were not operational in August of 2023. Executive Director sent a request to multiple companies for repair quotes for repair. Director submitted the received quotes to the corporate office. The lights were repaired in December of 2023. LPA reviewed Resident Council meeting notes and did not observe any reference to a lack of lighting in the Assisted living section of the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 9, 2024 · control 21-AS-20240104111022

Type of visit: Case Management - Incident

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a case management visit in regards to several SOC 341, Report of Suspected Dependent Adult/Elder Abuse, forms. LPA met with Administrator Charmin Bailey, interviewed staff and reviewed records. Based on records reviewed, there have been several incidents in the memory care section of the facility between residents. The incidents varied from yelling and pushing to one where a resident fell to the floor and was then kicked by another resident. Staff were nearby at each incident and separated the residents and assessed them for injuries. LPA reviewed care plans and assessments and found the facility has made adjustments to the care plans to prevent these behaviors. LPA reviewed staffing schedules and observed there have been two caregivers and one medication technician present. LPA observed notes posted for staff stating at least one staff should be in the common areas at all times and reminders to redirect residents when needed. LPA received copies of documents. LPA received an SOC 341 regarding a former staff that was reported to have taken a resident to a bank to withdraw money. The staff left employment in November 2023. The information regarding the bank visit was reported 12/29/2023. LPA received copies of employee file and will request follow up with Law Enforcement. No citations issued during this visit.the state’s words, verbatim · CDSS document, Jan 9, 2024

Allegation investigated: Staff did not follow Power of Attorney of resident. Staff isolates resident in bedroom. Staff is not communicating with resident's responsible party.

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Executive Director Charmin Bailey and reviewed records. Based on records reviewed and interviews conducted, Resident, R1, was their own responsible party. R1 signed their own admission agreement and listed themselves as the person to contact. Based on interviews conducted and records reviewed, facility does not isolate resident in their room. R1 informed the facility that they would like to stay in their room. R1 is ambulatory and is free to move about the facility as they wish. LPA observed the door to R1's room and there was no sign of any locking device that would prevent R1 from leaving their room. Continued on LIC9099-C... Unsubstantiated R1 does not receive additional services from the facility. R1 is being charged the basic rate and has not been charged additional fees while living at the facility. This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Based on interviews conducted and records reviewed, the facility abided by the admission agreement and contact information regarding R1. The facility did not disclose information regarding R1 to persons that were not approved by R1. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.the state’s words, verbatim · CDSS document, Dec 18, 2023 · control 21-AS-20231005090206

Type of visit: Case Management - Annual Continuation

At approximately 10:30AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced visit to continue the annual required inspection conducted on 11/20/2023. LPA met with Executive Director Charmin Bailey. At approximately 10:50AM, LPA reviewed 5 resident records. Records contained the required documents. Medication records were current and physician orders were on file. Facility has implemented a new procedure to conduct emergency drills and will begin conducting drills every month. LPA reviewed staffing schedules and food storage. Facility currently has staff to meet the needs of residents. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Charmin Bailey and Appeal rights were given.the state’s words, verbatim · CDSS document, Dec 4, 2023

Type of visit: Required - 1 Year

At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with Executive Director Charmin Bailey. At approximately 11:15AM, LPA toured the building and grounds which was found to be clean and in good repair. Facility staff were in the process of painting the memory care section of the facility. Staff were present with all painting supplies. A new floor is being installed in the medication room. All medications were relocated to another secure location during the project. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed residents preparing for an activity in the activity room. LPA observed the activity schedule for the day had several activities planned. Toxins are stored in locked storage areas and house keeping carts were secure. LPA tested water temperature at various locations throughout the building. Water temperature measured within regulation between 105 and 120 degrees F. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Facility has fire sprinklers throughout. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. LPA inspected the kitchen and food storage areas. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. LPA observed all staff were wearing proper protective equipment for food preparation. At approximately 12:30PM, LPA reviewed 5 staff records. 3 of 5 records did not contain documentation of completed training hours as required. Evidence of current first aid and CPR training were current. Continued on LIC809-C... At approximately 2:20PM, LPA reviewed the facility emergency disaster plan. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has the required evacuation stair chairs in place. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility does not have documentation of completed disaster drills. Facility was having an issue with their computer system and LPA was not able to review resident files. LPA will return at a later date to complete this inspection. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Charmin Bailey and Appeal rights were given.the state’s words, verbatim · CDSS document, Nov 20, 2023