Beverly Hills Loving Care

Allegation investigated: Staff did not meet resident's hygenic needs.

On 08/28/2026, LPA Watson conducted a subsequent complaint visit to the facility listed above. LPA Watson met with the Administrator Lida Zarafashan and explained the reason for the visit. LPA Watson was granted entry into the facility. Investigation consisted of the following: On 08/27/2026, the department requested, obtained, and reviewed the following documentation: Resident Roster, Staff Roster, Admission Record (Culver West Health Center) for R1 dated 08/03/2026, Medical Assessment for R1 dated 05/08/2025, Appraisal Needs and Services for R1 dated 09/16/2026, Unusual Incident Reports for R1 dated 08/13/2026, 08/19/2026, and 07/20/2026, Transfer/Discharge Report for R1 dated 08/04/2026, and Discharge Summary for R1 dated 08/04/2026. CONTINUED ON LIC9099-C Unsubstantiated The department interviewed Staff #1–#5 (S1–S5) and Residents #2–#7 (R2–R7). An attempt to interview Resident #1 (R1) was made, but R1 was not present at the facility during the time of interviews. Investigation revealed the following: Allegation: Staff did not meet resident’s hygienic needs. It is alleged that staff neglected the resident’s hygienic needs, resulting in the resident being diagnosed with scabies and head lice. On 08/27/2026, the department interviewed the Administrator Lida Zarafashan, Staff #1 (S1). S1 was asked by the department if staff meet residents’ hygienic needs. S1 answered yes. S1 stated that staff provide showers to all of the residents three times a week or as needed, wash residents’ laundry, change their briefs, clean resident rooms daily, send linens out weekly or as needed for sterilization, and assist with Activities of Daily Living (ADL's) daily. During the interview, S1 was asked if staff observed any signs of R1’s skin irritation, itching, rash, or discomfort prior to R1’s hospital admission, and whether S1 knew R1 had scabies prior to admission. S1 stated that no resident in the facility had been diagnosed with scabies or head lice, and that there were no scabies or lice outbreak in the facility. S1 also stated that any rashes observed on R1 was typically due to medication, allergies, or dry skin. S1 was also asked if R1 ever refused hygiene assistance. S1 stated yes, R1 sometimes refused assistance because he was independent. The department further asked whether any other residents or staff had reported symptoms consistent with scabies or lice within the past 60 days. S1 answered no. The department toured the facility with S1 and found the facility clean and in good repair. On 08/27/2026, the department interviewed Staff #1–#5 (S1–S5) and Residents #2–#7 (R2–R7). Out of those interviewed, 5 out of 5 staff and 6 out of 6 residents denied the above allegation. An attempt to interview Resident #1 (R1) was made, but R1 was not present at the facility during the time of the interviews. On 08/29/2026 the department reviewed R1’s Medical Assessment dated 05/08/2025 and it showed no infectious diseases. The department then reviewed R1’s Appraisal Needs and Services Plan, which indicated that R1 requires supervision while bathing and that caregivers follow a bathing schedule for him. CONTINUED ON LIC9099-C On 07/23/2026, R1 was admitted to Culver West Health Center. The department reviewed the transfer/discharge report from Culver West, which showed R1 was treated for several health conditions, but no treatment for scabies or head lice was. The department also reviewed R1’s Unusual Incident Report dated 08/13/2026, indicating that R1 was transferred to Cedar Sinai Medical Center and was not scheduled for treatment related to scabies or head lice. Based on the information gathered, interviews conducted, and an analysis of records reviewed, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. An exit interview was conducted with the Administrator Lida Zarafashan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2026 · control 11-AS-20260821143814

Allegation investigated: Staff did not seek medical attention in a timely manner. Staff did not provided emergency services with resident's medical records. Staff does not effectively communicate with residents due to language barrier.

On 08/28/2026 at approximately 09:15 AM LPA Watson conducted a subsequent complaint visit to the facility listed above. LPA Watson met with the Administrator Lida Zarafashan and explained the reason for the visit. LPA Watson was granted entry into the facility to conduct the complaint visit. Investigation consisted of the following: On 08/27/2026, between 10:39 AM and 04:30 PM, the department requested, obtained, and reviewed the following documentation: Staff Roster, Resident Roster, Unusual Incident Reports dated 06/13/2024 and 08/14/2026, Appraisal Needs and Services dated 07/16/2026, and Medical Assessment for R1 dated 07/24/2026. On 08/27/2026 between 10:39 AM and 04:30 PM, the department interviewed Staff #1–#5 (S1–S5) and Residents #1–#7 (R1–R7). CONTINUED ON LIC9099-C Unsubstantiated Investigation consisted of the following: Allegation: Staff did not seek medical attention in a timely manner. It is alleged that staff did not seek timely medical attention for a resident who was described as dizzy and disoriented following a fall. The department interviewed Administrator Lida Zarafashan (S1) regarding the incident on 08/12/2026. During an interview with S1, the department asked if staff sought medical attention for R1 in a timely manner. S1 said that staff sought medical attention immediately by calling the Medtech, calling 911, and contacting R1’s authorized representative. S1 also said paramedics arrived, but the resident refused to be transported to the hospital. On 08/27/2026 between 10:39 AM and 04:30 PM, the department interviewed Staff #1–#5 (S1–S5) and Residents #1–#7 (R1–R7). Out of those interviewed, 5 out of 5 staff and 7 out of 7 residents denied the above allegation. On 08/28/2026, between 09:15 am and 02:30pm the department reviewed the Unusual Incident Report dated 08/17/2026. The report showed that on 08/14/2026 at 6:10 PM, R1 had a fall in her room, and a cut was observed on the top of her left eyebrow. The report also indicated that the facility’s Certified Nursing Assistant (CNA) and Medtech found R1 on the floor, called for assistance, contacted 911, and paramedics arrived. It also showed that R1’s primary care physician was notified and that R1’s relative refused hospitalization. Further review of the report showed that R1 stated she lost her balance while getting something from the refrigerator. Based on the information gathered, interviews conducted, and an analysis of records reviewed, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. CONTINUED ON LIC9099-C Allegation: Staff did not provide emergency services with R1’s medical records. It is alleged that staff were unable to provide paramedics with the residents’ medical information, hindering emergency care. On 08/27/2026, the department interviewed the Administrator Lida Zarafashan (S1). During the interview, the department asked S1 if staff provided emergency services with R1’s medical records. S1 said that on 08/12/2026, the resident fell and sustained an eyebrow injury, staff called 911, and notified the resident’s relative, and both the resident and relative refused hospitalization. S1 also said that staff have access to all residents’ emergency files, and when emergency services are contacted, staff routinely make copies of the resident’s emergency packet to provide to paramedics prior to their arrival. On 08/27/2026 between 10:39 AM and 04:30 PM, the department interviewed Staff #1–#5 (S1–S5) and Residents #1–#7 (R1–R7). Out of those interviewed, 5 out of 5 staff and 7 out of 7 residents denied the above allegation. On 08/28/2026, between 09:15 am and 02:30pm, the department reviewed R1’s Unusual Incident Reports dated 06/13/2024 and 08/14/2026, which showed that the facility filed both reports in a timely manner and immediately offered R1 assistance at the time of each occurrence. Based on the information gathered, interviews conducted, and an analysis of records reviewed, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. Allegation: Staff do not effectively communicate with residents due to language barriers. It is alleged that staff are often unable to communicate effectively with several residents, noting that many of the residents are Persian. CONTINUED ON LIC9099-C On 08/27/2026, the department interviewed Administrator Lida Zarafashan (S1) regarding communication with the residents. During the interview, S1 was asked if staff effectively communicated with the residents. S1 said that most caregivers speak or understand Farsi and can communicate effectively with residents. S1 also said that if additional help in translation is needed, staff will contact the administrator or on-call personnel, who will provide translation assistance 24 hours a day. On 08/27/2026 between 10:39 AM and 04:30 PM, the department interviewed Staff #1–#5 (S1–S5) and Residents #1–#7 (R1–R7). Out of those interviewed, 5 out of 5 staff and 7 out of 7 residents denied the above allegation. On 08/28/2026, between 09:15 am and 02:30pm the department interviewed R1, who was asked if they ever had trouble communicating with staff because of language differences and whether it affected how quickly they received help when needed, and R1 said no. Based on the information gathered, interviews conducted, and an analysis of records reviewed, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is Unsubstantiated. An exit interview was conducted with the Administrator Lida Zarafashan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2026 · control 11-AS-20260817103402

Allegation investigated: Staff do not ensure residents' medication records are up to date.

On July 22, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit. LIDA ZARFSHAN the Administrator, greeted the LPA and explained that the purpose of the visit was to investigate the allegation mentioned above. The investigation involved collecting documents and inspecting the facility. A review was conducted of the Personnel Report LIC 500 (dated July 22, 2026), the Facility Resident Roster (dated July 08, 2026). Physician Orders (dated 07/08/26 – 08/06/26), MARs (dated 07/08/26 – 08/06/26), and Centrally Stored Medication logs and other pertinent records associated with this complaint. Interviews with Resident #1- #9 and Staff #1 - #4. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff do not ensure residents’ medication records are up to date. It is alleged that facility staff do not ensure residents’ medication records are up to date. Reports indicated concerns that facility staff are not authorized to discuss medications over the phone, which hinders efficient patient care. Further reports noted difficulties in getting updated patient medication lists, which are often outdated and pose risks to patient safety. Additionally, reports mentioned that staff members seem to be out of the office frequently. No further detailed information was provided. On July 22, 2026, between 10:55 AM and 12:20 PM, the Department interviewed residents identified as Resident #1 through Resident #9 (R1-R9). Nine (9) out of the nine (9) resident members who receive medication assistance could not corroborate this claim. Residents expressed a positive experience regarding the assistance they receive with their medications. They noted that staff consistently provide reliable support and that they have not encountered any problems related to incorrect, missing, or outdated medication information. Furthermore, residents appreciate communication from staff regarding any changes in their medications, ensuring they are well-informed and supported throughout the process. expected. All residents reported no staffing issues and confirmed staff are always available to assist. On July 22, 2026, between 10:30 AM and 1:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Four (4) out of the four (4) staff members could not support this claim. According to staff members S3 and S4, those responsible for medication administration maintain up-to-date medication records, promptly receive and file physician orders, and update Medication Administration Records (MARs) and Centrally Stored Medication logs when changes occur. The staff described their procedures for receiving new orders, documenting changes, and communicating updates during shift transitions. Additionally, for prescription refills of PRN medications, the facility collaborates with Omnicare, and all refills are processed electronically without delays. (S3 and S4) mentioned that the facility typically only receives requests for medication lists when a resident is hospitalized. At that point, a request for a physician’s medication order is faxed to the hospital. (Evaluation Report continues LIC 9099-C) (S1- S4) emphasized that discussions regarding residents’ medications by telephone are rare due to the requirements of the Health Insurance Portability and Accountability Act (HIPAA). (S2) noted that all staff have completed American Health Care training on (HIPAA), and a registered nurse conducts audits of the Physician Orders and MARs for accuracy weekly. According to (S1-S4) our med team is well-staffed, with four med-technicians on the morning shift, three on the evening shift, and one available for the NOC shift, ensuring full coverage throughout the day and night. The Department's review of medication administration records for a sample of residents showed that Physician Orders (dated 07/08/26 – 08/06/26), MARs (dated 07/08/26 – 08/06/26), and Centrally Stored Medication logs were consistent and current. No discrepancies were observed between the medications present in the facility and the written records reviewed. No documentation was found to indicate outdated or inaccurate medication records. Additional review of staff American Health Care Academy (HIPAA) training. Further review of Personnel Report LIC 500 (dated 07/22/26) verified med team staffing for all shifts. Based on interviews conducted and records reviewed, there was insufficient evidence to support the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with LIDA ZARAFSHAN, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Jul 22, 2026 · control 11-AS-20260715204314

Allegation investigated: Facility staff did not seek timely medical attention for a resident who developed an abscess.

On 07/06/2026 at 10:10 am, the Department conducted a initial visit at the facility to deliver the complaint investigation findings. During today’s visit, Licensing Program Analyst (LPA) Zina Brown met with Administrator Lida Zarafshan and explained the purpose of the visit. The investigation consisted of the following: On 04/15/2026, the Department conducted interviews between 8:49am – 1:41pm with the Administrator (A1), Staff (S1–S9), and Residents (R2–R9). On 05/19/2026 between 9:46am – 9:51am, the Department interviewed R1. The Department contacted the W1 on 04/14/2026 at 2:05pm, 05/20/2026 at 10:10am, and 07/06/2026 at 8:26am, with no response. Additional attempts were made on 05/18/2026 at 1:38pm and 06/04/2026 at 4:19pm, to speak with W2 also with no response. LPA also reviewed the following records for R1: LIC 601 Identification & Emergency Information (dated 02/04/2025); LIC 602 Physician Report for RCFE (dated 01/30/2026), LIC 603A Preplacement Appraisal Information (dated 02/04/2025), LIC 625: Needs & Appraisal Service (dated 02/10/2026), Medication Administrator Record (MAR) (dated 09/2025 - 05/19/2026), LIC 624 Unusual Incident Injury Report (dated 04/09/2026), Admission Agreement (dated 02/04/2026) and the discharge packet from Beachwood Post Acute & Rehab (dated 04/30/2026). Unsubstantiated On 04/27/2026 between 10:00am – 10:30am, the Department reviewed records and observed that the LIC 624 (dated 04/08/2026) documented R1’s transfer to Cedars Sinai Medical Center due to the discovery of a lump under the left armpit area. The LIC 602 (dated 01/30/2026) indicated “No” under Section I, item M: History of Skin Condition or Breakdown. On 05/18/2026 between 3:15pm – 3:25pm, the Department reviewed the discharge packet from Beachwood Post Acute & Rehab. Records showed that R1 was hospitalized from 04/08/2026 – 04/20/2026 and admitted to rehab from 04/20/2026 – 04/30/2026. The admission record documented diagnoses including cutaneous abscess of limb, cutaneous abscess of chest wall, and MRSA infection. The discharge summary noted that R1 received nursing care and therapy services during the rehab stay. Based on interviews and record reviews, there is not enough evidence to support the allegation. 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. Exit interview conducted with Lida Zarafshan (Administrator) and a copy of this report was provided. The investigation revealed the following: Allegation: Staff did not seek timely medical attention for a resident who developed an abscess It was alleged that a resident developed a lump under the left armpit area that required hospital evaluation, and concerns were raised about whether the condition had been identified and addressed in a timely manner On 04/15/2026 between 10:42am – 11:01am, the Department interviewed A1 regarding the allegation. A1 denied the allegation. A1 stated that on 04/08/2026, when R1 was taking a shower, a caregiver observed swelling and an abscess under the resident’s left armpit. A1 reported that R1 and R1’s primary care physician were informed immediately, and a family member arrived at the facility and was present during transportation. A1 stated that R1 was transported to Cedars Sinai Hospital per physician order without delay, and an incident report was submitted to the Department on 04/09/2026. On 06/16/2026 at 3:45 PM, the Department contacted A1 for further clarification. A1 reiterated that the caregiver discovered the swelling and abscess during R1’s shower on 04/08/2026, that the primary care physician and family were notified immediately, and that R1 was transported to the hospital per physician order. On 04/15/2026 between 8:49am – 11:32am, the Department interviewed nine (9) staff. 9 out of 9 staff denied the allegation. Staff reported awareness that R1 had been transported to the hospital but did not report any concerns or delays related to the facility’s response to the abscess. On 04/15/2026 between 11:43am – 1:41pm, and on 05/19/2026 between 9:46am – 9:51am, the Department interviewed nine (9) residents. 9 out of 9 residents denied the allegation. Residents did not report concerns regarding staff response to medical needs or delays in seeking medical attention. Investigation continues on LIC 9099-Cthe state’s words, verbatim · CDSS document, Jul 6, 2026 · control 11-AS-20260706082126

Allegation investigated: Staff did not maintain the facility hallways free of obstructions Staff are not properly trained Staff retained expired food at the facility Staff did not practice proper hand hygiene when handling foods

On 05/20/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator Controller, Ilana Yazdi, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During today’s visit, LPA inspected the facility, observed lunch being served, interviewed Staff S1-S8, interviewed Residents R1-R9, and received and reviewed documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, Medication Technician Training, California Board of Registered Nursing Licensing Details, kitchen staff California Food Handler Certificate and receipts from West Pico Distributor (dated 05/05/26), Good Quality Produce Inc (dated 05/21/2026), Pacific Fresh Fish Co (dated 05/20/2026), and Dairy King (dated 05/20/26). The investigation revealed the following: Unsubstantiated Allegation: Staff did not maintain the hallway facility free of obstructions The allegation alleges that staff have placed tables in the hallways which is a hazard in case of an emergency. During the facility inspection, LPA and S1 walked all hallways in the facility. LPA observed all walkways and hallways were clean, clear, and free of debris, hazards, and obstructions. LPA did observe, while residents were participating in activities and having meals, staff were placing walkers in the hallway, outside the door. LPA observed that with the walkers lined up against the walls, there was still ample space for residents, residents with a walker or wheelchair, and staff, to pass through safely. Additionally, LPA observed that hallways have small trash cans and fans pressed up against the walls, not obstructing hallways. During interviews with Staff S1-S8, were asked if the walkways and hallways were kept clear and free of obstructions, eight (8) out of eight (8) stated yes, the hallways and walkways are kept clear. During interviews with Residents R1-R9, were asked if staff keep the hallways clear of obstructions, nine (9) out of nine (9) stated yes, staff ensure hallways are kept clear. Additionally, Residents R1-R9 were asked if staff have placed items such as a table, chairs, or cabinet in the hallway that limits their access to get through, nine (9) out of nine (9) stated no, there are not items like that placed in the hallways. Allegation: Staff are not properly trained The allegation alleges that caregivers have been assigned to be med techs but have not been fully trained. During record review, LPA received and reviewed the medication technician training records and observed medication technicians have received the 24-hours initial training, including 16- hours of shadowing. Medication Technicians received the following training regarding medications, Medication Pass Fundamental Video Training that consists of Preparation, Errors, Safety Security and Controlled Substances, Route Specific Administration and Common Errors: Oral, Ophthalmic, Otic, Nasal, Enteral, Topical, Inhaled, Subcutaneous and Suppositories. Additional training includes Personal Rights of the Resident, personal and Direct care, Medication Management, Psychosocial Needs of the Elderly, Occupational Health, Resident Health, Surveillance and Disease Reporting, Hand Hygiene, Standard and Transmission Based Precautions, Respiratory Hygiene and Source Control, Injection Safety, and Environmental Cleaning. Med Techs additionally receive training from Omnicell Nurse Training including Cycle Counting Module, Basic Workflow Training, Restocking Module, Super User Task Module, and Overview Training. During interviews with Staff S1-S6, were asked if they received the required 24-hours of training for assisting residents with self-administration of medications, six (6) out of six (6) stated yes, they initially received 8-hours of instruction and 16-hours of shadowing for a total of 24-hours. During interviews with Residents R1-R9, were asked if they have any concerns regarding the medication technicians training, nine (9) out of nine (9) stated no, they have no concerns regarding medication technician’s training. Allegation: Staff retained expired food at the facility The allegation alleges that expired milk was observed in the refrigerator in the kitchen. During the facility inspection, LPA reviewed the dates on perishable foods and non-perishable foods. LPA observed fresh produce in the refrigerator properly stored and dated when delivered and opened. LPA checked the dates on the dairy products, eggs, grains, and meats and observed the best before dates have not passed. During record review, LPA received and reviewed receipts for food purchased for the month of May 2026. The receipts are from the following West Pico Distributor (dated 05/05/26), Good Quality Produce Inc (dated 05/21/2026), Pacific Fresh Fish Co (dated 05/20/2026), and Dairy King (dated 05/20/26). During interviews with staff S1-S8, were asked if expired food is retained by staff and served to the residents, eight (8) out of eight (8) stated no, to their knowledge expired food is not retained or served to residents. Additionally, Staff S1-S8 were asked if there has been any complaint about the food being spoiled, one (1) out of eight (8) stated there was once a while ago that a resident complained their food smelled rancid. During interviews with Resident R1-R8 were asked if they had been served expired or spoiled food, eight (8) out of eight (8) stated no, they have not been served expired or spoiled food. Allegation: Staff did not practice proper hand hygiene when handling foods During record review, LPA received and reviewed the kitchen staff’s Certificate of Achievement California Food Handler. LPA observed all California Food Handlers Certificates are valid till various dates in 2027. During the facility inspection, LPA observed kitchen staff preparing plates for lunch service. LPA observed staff had gloves on their hands, and were using spoons, spatulas, and tongs to serve food. LPA observed a kitchen staff assist a caregiver in the dining room, and when he returned to the kitchen, he washed his hands and put on a new pair of gloves. During interviews with Staff S1-S8, were asked if kitchen staff practice proper hand hygiene when handling food, five (5) out of eight (8) stated yes, staff practice proper hand hygiene when handling foods. Two (2) out of the eight (8) stated they are trained to practice proper hand hygiene and believe the kitchen staff are practicing proper hand hygiene. Additionally, Staff S1-S8 were asked if kitchen staff use gloves while preparing and serving food eight (8) out of eight (8) stated they see staff using gloves while serving food. During interview with Resident R1-R9, were asked if kitchen staff practice proper hand hygiene when handling food, nine (9) out of nine (9) stated yes, staff practice proper hand hygiene when handling food During the course of the investigation, LPA was unable to find evidence to support the allegation(s). Although the allegation(s) may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) is/are unsubstantiated. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 20, 2026 · control 11-AS-20260511095526

Allegation investigated: Staff do not provide residents with medication as prescribed. Staff do not ensure that the facility is kept clean.

On 05/19/2026 at 9:00am, the Department conducted an subsequent visit at this facility deliver the complaint investigation findings. During today's visit, the Department met with Lida Zarafshan (Administrator) and explained the purpose of the visit. The investigation consisted of the following: On 04/15/2026, the Department conducted interviews between the hours of 8:49am - 1:41pm with Administrator (A1), Staff (S1- S9), Resident (R2 - R9) and on 05/19/2026 between the hours of 9:46am - 9:51am interview was conducted with R1. The Department requested copies of the staff roster (dated 04/09/2026) and resident roster (dated 03/02/2026, 04/08/2026, 04/14/2026). LPA also reviewed the following records for R1: LIC 601 Identification & Emergency Information (dated 02/04/2025); LIC 602 Physician Report for RCFE (dated 01/30/2026), LIC 603A Preplacement Appraisal Information (dated 02/04/2025), LIC 625: Needs & Appraisal Service (dated 02/10/2026), Medication Administrator Record (MAR) (dated September 2025 - May 19, 2026), LIC 624 Unusual Incident Injury Report (dated 04/09/2026), Admission Agreement (dated 02/04/2026) and Discharge Summary (dated 04/30/2026) Unsubstantiated The investigation revealed the following: Allegation: Staff do not provide residents with medication as prescribed. It was alleged that a resident has had scabies since on or around 10/20/2025 and that facility staff have not been applying the medicated cream prescribed for treatment of the condition. It was further alleged that despite the ongoing nature of the condition, no improvement has been observed, raising concerns that the prescribed topical treatment has not been consistently administered as ordered. On 04/15/2026 between 10:42am – 11:01am, the Department interviewed A1. A1, who denied the allegation, stated that the resident received treatment for suspected scabies; however, no biopsy confirming scabies were present for R1. A1 reported that a medicated cream was prescribed and administered by the medtech, and that topical treatments are documented on daily communication logs. A1 stated the resident had been transported to Cedars Sinai Hospital on 04/08/2026 for an abscess near the armpit, and an incident report was filed to the Department on 04/09/2026. On 04/15/2026, between 8:49am – 11:32am, the Department interviewed 9 staff regarding the allegation. 6 of 9 denied the allegation and stated that they were responsible for medication administration. These six (6) staff reported verifying topical treatments through labels, physician orders, and the MAR, and stated they had never skipped a prescribed topical treatment. Staff mentioned awareness of residents receiving scabies treatment and stated treatments were applied as ordered. 3 out of 9 staff were unaware of the allegation and did not know about any failure to administer prescribed medication. On 04/15/2026, between 11:43am – 1:41pm, and on 05/19/2026, between the hours of 9:46am - 9:51am, the Department interviewed 9 Residents (R1–R9) regarding the allegation. 9 out of 9 residents denied the allegation. Residents consistently stated that staff provide medications on time and as prescribed, and none reported missed doses. On 04/27/2026, between 10:00am – 10:30am the Department conducted a records review and observed that according to the LIC 624 (dated 04/08/2026), R1 was transferred to Cedars Sinai Medical Center per physician direction due to the discovery of a lump on the left armpit area. A review of the LIC 602 Medical Assessment for Residential Care Facilities for the Elderly (dated 01/30/2026) showed that on page 4 of 9, under Section I: Overall Physical Health, item M. “History of Skin Condition or Breakdown” was marked No, indicating no documented history of skin breakdown or chronic skin conditions at the time of assessment. On 05/18/2026, between 3:15pm– 3:25pm, the Department reviewed the discharge packet provided by the Administrator. Records showed that R1 was hospitalized at Cedars Sinai from 04/08/2026 - 04/20/2026, and subsequently admitted to Beachwood Post Acute & Rehab from 04/20/2026 - 04/30/2026. The admission record documented multiple diagnoses, including cutaneous abscess of limb, cutaneous abscess of chest wall, and MRSA infection. The discharge summary dated 04/30/2026 indicated that R1 received nursing care, physical therapy, occupational therapy, and speech therapy during the rehab stay. The clinical recap documented that R1’s skin was clear at discharge, R1 was alert, and no concerns were noted regarding medication administration. The discharge packet included a reconciled medication list provided to the resident representative and confirmed that medications and treatments were reconciled by the physician and prior to discharge. The discharge summary further documented that R1 was discharged home with home health services and that the family initiated the immediate discharge to an assisted living facility. No documentation in the rehab records indicated missed, delayed, or improperly administered medications, and no records referenced scabies treatment or a confirmed scabies diagnosis during the rehab stay. On 05/19/2026, between 9:15am – 9:45am, the Department conducted a medication records review for R1 (September 2025 - April 2026) and for six residents including R1 (for May 2026 medication). For the month of May 2026, beginning with the new medication cycle on 05/09/2026, the Department observed that residents in Rooms 100, 102, 116, 124, and 134 were administered all medications as prescribed by their primary physicians from 05/09/2026 to the date of review 05/19/2026. No discrepancies, missed doses, or irregularities were observed in theMARs reviewed. Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. 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. Allegation : Staff do not ensure that the facility is kept clean. It was alleged that the facility is not maintained in a clean condition and that staff are engaging in cross-contamination practices. It was further alleged that the overall cleanliness of the facility is inadequate, posing a potential health and safety risk to residents. On 04/15/2026 between 10:42am – 11:01am, the Department interviewed A1. A1 denied the allegation. A1 stated that housekeeping cleans the facility daily, infection control procedures include PPE, handwashing, and quarantining residents with rashes, and no complaints regarding cleanliness had been received. On 04/15/2026, between 8:49am – 11:32am, the Department interviewed 9 staff regarding the allegation. 9 out of 9 staff denied the allegation. Staff reported that housekeeping performs daily cleaning and that caregivers assist only as needed, such as when linens or clothing are soiled. Staff stated they follow infection control procedures, including glove use, handwashing, and PPE removal before exiting resident rooms. Housekeeping staff confirmed daily cleaning routines, including linen changes, bathroom sanitation, dusting, sweeping, mopping, and towel replacement. No staff reported concerns regarding cleanliness or cross-contamination. On 04/15/2026, between 11:43am – 1:41pm and on 05/19/2026, between the hours of 9:46am - 9:51am, the Department interviewed 9 Residents (R1–R9) regarding the allegation. 9 out of 9 residents denied the allegation. Residents consistently described the facility as clean, reported that their rooms are cleaned daily, and stated they observe staff changing gloves or washing hands between assisting residents. No residents reported concerns regarding cleanliness or cross - contamination. 04/15/2026, between the hours of 1:43pm - 1:53pm and on 05/19/2026 between the hours of 9:41am - 9:43am, the Department conducted a walk-through of the facility and observed the following: In Rooms 100, 102, 116, 124, 134, and 228 were observed to be clean, with beds made, linens in place, and no visible debris or odors. Floors were free of spills or clutter, and trash receptacles were not overflowing. Resident bathrooms observed during the walk through were clean, with stocked supplies and no visible sanitation concerns. Staff were observed wearing gloves while assisting residents and removing gloves before exiting resident rooms. No cross contamination concerns were observed during the walk through. Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. 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. Exit interview conducted with Lida Zarafshan (Administrator) and a copy of this report was providedthe state’s words, verbatim · CDSS document, May 19, 2026 · control 11-AS-20260413125505

Type of visit: Required - 1 Year

On 1/15/2026, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Lida Zarafshan/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (176) elderly adults ages 60 and above, of which (64) can be non-ambulatory and (5) bedridden on rooms:104, 106, 108, 118, and 128. Currently the facility has (80) residents. This facility consists of two buildings. Wooster Building consists of 50 bedrooms with private bathrooms, a dining room, kitchen, activity rooms, and an underground garage. Olympic Building consists of 62 bedrooms with private bathrooms, a dining room, kitchen, activity rooms and an underground garage. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (6) bedrooms and (6) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 104.0°F to 116°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there were sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 1/15/26. A review of (4) residents' service files and (4) staff personnel files was maintained in order. LPA reviewed (4) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was provided to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Lida Zarafshan/Administrator.the state’s words, verbatim · CDSS document, Jan 15, 2026

Allegation investigated: Staff did not keep facility free of bed bugs.

On 02/19/25, the department conducted an unannounced complaint visit to investigate the above-mentioned allegation. The department met with Administrator, Lida Zarafshan, and the purpose of today’s visit was explained. The investigation consisted of the following: The department requested, and received the following documents: staff roster, resident roster, and pest control records (dated: 11/09/24, 11/27/24, 12/09/24, 12/27/24, 01/09/25, and 01/30/25). The department interviewed staff #1-#6 and resident’s #1-#6 (R1-R6). Furthermore, the department conducted a tour of the entire facility and inspected rooms #103, #104, #109, #111, #115, and #121, #127, #201, #202, and #217. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff did not keep facility free of bed bugs. It is being alleged that multiple residents have bed bug bites. Based on interviews conducted, 6 out of 6 staff interviewed denied the allegation. 6 out of 6 staff interviewed stated they have not observed any bed bugs in the facility. 6 out 6 staff interviewed stated that the resident’s rooms are cleaned daily and as needed. 6 out of 6 staff interviewed stated there is a pest control company that comes and provides services twice a month. Based on interviews conducted, 6 out of 6 residents interviewed stated they have not observed any bed bugs, in their rooms or in the facility. 6 out of 6 residents interviewed stated that their rooms are cleaned daily, and bed sheets are changed once a week. 6 out of 6 residents interviewed stated they have seen a pest control company come to the facility and provide services. 6 out of 6 residents interviewed stated that they are overall satisfied with the facility and the services they are receiving. During the facility inspection, the department did not observe bed bugs or any traces of them. The facility and rooms inspected were observed to be clean and sanitary. During Record review, the department received and reviewed receipts from American City Pest & Termite dated 11/11/09/24 through 01/30/25. The department observed American City Pest & Termite has come out twice a month to provide services. S2 stated that American City Pest & Termite is scheduled to come this month to provide services as well. Based on interviews and records reviewed, there is not sufficient evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited during this visit. An exit interview was conducted with, Administrator, Lida Zarafshan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 19, 2025 · control 11-AS-20250212122159

Type of visit: Required - 1 Year

On 1/29/2025, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Lida Zarafshan/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (176) elderly adults ages 60 and above, of which (64) can be non-ambulatory and (5) bedridden on rooms:104, 106, 108, 118, and 128. Currently the facility has (80) residents. This facility consists of two buildings. Wooster Building consists of 50 bedrooms with private bathrooms, a dining room, kitchen, activity rooms, and an underground garage. Olympic Building consists of 62 bedrooms with private bathrooms, a dining room, kitchen, activity rooms and an underground garage. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (8) bedrooms and (8) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 105.0°F to 117.2°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 1/28/25. A review of (4) residents' service files and (4) staff personnel files was maintained in order. LPA reviewed (4) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance will be email to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Lida Zarafshan/Administrator.the state’s words, verbatim · CDSS document, Jan 29, 2025

Allegation investigated: Staff neglect/lack of supervision resulted in a resident sustaining a serious injury. Facility ramp is unsafe causing resident to fall. Staff did not respond to resident's request for assistance as needed.

On 10/21/2024 LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Lida Zarafshan/Administrator. LPA explained the purpose of this visit. Investigation Consisted of: Investigations Branch (IB) referral accepted dated 12/12/23 and completed investigation on 8/22/24. CCLD staff conducted the following interviews: Administrator Interview (A#1) 1/11/24, Facility Staff 1 Interview (S#1) 1/11/24, Witness Interview 1 (W#1) 1/31/24, Resident 1 Interview (R#1) 3/15/24, Witness Interview 2 (W#2) 4/15/24, Resident 2 Interview (R#2) 5/23/24, Resident 3 Interview (R#3) 5/23/24, Resident 4 Interview (R#4) 5/23/24, Resident 5 Interview (R#5) 5/23/24, Resident 6 Interview (R#6) 5/23/24, Facility Staff 2 Interview (S#2) 5/23/24, Facility Staff 3 Interview (S#3) 6/18/24. CCLD staff gathered the following documents: (R#1)’s Resident Appraisal/Needs and Services Plan dated 6/16/21, (R#1)’s Unusual Incident Reports dated: 10/28/2019, 11/21/2019, 02/24/2020, 04/18/2022, 05/18/2022 and 10/6/2023 and (R#1)’s medical records from Cedar Sinai Hospital dated 2/14/24. On 10/21/2024, the department interviewed the facility administrator (A#1), facility staff (S#1-S#5), residents (R#7-R#13) and conducted a health and safety check. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff neglect/lack of supervision resulted in a resident sustaining a serious injury. The details of the complaint alleged that (R#1) sustained a serious injury due to staff neglect/lack of supervision. During records review gathered by CCLD staff, LPA Iniguez observed that on (R#1)’s Resident Appraisal/Needs and Services Plan dated 6/16/21, there was no indication of a fall risk or prior falls. In addition, (2) out of (5) Unusual Incident Reports from facility regarding (R#1), are related to falls. Moreover, LPA Iniguez observed (R#1)’s medical report from Cedar Sinai Hospital dated 2/14/24. Hospital records does not state that (R#1) has a history of falls. Also, the department reviewed (R#1)’s Physician’s Report for Residential Care Facilities for the Elderly or LIC 602A dated 7/14/22, it is marked that (R#1) is ambulatory and can independently transfer to and from bed. During an interview conducted by CCLD staff with facility administrator (A#1) on 1/11/24, she stated that on 10/4/23 the facility was hosting a party, (R#1) informed the facility staff that they did not want to attend the party. (A#1) stated that later that day, (R#1) changed their mind and decided they wanted to attend the party, (R#1) made the decision to walk using their walker unassisted from their room towards where the party was held. During an interview conducted by CCLD staff with facility staff (S#1-S#3), (3) out of (3) stated that (R#1) did not wanted to go to the party but, later they changed their mind and decided to walk with their walker without telling the facility staff. In addition, (3) out of (3) facility staff stated that they are always assisting residents in care. Evaluation Report continues LIC 9099-C During an interview conducted by CCLD staff with resident 1 (R#1), (R#1) was not able to answer (IB) investigator questions due to cognitive impairment. During an interview conducted by CCLD staff with residents (R#2-R#6), (5) out of (6) stated that facility staff are always attentive and checking on them frequently. During an interview conducted by CCLD staff with (R#1)’s Primary physician (W#2), (IB) investigator asked him “if he had ever stipulated an updated in (R#1)’s care plan regarding them able to walk unassisted, (W#2) stated “no to his knowledge”. Allegation: Facility ramp is unsafe causing resident to fall. The details of the complaint alleged that (R#1) sustained a serious injury due to facility ramp is unsafe. During a physical tour of the facility, the department observed that the facility ramp was built from cement and seemed sturdy. Also, the department observed metal railings on both sides of the ramp and an anti-slippery mat where the ramp is. During an interview with the facility administrator (A#1), she stated, "Yes, the ramp is safe for the residents; it has railings on both sides to help residents grab an anti-slippery mat." During an interview with facility staff (S#1-S#5), (5) out of (5) stated that the facility ramp is safe for the residents to use. During an interview with residents (R#7-R#14), (7) out of (7) stated that the facility ramp is safe to use. Evaluation Report continues LIC 9099-C Allegation: Staff did not respond to resident's request for assistance as needed. The details of the complaint alleged that facility staff does not respond to resident’s request for assistance. During an interview with the facility administrator (A#1), she stated that yes, the facility staff responded to the resident’s request immediately, in less than 5 minutes. There’s always an extra caregiver to assist with the call light when the resident requests assistance. During an interview with facility staff (S#1-S#5), (5) out of (5) stated that they do assist the residents promptly; it takes them less than 5 minutes to help them. During an interview with residents (R#7-R#14), (7) out of (7) stated that the facility staff assisted them in a timely manner, and it took them less than 5 minutes. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. 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. An exit interview was conducted, and a copy of the Complaint Report was given to Lida Zarafshan /Administrator.the state’s words, verbatim · CDSS document, Oct 21, 2024 · control 11-AS-20231221160832

Allegation investigated: Staff did not adequately assist resident with mobility needs. Staff accepted money outside of monthly rent fees from resident.

On 4/17/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Lida Zarafshan /Administrator and explained the purpose of this visit. Investigation Consisted of: Interview with Administrator(A#1), Facility Staff (S#1-S#5), Residents (R#1-R#8), Witnesses (W#1 and W#2) and Reporting Party (RP). LPA Iniguez reviewed the following records: Staff Roster, Residents Roster, (R#1-R#5) Physicians Report for Residential Care Facilities for the Elderly or LIC 602, (R#1-R#5) Admissions Agreement, (R#1-R#5) Identification and Emergency Information LIC 625, (R#1-R#5) Appraisal/Needs Service Plan LIC 625, (R#1-R#5) Medication Administration Record (MARS) for the month of March 2024, copies of staff training regarding residents falls. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff did not adequately assist resident with mobility needs. The details of the complaint alleged that facility staff are did not adequately assist resident with mobility needs while in care. As part of the records review, LPA carefully examined (R#1)'s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A. According to the report, (R#1)'s mental condition does not hinder their ability to make decisions, follow instructions, or communicate their needs. Moreover, (R#1) can transfer to and from the bed independently and uses a walker as an assistive device. During interview with the Administrator (A#1), she mentioned that the facility takes several measures to prevent residents from falling. These measures include in-services for all employees, regular checks on residents' medications to determine if there are any changes that might increase the risk of falling and advising residents to pull the call cord to receive assistance in getting up and prevent falling. (A#1) also stated that (R#1) has fallen no more than four times recently, and only twice recently. However, if a resident falls consecutively, the facility will immediately inform their physician and family. The facility also provides fall prevention services for all staff every three months, and all staff members are available to assist residents whenever they ask for help. During an interview with witnesses (W#1 and W#2), they both confirmed that they perceive (R#1) as safe and well taken care of at the facility. They also agreed that whenever (R#1) requests assistance from the staff, they are prompt to come and help, although it may take around 20 minutes. Furthermore, (W#1) and (W#2) clarified that (R#1) has only fallen twice recently, and not more than that. They also stated that the staff is not responsible for (R#1)'s falls. Evaluation Report continues LIC 9099-C During interviews with residents (R#2-R#8), (7) out of (7) residents stated that they feel safe living here and that they get assistance from staff when they request it. In addition, (7) out of (7) state that they have not fallen due to lack of help from staff. During interviews with staff (S#1-S#5), (5) out of (5) staff members stated that the facility has a process in place that allows them to identify fall-risk residents; also, they said that when a resident needs assistance, they always use the "call light" and we go and check on them. In addition, (5) out of (5) staff members stated that they do not know (R#1) falling more than four times recently or another resident in care; also, they stated that they received training every three months regarding Fall Prevention and they all state that when (R#1) or another resident in care needed assistance, they always providing it. Allegation: Staff accepted money outside of monthly rent fees from resident. The details of the complaint alleged that facility accepted money outside monthly rent fees from resident. During the records review, LPA Iniguez examined (R#1)'s admission agreement. The agreement stated that the facility is not responsible for managing (R#1)'s finances and that the family is responsible for it. Evaluation Report continues LIC 9099-C During an interview with the administrator (A#1), it was mentioned that (R#1)'s family, (W#1) and (W#2), manage their finances, and that (R#1) does not have any money with them at the facility. Additionally, (A#1) stated that the facility staff, including herself, do not accept gifts or tips from residents. If a resident wishes to give the staff a gift or a tip, they must inform the administrator beforehand. This is because some residents in care have a medical condition that would make them forget about it, and they will not remember giving the gift the next day. However, it is okay for families to provide gifts. Furthermore, (A#1) denies any financial abuse towards (R#1) or any other resident in her care. During an interview with witnesses (W#1 and W#2), both stated that (R#1) does not give monetary tips to facility staff since (W#1) manages (R#1) financial affairs. Also, they both state that facility staff has yet to ask (R#1) for extra money. In addition, both (W#1) and (W#2) state that they feel they can trust the facility staff to take care of (R#1). During interviews with residents (R#2-R#8), (7) out of (7) residents stated that they do not give monetary tips to facility staff, and facility staff has yet to ask them for additional money. In addition, (7) out of (7) state that they feel they can trust the facility staff to take care of them. During interviews with staff (S#1-S#5), all (5) staff members categorically denied receiving monetary tips from (R#1) or any other resident in care. They also vehemently denied any instances of financial abuse towards (R#1) or any other resident in care, thereby affirming their integrity. Evaluation Report continues LIC 9099-C During this investigation, LPA found did not find sufficient evidence to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. 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. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Complaint Report was given to Lida Zarafshan /Administrator.the state’s words, verbatim · CDSS document, Apr 17, 2024 · control 11-AS-20240412095519

Type of visit: Required - 1 Year

On 2/7/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit. LPA met with the facility’s administrator Lida Zarafshan and the purpose of today’s visit was explained. LPA was granted access to this facility. The facility is licensed to serve one hundred seventy-six (176) residents sixty-four (64) non-ambulatory and five (5) bedridden in rooms # 104, #106, #108, #118 and #128. There are currently eighty (80) residents in placement. This facility consists of two buildings. Wooster Building consists of 50 bedrooms with private bathrooms, a dining room, kitchen, activity rooms, and an underground garage. Olympic Building consists of 62 bedrooms with private bathrooms, a dining room, kitchen, activity rooms and an underground garage. LPA Gonzalez and administrator Lida Zarafshan toured the inside and outside grounds of the facility. As part of this inspection LPA checked rooms #105, #110, #111, #119 in Olympic building and rooms #103, #104, #109, #115 in Wooster building. All resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, the shower was free of mold/mildew and a non-skid mat was in place. The water temperature measured between 105.0 F and 120.0 F in all bathrooms. Extra linen, bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. LPA did not observe any bodies of water. A comfortable temperature was maintained in both buildings. LPA observed the facility to be clean and appropriately furnished at the time of visit. The kitchen was checked and observed to be within Title 22 regulations. Sufficient perishable and non-perishable food supply was maintained adequately. All sharps, toxins, cleaning solutions, hazardous items, and medications were securely locked and inaccessible to clients. Continued on LIC 809-C The facility has a landline telephone on-site in working condition. Medications were centrally stored and properly locked. Smoke detectors and carbon monoxide detectors were operational and working properly. LPA observed a fully charged fire extinguishers. LPA observed a stocked First Aid kit along with manual locked and inaccessible to clients. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, LPA observed sanitizing stations located in common areas and restrooms. LPA observed all the required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility has an approved CCLD Mitigation Plan. During this inspection LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Report and Appeal Rights was provided to administrator Lida Zarafshan.the state’s words, verbatim · CDSS document, Feb 7, 2024

Allegation investigated: Staff forged resident's documents

On 1/11/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced subsequent visit to this facility. LPA was met by Director, Lida Zarafshan, and explained the purpose of the visit is to deliver findings for the allegations mentioned above and was granted access to the facility. The investigation consisted of the following: On 1/5/24 LPA reviewed resident files and toured the facility. LPA reviewed and requested copies of the following records: Resident Roster, Staff Roster, resident files and payment standards for requested residents. The investigation revealed the following: Cont'd 9099-C Unsubstantiated Allegation: Staff forged resident’s documents It is alleged that R-1 was asked to sign a document that they believe did not belong to them as all the information on the document was incorrect. On 1/5/24 LPA Shirley reviewed resident files. During file review, found there to be no evidence of forged documents. LPA did not find a description of a document that R-1 claims they were requested to sign. LPA described said document to the director at the facility and director does not recall any such document. LPA verified SSA# on file with R-1. Resident answered with the correct number. LPA verified address on file with R-1 and resident was confused about which side of the facility she lived on, as this facility uses two mailing addresses. The address assigned is determined by the location of your room. On 1/5/24 LPA conducted interviews with both staff and residents. LPA interviewed staff, staff 1 – staff 7 (S-1 – S-7). LPA asked staff, “Do you forge resident’s document.” Of those interviewed 7 out of 7 stated no. LPA interviewed residents 1 – resident 7 (R-1 – R-7). LPA asked residents, if they believe that staff has forged their documentation. Of those interviewed, 6 out of 7 answered, no. Based on information gathered, the department did not find sufficient evidence to support allegations "Staff forged resident’s documents.” 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. An exit interview was conducted and a copy of the LIC 9099 was provided to Director Lida Zarafshan.the state’s words, verbatim · CDSS document, Jan 11, 2024 · control 11-AS-20231228141222