Arcadia Gardens Retirement Hotel

Allegation investigated: Staff is not dispensing resident's medication as prescribed. Staff are not serving a good quality of food. Facility has ants.

***This licensing report supersedes the original complaint investigation report, dated 06/23/22. The findings remain as Unsubstantiated. *** Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint investigation for the allegations listed above on 09/07/23. An initial complaint visit was conducted on 10/08/21 and subsequent visit was conducted on 06/23/22. During today’s visit, LPA Tao met Administrator Pamela Parsons, and explained the purpose of today's visit, which was to interview residents and re-deliver the investigation findings of the above-mentioned allegations. The investigation consisted of the following: interviews with Staff #1 (S1) through Staff #6 (S6); interviews with Resident #1(R1) through Resident #11 (R11); attempted to interview resident #12 (R12) and resident#13 (R13), reviews of resident #1’s facility records and a tour of the physical plant. LPA obtained copies of the staff/resident rosters; copies of In-Service Training (Insulin Administration) Records, Pest Control Service Agreement, and Pest Control Company Invoices; and resident #1(R1)’s file for review of relevant information. (-continued in LIC 9099 C-) Unsubstantiated ***This licensing report supersedes the original complaint investigation report, dated 06/23/22. The findings remain as Unsubstantiated. *** In regard to allegation "staff is not dispensing resident's medication as prescribed," it was alleged that staff did not administer resident’s medication and/or insulin as prescribed. Per residents’ interview, eleven (11) out of eleven (11) residents could not corroborate the allegation. Residents interview revealed their medication was administered as prescribed. Per the interviews with residents who were on insulin revealed that staff would check their blood sugar prior administer their insulin and provided proper dosages accordingly. Per staff interviews, six (6) out of six (6) staff denial the allegation. Staff interviews revealed staff would follow the resident’s chart to administer residents’ medication and observe residents when taking the medication. Staff / LVNs would check the resident’s blood sugar between 7:30 a.m. to 8:00 a.m. daily. Night shift LVNs would administer the resident’s medication (Insulin) on Fridays and Saturdays. During the weekday, the morning shift LVN would administer residents’ medication (Insulin). Residents’ blood sugar readings were checked daily and posted in the medication administration record (MAR). The MAR recorded the blood sugar to determine whether the resident’s medication (Insulin) administration was needed. Medication was recorded and documented in the medication computerized system which keeps track of the prescribed medication (Insulin). The medication (Insulin) dosage was determined by the resident's physician. Per the review of residents’ Medication Administration Records (MAR) from 09/01/21 to 09/30/21 and from 10/01/21 to 10/08/21, MAR documented residents had received their blood glucose checks at 7:30 a.m. and at 4:30 p.m. and administered their prescribed medication at 8:00 a.m. Per file reviews, the facility’s in-service training records documented the facility offered training on 08/15/21 to facility LVNs presented by facility’s LVN Director regarding the topic: “Insulin Administration”. Therefore, staff is dispensing resident’s medication as prescribed. In regard to allegation "staff are not serving a good quality of food", it was alleged that facility did not provide good quality food to residents. Per residents’ interview, nine (9) out of eleven (11) residents could not corroborate the allegation. Residents’ interview revealed the majority of residents corroborated that the facility’s food service is good and there were no issues with the quality of food service. Two (2) out of eleven (11) residents stated the food was not good because it tasted bland or overdone. Per staff interviews, six (6) out of six (6) staff denial the allegation. Staff interviews revealed staff would provide good quality of food and alternate menu was available to residents. (-continued in LIC 9099C-) ***This licensing report supersedes the original complaint investigation report, dated 06/23/22. The findings remain as Unsubstantiated. *** A virtual tour of the facility’s physical plant was conducted including the kitchen, dining area, food supply; and a review of the facility’s menus showed the facility was all in compliance. During the subsequent visit, LPA/RA Ceniceros conducted a tour with Administrator Parsons to the commercial kitchen, dining room area, and residents’ bedroom to ensure food services were in compliance. LPA Tao toured to the kitchen and observed food were cooked fresh and served hot. Thus, staff is providing good quality food to residents. In regard to allegation “facility has ants", it was alleged that facility had ants in the facility. Per residents’ interview, ten (10) out of eleven (11) residents could not corroborate the allegation and had not seen ants in their rooms. One (1) resident out of eleven (11) residents said only seen ants when food was left out overnight. Residents’ interview revealed the facility did not have ants issues. Per staff interviews, six (6) out of six (6) staff denial the allegation. Staff interviews revealed staff did not see ants in the facility. During the initial visit conducted by LPA Tao, and subsequent visit conducted by LPA/RA Ceniceros, no ants were observed during the physical plant including facility’s commercial kitchen, dining room area, and residents’ bedroom. As a preventive measure, the facility had a monthly contract with a pest control company that conducts services. Therefore, the allegation of the facility has ants is found to be UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator and a hard copy was provided.the state’s words, verbatim · CDSS document, Sep 7, 2023 · control 28-AS-20211004122114

Allegation investigated: Facility does not have enough staff to meet resident care needs. Contact information of the ombudsman program is not easily accessible to residents and their representatives. Staff required unlawful changes to resident's insurance from resident's representative.

Licensing Program Analyst (LPA) Tao conducted an unannounced 10-day complaint visit to this facility. LPA met with Administrator, Pamela Parsons, who assisted with the visit. LPA explained the purpose of today’s visit was to investigate the above-mentioned allegations. The investigation consisted of the following: resident interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster, and residents facility file. The investigation revealed the following: In regard to allegation “facility does not have enough staff to meet resident care needs," it was alleged that facility did not have enough staff to help residents to get into bed or take back to residents’ room after eating in the dining room and keep their oxygen cannula not on the floor of residents’ room. (-continued LIC 9099 C-) Unsubstantiated Ten (10) out of ten (10) residents interviewed revealed that facility staff had helped residents on getting them into bed, taking them back to their rooms timely and keeping their oxygen cannulas not on the floor. Four (4) out of four (4) staff denied the allegation. Staff interviews revealed that staff would assist residents to meet residents’ care needs. Per LPA’s observation, staff would assist residents to get into bed and take residents to dining room/back to residents' room. Per facility tours and resident interviews, LPA did not see residents’ oxygen cannula were on the floor during the facility tour. After mealtime, staff would take a few residents back to their rooms at a time to prevent traffic jam or congestion in the hallway and elevator. Other residents would remain at the dining room waiting for their turn. Therefore, facility did not show lack of staff to meet residents care needs. In regard to allegation “contact information of the ombudsman program is not easily accessible to residents and their representatives," it was alleged that facility had no public posting of ombudsman. Ten (10) out of ten (10) residents interviewed could not corroborate the allegation. All four staff interviewed denied the allegation. Per LPA observation, facility had posted the public posting of ombudsman program poster (in size 1.5ft x 2ft) in the lobby next to the resident’s elevator and administrator office. Therefore, facility had posted the contact information of the ombudsman program at the facility’s common area. In regard to allegation “staff required unlawful changes to resident's insurance from resident's representative," it was alleged that facility was unlawfully changed resident’s health Insurance in mid-May effective June 1st. (-continued LIC 9099 C-) Ten (10) out of ten (10) residents interviewed could not corroborate the allegation. Four (4) out of four (4) staff denied the allegation. Staff interviews revealed that some residents’ insurance agency would end its services with the facility on June 1, 2023. Therefore, staff notified residents/responsible parties about their insurance issues on updating/switching their insurance to another insurance agencies to continue their coverage. Administrator explained that a total of 17 residents’ health insurance would end on May 31, 2023. Therefore, a letter was sent to residents/ responsible parties to notify them regarding the end of the service term of their current health insurance. Facility had provided options to residents on agencies selections and residents could make their decision voluntarily. Per file reviews, that particular health insurance agent would end its service term with the facility in June 2023. Notification letters were provided, and phone calls were made to residents/ residents' responsible parties regarding facility suggestions and residents’ options. Residents have right to make selection of their own. Therefore, staff did not require unlawful changes to resident's insurance from resident's representative. 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 Administrator. A hard copy of the reports were provided.the state’s words, verbatim · CDSS document, May 18, 2023 · control 28-AS-20230508144515

Allegation investigated: Facility not assisting resident with ADLs. Facility did not provide lunch to residents. Food served to residents is cold.

***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint visit to the facility regarding the above-mentioned allegations. Upon arrival at the facility, LPA met Pamela Parsons, Administrator and explained the purpose of today’s visit. On 12/28/20, LPA Tao conducted the initial investigation visit telephonically due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. LPA obtained resident roster, staff roster, facility’s house rules, resident #1’s (R1) Physician Report, R1’s Identification and Emergency Information, R1’s Appraisal, R1’s Care plan, R1’s Needs and Services Plan, R1’s Individual Service Plan (IPP) Initial Assessment (06/02/20), and R1’s Narrative Charting (progress report). (- continued in LIC 9099 C-) Unsubstantiated ***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** LPA Tao also obtained R1’s Individual service plan (IPP), R1’s Admission Agreement, R1’s assessment plans, Activities and Outings guidance (December 2020), L.A. County, DPH Activity Protocol, Facility’s Activity Plan for Christmas special event, Dietary Protocol, Alternative Meal Delivery Procedure, Menus (November 29, 2020 - January 2, 2021), Activities Calendar (December 2020), resident#2 (R2)’s Assessment, R2’s Individualized Service Plan (IPP), R2’s Physician’s report, R2’s Move in Notification (6/2/20), R2’s personal rights, R2’s care plan, R2’s narrative charting, Dietary services (1/4/21) during facility’s COVID outbreak, DPH Outbreak Notification letter of COVID – 19 outbreak (12/16/20), and virtually toured the facility which included the kitchen, dining area, and activity room. In addition, LPA interviewed staff#1 (S1) and resident#1 (R1) telephonically. On 06/23/22, LPA/Retired Annuitant (RA) Elizabeth Ceniceros conducted a subsequent visit at the facility, reviewed resident files and delivered findings. LPA/RA obtained copies of Resident #2 (R2)’s Emergency Identification and Information, R2’s Physician’s Report, R2’s Medication Administration Record, R2’s Appraisal/Needs and Services Plan. LPA/RA toured the facility’s commercial kitchen and dining room area. On 03/14/23, LPA Tao conducted another subsequent visit. During the visit, LPA obtained copies of staff and resident rosters, reviewed residents’ files, interviewed staff and residents, conducted a facility tour, and delivered findings. LPA interviewed staff from staff #2 (S2) through staff #6 (S6) and residents from resident#2 (R2) to resident#13 (R13). The investigation consisted of resident interviews, staff interviews, residents’ files review, facility tour, and LPA’s observation. In regard of allegation, “facility not assisting resident with ADLs (activities of daily living)”, it was alleged that staff did not assist resident #2 (R2) with daily living activities needs and provide social activities. The investigation revealed the following: LPA interviewed resident#1(R1), resident said staff did not assist resident #2 (R2) with daily living activities needs and social activities. Twelve (12) out of thirteen (13) residents, including R2, interviewed could not corroborate the allegation. All staff interviewed denied the allegation. (- continued in LIC 9099 C-) ***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** Per LPA/RA Ceniceros’ file review revealed that R2 had a caregiver to assist resident’s ADLs. A review of Resident #2’s Physician’s Report (dated 09/28/21) documented that R2 requires assistance with activities of daily living. Facility staff would assist R2 to bathe, get dressed, assist in placing the resident in resident’s chair, bring the resident food, conduct room checks, wash/dry/fold laundry, and administer R2’s medications. LPA Tao reviewed DPH Outbreak Notification letter, it stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting social activities. During today’s visit, LPA observed staff would assist residents when residents needed help. Therefore, there is not preponderance evidence to prove staff was not providing ADLs and social activities to residents. In regard of allegation, “facility did not provide lunch to residents”, it was alleged that facility did not provide lunch at the dining room for communal dining and residents only got food tray services. The investigation revealed the following: LPA interviewed resident#1(R1), resident clarified the allegation was that residents did get meals on that day but not having the meal at the dining hall for communal dining. Twelve (12) out of thirteen (13) residents interviewed stated they did not recall missing tray services of meals. All staff interviewed denied the allegation. Per LPA/RA Ceniceros’ investigation, it revealed that residents did not complain about missing meal during lockdown period due to the situation surrounding Coronavirus. LPA Tao reviewed DPH Outbreak Notification letter, it stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting communal dining. On 12/28/20, a virtual tour of the facility’s physical plant was conducted including facility kitchen, dining room, and food pantry, they were observed to be in compliance. Therefore, facility had provided meal to residents. In regard of allegation, “food served to residents is cold,” it was alleged that facility was not equipped to keep residents' food warm while in transit from the kitchen to residents’ rooms and food was cold when delivered to residents. The investigation revealed the following: LPA interviewed resident#1(R1), resident revealed the food was cold while in transit from the kitchen to resident’s room. Twelve (12) out of thirteen (13) residents interviewed stated their meals were warm and not cold when the meal tray delivered to their rooms. All staff interviewed denied the allegation. (- continued in LIC 9099 C-) ***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** Staff interviewed revealed facility was followed DPH’s COVID protocol on food services and staff did not receive complaints from residents regarding his/her food being served cold. Per LPA/RA Ceniceros’ investigation, it revealed that residents’ meal delivery was being served in “to-go” style which they were served in Styrofoam containers with plastic utensils, cups and paper napkins, to ensure food reaches the residents as hot as possible during COVID -19 lock down when the dining room was shut down for communal dining. A review of the facility’s menus were in compliance with food service. As mentioned above, DPH Outbreak Notification letter stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting communal dining. Per file review, facility had set up and followed Dietary Protocol, Alternative Meal Delivery Procedure, and dietary Menus during COVID lock-down period. Therefore, there is not preponderance of evidence to prove the facility had served food to residents when food was cold. 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. An exit interview was conducted with Administrator. A hard copy of the reports was provided.the state’s words, verbatim · CDSS document, Mar 14, 2023 · control 28-AS-20201218152356

Allegation investigated: Residents are not being provided activities. Staff are not providing adequate food service.

***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint visit to the facility regarding the above-mentioned allegations. Upon arrival at the facility, LPA met Pamela Parsons, Administrator and explained the purpose of today’s visit. On 01/04/21, LPA Tao conducted the initial investigation visit telephonically due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. LPA obtained resident roster, staff roster, facility’s house rules, resident #1’s (R1) Physician Report, R1’s Identification and Emergency Information, R1’s Appraisal, R1’s Care plan, R1’s Needs and Services Plan, R1’s Individual Service Plan (IPP) Initial Assessment (06/02/20), R1’s Narrative Charting (progress report), and R1’s Individual service plan (IPP). (- continued in LIC 9099 C-) Unsubstantiated ***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** LPA Tao also obtained R1’s Admission Agreement, R1’s assessment plan, Activities and Outings guidance (December 2020), L.A. County DPH Activity Protocol, Facility’s Activity Plan for Christmas special event, Dietary Protocol, Alternative Meal Delivery Procedure, Menus (November 29, 2020 - January 2, 2021), Activities Calendar (December 2020), resident#2 (R2)’s Assessment, R2’s Individualized Service Plan (IPP), R2’s Physician’s report, R2’s Move in Notification (6/2/20), R2’s personal rights, R2’s care plan, R2’s narrative charting, Dietary services (1/4/21) during facility’s COVID outbreak, DPH Outbreak Notification letter of COVID – 19 outbreak (12/16/20), and virtually toured the facility which included the kitchen, dining area, and activity room. Besides, LPA interviewed staff#1 (S1) and resident#1 (R1) over the phone. On 06/23/22, LPA/Retired Annuitant (RA) Elizabeth Ceniceros conducted a subsequent visit at the facility, reviewed resident files and delivered findings. LPA/RA obtained copies of staff roster and resident roster; and toured the facility’s commercial kitchen and dining room area. On 03/14/23, LPA Tao conducted another subsequent visit. During the visit, LPA obtained copies of staff and resident rosters, reviewed residents’ files, interviewed staff and residents, conducted a facility tour, and delivered findings. LPA interviewed staff from staff #2 (S2) through staff #6 (S6) and residents from resident#2 (R2) to resident#13 (R13). The investigation consisted of resident interviews, staff interviews, residents’ files review, facility tour, and LPA’s observation. In regard of allegation, “residents are not being provided activities”, it was alleged that staff did not provide social activities during COVID 19 lockdown of the facility. The investigation revealed the following: LPA interviewed resident, one (1) out of thirteen (13) residents said staff did not provide social activities during COVID lockdown. Twelve (12) out of thirteen (13) residents interviewed stated facility had provided activities to residents during lockdown. All staff interviewed denied the allegation. (- continued in LIC 9099 C-) ***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** Staff interviews and file reviews revealed the facility was going through lockdown due to COVID 19 outbreak occurred at the facility. Per LPA/RA Ceniceros’ investigation revealed that facility was following all state/county recommendations during the COVID-19 pandemic protocol. It included limiting the number of residents in social activities, facilitate social distancing, and outings. Residents were to limit their trips out of the community in accordance with local guidelines. Facility modified events to in-room activities/ games which caregivers provided activities to residents by going around each of the residents’ rooms and offering activities, such as Zen coloring, exercises, word search/sudoku, music/guitar playing, in-room games (Uno, dice games, cards), various room crafts, and movies. A review of the facility’s Activity Calendar (December 2020) showed facility had provided activities for the residents – including a holiday schedule of events on 11/12/20, 11/26/20, 12/10/20, 12/17/20, 12/18/20, 01/01/21. Facility had provided activities and still keep social distancing within the pandemic protocol. LPA Tao reviewed DPH Outbreak Notification letter, it stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting social activities. During today’s visit, LPA observed residents had social activities at the facility. Therefore, there is not preponderance evidence to prove residents are not being provided activities. In regard of allegation, “staff are not providing adequate food service,” it was alleged that food comes to residents’ rooms in “to go” boxes and is cold. The investigation revealed the following: LPA interviewed resident#1(R1), resident revealed the food was cold when delivered to resident’s room. Twelve (12) out of thirteen (13) residents interviewed stated their meals were warm or not cold when the meal trays delivered to their rooms. All staff interviewed denied the allegation. Staff interviewed revealed facility had followed DPH’s COVID protocol on food services and staff did not receive complaints from residents regarding food was being served cold. Per LPA/RA Ceniceros’ investigation, it revealed that residents’ meal delivery was being served in “to-go” style which they were served in Styrofoam containers with plastic utensils, cups and paper napkins, to ensure food reaches the residents as hot as possible during COVID -19 lock down when the dining room was shut down for communal dining. Per record review, a special meal was provided on Christmas Day and residents had been notified prior to this holiday event which included Christmas caroling to the residents. A review of the facility’s menus was in compliance with food service. (- continued in LIC 9099 C-) ***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. *** As mentioned above, DPH Outbreak Notification letter stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting communal dining. Per file review, facility had set up and followed Dietary Protocol, Alternative Meal Delivery Procedure, and dietary Menus during COVID lock-down period. On 12/28/20, a virtual tour of the facility’s physical plant was conducted including facility kitchen, dining room, and food pantry, they were observed to be in compliance. Therefore, staff were providing adequate food service. 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. An exit interview was conducted with Administrator. A hard copy of the reports were provided.the state’s words, verbatim · CDSS document, Mar 14, 2023 · control 28-AS-20201223122514

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection using the Infection Control tool to evaluate the facility. LPA Maldonado met with Licensee, Julie Chirikian and Executive Director, Pamela Parsons, and explained the purpose for the visit. LPA conducted a tour of the physical plant, observed COVID-19 procedures, reviewed resident's medications and records, observed food supply, and reviewed staff records. The facility cares for elderly residents of ages 60 and above and is approved to care for (200) non-ambulatory residents, of which (25) may be bedridden. The facility also has a memory care unit with approved delayed egress and an approved hospice waiver for (23). The facility is a three-story building, located in a residential neighborhood. It consists of 186 resident bedrooms and private bathrooms. Resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library and laundry rooms are located at the lower level. Reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry room are located at main level. Upper level consists of resident bedrooms, nurse's office, penthouse, recreation/activity rooms and laundry room. LPA toured random resident bedrooms on each floor in building sections A, B, C, D, E and F. Each room had the required furniture and sufficient closet space for storage. Bathrooms inspected were equipped with a toilet, shower, and wash basin. They were clean, operable, and had the required grab bars and non-skid mats. The hot water temperature was in a range of 105.6*F- 110.4*F, which is within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. The kitchen was toured and a sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Fire extinguishers were observed throughout the facility to be fully charged and with recent inspections. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. Outside grounds were toured and pool/spa area with self latching fenced gate is observed. The outdoor activity area has a shaded patio with ample seating. (Report Continued on LIC809-C...) There is a screening station at the entrance of the facility for universal symptom screening/temperature check. A 30-day supplies of Personal Protective Equipment (PPE) was observed in storage and throughout the facility, readily available for client/staff/visitor use. COVID-19 signange was observed at the entrance and throughout the facility to promote mask wearing, social distancing, hand washing, and cough/sneeze etiquette. LPA reviewed (17) client files for updated emergency contact information and current health screenings- confirmed to be on file. LPA reviewed (6) staff files for health screenings, proof of required annual training, and fingerprint clearances- confirmed to be on file. LPA reviewed (17) clients' medications and were observed to be documented properly and given as prescribed. Per California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. An exit interview was held with Licensee, Julie Chirikian and Executive Director, Pamela Parsons and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 25, 2023

Allegation investigated: Facility is not allowing resident to have visitors.

This report supercedes the report dated 11/09/2022 to clarify information regarding the above allegation. Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Araceli Dimaguila and explained the reason for the visit. At today's visit Resident R 1 was interviewed at 9:45 AM. The initial visit was conducted on 08/09/2022 and the following was done: LPA conducted an interview with Executive Director Pamela Parsons at 9:30 AM . LPA collected copies of Staff and Resident Rosters. LPA reviewed Resident 1 (R1) file and requested copies of pertinent documents related to complaint allegation. LPA interviewed Resident R1- R6 from 10:00 AM to 12:00 PM. Subsequent visit was conducted on 10/13/2022 and included Resident R 1 was interviewed at 9:50 AM. At 10:30 AM family member for R 1 was interviewed. Interview was conducted with Owner Julie Chirikian and also with the Consultant for the facility at 11:00 AM. Substantiated In regards to the allegation Facility is not allowing resident to have visitors, based on interviews conducted and information gathered with residents, staff, Power of Attorney, and review of various documents from Resident's 1 file, Resident R 1 was interviewed on 3 visits 11/09/22, 10/13/22 and 08/09/22 and stated that Individual # 1 is a very good friend and helps her out. Stated she doesn't understand why the facility and her family don't want him to see her. Stated that yes she does want him to visit her at the facility. Stated he has never done anything bad physically or verbally to her and that he respects her and if she tells him no he won't do it. Power of Attorney documentation dated 11/17/2018 does not state a restriction for visitation. Resident R 3 stated that Individual # 1 would not hurt her and has not seen anything bad between the 2 of them. Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 1. See LIC 9099D. Assistant Administrator refused to sign the report. Exit interview conducted and copies provided.the state’s words, verbatim · CDSS document, Nov 22, 2022 · control 28-AS-20220802163705

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Nov 10, 2022

Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by: Based on interviews conducted and file review licensee failed to have Individual # 1 be permitted to visit which causes an Immediate Health and Safety Risk to Residents in care.the state’s words, verbatim · CDSS document, Nov 22, 2022

Plan of correction: Facility to submit by POC due date to licensing self-certification that facility will allow Individual # 1 and all visitors to visit during reasonable hours

Allegation investigated: Resident wasn’t provided transportation to doctor’s appointment. Facility was not safeguarding resident(s) belongings.

Licensing Program Analyst (LPA) Tao conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met Administrator, Pamela Parsons. LPA explained the purpose of today’s visit is to discuss the above-mentioned allegations. The investigation consisted of resident interviews, staff interviews, facility tours, and review of facility records. LPA Tao spoke with Administrator and obtained resident roster, staff roster, and Resident #1’s (R1)’s facility files. The investigation revealed the following: In regard to allegation “resident wasn’t provided transportation to doctor’s appointment," it was alleged that facility did not provide transportation to resident #1 (R1) for a medical appointment on June 2022. (-continued in LIC 9099C-) Unsubstantiated Eight (8) out of eight (8) resident interviews revealed that facility would provide transportation to residents for doctor appointments. Six (6) out of six (6) staff denied the allegation. Staff interviews revealed that staff would arrange and provide transportation to residents when residents needs a ride to appointments. File review revealed that facility arranged transportation for resident#1 on June 2022; however, the appointment was rescheduled. Thus, the ride for that appointment was canceled. Therefore, investigation revealed facility would provide transportation to residents for doctor appointments. In regard to allegation “facility was not safeguarding resident(s) belongings," it was alleged that resident#1’s clothing items were not returned to residents after washed or replaced after misplaced. Eight (8) out of eight (8) resident interviews revealed that facility returned clothing items to residents after washed and residents did not aware of any items misplaced. Six (6) out of six (6) staff denied the allegation. Staff interviews revealed that staff would return residents’ clothing items to residents. If clothing items were misplaced, staff would search for the items and return them to residents. File review revealed resident #1 has clothing items under resident’s possession, however, resident#1 did not aware of any item missing. Therefore, investigation did not reveal facility fail to safeguard residents belongings. During the interview, all residents said that they did not feel their visitors or family members who came to visit them at the facility was being discriminated. They said staff and administrator were nice to residents’ visitors. 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 allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator, Pamela Parsons. A hard copy of the reports was provided.the state’s words, verbatim · CDSS document, Nov 21, 2022 · control 28-AS-20221117084448

Allegation investigated: Facility is not allowing resident to have visitors.

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Araceli Dimaguila and explained the reason for the visit. At today's visit Resident R 1 was interviewed at 9:45 AM. The initial visit was conducted on 08/09/2022 and the following was done: LPA conducted an interview with Executive Director Pamela Parsons at 9:30 AM . LPA collected copies of Staff and Resident Rosters. LPA reviewed Resident 1 (R1) file and requested copies of pertinent documents related to complaint allegation. LPA interviewed Resident R1- R6 from 10:00 AM to 12:00 PM. Subsequent visit was conducted on 10/13/2022 and included Resident R 1 was interviewed at 9:50 AM. At 10:30 AM family member for R 1 was interviewed. Interview was conducted with Owner Julie Chirikian and also with the Consultant for the facility at 11:00 AM. Substantiated In regards to the allegation Facility is not allowing resident to have visitors, based on interviews conducted and information gathered with residents, staff, Power of Attorney, and review of various documents from Resident's 1 file, Resident R 1 was interviewed on 3 visits 11/09/22, 10/13/22 and 08/09/22 and stated that Individual # 1 is a very good friend and helps her out. Stated she doesn't understand why they don't want him to see her. Stated that yes she does want him to visit her at the facility. Stated he respects her and if she tells him no he won't do it. Power of Attorney documentation dated 11/17/2018 does not state a restriction for visitation. Resident R 3 stated that Individual # 1 would not hurt her and has not seen anything bad between the 2 of them. Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 1. See LIC 9099D. Assistant Administrator refused to sign the report. Exit interview conducted and copies provided.the state’s words, verbatim · CDSS document, Nov 9, 2022 · control 28-AS-20220802163705

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Nov 10, 2022

Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by: Based on interviews conducted and file review licensee failed to have Individual # 1 be permitted to visit which causes an Immediate Health and Safety Risk to Residents in care.the state’s words, verbatim · CDSS document, Nov 9, 2022

Plan of correction: Facility to submit by POC due date to licensing self-certification that facility will allow Individual # 1 and all visitors to visit during reasonable hours

Allegation investigated: Facility not assisting resident with ADLs. Facility did not provide lunch to residents. Food served to residents is cold.

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Administrator (Pamela Parson). The purpose of this visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations. LPA/RA obtained copies of Resident #2’s Emergency Identification and Information, Physician’s Report, Medication Administration Record, Appraisal/Needs and Services Plan. LPA/RA toured the facility’s commercial kitchen and dining room area. LPA Bonnie Tao conducted the virtual 10-Day Visit on 12/28/20. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, the complaint investigation was conducted telephonically with Administrator (Pamela Parsons). During the virtual, video conference call with Administrator Parsons, LPA Tao had conducted a virtual tour of the facility’s physical plant which included the kitchen, dining area, and activity room. LPA Tao interviewed Staff #1 (Administrator) and Resident #1 and requested pertinent documents: Residents & Staff Rosters, Staff Work Schedules, Unsubstantiated Activities Calendar (December 2020), L.A. Co. DPH Activity Protocol, Facility’s Activity Plan for Christmas special event, and Dietary Protocol. Resident #1 (R1) Admission Agreement, Physician's Report, Identification and Emergency information, Care Plan, House Rules, Alternative Meal Delivery Procedure, Menus (November 29, 2020 - January 2, 2021), and Activities Calendar (December 2020). Resident #1’s Admission Agreement, Physician's Report, Identification and Emergency information, Resident’s Care Plan, Appraisal/Needs and Services Plan, Resident Assessment (06/02/20), Narrative Charting (05/04/20, 06/02/20, 06/03/20, 06/04/20, 06/05/20, 07/18/20), Individual Service Plan (IPP) Initial Assessment (06/02/20), and Assessment Plan. Resident #2’s Identification and Emergency information, Physician's Report, Appraisal/Needs and Services Plan. Regarding Allegation #1: this investigation revealed that Resident#2 is wheelchair bound. Facility staff assists the resident with its ADLs whenever the resident needs care. A caregiver is assigned to the hallway for the resident. Facility Staff would assist Resident #2 to bathe, get dressed, assist in placing the resident in its chair, bring the resident food, conduct room checks, wash/dry/fold laundry, and administer its medications. A review of Resident #2’s Physician’s Report (dated 09/28/21) documented that the resident the resident requires assistance with its activities of daily living. The majority of interviews conducted with residents, corroborated that they have not observed facility not assisting residents with ADLs. Based on the evidence gathered and interviews conducted and records reviewed, 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 of NEGLECT/LACK OF CARE: Facility not assisting resident with ADLs is found to be UNSUBSTANTIATED. Regarding Allegation #2: this investigation revealed that the majority of the residents interviewed, corroborated that he/she do not recall having had a missed tray service delivered to his/her room when the dining room was shut down for communal dining. The majority of staff interviewed, corroborated that they did not receive complaints from residents regarding a meal not being served during the situation surrounding Coronavirus. A virtual tour of the facility’s physical plant included the kitchen, dining area, and food pantry that were in compliance. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PERSONAL RIGHTS: Facility did not provide lunch to residents is found to be UNSUBSTANTIATED. Regarding Allegation #3: this investigation revealed that the majority of residents interviewed,corroborated that their meal delivery was being served in “to-go” style (Styrofoam containers with plastic utensils, cups,and paper napkins) to ensure food reaches the residents as hot as possible during the situation surrounding the Coronavirus when the dining room was shut down for communal dining. The majority of staff interviewed, corroborated that they did not receive complaints from residents regarding his/her food being served cold. A review of the facility’s menus were in compliance with food service; and, a virtual tour of the facility’s physical plant included the kitchen, dining area, food supply was in compliance. Based on the evidence gathered and interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation of FOOD SERVICE: Food served to residents is cold is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator (Pamela Parsons).the state’s words, verbatim · CDSS document, Jun 23, 2022 · control 28-AS-20201218152356

Allegation investigated: Resident's are not being provided activities. Staff are not providing adequate food service.

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Administrator (Pamela Parsons). The purpose of today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations. LPA/RA toured the facility’s commercial kitchen, dining room area, and observed residents in the Activity Room. LPA Bonnie Tao conducted a virtual 10-Day visit on 01/04/21. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, the complaint investigation was conducted telephonically with Administrator (Pamela Parsons). During the virtual, video conference call with Administrator Parsons, LPA Tao had conducted a virtual tour of the facility’s physical plant which included the kitchen, dining area, and activity room. LPA interviewed Staff #1 (former Administrator) and Resident #1. LPA requested pertinent documents: Residents & Staff Rosters, Staff Work Schedules, House Rules, Alternative Meal Delivery Procedure, Facility Menus (November 29, 2020 - January 2, 2021), Unsubstantiated Appraisal/Needs and Services Plan, Resident Assessment (06/02/20), Narrative Charting (05/04/20, 06/02/20, 06/03/20, 06/04/20, 06/05/20, 07/18/20), Individual Service Plan (IPP) (dated 06/02/20), and Assessment Plan. Regarding Allegation #1: this investigation revealed that the facility was following all state/county recommendations during the COVID-19 pandemic protocol. It included limiting the number of residents in activities, facilitate social distancing, and outings. The residents were to limit their trips out of the community in accordance with local guidelines. The facility modified events (i.e., in-room activities and limited small groups). The caregivers provided activities to the residents by going around each of the residents’ rooms and offering activities; such as: Zen coloring, exercises, word search/sudoku, music/guitar playing, in-room games (Uno, dice games, cards), various room crafts, and movies. A review of the facility’s Activity Calendar (December 2020) documented activities for the residents – including a holiday schedule of events on 11/12/20, 11/26/20, 12/10/20, 12/17/20, 12/18/20, 01/01/21. The majority of interviews conducted, corroborated that it was understood that this was a way for the facility to provide activities and still keep social distancing within the pandemic protocol. Based on the evidence gathered and interviews conducted and records reviewed, 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 of OTHER: Residents are not being provided activities is found to be UNSUBSTANTIATED. Regarding Allegation #2: this investigation revealed to ensure meals reached the residents as hot as possible, insulation boxes were used to keep the food warm. The meal trays were delivered in smaller batches per trip. Facility staff would make half trip deliveries instead of whole trip deliveries. The majority of interviews conducted, corroborated that the meal delivery was being served in “to-go” style (Styrofoam containers with plastic utensils, cups, and paper napkins) during the situation surrounding the Coronavirus when the dining room was shut down for communal dining. The majority of staff interviewed, corroborated that they did not receive complaints from residents regarding his/her meal being served cold. During the holiday a special meal was provided on Christmas Day; and, the residents had been notified prior to this holiday event – which included Christmas caroling to the residents. A virtual tour of the facility’s physical plant included the kitchen, dining area, food supply; and, a review of the facility’s menus were all in compliance. Based on the evidence gathered and interviews conducted and records reviewed, 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 of FOOD SERVICE: Staff are not providing adequate food service is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator (Pamela Parsons).the state’s words, verbatim · CDSS document, Jun 23, 2022 · control 28-AS-20201223122514

Allegation investigated: Staff is not dispensing resident's medication as prescribed. Staff are not serving a good quality of food. Facility has ants.

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Administrator (Pamela Parsons). The purpose of today’s visit is to conduct a subsequent visit and to deliver the findings pertaining to the above-mentioned allegations. LPA/RA obtained copies of Resident and Staff rosters and toured the facility’s commercial kitchen, dining room area, and residents’ bedroom. LPA Bonnie Tao conducted an unannounced 10-Day visit on 10/08/21. LPA met with Administrator (Pamela Parsons). During the visit, LPA Tao interviewed Staff#1 thru Staff #6, Resident #1 and Resident #7. A physical plant tour of the facility was conducted that included residents’ rooms #309-D and #164-E. LPA Tao obtained copies of the Residents and Staff Rosters, In-Service Training (Insulin Administration) Records, Pest Control Service Agreement, and Pest Control Company Invoices; R1's Admission Agreement, Pre-Appraisal, Emergency Identification and Information, Physician’s Report, Medication Administration Record (09/2021, 10/2021), Appraisal/Needs and Services Plan. Unsubstantiated Regarding Allegation #1: this investigation revealed that the facility’s LVNs administer Resident #2’s prescribed medication (Insulin). LVN will follow the resident’s chart to administer the medication and observe the resident when taking the medication. LVN will check the resident’s blood sugar (between 7:30 a.m. to 8:00 a.m.). NOC shift LVNs administers the resident’s medication (Insulin) on Fridays and Saturdays. During the weekday, the morning shift LVN administers Resident #2’s medication (Insulin). Resident #2’s blood sugar reading is a daily check and posted in the medication administration record (MAR). The MAR records the blood sugar and determines whether the resident’s medication (Insulin) administration is needed. The unit of medication (Insulin) from the pen is given (based on the MAR) and is a fixed amount per doctor’s orders. After the medication (Insulin) is given to Resident #1, the LVN will check off the medication in the medication computerized system which keeps track of the prescribed medication (Insulin). The medication (Insulin) dosage is determined by the resident's physician; and, it’s a fixed dosage. A review of the Medication Administration Record (MAR) documented Resident #1 received its blood glucose check (from 09/01/21 to 09/30/21) at 7:30 a.m. and at 4:30 p.m. and prescribed medication [Novolin 70-30 VL (10ML)] administered at 8:00 a.m. (from 09/01/21 to 09/30/21). Resident #1 received its blood glucose check (from 10/01/21 to 10/08/21 at 7:30 a.m. and 4:30 p.m. and prescribed medication [Novolin 70-30 VL (10ML)] administered at 8:00 a.m. (from 10/01/21 to 10/08/21). A review of the facility’s in-service training records documented the facility offered training on 08/15/21 to facility LVNs presented by Staff #2 (LVN Director) regarding the topic: “Insulin Administration”. Based on the evidence gathered and interviews conducted and records reviewed, 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 of MEDICATION: Staff is not dispensing resident’s medication as prescribed is found to be UNSUBSTANTIATED. Regarding Allegation #2: this investigation revealed based on interviews conducted of residents, the majority corroborated that the facility’s food service is good and there were no issues with the quality of food service. The majority of interviews conducted with staff, corroborated that they had not received complaints from residents regarding the quality of food service. A virtual tour of the facility’s physical plant included the kitchen, dining area, food supply; and, a review of the facility’s menus are all in compliance. During the subsequent visit, LPA/RA Ceniceros conducted a tour (together with Administrator Parsons) of the commercial kitchen, dining room area, and residents’ bedroom. Based on the evidence gathered and interviews conducted and records reviewed, 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 of FOOD SERVICE: Staff are not serving a good quality of food is found to be UNSUBSTANTIATED. Regarding Allegation #3: this investigation revealed based on interviews conducted of residents, the majority corroborated that they have not seen ants in his/her bedroom or in his/her food. Interviews conducted of staff members, the majority corroborated that they may have received complaints from residents observing ants in their rooms or in their food. During the initial visit conducted by LPA Bonnie Tao, no ants were observed in the reporting party’s room. LPA/RA Ceniceros conducted a tour of the facility’s commercial kitchen, dining room area, and residents’ bedroom and did not observe ants in the various locations. The facility has a monthly contract with a pest control company that conducts services. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PHYSICAL PLANT: Facility has ants is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator (Pamela Parsons).the state’s words, verbatim · CDSS document, Jun 23, 2022 · control 28-AS-20211004122114

Allegation investigated: Facility is not allowing visitors for a resident.

Licensing Program Analysts (LPAs) Tao, Calderon and Maldonado conducted an unannounced initial complaint investigation for the allegation listed above. During today’s visit, LPAs met Administrator, Pamela Parsons and explained the purpose of today's visit. The investigation consisted of the following: interviews with staff from Staff #1 through Staff #5; interviews with residents from Resident #1 through Resident #6, reviews of resident #1’s facility records and conducts a tour of the physical plant. LPA obtained copies of the Staff and Resident Rosters; and Resident #1 file for review of relevant information. In regard to allegation "Facility is not allowing visitors for a resident", it was alleged that facility staff did not allow visitor #1(V1) to visit resident #1(R1). Six (6) out of six (6) residents could not corroborate the allegation. Resident interviews revealed that resident#1 did not want visitor #1 visiting. (-Continued in LIC 9099 C-) Unsubstantiated All six (6) residents stated they have staff allow visitors who come for visits. Five (5) out of five (5) staff denied the allegation. Facility did not have a court ordered restraining order in place to deny V1’s visits. LPA's review of R1s letter dated 05/12/22, indicates R1 did not wish V1 to visit R1 at the facility. Therefore, the investigation revealed that R1’s personal right to have visitors was not violated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator and a hard copy was provided.the state’s words, verbatim · CDSS document, May 20, 2022 · control 28-AS-20220513102000

Allegation investigated: Facility staff left resident on the floor for an extended period of time. Facility staff do not allow residents to have visitors.

***This licensing report supersedes the original complaint investigation report, dated 02/14/22. The findings remain as Unsubstantiated. *** Licensing Program Analysts (LPAs) Tao and Calderon, conducted an unannounced subsequent complaint investigation for the allegations listed above on 04/22/22. An initial complaint visit was conducted on 11/03/21 and subsequent visits were conducted on 12/07/21 and 02/14/22. During today’s visit, LPA Tao met Administrator Pamela Parsons, and explained the purpose of today's visit, which was to deliver the investigation findings of the above-mentioned allegations. The investigation consisted of the following: interviews with Staff #1 through Staff #6; interviews with Resident #1 through Resident #7, review of resident #1’s facility records and a tour of the physical plant. LPA obtained copies of the Staff and Resident Rosters; and Resident #1 file for review of relevant information. (-continued in LIC 9099 C-) Unsubstantiated ***This licensing report supersedes the original complaint investigation report, dated 02/14/22. The findings remain as Unsubstantiated. *** In regard to allegation "Facility staff left resident on the floor for an extended period of time," it was alleged that R1 fell off the bed and was on the floor for an hour. Seven (7) out of seven (7) residents could not corroborate the allegation. Residents had no knowledge of the incident. Per R1's interview, R1 denied that R1 fell off the bed and left on the floor for an hour. Five (5) out of five (5) staff were not aware of the incident of the allegation. Staff interviews revealed no residents were left on the floor for an extended period of time. File review did not reveal incident happened on R1 related to the allegation. LPA did not observe residents fell off the bed and left on the floor for an extended period of time during the visit. In regard to allegation "Facility staff do not allow residents to have visitors", it was alleged that facility staff did not allow resident #1 to have visitor#1 (V1), who was a former resident. Seven (7) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that five (5) out of seven (7) residents stated they have staff allow visitors who come for visits. Two (2) out of seven (7) residents stated their visitors may meet residents in the outdoor visiting area, due to the visitors being unvaccinated or not providing staff with proof of a recent PCR test with negative results. Five (5) out of five (5) staff denied the allegation. Per LPA’s interviews with Administrator Pamela Parsons, Administrator reported that R1’s family member, who has power of attorney (POA), provided Administrator with a letter dated 07/16/21, requesting that the facility not allow visitor #1 (V1) to visit with R1. Administrator informed LPA Tao that the Administrator was complying with POA’s letter and did not allow V1 to visit with R1 on 10/20/21. Per staff interview, staff notified R1 and asked R1 whether R1 wishes V1 to visit on 10/20/21. R1 did not want V1 to visit R1. V1 acted aggressively at the entrance and, therefore, Administrator called local law enforcement due to V1 behavior. Law enforcement arrived at the facility and did not arrest V1. Instead, law enforcement escorted V1 off the premises. Per LPA’s interview with R1, R1 informed LPA that R1 does not feel comfortable when V1 visits. Interviews with Administrator and R1’s POA confirmed that the facility did not have a court ordered restraining order in place to deny V1’s visits. LPA's review of R1s letter dated 01/18/22, indicates R1 does not wish V1 to visit R1 at the facility, however, the letter is prior to the 10/20/21 incident. (-continued in LIC 9099 C-) LPA's review of facility’s unusual incident report dated 10/20/21, indicated that V1 went to the facility to visit with R1 and was met outside the facility by Administrator Parsons, who informed V1 that the facility was a private property and R1’s P.O.A. had instructed the facility to not allow visit from V1. Therefore, the investigation revealed that R1’s personal right to have visitors was not violated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator and a hard copy was provided.the state’s words, verbatim · CDSS document, Apr 22, 2022 · control 28-AS-20211025125712

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Administrator, Pamela Parsons, and Licensee, Julie Chirikian. Administrator assisted LPA with the visit. The facility is licensed to serve for a capacity of 200 non- ambulatory residents including 25 bedridden residents, ages 60 and above. The facility has an approved Hospice Waiver on file for twenty three (23) residents. Currently, fourteen (14) residents on Hospice. Facility has an approved Dementia Care Plan in their plan of operation and accept residents with dementia. Facility does not handle residents’ moneys. Annual licensing fee is current. Administrator certificate is current and expires on 07/31/22. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is located in a residential neighborhood, consists of three floors/levels and has 186 resident bedrooms and bathrooms. Resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library and laundry rooms are located at the lower level. Reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry room are located at main level. Upper level consists of resident bedrooms, nurse's office, penthouse, recreation/activity rooms and laundry room. A physical tour was conducted. LPA toured resident rooms in random on each floor in building sections A, B, C, D, E and F. Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 105.2 - 114.8 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. The resident rooms have a signal systems located in each restroom and facility phones to call the front desk. The signal system was tested in different resident's room on each level and was operable. Staff arrived at residents' rooms to respond the calls in a range of 3 to 5 minutes. (-continued in LIC 809 C-) No firearms on the premises. Facility had central air and heating accommodations in the common areas. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable at the memory care unit at the lower level. Interior and exterior space was available to permit residents to wander freely and safely. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Food is stored in covered containers at the appropriate temperatures. No pesticides or poisons are stored in the food areas. The last Fire/Emergency Drill is conducted on 01/11/22. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers has the last service on 01/12/22, are fully charged and in compliance. The carbon monoxide detectors are operable and in compliance. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. Outside grounds were toured and pool/spa area with self latching fenced gate is observed. The outdoor activity area has a shaded patio with ample seating. Medications are centrally stored and locked in the nurse's office on the upper level. First aid kit is fully stocked. Mandated documents and signages are posted in common areas. Resident records are stored in a locked cabinet and inaccessible to residents. Toxic substances are inaccessible to residents. Deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Administrator, whose signature on this form confirm receipt of these documents. A copy of appeal rights was provided.the state’s words, verbatim · CDSS document, Mar 4, 2022

Allegation investigated: Resident is isolated. Residents are served cold food.

Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit and delivered findings on the above allegations. The purpose of the visit was discussed with Executive Director Pamela Parsons. The investigation consisted of the following: On 1/14/2021, staff (S1 & S2), and resident (R1) were interviewed. A virtual physical plant tour of kitchen area/food preparation station, and resident rooms 117B, and 118 was conducted at 11:45 AM via FaceTime due to Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. The following items were obtained: [COVID Mitigation Plan, Food Menu [Nov.2020 – Jan.2021], food preparation, service, and storage protocols during COVID-19 pandemic, Dietician Contact Information, pandemic staff training protocols, LIC 500 Personnel Report, Resident Roster, Identification and Emergency Information (Face Sheet) & Physician Reports for 2 residents, and staff and resident contact information]. During today's visit, residents (R2- R10) and staff (S3) were interviewed, a tour of the physical plant, including the kitchen and serving area were conducted. See LIC 9099C for report continuation. Unsubstantiated Allegation: "Resident is isolated." Based on interviews conducted and due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) residents at the facility have quarantined in their private rooms a few times since the beginning of the pandemic. It is alleged that resident (R2) was isolated in the room in December 2020 and January 2021. On December 7, 2020, the facility stopped communal meals in the dining room due to COVID-19 precautionary measures recommended by Department of Public Health. Five (5) out of 10 residents interviewed stated they did feel isolated when the facility asked residents to stay in their rooms as a precautionary measure due COVID-19 cases in the building. All residents interviewed stated they understood the reason they had to quarantine in their rooms. Resident (R2) stated that although it felt isolated with the public health directive, the facility was trying to protect the residents from the COVID-19 virus. Staff stated that each time residents were asked to stay in their rooms staff did room to room visits, hallway exercise activities, and small group activities in the oval room. In addition they delivered to resident's rooms arts and crafts materials. There are 3 different activity personnel that check on the residents regularly. Caregivers helped residents make phone calls, and Facetime, and check on them throughout the day. Allegation: "Residents are served cold food." Based on observation and interviews conducted the findings indicate that when the residents were asked to stay in their room due to COVID-19 virus health orders the meals were served in styrofoam containers. The food was cooked, was placed into a heat lamp, then into the styrofoam box, then cart, and then taken to the residents rooms. Kitchen staff checked the temperature of the food. In addition, the facility purchased heat packs. All residents were provided portable tables for food. Most of the residents have microwaves in their rooms, and some residents have kitchenettes. Mealtimes are 8:00 am, 12:00 and 5:00 pm, and snack times are 10:00 am, 2:00 pm, and 7:00 pm. One (1) out of 10 residents stated the food served in their room often arrived cold, and was not able to warm it itself because it did not have a microwave in the room. All other residents interviewed had no issues with the food delivery at that time or during the most recent resident quarantine. Staff denied this allegation. During both visits, a tour of the kitchen was conducted. Meal preparation, serving protocols, menus, and tray service was observed to be compliant with food handling regulations. The kitchen and dining rooms are clean and sanitary. Based on interviews conducted and observations made there was insufficient evidence to prove the allegations. 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. Exit interview was conducted with Executive Director Pamela Parsons. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 24, 2022 · control 28-AS-20210105145651

Allegation investigated: Facility is not allowing visitors for a resident Facility staff failed to meet resident's needs Facility staff failed to safeguard resident's personal belongings Facility staff failed to provide activities for resident in care

Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent visit to deliver complaint investigation findings. LPA met with Executive Director Pamela Parsons and explained the purpose of the visit. The Investigation consisted of the following: On 1/20/22, LPA conducted an interview with Executive Director Pamela Parsons. LPA collected copies of Staff and Resident Rosters. LPA reviewed Resident 1 (R1) file and requested/ received copies of pertinent documents related to complaint allegation. On 2/15/22, LPA conducted interviews with Residents 1-6 (R1-6), Staff 1-6 (S1-6) and conducted a tour of facility activity room, lobby, dining room and R1's bedroom. LPA also collected copies of Facility Activity Schedule, and Staff/ Resident Rosters. LPA interviewed R1 Family Members (FM1-2). (See LIC9099C for continuation) Unsubstantiated Investigation revealed the following: Regarding allegation, Facility is not allowing visitors for a resident, it is alleged that the facility has not allowed R1 to receive visits from a former resident, who is a friend, for the last 4 months. 7 out of 7 residents that were interviewed stated that they receive visits. 1 of 7 residents stated that they do not care for visits from their former friend and stated that they do receive visits from family and friends. 6 out of 6 staff that were interviewed stated that facility residents are allowed visits and that visitors just have to go through COVID-19 visitation guidelines and screening procedures that are set in place to mitigate the spread of COVID-19. Interview with Executive Director Pamela Parsons revealed that there was a potential visitor for R1 that was denied entrance into the facility due to aggressive behavior and due to safety concerns for R1 and all facility residents. She stated that the police department had to be called due to the individual's aggressive behavior. She stated that visitors are allowed as long as they go through the screening processes that are currently set in place to mitigate the spread of COVID-19. LPA observed visitors being screened and coming in to visit residents during time of visit. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation. For allegation, Facility staff failed to meet the resident's needs, it is alleged that facility staff did not assist a facility resident when the resident was screaming for assistance due to resident feeling cold during the winter. Facility resident allegedly left screaming for help for over 20 minutes and staff stated that they were understaffed. Interviews conducted with Executive Director Pamela Parsons and S1-6 revealed that facility residents are never left unattended for extended periods of time. They stated that staff constantly check in on residents to see if they need help or need anything. S1-6 stated that they check on residents every 2 hours or as needed if assistance is requested by a resident. Executive Director Parsons and S1-6 denied that any facility resident was left screaming for over 20 minutes. They also stated that facility temperature is keep at appropriate temperatures during the different seasons and temperature is adjusted as needed. Interviews conducted with S1-6 revealed that residents are properly cared for at all times. Interviews conducted with R1-6 revealed that they are satisfied with the services provided at the facility and stated that their needs are met. R1 stated that staff are very helpful and provide good care and they are very satisfied with the services that they receive. LPA toured R1's room and observed room temperature to be adequate as well as temperature throughout the facility which included the lobby area, activity room and dining room. LPA also observed proper bedding and blankets in R1's room. Based on LPA observations, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation. For allegation, Facility staff failed to safeguard resident's personal belongings, it is alleged that someone stole several valuable items that were given as a gift to R1 from their room at night. The gifted items were allegedly a ring worth $1900, a bible, a DVD player and a CD player and someone stole everything from the resident’s room at night. Interviews conducted with Executive Director Pamela Parsons and S1-6 revealed that if a resident reports any missing items, facility staff will assist the resident with trying to locate the item. They stated that most of the time items are located in the residents rooms and the items had just been misplaced. Executive Director Parsons denied that R1 had such items taken from their room. R1's FM1-2 denied that R1 had such items missing and stated that they are satisfied with the services that R1 is receiving at the facility. They stated that R1 had a few clothing items missing but that they were found in the laundry room. Interviews conducted with R1-6 revealed that they are satisfied with the services provided at the facility and stated that they have not had any of their personal belongings taken from their rooms. R1 stated that they are not missing a ring, DVD player, bible or a CD player. LPA reviewed R1's list of Personal Property and Valuables and did not observed the mentioned items on the list of items. Based on LPA review of documents, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation. For allegation, Facility staff failed to provide activities for resident in care, it is alleged that facility staff isolated R1 in their room and did not provide any activities for resident. Interviews conducted with Executive Director Pamela Parsons and S1-6 revealed that facility residents are provided daily activities. They stated that R1 enjoys playing Bingo, listening to music and crotchet. R1-6 stated that the facility does provide daily activities. R1 stated that they love playing bingo. S1 stated that R1 is a regular activity attendee as well as many facility residents. S1 stated that the activity schedule is full of activities to keep the residents busy and entertained throughout the day. Interviews conducted with R1-6 revealed that they are satisfied with the actiivities that the facility provides and stated that they have fun. LPA toured Facility Activity Room and observed residents participating in an activity. LPA observed R1 participating in the activity and also observed facility staff encouraging residents to participate in scheduled activities. LPA reviewed Facility Activity Schedule and observed that the facility provides activities for the residents throughout the day on a daily basis. Based on LPA observations, review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held. A copy of the report was provided to Executive Director Pamela Parsons.the state’s words, verbatim · CDSS document, Feb 15, 2022 · control 28-AS-20220111114948

Allegation investigated: Facility staff left resident on the floor for an extended period of time. Facility staff do not allow residents to have visitors.

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint investigation for the allegations listed above. An initial complaint visit was conducted on 11/03/21 and a subsequent visit was conducted on 12/7/2021. During today’s visit, LPA was allowed entry by Administrator. LPA explained the purpose of today's visit. Investigation consisted of the following: interviews of Staff #2, Staff#4 and Staff #5; interviews of residents from Resident#2 to Resident #7, reviewed resident#1’s record reviews, and a facility tour. LPA obtained copies of the Staff and Resident Rosters; and resident files for Resident #1 (R1) with relevant information. The investigation revealed the following: In regard to allegation "Facility staff left resident on the floor for an extended period of time," it was alleged that R1 fell off the bed and was on the floor for an hour. (-continued in LIC 9099 C-) Unsubstantiated Seven (7) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that residents did not fell off bed and being left on the floor for an hour. Five (5) out of five (5) staff denied the allegation. Staff interviews revealed no residents were left on the floor for an extended period of time. File review did not reveal incident happened on R1 related to the allegation. LPA did not observe residents were fell off the bed and left on the floor for an extended period of time during the visit. 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. In regard to allegation "Facility staff do not allow residents to have visitors", it was alleged that facility staff did not allow resident #1 to have a visitor, a former resident. Seven (7) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that five (5) out of seven (7) residents stated they have no issue with visitors coming for visits. Two (2) out of seven (7) residents stated their visitors may meet residents at the outside areas. Five (5) out of five (5) staff denied the allegation. All five staff interviews revealed that visitor was acting aggressively at the entrance and therefore, that person was not allowed for entry due to the safety concern. 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 Administrator and a hard copy was provided.the state’s words, verbatim · CDSS document, Feb 14, 2022 · control 28-AS-20211025125712

Allegation investigated: Facility does not have adequate hot water available to residents.

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Araceli Dimaguila (RN) and explained the purpose of the visit. During today's investigation, LPA obtained a copy of the Staff, Resident roster and repair invoice. LPA interviewed Staff #1, #2 and #3 in the conference room between 10:00 am to 10:37 am. LPA toured the facility with Staff #3 at 10:40 am, measured the water temperature in various bedrooms and interviewed Residents #1 to Resident #10 between 10:45 am to 12:00 pm in various locations of the facility . In regards to the allegation: Facility does not have adequate hot water available to residents. LPA reviewed a copy of a service invoice dated 12/13/21 indicating a water pipe was replaced due to leakage. Services were rendered the same day on 12/13/21. Interviews with Staff indicate that in the past month the only water issue the facility experienced was on 12/13/21 and the problem was resolved with a water pipe replacement. Continue to LIC9099C...... Unsubstantiated LPA tested the water temperature in 11 different Resident bathrooms in different sections of the facility and water temperature in all bedrooms measured within Title 22 guidelines. LPA's interviews with 10 of 10 Residents indicate hot water is available in the facility. Based on LPA's record review, observations and interviews, investigation revealed: 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 David Chirikian and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 10, 2022 · control 28-AS-20220103112145

Allegation investigated: Staff did not assist resident with walking. Staff did not protect resident's personal items

This is a corrected report for report created on 7/28/21 to provide additional information and supersedes report dated 7/28/21. On 7/28/21 Licensing Program Analyst(s)(LPA) Bonnie Tao conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Tao met with Pamela Parson administrator and explained the reason for the visit. The investigation consisted of the following: LPA Tao conducted interview with administrator, resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6),#7(R7),#8(R8),#9(R9),#10(R10),#11(R11),#12(R12),#13(R13),#14(R14) and staff #2(S2), #3(S3),#4(S4),#5(S5), and contacted family representative for R1. LPA Tao reviewed documents for R1. Unsubstantiated The investigation revealed the following: Regarding allegation: Staff did not assist resident with walking. It is alleged staff was requested to walk resident up and down the hall and facility hasn't done that. During interviews with 13 out of 14 residents it was stated staff assist them with walking when they request for assistance and 1 out of 14 was unable to answer due to cognitive skills. During interviews with staff 5 out of 5 staff interviewed stated to assist residents with walking when requested and if the residents show change in condition staff report it to facility's wellness department to obtained further assistance. Administrator stated staff does assist residents that need help and will request physical therapy for those that need more assistance. Documents reviewed revealed R1 does require a walker but no notes on need for physical therapy were observed. R1's responsible party stated R1 is able to walk without assistance. Based on interviews and documents reviewed the preponderance of evidence has been met, therefore the allegation is found UNSUBSTANTIATED. Regarding allegation: Staff did not protect resident's personal items. It is alleged that resident's personal items were stolen by staff. During interviews with residents 8 out of 14 residents stated to not have lost or think items might have been stolen from their rooms. 5 out of 14 residents stated to have lost clothes or money at the facility and some reported to the administrator. Interviews with 2 out of 5 staff stated residents usually misplace items and 3 out of 5 staff stated there have not been reports from residents stating to have lost items. Administrator stated residents usually misplaced items and staff looks and will find items in residents' rooms. Documents reviewed for R1 revealed, Resident Personal Property and Valuables revealed the following items do not match the list of missing items. R1's responsible party stated items listed as missing do not belong or have been left in R1's room. Based on interviews and documents reviewed the preponderance of evidence has been met, therefore the allegation is found UNSUBSTANTIATED. Exit interview was conducted with Pamela Parsons and a copy of this report was email for signature and provided.the state’s words, verbatim · CDSS document, Dec 11, 2021 · control 28-AS-20210721121808

Allegation investigated: Staff opened residents mail.

Licensing Program Analyst (LPA) Tao, conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Administrator, Pamela Parsons. LPA explained the purpose of today’s visit is to discuss the above mentioned allegation. The investigation consisted of interviews with Resident #1 through Resident #11; Administrator, Staff#2 through Staff#10; reviewed Resident #1 file and mail policy. A copy of mail policy was obtained. In regards to the allegation: Staff opened residents mail. Per interviews of residents, eleven (11) out of eleven (11) residents revealed that staff did not open their mail. Per interviews of staff, ten (10) out of ten (10) denied staff open residents’ mail. Based on interviews conducted, the statements obtained did not corroborate with this allegation. Review of mail policy, resident’s mails are remained un-open and placed into resident’s locked mailbox. During the visit, LPA did not observe opened residents mail at the front desk. (- Continued in LIC 9099C-) Unsubstantiated LPA observed front desk staff distributing mails into residents’ locked mailbox. Residents opened their mailboxes using a key when picked up their mail. Based on interviews conducted with facility staff and residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation that staff opened residents mail. Although the allegation 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 allegation is unsubstantiated. An exit interview was conducted with Administrator. A hard copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 7, 2021 · control 28-AS-20211201091411

Allegation investigated: Resident sustained multiple pressure injuries due to neglect. Staff left resident in soiled diapers for an extended period of time.

***This licensing report supersedes the complaint investigation report dated 07/01/2020. The findings have been changed to Unsubstantiated*** The initial investigation was conducted on 05/17/19, during visit, LPA Day, reviewed resident records, interviewed residents, Owner, Administrator and LPA Day toured the facility. Subsequent visits were conducted on 01/03/20 and 06/12/20. During the subsequent visits, LPA Day interviewed Administrator Pat Redner, attempted to interview Resident #1 (R#1) and Resident #1 private caregiver, however, R#1 and R#1 private caregiver were not available. LPA Day reviewed R#1 facility file and received copies of R#1's Admission agreement, Face sheet and ID information, last physical, pre-placement appraisal and medication log and interviewed administrator Pat Redner and two (2) facility staff. (- Continued in LIC 9099 C-) Unsubstantiated On 05/19/21, LPA Tao obtained copies of Staff and Residents rosters, toured the physical plant and did not observe that facility staff were not assisting with residents with incontinent care and LPA Tao did not observe any unusual odors in the facility. During the investigation, LPA Tao interviewed with Resident#2-#12 and Staff#2-#5 and Staff#11; reviewed R#1 medical records and R#1 facility file. In addition, on 08/22/19, LPA Razo conducted interviews with staff #6-#10. In regard of allegation: Resident sustained multiple pressure injuries due to neglect. The investigation revealed the following. The allegation was alleged that R#1 received extensive skin damage due to moisture and had multiple pressure injuries. Former Administrator Pat Redner denied the allegations. Per resident interviews, ten (10) out of twelve (12) residents stated they were not aware of a resident who sustained pressure injuries due to neglect. One (1) of twelve (12) residents was unable to answer LPA's questions. LPA Tao was unsuccessful in attempts to interview R#1, who has been relocated and lost contact. Interviews with eleven (11) out of eleven (11) staff indicated that staff denied knowledge that a resident sustained multiple pressure injuries due to neglect. Interviews with staff revealed that staff provided care to R#1 by repositioning/turning R#1 every two hours and elevated R#1's feet while R#1 was in chair and/or bed. During a site visit on 05/19/21, LPA Tao observed staff would assist residents who required assistance with repositioning as needed. The investigation revealed the following, R#1 was admitted to the facility on 01/21/19, upon admission to the facility, R#1 had redness to inner buttock, left and right legs. (-Continued in LIC 9099 C-) From date of admission through 05/04/19, staff assisted R#1 with changes of R#1 adult briefs due to incontinence care and repositioned R#1 as needed. There was no evidence to support that staff left R#1 skin moist or wet. Review of R#1's records; including medical records revealed that R#1 was admitted to Arcadia Methodist Hospital on 05/05/19 for general weakness and not feeling well. Upon admission to the hospital, it was noted by medical staff that R#1 had redness on resident's inner buttocks, left and right legs. On 05/06/19, the hospital’s physician ordered a test to determine and assess if R#1’s wounds were due to artery blockage since the wounds appeared to be arterial in nature. The results of the test were received on 05/06/19, which indicated R#1 wounds were caused by poor blood circulation or artery blockage and not by moisture on the skin. The investigation did not reveal that staff neglected R#1, resulting in R#1 sustaining wounds. In regard of allegation: Staff left resident in soiled diapers for an extended period. The investigation revealed the following. Per the complaint, it was alleged that Resident #1 was left in soiled diapers for an extended period. Administrator denied the allegation. Per resident interviews, seven (7) out of twelve (12) residents who use adult briefs stated staff did not leave them in soiled diaper for an extended period Three (3) out of twelve (12) residents who did not use adult briefs stated they were not aware of residents who used adult briefs complaining of staff leaving residents in soiled diaper for an extended period. One (1) of twelve (12) residents was unable to answer LPAs questions. LPA Tao was unsuccessful in attempts to interview R#1, since resident has been relocated and lost contact resident. (-Continued in LIC 9099 C-) Interviews with eleven (11) of eleven (11) staff revealed that staff would change residents' diapers in a timely manner. Per staff interviews, staff denied residents were being left in soiled diapers for an extended period and changed resident’s adult briefs every two hours or as needed. Review of resident record regarding resident who were incontinent and needed assistance with changing of adult briefs, revealed that staff changes resident’s adult briefs every two hours. Per LPA Razo's and LPA Tao’s observations during site visits conducted on 10/19/19 and 05/19/21, LPAs did not observe any foul odors or smell of urine at the facility. The investigation did not reveal any evidence to support that staff left residents in soiled diapers for an extended period. Therefore, there was insufficient evidence to corroborate with the allegation. Based on the information obtained during the investigation, interviews with staff, residents, review of resident file/medical records and LPAs' observation, the investigation did not reveal any evidence to support the following allegations: Resident sustained multiple pressure injuries due to neglect and Staff left resident in soiled diapers for an extended period. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator, Pamela Parsons and Licensee, Julie Chirikian. Findings were discussed. A copy this report was provided to Administrator at time of visit.the state’s words, verbatim · CDSS document, Dec 1, 2021 · control 28-AS-20190515163549

Allegation investigated: Staff did not respond to resident's call in a timely manner. Staff do not safeguard resident's personal items.

Licensing Pogram Analyst (LPA) Cynthia Chan initiated the complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with Executive Director, Pamela Parsons, to explain the purpose of the visit. The investigation consisted of the following: LPA Chan obtained copies of the Staff, Resident rosters, and list of caregivers assigned unit. Interviews were conducted with the Executive Director, 6 Staff, and 14 Residents. The investigation revealed the following: Allegation – Staff did not respond to resident’s call in a timely manner. Executive Director Parsons stated that the facility has a call light system in place. When a resident pushes the button or pulls the string in the bathroom, the signal will be triggered in the records room by the front desk. The front desk will page caregivers through a walkie talkie for them to check on the resident. (Continue on the LIC9099) Unsubstantiated Staff interviewed stated they always try to respond to residents as soon as possible. The caregivers have assigned units and responsible for residents during their shifts. However, if they are assisting a resident and cannot tend to a call signal right away, they would request for assistance. Supervisors and caregivers stated if they are available, they would help one another. LPA interviewed 14 Residents which 12 out of 14 indicated that staff respond to their calls in a timely manner. Some also stated that the staff are helpful and assist with their needs. During today's visit, LPA tested the call system by pushing the call button in a resident's room. A caregiver was notified and responded to the call within 2 minutes Allegation – Staff do not safeguard resident’s personal items. According to the Executive Director, an inventory of personal belongings are listed upon admission. Families and residents are encouraged to not bring in expensive items such as jewelry or large amount of cash to the facility. Executive Director stated the residents are often encouraged to lock their rooms when they leave and are reminded again during resident council meetings. Caregivers interviewed stated residents report missing items but they are typically found in a different area of their room. 3 out of 14 residents indicated some of their personal items have been missing and have not been retrieved. 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. An exit interview was conducted. A copy of this report along with the appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 17, 2021 · control 28-AS-20211115140009

Allegation investigated: Staff did not assist resident with walking. Staff did not protect resident's personal items

***This report serves as an amendment and supersedes the original complaint investigation report created on 07/28/2021. The finding remains the same as in the prior licensing report -Unsubstantiated. *** Licensing Program Analysts (LPA) Tao, conducted a follow up unannounced 10-day complaint visit to this facility. Upon arriving at the facility, LPA met with Pamela Parsons, Administrator, and Julie Chirikian, Licensee. LPA explained the purpose of today’s visit and discuss to them above mentioned allegations. Regarding allegation: Staff did not assist resident with walking. The Investigation consisted of LPA’s observations, interviews with residents#1 - #14, interviews with staff #1- #4 and review of Resident #1’s file. On today's visit, LPA Tao interviewed Staff #1-#5 and Resident #1-#14. Resident interviews revealed that twelve (12) out of fourteen (14) residents reported that staff assist them with walking when they need assistance. Two (2) out of fourteen (14) residents were not able to answer or did not remember if staff assist them with walking. (- continued in LIC 9099 C-) Unsubstantiated Staff interviews revealed that four (4) out of four (4) staff indicated that staff would assist resident with walking. LPA interviewed Resident #1 (R#1) and observed that R#1 was seated in a wheelchair. R#1 reported that staff would assist R#1 with walking when requesting staff to assist. Interviews with residents #2 - #4 and #6-#14 revealed that Staff assist resident with walking. During today’s visits, LPA Tao observed staff assisted residents with walking when residents requested assistance. 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. Regarding allegation: Staff did not protect resident's personal items. The Investigation consisted of LPA’s observations, interviews with residents#1 - #14, interviews with staff #1- #4 and review of Resident #1’s file. LPA Tao interviewed Resident#1(R#1) who did not recall missing any personal items in the facility. Based on resident interviews, eight (8) out of fourteen (14) residents stated they did not have personal items missing in the facility and resident reported that staff did protect resident’s personal items. One (1) out of fourteen (14) residents were unable to answer LPA interview questions. Four (4) out of fourteen (14) residents stated they have personal items missing; however, staff would assist residents to find the missing items. Staff interview revealed, with resident's permission, staff would search their rooms when residents report missing items. Most of the time, items were misplaced instead of missing. Four (4) out of four (4) staff stated that staff did protect resident's personal items. Administrator would remind residents not leaving valuable items unattended. Per resident#1 file review of R#1’s personal belongings and interview with R#1’s responsible party, R#1 and R#1’s Responsible Party reported R#1 did not have any valuable items that were allegedly lost or missing due to staff not protecting R#1 personal items. LPA Tao toured resident rooms for residents #4-#10 and did not observe valuable items visible in their rooms. The investigation did not reveal any evidence to support the allegation that staff do not protect resident's personal items. 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. An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 28, 2021 · control 28-AS-20210721121808

Allegation investigated: Staff failed to keep residents call button in operable condition.

***This report is being amended and superseded for visit conducted on August 14, 2019, for purposes of downgrading deficiency cited under Regulation Section 87303(a) - Maintenance and Operation, from a Type A deficiency to a Type B deficiency. The findings on this complaint investigation remain unchanged.*** Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Assistant Administrator / Valantine Ashjian and was later joined by Licensee Representatives / Julie and David Chirikian and the Administrator / Pat Redner who assisted with the visit. LPA explained the purpose of today’s visit is to discuss the above mentioned allegation of "Staff failed to keep resident’s call button in operable condition". During today's visit, LPA interviewed Licensee Representatives / Julie and David Chirikian, Assistant Administrator / Valantine Ashjian, Administrator / Pat Redner, Resident #2 and Technician / Sean Thompson and his Supervisor / Don Gates from Safety Centric Security Installation. LPA attempted to interview Resident #1 (R1) but R1 declined to speak with the LPA. Also, between the hours of 9:35AM and 10:15AM, LPA toured Substantiated learned that R1 was admitted to Vitas Hospice on 6/20/18 due to having a terminally ill disease. Based on interview of the Administrator, LPA was told that facility has been following physician's orders and hospice notes in order to meet he needs of the R1. LPA was unable to interview R1 as R1 declined to speak with LPA. After reviewing the file of R1, LPA did not observe any concerns of facility not following physician's orders. There is insufficient evidence to support this 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. An exit interview was conducted and a copy of this report was provided to the Administrator. resident bedrooms located on the Basement floor of the D and E sections of the building and tested the call light buttons. LPA obtained a copy of the contract from Safety Centric regarding installation of the new call light system along with the "Call Light Safety Log" performed by staff. The investigation revealed the following; Allegation: Staff failed to keep residents call button in operable condition. Based on interviews conducted of management, the statements obtained did not corroborate with this allegation. During a walk through of resident rooms located on the Basement floor of the D and E sections of the building and observed the following concerns; -At 9:57AM, Assistant Administrator tested the call light button in Room #153E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. -At 10:05AM, Assistant Administrator tested the call light button in Room #155E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. -At 10:07AM, Assistant Administrator tested the call light button in Room #159E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. -At 10:09AM, Assistant Administrator tested the call light button in Room #157E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. -At 10:11AM, Assistant Administrator tested the call light button in Room #156E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. -At 10:13AM, Assistant Administrator tested the call light button in Room #158E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. -At 10:15AM, Assistant Administrator tested the call light button in Room #160E with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff. LPA learned that the intercom has been in disrepair since 8/13/19. Based on LPAs observations, the only resident room located in the E section of building (basement level) with a working call light was Room #161E. Currently the facility is in the process of updating all resident rooms with a new call light and intercom through Safety Centric Security Installation (SCSI). After speaking with the Technician and his Supervisor from SCSI, LPA was told that although the facility is upgrading to a new call light system, nothing was disconnected on the existing call light system or wiring in resident rooms. Supervisor / Ron Gates stated that the new call light equipment is independent from the exiting system and has a new wiring and a new brain. LPA was also told that the existing call light system is removed upon installation of the new call light system in each resident bedroom so that residents may continue to alert staff if needed without interruption. Based on LPA’s observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to the Administrator along with the Appeals Rights.the state’s words, verbatim · CDSS document, Aug 14, 2019 · control 28-AS-20190805131639

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 15, 2019

Maintenance and Operation. 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; On 8/14/19, During a walk through of resident rooms between the hours of 9:35AM - 10:15AM, the Assistant Administrator tested the call light button in the following resident rooms with LPA present and the call light button was observed to be inoperable as there was no light or sound on the intercom and no response from staff; Rooms 153E, 155E, 159E, 157E, 156E, 158E and 160E.the state’s words, verbatim · CDSS document, Aug 14, 2019

Plan of correction: According to Licensee Representative / David Chirikian, a new call light system will be installed in rooms 153E, 155E, 159E, 157E, 156E, 158E and 160E by the end of today (8/14/19). In the mean time, there is one (1) staff monitoring the E section of the building from 7AM - 10PM (basement level) and will continue to monitor until the new call light system has been installed and is operable. Licensee will self certify to CCL once installation has been completed of the new call light system in the E section of the building by the POC due date.