Kingsley Manor

***This LIC-9099 report supersedes the LIC-9099 report dated 07/29/2025 to clarify the findings of only this allegation; However, the findings will remain the same.*** Licensing Program Analysts (LPAs) Luis De Leon conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with Director of Health Services Milca Osorio and reason of visit was explained. Director Osorio stated that Director Liyon O'Quinn was not available for today's visit. The investigation consisted of the following: On today’s visit, LPA De Leon obtained the following documents: Admission Agreement, Physician’s Report, Pre-Admission Appraisal, re-appraisal, Incidents Reports (SIRs), Nurse notes, Health and Wellness Review, and Face Sheet. Report continues with page 9099C... UnsubstantiatedRead the full finding— CDSS inspection report, October 7, 2025 · control 28-AS-20250721131320

Licensing Program Analysts (LPAs) Luis De Leon conducted a subsequent complaint investigation visit to deliver findings for the allegation listed above. LPA met with the Director of Health Services Milca Osorio and explained the reason for today’s visit. Director Osorio stated that Director Liyon O'Quinn was not available for today's visit During the initial visit on 07/29/2025, LPA De Leon obtained the following documents: Staff and Resident Rosters, admission Agreement, Physician’s Report, Nurse’s notes, Face Sheet, SIRs, and hospital discharge. LPA conducted Interviews with residents and staff. On today’s visit, LPA toured residents’ common areas and observed no health and safety risks. LPA delivered findings on above allegations. Report continues on page LIC-809C... SubstantiatedRead the full finding— CDSS inspection report, October 7, 2025 · control 28-AS-20250723092255

Licensing Program Analysts (LPAs) Luis De Leon conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with the Director Liyon O'Quinn and explained the reason for the visit. The investigation consisted of the following: On today’s visit, LPA De Leon obtained the following documents: Admission Agreement, Physician’s Report, Pre-Admission Appraisal, re-appraisal, Incidents Reports (SIRs), Nurse notes, Health and Wellness Review, and Face Sheet. LPA toured resident's common areas and observed no health and safety risks, Regarding allegation: Facility is charging residents for services not rendered. It is alleged that the facility did not inform R1’s responsible party of additional monthly fee and that R1’s responsible party did not consent to the additional services. It is alleged that the additional fee is not listed in R1's admissions agreement. R1’s responsible party learned of the additional fee in April 2025 when Director Ms. Liyon gave R1’s rRead the full finding— CDSS inspection report, July 29, 2025 · control 28-AS-20250721131320

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation regarding the above allegation(s). LPA was met by Administrator Liyon O’Quinn and explained the purpose of the visit. The investigation consisted of the following: LPA requested and obtained a copy of Staff roster, Resident roster, Plan of Operation, Current admission packet, pest control records from 08/01/20 to 02/01/21. LPA Ramirez interviewed Staff 1 – Staff 5 (S1 - S5), and Resident 1 – Resident 4 (R1- R4). LPA Ramirez toured kitchen and dining room during lunch time and 4 resident rooms at 1:55 pm. SubstantiatedRead the full finding— CDSS inspection report, February 3, 2023 · control 28-AS-20200831135015

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation regarding the above allegation. LPA was met by Administrator Liyon O’Quinn and explained the purpose of the visit. The investigation consisted of the following: LPA requested and obtained a copy of Staff roster, Resident roster, Plan of Operation, and current admission packet. LPA Ramirez interviewed Staff 1 – Staff 5 (S1 - S5), and Resident 1 – Resident 4 (R1- R4). LPA Ramirez toured kitchen and dining room during lunch time and 4 resident rooms at 1:55 pm. Unsubstantiated— CDSS inspection report, February 3, 2023 · control 28-AS-20200831135015

Licensing Program Analyst (LPA) Tao conduct a subsequent unannounced complaint investigation and addressed the above allegations. LPA conducted an initial virtual complaint investigation on 01/08/21. Today, LPA met with Administrator, Liyon O'Quinn and explained the purpose of today's visit. Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #8 (S8); interviews of residents from Resident #1 (R1) through Resident#7 (R7); reviewed Resident#1’s record reviews, and a facility tour. LPA obtained copies of the staff and resident rosters; and resident#1 files with relevant information. The investigation revealed the following: In regard to allegation: “staff failed to return resident's personal belongings," it was alleged that staff did not return Amazon packages to resident #1 (R1) and charge R1 for packages storage. (-Continued in LIC 9099 C-) UnsubstantiatedRead the full finding— CDSS inspection report, January 24, 2023 · control 28-AS-20201231140851

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced initial 10-day complaint investigation regarding the above allegation. LPA discussed the purpose of the visit with Liyon O'Quinn, Executive Director. The investigation consisted of the following: LPA reviewed Admissions Agreement and Shower schedule for Resident (R1). LPA toured Resident (R1's) Room 100 and interviewed Resident (R1) at 10:30 AM to 11:00 AM LPA interviewed Staff (S1) and Administrator from 10:00 AM to 10:30 AM. In regards to the allegation Staff are not meeting residents showering needs, based on interviews conducted and information gathered Staff interviewed stated that facility staff assisted Resident (R1) with all showering needs on 11/13/2022 and have the next shower with assisting R1 to be completed on 11/20/2022. Staff stated that it is R1's preference to be showered 1x a week on Sunday's. Staff stated that a meeting is scheduled for 11/17/2022 with R1, family member of R1, Social Worker of R1Read the full finding— CDSS inspection report, November 16, 2022 · control 28-AS-20221107092001

Licensing Program Analyst (LPA) Tao conducted an unannounced initial 10-day complaint investigation regarding the above allegation. LPA discussed the purpose of the visit with Liyon O'Quinn, Executive Director. The investigation consisted of the following: LPA interviewed staff from staff#1 (S1) to staff #5 (S5); interviewed residents from resident #1 (R1) to resident #6 (R6); obtained resident roster and staff roster; reviewed facility file of resident#1, including a copy of the plan of operation - Eviction Process, three collection letters, 30-day eviction letter dated 10/5/22, face sheet, admission agreement, physician report, rent increase letter (dated 12/20/21), rental agreement, resident handbook and progress notes. LPA conducted a physical plant tour during the visit. (-Contined in LIC 9099C-) UnsubstantiatedRead the full finding— CDSS inspection report, November 8, 2022 · control 28-AS-20221101142848

*This report supersedes the report dated 10/07/22 to include additional information* Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Lyon O’Quinn (Executive Director) and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the resident and staff rosters, and interviewed Executive Director, Staff 1 - Staff 3 (S1 - S3), and Resident 1 - Resident 8 (R1 - R8).Copies of R1's physician report, admission agreement, care plan meeting, and resident appraisal, The investigation revealed the following: regarding the allegation "staff do not assist resident with showering”, it is alleged that staff have stopped assisting R1 in transferring from the wheelchair to the shower. R1 has not been able to shower due to the lack of assistance. (CONTINUED TO LIC 9099C) SubstantiatedRead the full finding— CDSS inspection report, October 18, 2022 · control 28-AS-20221004165836

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Lyon O’Quinn (Executive Director) and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the resident and staff rosters, and interviewed Executive Director, Staff 1 - Staff 3 (S1 - S3), and Resident 1 - Resident 8 (R1 - R8).Copies of R1's physician report, admission agreement, care plan meeting, and resident appraisal, The investigation revealed the following: regarding the allegation "staff do not assist resident with showering”, it is alleged that staff have stopped assisting R1 in transferring from the wheelchair to the shower. R1 has not been able to shower due to the lack of assistance. (CONTINUED TO LIC 9099C) SubstantiatedRead the full finding— CDSS inspection report, October 7, 2022 · control 28-AS-20221004165836

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Executive Director (ED: Liyon O'Quinn). LPA/RA spoke to ED O'Quinn prior to entering the facility to conduct a risk assessment. ED O'Quinn informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff have symptoms. The purpose of today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegations. An initial 10-Day virtual visit was conducted by LPA Angelica Rea on 06/18/20 (via telephone) with (former) Administrator (A1: Shaun Rushforth) due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. LPA/RA Ceniceros interviewed (between 8:30 a.m. - 9:00 a.m.) two (2) staff members. Resident #1 no longer resided at the facility, effective 09/2020. LPA/RA reviewed (between 9:30 a.m. – 10:00 a.m.) pertinent documentation: AdmissioRead the full finding— CDSS inspection report, September 27, 2022 · control 28-AS-20200612090026

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Executive Director Liyon O'Quinn and explained the reason for the visit. The investigation consisted of: On 3/14/22, LPA Gonzalez collected copies of Staff and Resident Rosters. LPA conducted an interview with Executive Director Liyon O'Quinn and Residents 1-6 (R1-6) and requested/ received pertinent documents related to complaint ninvestigation. On 5/12/22, LPA Gonzalez interviewed Exectutive Director Liyon O'Quinn, Divisional Vice President Randy Herzig, Staff 1-6 (S1-6), Residents 7-19 (R7-19) and conducted a tour of the facility with Executive Director Liyon O'Quinn. LPA toured the facility and observed residents in care in the following facility buildings: Main Building, Leitzell Hall, Administration Building, Margaret Hall, Holly Cottage (Library/Fitness Center), and the Dining hall. LPA also collectedRead the full finding— CDSS inspection report, May 16, 2022 · control 28-AS-20220307130848

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Executive Director Liyon O'Quinn and explained the reason for the visit. The investigation consisted of: On 3/14/22, LPA Gonzalez collected copies of Staff and Resident Rosters. LPA conducted an interview with Executive Director Liyon O'Quinn and Residents 1-6 (R1-6) and requested/ received pertinent documents related to complaint ninvestigation. On 5/12/22, LPA Gonzalez interviewed Exectutive Director Liyon O'Quinn, Divisioanl Vice President Randy Herzig, Staff 1-6 (S1-6), Residents 7-19 (R7-19) and conducted a tour of the facility with Executive Director Liyon O'Quinn. LPA toured the facility and observed residents in care in the following facility buildings: Main Building, Leitzell Hall, Administration Building, Margaret Hall, Holly Cottage (Library/Fitness Center), and the Dining hall. LPA also collectedRead the full finding— CDSS inspection report, May 12, 2022 · control 28-AS-20220307123621