Golden Assisted Living

Allegation investigated: Staff do not allow resident to receive phone calls at the facility Staff do not provide resident with bed linen Staff do not meet resident's dietary needs Staff did not properly supervise resident, resulting in resident sustaining an injury

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigation at 10:12 AM and interviewed residents and staff between 10:30 AM to 1:25 PM. Regarding the allegation that Staff do not allow resident to receive phone calls at the facility, it was alleged that staff do not allow Resident #1 (R1)'s family member speak to R1. LPA's observation during visit on 07/24/23 at 9:30 AM revealed that R1 owned a cell phone and kept on R1's drawer. LPA's interview with Resident #2 (R2) on 07/24/23 at 10:30 AM revealed that R1 used own phone every now and then. LPA's interview with the administrator also revealed that whenever the office received a phone call for a resident, they page and locate the resident and bring to the office to use the phone, if unable to locate, they ensure to pass the message to the resident, if there is any. (continued on LIC 9099-C) Unsubstantiated Further, LPA's interview with twelve (12) residents or more than 10% of the current census revealed that eight (8) of the residents interviewed had their own cell phone and twelve (12) out of twelve (12) residents did not have any problem with the facility receiving their phone calls. Regarding the allegation that Staff do not provide resident with bed linen, it was alleged that R1 was not provided bed linen by the staff. On 07/24/23 at around 10:30 AM, LPA observed that the bed of R1 was made and had a clean linen. Also, during that visit, LPA's interview with R2 (R1's room mate) revealed that staff regularly change their linen once a week or if there is any accident, they change it immediately. LPA's interview with staff today revealed that they changed bed linens of every resident a minimum of once a week and immediately if there are "accidents" or if the linen is wet. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents stated that their bed linens are changed at least once a week by the staff. Regarding the allegation that Staff do not meet resident's dietary needs, it was alleged that staff do not feed R1 three (3) meals a day. LPA’s interview with R2 (R1's room mate) revealed that R1 eats regularly in the dining room three (3) times a day. LPA's interview with care staff confirmed that R1 regularly went to the dining room to eat meals and never requested tray service. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents stated that the facility serve meals three (3) times a day at the dining room. Regarding the allegation that Staff did not properly supervise resident resulting in resident sustaining an injury, it was alleged that R1 was attacked by a former roommate injuring R1's leg. LPA's record review today at 1:30 PM revealed that there was no record of R1 injuring own leg at any time while living at this facility. LPA's interview with the administrator today also revealed that she did not receive any report of R1 being attacked by a room mate during R1's stay at the facility. LPA's interview with R2, R1's last room mate, revealed that R2 gets along with R1 and there was no time that they had any altercation or argument. Further interview with the administrator also revealed that the former room mate of R1 prior to R2 left the facility on 03/24/2023. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 31-AS-20230720082501

Allegation investigated: Facility staff are not addressing a bio hazard on facility premises

Licensing Program Analysts (LPAs) Gary Tan and Gina Saucedo conducted an unannounced complaint visit at this facility to investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPAs conducted physical plant tour at 9:55 AM, requested copies of facility documents relevant to the investigation at 10:18 AM. It was alleged that several of the men who live at this facility urinate on the side of the wall on the outside grounds of the facility, LPAs observation during physical plant tour today at 9:55 AM, revealed that there was a faint smell of urine along the pathway on the side of the facility leading to the smoking patio of the outside yard. LPAs also observed some urine marking on the floor on the bicycle rack near the smoking patio. LPAs record review of photographic evidence also revealed that some of the residents are indeed urinating outside near the smoking patio area. Based on the information gathered during this visit, the allegation is deemed substantiated at this time. Exit interview conducted. Copy of this report issued. Substantiatedthe state’s words, verbatim · CDSS document, Sep 15, 2023 · control 31-AS-20230913160843

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 29, 2023

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: Based on LPAs observation the licensee failed to ensure that the facility is clean, safe and sanitary at all times which poses a potential health and safety hazard to the residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: Administrator agreed to clean the area and put more lights, cctv and warning speaker so that night staff could warn the residents trying to urinate in the area and agreed to submit proof of correction on or before the POC date.

Allegation investigated: Staff sexually abused residents in care

Licensing Program Analyst (LPA) Gary Tan and Mariana Agban conducted an unannounced subsequent complaint visit at this facility to deliver the finding for the above allegation. LPAs met with Licensee Marilyn Ngueyn and explained the reason for the visit. On 04/19/23, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s Investigation Branch (IB) and assigned to IB investigator Olivia Spindola. On 04/20/23 at 10:30 AM, then LPA Stamps initiated the complaint visit. LPA obtained copies of the facility records relevant to the investigation. During the course of the investigation, Investigator Spindola interviewed the administrator of the facility where the former resident of this facility is currently residing. Investigator also interviewed the former resident of this facility and determined that a full investigation pertaining to the allegation was not warranted at this time. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation: staff sexually abused resident in care, it was alleged that a suspected group of paid individuals came into the room of Resident #1 (R1) once every month to rape (R1). LPA’s interview with the administrator on 05/17/23 at 1:30 PM revealed that R1 was a long-time former resident of this facility grandfathered in from the former owner but left sometime in 2018. LPA’s interview with the administrator of the facility where R1 is currently residing revealed that R1 was admitted at this facility on 09/11/2019. Investigator Spindola’s interview with the administrator of the current facility of R1 on 05/16/23 at 1:00 PM revealed that R1 is currently taking medication for Schizophrenia, Dementia, Alzheimer's among other medical conditions. Furthermore, R1 has sent more than fifty (50) letters to multiple governmental agencies, private companies, and institutions requesting large sums of money believing that these entities owe R1 money. Investigator Spindola’s interview with R1 on 05/16/23 at 1:40 PM revealed that R1 was not able to identify any person who allegedly raped R1 and was unable to provide any useful detail as to when, where and how the allegation happened. Rather, R1 states a more implausible allegation of being drugged while being raped by the Chief of Police, Firemen and rich people. Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 31-AS-20230419162022

Allegation investigated: Staff did not safeguard resident's belongings Staff do not assist resident with bathing and grooming Staff do not maintain facility clean and sanitary at all times

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with licensee Marilyn Nguyen and explained the reason for the visit. LPA conducted physical plant tour at 9:21 AM, requested copies of facility documents relevant to the investigation at 9:49 AM and interviewed staff and residents between 10:10 AM to 1:30 PM. Regarding the allegation that Staff did not safeguard resident's belongings, it was alleged that Resident #1 (R1)'s laptop, cellphone, clothing and wallet are missing at the facility. LPA's record review today at 1:30 PM revealed that R1 only declared laptop and guitar on Resident's Personal Property and Valuable (LIC 624) and LPA observation during physical plant tour at about 9:30 AM confirmed and located the laptop, guitar and cell phone in R1's room. (continued on LIC 9099-C) Unsubstantiated (continued on LIC 9099) Regarding the allegation that Staff do not assist resident with bathing and grooming, it was alleged that staff do not assist R1 with bathing and grooming, resulting in the resident having some medical issues. LPA's record review today revealed that R1 was able to bathe, dress/groom and care for own toileting needs. LPA's interview today with Resident #2 (R2) who is R1's room mate for about a year revealed that R1 bathe, dress and groom on R1's own and able to take care of R1's own toileting needs. LPA's interview with care staff today at 12:00 PM also confirmed that R1 was able to do everything on R1's own and never asked for any assistance from them. Regarding the allegation that Staff do not maintain facility clean and sanitary at all times, it was alleged that staff do not clean residents' bedrooms, nor clean the facility hallway. LPA's observation today at 9:35 AM revealed that all the common rooms are clean and in proper order. LPA's visited seven (7) random rooms including R1's room and observed that all the seven (7) room visited were clean and in proper order. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents interviewed stated that the facility is being clean regularly on a daily basis including their bedrooms. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 24, 2023 · control 31-AS-20230720082501

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff injured resident while in care Staff locked resident in room

This report was amended to change the findings from unfounded to unsubstantiated. Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:20 AM, requested facility documents relevant to the investigation at 9:55 AM, conducted record review between 10:00 AM to 11:35 AM and interviewed the administrator and staff between 11:35 AM to PM to 1:00 PM. Regarding the allegation that the staff injured resident while in care, it was alleged that Staff "Maria" cut Resident #1 (R1)'s right under chest on 04/03/23 at 1:00 PM while in own bed. LPA's record review today between 10:00 AM to 11:35 AM of R1's exit documents and Unusual Incident report (LIC 624) revealed that R1 left the facility on 04/01/23 at around 11:00 AM, transported to a nearby hospital and did not come back to the facility since. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with the administrator today at 11:50 AM revealed that R1 complained of leg pain that was why R1 was sent to the hospital. Further interview also revealed that there was no care staff named "Maria" working in the morning and/or afternoon shift and the only care staff named "Maria" is working only on graveyard shift. Regarding the allegation that Staff locked resident in room, it was alleged that staff Maria locked R1 in own room on 04/03/23 at about 1:00 PM. LPA's record review today between 10:00 AM to 11:35 AM of facility's unusual incident report (LIC 624) revealed that R1 left the facility on 04/01/23 at around 11:00 AM, transported to a nearby hospital and did not come back to the facility since. LPA's interview with the administrator today at 11:50 AM revealed that R1 complained of leg pain that was why R1 was sent to the hospital. Further interview also revealed that there was no care staff named Maria is working in the morning or afternoon shift and the only care staff named "Maria" is working only on graveyard shift. LPA's observation today at 9:35 AM also revealed that R1's roommate when R1 was still at the facility is still living at the facility to date. LPA's interview with R1's roommate revealed that no staff had locked their room nor witnessed any staff harming R1 when R1 was still at the facility. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 20, 2023 · control 31-AS-20230428114119

Allegation investigated: Facility is not kept clean Staff did not ensure facility is kept free of pests Facility is refusing to accept resident back to the facility

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:05 AM, requested copies of facility documents relevant to the investigation at 9:45 AM and interviewed staff and residents between 10:00 AM to 2:00 PM. Regarding the allegation that the facility is not kept clean, it was alleged that the restrooms are not kept clean. LPA's physical plant tour at 9:05 AM in ten (10) random residents' rooms on both floors revealed that the ten (10) out of ten (10) restrooms are generally clean. LPA's interview with the administrator at 10:00 AM revealed that they four (4) housekeepers during morning shift, two (2) housekeepers for each floor who cleans the residents bathroom on a daily basis. LPA's interview with twelve (12) residents or 10% of the current census revealed that all of the twelve (12) residents interviewed stated that housekeeping staff clean their restrooms everyday. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not ensure facility is kept free of pests, it was alleged that the facility is infested with cockroaches. LPA's record review today at 1:21 PM revealed that the facility has a contracted pest control company who visit every month to ensure that the facility is free of pests inside and outside. LPA's interview with twelve (12) residents or 10% of the current census between 10:00 AM to 2:00 PM also revealed that twelve (12) out of twelve (12) residents interviewed did not see or observed any cockroach in their room or anywhere in the facility. Regarding the allegation that the Facility is refusing to accept resident back to the facility, it was alleged that the facility administrator did not want to accept Resident #1 (R1) to go back at the facility. LPA's record review today at 1:21 PM revealed that R1 is still at the Skilled Nursing Facility (SNF) in Van Nuys and still undergoing Occupational Therapy until 06/27/23. LPA's interview with the administrator today at 10:00 AM revealed that she did not refused nor evicted R1 but was communicating with the SNF and was informed that R1 was still undergoing therapy and not ready to be discharged. Further interview also revealed that the SNF had already contacted a six (6) beds Assisted Living Facility in Valley Glen to move R1 upon discharge and the Power of Attorney (POA) of R1 has already called the facility to pack R1's belongings at the facility for a later pick up. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 9, 2023 · control 31-AS-20230601140224

Allegation investigated: Staff member is physically abusing resident(s) in care Staff member is verbally abusing resident(s) in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted physical plant tour at 9:15 AM, requested copy of facility documents relevant to the investigation at 9:42 AM and interviewed staff and residents between 10:00 AM to 2:10 PM. Regarding the allegation that Staff member is physically abusing resident(s) in care, it was alleged that a male staff member who is physically abusing residents and "fight" with a female resident. Resident #1 (R1) allegedly saw the staff hit this resident "3-4 times" and stated that other staff members saw and heard the incident as well. LPA's interview with R1 on 03/21/23 between 10:00 AM to 1:00 PM revealed that R1 did not actually see the "fight" but just heard it as it occurred just outside of R1's room. R1 also denied being hit by any staff. LPA's interview with staff closely resembling the description given by R1 and was on duty on 03/12/23 or the day of the incident, today between 10:00 AM to 2:10 PM, revealed that both of these staff denied hitting anyone on the day of the alleged incident or at anytime. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's close circuit television (CCTV) review today at 1:35 PM also revealed that there was no incident of "fighting" or "yelling" on the date and time described by R1 outside of R1's room nor there is any incident "fighting" nearby R1's room. Regarding the allegation that Staff member is verbally abusing resident(s) in care, it was alleged that R1 was verbally abused by the staff by threatening R1 that the Staff is going to "kill" him. LPA's interview with two (2) staff present on the day of the alleged incident revealed that no one threatened R1 nor they heard any other staff threatened R1. LPA's interview with Resident #2 (R2) today between 10:00 AM to 2:10 PM revealed that R2 did not see or hear any staff fighting with any resident at anytime nor witnessed any staff threatening to "kill" R1. LPA's interview with twelve (12) random residents or more than 10% of the current census today between 10:00 AM to 2:10 PM also revealed that ten (10) out of twelve (12) residents stated that the staff are respectful to them and twelve (12) out of twelve (12) residents did not experience being yelled at by any staff nor they witness any staff yelling or threatening anyone. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 27, 2023 · control 31-AS-20230320154213

Allegation investigated: Resident sustained unexplained bruises while in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:10 AM, requested copies of facility documents relevant to the investiation at 9:30 AM and interviewed staff between 9:30 AM to 10:40 AM. It was alleged that Resident #1 (R1) had bruises on legs when family members picked up R1 at the facility. LPA records review today between 10:40 AM to 11:30 AM revealed that R1 was admitted at the facility on 02/07/23 from the hospital at around 4:30 PM and was taken by the family members on 02/12/23 at 1:21 PM from the facility, hospital records and physician's report did not mention of any bruise on R1's body. Pre placement appraisal and appraisals needs and services plan of R1 were also reviewed and showed that R1 did not have any bruise and was capable of self care including but not limited to bathing, grooming, feeding and toileting. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with six (6) staff on 02/21/23 between 10:30 AM to 1:00 PM and today between 9:30 AM to 10:40 AM revealed all six (6) staff did not observe any bruise on R1's legs or body during R1's short stay at the facility. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 17, 2023 · control 31-AS-20230217124055

Allegation investigated: Resident developed multiple pressure injuries while in care Resident sustained an unexplained stab wound while in care Resident was assaulted while in care Staff are not providing a safe environment for resident in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. Initial investigation visit was conducted by LPA Nicholas Reed on 08/16/2022. At the time of visit between 10:35 AM and 12:20 PM. LPA Reed conducted a physical plant tour and a records review. The case was later referred to the Investigation’s Branch (IB) and an investigation was continued by the IB Investigator Real. Between 09/22/2022 and 12/07/2022 IB investigator conducted interviews with Resident #1 (R1)'’s home health care providers, doctors, facility Administrator, staff, and residents and obtained medical records from R1’s hospitalization. Regarding the allegation “Resident developed multiple pressure injuries while in care”, it was alleged that R1 developed pressure injuries on their heel and coccyx while in care. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) From staff interviews on 09/23/22 and 10/14/22, staff mentioned routine observation of R1 about every two hours. Staff #1 (S1) and Staff #2 (S2) did not notice any pressure injuries on R1 prior to 08/05/2022. From review of R1’s hospital records conducted on 01/25/2023 at 10:20 AM, R1 was seen in emergency department (ED) at approximately 8:30 PM on 08/05/2022. And was transferred to the hospital at 12:00 AM on 08/06/2022. Hospital staff observed R1’s pressure injuries, but a wound consultation was not performed until 4:41 PM on 08/08/2022. At that time, it was determined that R1 developed three (3) Unstageable pressure injuries. A review of medical records did not reveal any supporting information to determine that R1 had unstageable pressure injuries at the time of admission to ED. Based on interviews and record review, there is no sufficient information to support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Resident sustained an unexplained stab wound while in care”, it was alleged that R1 was stabbed in the knee while under facility care. From medical record review, R1 was admitted to the hospital on the night of 08/05/2022 with “multiple penetrating wounds”. From interviews conducted on 09/23/22, 10/14/22, and 10/28/22, no residents or staff witnessed the incident. On the night of 08/05/2022, R1 was observed on the floor of their room with blood on their leg and head. A broken coffee cup was also seen on the ground. R1 did not reveal how the injury happened. Resident #2 (R2) was the roommate of R1, and R2 did not report any previous issues or altercations with R1. R2 initially denied any knowledge of R1’s injury. R2 later stated that R2 hit R1 with the coffee mug but did not disclose further details. R2’s interview was of low credibility due to inconsistencies in R2's statement. From interviews and record review, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Resident was assaulted while in care”, it was alleged that R1 was stabbed by an unknown assailant at the facility. From record review, the facility submitted an incident report after the police investigation. The police report has yet to be released, though it was determined that the stab wounds were self-inflicted. From interviews on 09/23/22 and 10/14/22, staff and residents did not see or hear any altercations leading up to R1’s injury. Staff #2 (S2) stated R1’s roommate R2 was observed lying down and appeared to be asleep when R1 was injured. Based on record review and interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. (continued to LIC 9099-C) (continued from LIC 9099-C) Regarding the allegation “Staff are not providing a safe environment for resident in care”, it was alleged that R1 was unsafe at the facility”. From interviews 09/23/22 and 10/14/22, residents expressed no safety concerns and felt treated well by staff. Staff described their frequent observation of residents about every two hours. Staff had not observed any signs of danger or unsafe situations. R1 and roommate R2 maintained a good relationship. From file review conducted on 01/25/2023 at approximately 10:45 AM, the facility did not have a history which indicated a lack of safety. Based on interviews and file review, the allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Apr 28, 2023 · control 31-AS-20220815124252

Allegation investigated: Facility staff member tampered with resident's medications causing them to feel ill.

Licensing Program Analysts (LPAs) Gary Tan and Mariana Agban conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPAs met with administrator Monique Lopez and explained the reason for the visit. LPAs conducted physical plant tour at 12:06 PM, requested copy of facility documents relevant to the investigation at 12:30 PM and interviewed staff between 12:45 to 2:00. It was alleged that Resident #1 (R1) would see Staff #1 (S1) spray something onto R1's medication that would make R1 dizzy and give R1 a stomachache, LPAs' observation during physical plant tour revealed that all of residents' medications are in bubble pack and when the medication technician prepares the medication for each resident, medications were place in a small brown envelope individually for distribution to all residents. LPAs' record review today between 2:00 PM to 2:30 PM also revealed that R1 has a diagnosis of Gastroesophageal reflux disease (GERD) and Dizziness from the time of admission on 12/13/21, moreover, R1 left the facility on 03/24/23 to spend a week on a friend's house but wasn't able to return as R1 was brought to the hospital directly from R1's friend's house. Unsubstantiated (continued from LIC 9099) R1 brought all medications including PRN medication when R1 left the facility on 03/24/23 LPAs interview with S1 revealed that R1's medication are all in bubble pack and denied spraying or putting anything on R1's medication as they prepare all medications all at once immediately before distribution. LPA interview with another medication technician confirmed that no one spray anything on anyone's medication as they have no reason to as they want to make the residents better, not worse. Also, when they prepare the medication, no other person is present nor the door is open at the medication room aside from the medication technician preparing the medication. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 11, 2023 · control 31-AS-20230403165141

Allegation investigated: Staff are not adequately addressing outbreak of scabies at the facility.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:12 AM, requested copy of facility documents relevant to the investigation at 934 AM and interviewed staff and residents between 10:00 AM to 1:00 PM. Regarding the allegation that the Staff are not adequately addressing outbreak of scabies at the facility, LPA's interview with Resident #1 (R1) revealed that this happened sometime in January of this year. LPA's record review at around 1:05 PM revealed that R1 was admitted at the facility on 03/10/23. LPA's interview with staff between 10:00 AM to 1:00 PM revealed that there was no case of scabies at this facility for the last three (3) years. The allegation is therefore deemed unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of this report issued. Unfoundedthe state’s words, verbatim · CDSS document, Mar 21, 2023 · control 31-AS-20230320154213

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

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Required 1-year infection control inspection to this facility. LPA initially met with staff Amourfino Cruz who called the licensee and arrived 30 minutes later, LPA explained the purpose of the visit. At 9:18 AM, with the assistance of staff Marcelo Nogar, LPA conducted a tour of the facility inside and out. The following were observed: There is one main entrance being utilized at the facility. There are required poster posted at the entrance doors. Screening area is located in the reception area. Sign in log book, hand sanitizer and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. The facility had submitted and approved Mitigation Plan and Infection Control Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the entrance door. Hand washing, coughing etiquette, physical distancing and other necessary signage were posted in the bathroom and all over the facility. The facility has a designated visitor's area in the front of the main building. The facility has sufficient stock of PPE in the storage room The facility consists two (2) storey building and a basement. The facility is fire cleared for 128 ambulatory residents, sixty (60) of which maybe non-ambulatory. Hospice waiver for twenty five (25) residents. The basement has the Kitchen, Cafeteria, Activity room, Laundry Area, Staff break room and Storage rooms. There are sixty four (64) shared bedrooms with own bathroom and eight (8) public bathrooms. (continued to LIC 809-C) Common Areas: The Recreation rooms had chairs that were six (6) feet apart to promote social distancing. LPA observed four (4) signs posted alerting residents to wear masks maintain and two (2) signs for social distancing. The facility has two (2) elevators, both of which are working properly and had signs for masking requirements, coughing etiquette, and social distancing. There is a sign just outside of the elevator that only two (2) individuals should ride at a time. Signs were posted throughout hallways on all floors for social distancing, mask wearing, and cough etiquette. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on a regular basis. The facility is equipped with sprinkler system which was last tested on 04/20/22 and valid until 04/30/24. Fire extinguishers are located all throughout the facility and were last serviced on 10/10/22. Fire Drill was last conducted on 1/10/23. Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. Random resident rooms were inspected and observed with all required furnishings, working signal system, grab bars and nonskid surfaces in the bathrooms. Hot water temperature in random resident bathrooms were checked and measured a range of 108.5°F to 117.1°F. There were enough clean linen available. Basement: Kitchen and Cafeteria are located in the basement area the kitchen appeared clean, odorless and free from insects. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable foods. Frozen foods are wrapped and stored appropriately. Kitchen was observed to be inaccessible to residents. The cafeteria has tables which are approximately 6 feet apart from each other and observed to be clean and in proper order. Laundry room was observed to be locked during visit. There were two (2) shaded smoking area in the surrounding backyard equipped with outdoor furniture. There is no body of water in the facility. At 1:40 PM, LPA reviewed records of six (6) random residents and six (6) staff. Resident and staff records appeared to be complete and updated. Medications were observed to be locked in the medication room and inaccessible to residents. There were two ( 2) complete first aid kits in the medication room. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 26, 2023

Allegation investigated: Staff left resident soiled for an extended period of time Staff does not ensure resident is fed

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:15 AM, requested copy of facility documents relevant to the investigation at 10:00 AM and interviewed staff and residents between 10:30 AM to 1:00 PM. Regarding the allegation that staff left resident soiled for an extended period of time, it was alleged that Resident #1 (R1) was left with soiled diapers, LPA's record review at 10:16 AM revealed that R1 did not have bowel or bladder impairment and did not require assistance in dressing/grooming, toileting and bathing. LPA's interview with three (3) caregivers today between 10:30 AM to 1:00 PM, who attended to R1 while staying at the facility revealed that none of them was asked by R1 for assistance on toileting and/or change R1's diapers. All three staff (3) stated that R1 did not use diaper. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff does not ensure resident is fed, it was alleged that R1 was hungry, LPA's record review today between 10:00 AM to 10:30 AM revealed that R1 was given a tray service by a staff at 12:12 PM on the day that R1 was picked up by R1's family members. LPA's interview with three (3) caregivers today also revealed that while R1 was on the facility, R1 ate so little but being supplemented with Ensure every meal. LPA's interview with Resident #2 (R2) today at 12:35 PM, who was the room mate of R1 confirmed that R1 was able to go to the bathroom without any assistance, barely eat and was served tray during R1's less than five (5) days stay at the facility. Based on the information gathered during this visit, the above allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 21, 2023 · control 31-AS-20230217124055

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff do not prevent residents from possessing illegal drugs in the facility Resident's are required to maintain & complete the upkeep in the facility

Licensing Program Analyst conducted a subsequent complaint visit to the faciity to conclude the investigation regarding the above allegation. LPA met with office staff, Marcelo Nogar, and advised him of the visit. During the course of the investigation, interviews and a physical plant inspection was made. Record reviews were also conducted. At approximately 9:00am to 11:00am, an inspection of the physical plant was made to insure the health and safety of the residents. The facility is a two story building, with a lower level/basement, an outdoor patio, and a large parking lot. From 11:00am to approximately 2:30pm, interviews and record review were conducted. The investigation is as follows: Staff do not prevent residents from possessing illegal drugs in the facility: In regards to the allegation, it was reported that some residents in the facility posses and distribute meth and illegal drugs in the facility. LPA conducted interviews with eight out of eight staff, who could not confirm the allegation. Interviews with ten out of ten residents also could not corroborate the allegation. A physical plant Unsubstantiated inspection was made, checking random rooms and common areas for any evidence of drug usage or paraphernalia. LPA did not find any evidence during the investigation. Based on the information obtained during this investigation, there was insufficient evidence to prove that staff do not prevent residents from possessing illegal drugs in the facility. Therefore, the allegation is deemed Unsubstantiated at this time. Resident's are required to maintain & complete the upkeep in the facility: In regards to the allegation, it was reported that residents are required to maintain the facility and perform plumbing, gardening, housekeeping and provide care. Interviews with eight out of eight staff deny the allegation. No residents have been required to conduct any up keeping at the facility. Interviews with ten out of ten residents also deny the allegation that they have to maintain and keep the facility by gardening, plumbing, and housekeeping. LPA conducted a tour of the physical plant and did not observe any residents doing any maintenance, housekeeping or gardening during the day's investigation. Based on the information obtained, there was insufficient evidence to corroborate the allegation of the residents being required to maintain and upkeep the facility. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Dec 10, 2022 · control 31-AS-20211104100914

Allegation investigated: . Resident pulled a knife on another resident while in care 2. Resident's personal funds is missing while in care

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez and informed her the purpose of the visit. Allegation # 1: On 11/22/2021, LPA obtained documentation pertaining to the complaint, and attempted to contact the complainant, but was not successful. Resident # 1 (R1) was not at the facility at the time, so LPA could not interview R1. During today's visit, LPA conducted interviews with staff, and it was reported that R1 has been incarcerated since March 2022. Staff also reported to LPA, there was no incidents involving R1 with another client, and R1 never reported any issues with any other residents. Residents were interviewed, and did not know who R1 was, nor have they heard a resident pulling a knife on another resident. Therefore, based on interviews, and not able to interview the complainant or R1, there is insufficient evidence to corroborate the evidence, and the allegation is UNSUBSTANTIATED at this time. Unsubstantiated Allegation # 2: Resident's personal funds is missing while in care . On 11/22/2021, LPA obtained documentation pertaining to the complaint, and attempted to contact the complainant, but was not successful. Resident # 1 (R1) was not at the facility at the time, so LPA could not interview R1. During today's visit, LPA conducted interviews with staff, and it was reported that R1 has been incarcerated since March 2022. LPA reviewed R1's P&I records, provided by the facility, and it showed that R1 didn't start receiving money until February 2022, even though R1 had been admitted since June 2021. Staff reported that the agency, who was providing housing funds, and expenses, took several months for R1 to start receiving P&I expenses. Documentation revealed that the balance of R1's account in March 2022, was zero, and not the money that was alleged to be stolen. Staff also reported, they were not aware of any money being stolen by R1, and it was never reported to facility staff. Therefore, due to not being able to interview R1 and the complainant, LPA has insufficient evidence to prove the allegation, and it is UNSUBSTANTIATED at this time. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Dec 8, 2022 · control 31-AS-20211117114636

Allegation investigated: Facility staff served resident food with a screw in it.

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez and informed her the purpose of the visit. The following was determined: From 10am to 1230pm, LPA conducted interviews and reviewed documentation pertaining to the allegation mentioned above. From information obtained, it was determined, that there were no witnesses to corroborate the allegation "Facility staff served resident with screw in it". LPA conducted interviews with numerous residents, including the interested parties involved with the complaint, and reviewed the photo of the screw, but LPA could not find sufficient evidence, the screw was in the food, on the alleged date. Also, it was revealed, staff were not notified until days after, and there were no complaints about the food on the alleged date to staff or the cook. Based on interviews and documentation reviewed, LPA could not find sufficient evidence to prove the allegation, therefore it is UNSUBSTANTIATED at this time. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 8, 2022 · control 31-AS-20221130143933

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Resident was raped by another resident while in care

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez and informed her the purpose of the visit. On April 26, 2022, the Woodland Hills Regional South Adult and Senior Care Office received a complaint for the allegation mentioned above. On April 26, 2022, the complaint was referred to the Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB), and assigned to Investigator Brian Slatic, who determined the following: It was alleged that client #1 (C1) raped client #2 (C2) while in care at the facility. From 10am to 11am, on April 27, 2022, the initial visit was conducted by LPA Wendell Smith, who conducted interviews with the Administrator, who revealed C2 had a boyfriend at the facility and C2 would allow other male clients in the room. It was also reported that C2 did not report the alleged rape to staff and they were unaware of the allegation. Over the course of the investigation, Investigator Brian Slatic reported that C2 was raped twice but denied sexual intercourse. C2 also disclosed C1 tried to have sex with C2 twice but was able to fight C1 off. Previously, C2 told facility staff that C2 engaged in consensual oral sex with C1. C2 did not disclose to Unsubstantiated Investigator Brian Slatic that C2 engaged in oral sex with C1. C1 reported to Investigator that sex was consensual and denied raping C2. Although C2 reported to the Los Angeles Police Department (LAPD) that the sex was not consensual, the department found no evidence of a crime and attempted to interview C2 on several occasions, but was not successful, and will not be investigating. Therefore, Investigator Brain Slatic determined that based on inconsistent statements about non-consensual or consensual sex between C1 and C2, and through interviews, the allegation was deemed UNSUBSTANTIATED at this time. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Dec 8, 2022 · control 31-AS-20220426085021

Allegation investigated: Staff does not insure a comfortable temperature in the facility Staff doesn not provide resident with sufficient linens Resident had access to a sharp object

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to investigate the above allegations. LPA met with staff, Amourfino Cruz, and advised him of the allegations. During the course of the investigation, interviews, record review and a physical plant inspection were made. At approximately 9:15am to 11:30am, a physical plant inspection conducted on the first and second floors of the facility, 11:30am-2:00pm, interviews were made with residents and staff. Staff does not insure a comfortable temperature in the facility: In regards to the allegation, it was reported that the internal temperature of the facility is maintained cold year round. On warmer days, the temperature is even "cranked up" to high. During the course of the visit, LPA conducted a physical plant inspection of the first and second floors. LPA observed the temperature guage in the hallways and common areas maintained between 74-76 degrees. According to staff, the thermostat in the hallways are designated to control the temperture of three resident rooms. When a Unsubstantiated resident expresses that it is too hot, or too cold, it is adjusted by staff to insure the residents in the three rooms have a comfortable room temperature. Interviews with ten of ten residents reveal no complaints regarding the internal temperature being maintained at an uncomfortable level. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not insuring a comfortable temperature in the facility. Therefore, the allegation is deemed Unsubstantiated at this time. Staff does not provide resident with sufficient linens: In regards to the allegation, it was reported that when Resident 1 (R1) requested for clean towels, staff refused. Interviews with staff reveal that housekeeping is maintained once a day. As part of the housekeeping task, linens, beddings and towels are changed. Staff adds that if requested, residents are never denied a new set of towels. It is also provided per request. Interviews with ten of ten residents do not corroborate the allegation of not being provided sufficient linen. LPA checked the facility supply and observed a sufficient supply of clean bedding, linen and towels, kept in the linen closet on the first and second floors for the residents use. Based on the information obtained, there was insufficient evidence to prove that staff does not provide residents with sufficient linens. Therefore, the allegation is deemed Unsubstantiated at this time. Resident has access to a sharp object: In regards to the allegation, it was reported that on or around November 2021, a facility resident was observed walking around with a sword. The report received to this complaint did not identify a resident by name. Interviews with staff deny the allegation. Interviews with ten of ten residents also do not confirm that this allegation had occurred. Based on the information obtained, there was insufficient evidence to corroborate the allegation of a resident observed walking around the facility with a sword. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Dec 3, 2022 · control 31-AS-20211104100914

Allegation investigated: Facility staff did not prevent residents from sneaking illegal drugs and alcohol inside the facility. Lack of supervision resulting in residents engaging in a physical and verbal altercations. Female residents were inappropriately touched by male residents. Facility food services are inadequate.

Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced initial complaint visit to investigate the above allegations. Upon entry, LPA met with the administrator, Monique Lpoez, and discussed the reason for the visit. --- Facility staff did not prevent residents from sneaking illegal drugs and alcohol inside the facility. It was alleged that residents are sneaking drugs and alcohol into the facility. To investigate the allegation, on 11/15/2022 at 9:30 AM LPA reviewed records, at 10:00 AM, LPA made observations during a physical plant tour, at 11:00 AM, LPA interviewed residents and at 1:00 PM, LPA interviewed staff. A review of the Department’s records revealed that the facility has not reported any Incident Reports involving the use or possession of illegal drugs and/or alcohol. During a physical plant tour, LPA did not observe any alcohol, empty bottles of alcohol, drugs or drug paraphernalia in the facility. (Cont. on LIC9099-C) Unsubstantiated During interviews, all residents and staff stated that they have never witnessed or know of anyone sneaking or using drugs and/or alcohol in the facility. Based on record reviews, observations and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time. --- Lack of supervision resulting in residents engaging in a physical and verbal altercations. It was alleged that residents are engaging in physical fights and yelling. To investigate the allegation, on 11/15/2022 at 9:30 AM, LPA reviewed records, at 10:00 AM, LPA made observations during a physical plant tour, at 11:00 AM, LPA interviewed residents and at 1:00 PM, LPA interviewed staff. A review of the Department’s records revealed that the facility has not reported any Incident Reports involving any physical or verbal altercations recently. During a physical plant tour, LPA did not observe any physical or verbal altercations and did not hear any yelling. During interviews, all residents and staff stated that they have never witnessed or know of anyone who has had a physical altercation recently but S1, S6 and R5 stated that they have either heard or witnessed verbal altercations, arguments and yelling. Based on record reviews, observations and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time. --- Female residents were inappropriately touched by male residents. It was alleged that men inappropriately touch women. To investigate the allegation, on 11/15/2022 at 9:30 AM, LPA reviewed records, at 11:00 AM, LPA interviewed residents and, at 1:00 PM, LPA interviewed staff. A review of the Department’s records revealed that the facility has not reported any Incident Reports involving men inappropriately touching women. During interviews, all residents and staff stated that they have never witnessed or know of anyone that has touched a resident inappropriately. Based on record reviews and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time. --- Facility food services are inadequate It was alleged that the facility dismisses dietary restrictions and does not offer alternatives. (Cont. on LIC9099-C) To investigate the allegation, on 11/15/2022 at 10:50 AM LPA requested documents, at 11:00 AM, LPA interviewed residents and at 1:00 PM, LPA interviewed staff. A review of the facilities meal plan/menu revealed that the facility offers well-balanced and nutritious meals with alternatives for residents with dietary restrictions. During interviews, all residents and staff stated that they feel that the facility offers adequate meals that are well balanced. Furthermore, the Administrator stated that the facility offers alternative meals for those with dietary restrictions. Based on record reviews and interviews, there is not enough information to verify the allegation, therefore, the allegation is unsubstantiated at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 15, 2022 · control 31-AS-20221107155526

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced case management visit at this facility to interview additional residents and staff regarding returned complaint dated 07/08/21 (cc no.: 31-AS-20210708160740). LPA met with licensee Marilyn Nguyen and administrator Monique Lopez and explained the reason for the visit. At 9:00 AM, LPA conducted physical plant tour, requested copy of facility documents relevant to the investigation at 10:30 AM, and interviewed residents and staff between 10:40 AM to 2:00 PM. There is no health and safety issue observed during this visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 26, 2022

Allegation investigated: Insufficient staffing to meet residents' needs Staff left resident in wet clothing for extended periods of time

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with administrator and explained the reason for this visit. LPA conducted a physical plant tour from 8:45-9am to ensure no immediate health and safety issues were present, none were noted during the tour. Insufficient staffing to meet resident's needs & Staff left resident is wet clothing for an extended period of time. It is alleged that there is a lack of staff that has led to resident # 1 (R1) not being changed in a timely manner and having to sit in soiled clothing for a long period of time. LPA conducted interviews with R1 and other residents from 9:10-10:15am who require incontinent assistance. LPA also reviewed R1's facility file and obtained copies of pertinent information from 10:15-10:40am. LPA conducted an interview with facility staff regarding this allegation from 10:45-11am. Information obtained through interviews reveal that residents are being changed in a timely manner and that there is no issue with staffing. Based on the information obtained through interviews and record review both of these allegations are deemed Unsubstantiated at this time. Exit Interview conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 5, 2022 · control 31-AS-20220804093150

Allegation investigated: . Resident was inappropriately touched by another resident 2. Facility is not allowing visitor's resident's rooms

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit, pertaining to the allegations mentioned above. LPA met with Administrator Monique Lopez and Licensee Marilyn Nguyen, who was informed the reason of the visit, the following was determined: Allegation # 1: Resident was inappropriately touched by another resident. On July 26, 2022, from 8am to 1130am, LPA reviewed the complaint and documents, as well as, conducted interviews. From 12pm to 3pm, while at the facility, LPA conducted additional interviews and conducted a physical plant inspection. It was alleged, that resident # 1 (R1) was inappropriately touched by another resident. Through information obtained, there was an incident between R1 and another resident; but there were no witnesses, and R1 did not inform facility staff. R1 handled the situation, and the other resident was put on notice about the inappropriate behavior. R1 informed the other resident, that if the incident occurred again, facility staff would be notified. R1 reported, there has not been any other issues since then and the other resident has apologized to R1. Therefore, since R1 has addressed the issue, without staff interference, and based on interviews, the allegation Unsubstantiated is UNSUBSTANTIATED at this time. Allegation # 2: Facility is not allowing visitation in resident’s rooms. On July 26, 2022, from 8am to 1130am, LPA reviewed the complaint and documents, as well as, conducted interviews. From 12pm to 3pm, while at the facility, LPA conducted additional interviews and conducted a physical plant inspection. It was alleged that facility staff are not allowing visitation in resident’s rooms. Through the information obtained, it was reported to LPA that the facility does allow visitors in resident’s rooms, but prefers that visitation is conducted in spacious areas, such as the outside patio, or lobby. Residents did report to LPA that some visitation was not allowed, but mainly due to the facility’s COVID-19 policy. The facility has made exceptions, and family or friends have been allowed in their rooms. Although, recently it was alleged, the facility was not allowing visitors in resident’s rooms, it was reported to LPA, that if the resident and roommate agree and consent to the visitor being in the room, then it is allowed. Therefore, based interviews, the allegation is UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Jul 26, 2022 · control 31-AS-20220725142356

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 9, 2022

Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety...This requirement was not met, evidenced by, based on physical plant inspection, room # 103, had dirty and stained walls, dirty floors, missing flooring and exposed pipes and wires. This is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 26, 2022

Plan of correction: Administrator and Licensee will submit corrected repairs, with photos by POC date. If more time is needed, contact LPA.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a case management, in conjunction to complaint control # (31-AS-20220725142356). During the investigation, it was reported to LPA that resident # 1 (R1) personal items were stolen, and returned to R1. Upon further information, once the items were returned, they were then re-stolen, and returned back to R1. The only item that was not returned was a scale. The incident was not reported to Licensing, and LPA did not receive a special incident report (SIR). The Administrator informed LPA during the visit, that R1 was reimbursed for the scale that was stolen, and LPA received a SIR at the conclusion of the visit. Therefore, a citation was issued today, for failure to report, and plan of correction (POC) was submitted. This is a potential health and safety risk to residents in care. Exit interview, copy of report, appeals, and report was provided.the state’s words, verbatim · CDSS document, Jul 26, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jul 26, 2022

Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing...within seven days of the occurrence of any events specified in (A0 through (D)...This requirement was not met, evidenced by, based on information obtained during today's visit, items were stolen from a resident and facility did not submit an incident report.the state’s words, verbatim · CDSS document, Jul 26, 2022

Plan of correction: POC cleared during the visit.

Allegation investigated: Resident was left on the floor unattended for an unknown period of time. Resident was not supervised properly.

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit. Resident was left on the floor unattended for an unknown period of time. It is alleged that on 4/17/22 when resident #1 (R1) family came to visit them that R1 was laying on the floor unattended for an unknown period of time. LPA conducted interviews with the administrator, R1's family member, and facility staff from 10-11am regarding this allegation. LPA reviewed R1's facility file and obtained copies of pertinent information from 11-12pm. Information from interviews reveal that when R1's family came to visit them they were laying down on the couch in the lobby sleeping. R1 was not laying on the floor and was not unsupervised at that time. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. Unsubstantiated Resident was not supervised properly. It is alleged that R1 was not supervised properly resulting in R1 being hospitalized. LPA conducted interviews with the administrator, R1's family member, and facility staff from 10-11am regarding this allegation. LPA reviewed R1's facility file and obtained copies of pertinent information from 11-12pm. Interviews revealed that on the night of 4/16/22 R1 had a hard time sleeping. On 4/17/22 when R1's family came to see them they were sleeping on the couch in the facility lobby and upon waking up did not feel well. Staff checked on R1 and a decision was made to call emergency services and R1 was transferred to the hospital. A review of R1's needs and service plan reveal that R1 is ambulatory and can do all their activities of daily living independently. Interview with R1's family revealed that R1 is still hospitalized and will be discharged back to the facility later this week. LPA reviewed R1's medication documentation and spoke with the nurse that came saw R1 that morning. Based on the information obtained through interviews and documentation reviewed this allegation is deemed Unsubstantiated at this time. There is not enough information to state that facility failed to properly supervise R1 causing R1 to be hospitalized. Exit interview conducted.the state’s words, verbatim · CDSS document, Apr 19, 2022 · control 31-AS-20220418153904

Allegation investigated: Medication errors Food is not of good quality

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit. Medication Errors It is alleged that resident # 1(R1) has not received their medication as they are supposed to. LPA reviewed R1's medication and medication record from 11-12pm. LPA obtained copies of R1's medication record for March up to today's date. LPA interviewed R1 regarding this allegation from 1-1:30pm. Information from interview and review of medication reveal that R1 has been receiving their medication as they are supposed to therefore this allegation is deemed Unsubstantiated at this time. Unsubstantiated Food is not of good quality It is alleged that the food is not of good quality and that fruits and vegetables are not provided to residents. From 12pm-1pm LPA went to the dining room and observed lunch being served to residents and also checked the food supply. LPA also interviewed residents from 1-2pm regarding the food being provided by the facility. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time. Exit Interview conducted.the state’s words, verbatim · CDSS document, Apr 15, 2022 · control 31-AS-20220414140807

Type of visit: Required - 1 Year

At approximately 1:25 PM on 01/27/22, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Licensee and disclosed the reason for the visit. Census: 104 The facility has 3 floors. The lowest floor contains the kitchen, cafeteria, and outdoor patio. The first floor is the main floor and contains non-ambulatory rooms, a television room, the main entry, and the office. The second floor is designated for ambulatory residents. Floors are accessible through elevator and stair access. At approximately 2:04 PM, Licensee and LPA toured the physical plant. Entry: LPA observed 2 signs on the front door related to COVID-19 precautions for mask requirements and visitation. Screening: LPA was screened for symptoms of COVID-19 and had temperature taken upon entry to the facility. Facility maintains a log tracking visitors’ symptoms, names, and temperatures. When residents return from outings, staff conduct symptom checks and observe for any noticeable changes in condition. Facility uses rapid tests if residents are symptomatic. PPE: LPA observed an office with adequate amounts of N95 masks, surgical masks, sanitizer, gloves, and PCR tests. Bedrooms: The facility has 64 bedrooms. All bedrooms are shared and have a private bathroom. Licensee noted all bedrooms are cleaned three times a day, or as needed. If a resident submits a positive COVID test, the facility has vacant bedrooms to isolate their roommate. Bathrooms: The facility has 8 public bathrooms. LPA observed bathrooms on the first floor which were fully stocked with soap, paper towels, trash cans with tight-fitting lids, and signs with handwashing instructions. Kitchen and Cafeteria: LPA observed staff mopping the kitchen area. The kitchen appeared clean, odorless, and free from debris. The cafeteria has tables which are approximately 6 feet apart from each other. Common Areas: The television room had chairs which were 6 feet apart to promote social distancing. LPA observed 4 signs posted alerting residents to wear masks maintain and 2 signs for social distancing. Licensee noted the television room formerly had couches, but the facility switched to chairs due to COVID-19 mitigation efforts. The facility has 2 elevators, both of which had signs for masking requirements, coughing etiquette, and social distancing. The facility has a social distancing policy for elevators: 2 individuals at a time. LPA observed a free telephone for all residents’ use. LPA observed signs posted throughout hallways on all floors for social distancing, mask wearing, and cough etiquette. Outside Space: LPA observed outdoor areas to be free from obstruction and hazards. All emergency exits were unlocked. Al staff were observed wearing masks. Mitigation: Licensee told LPA that meal times are staggered, and residents have the option to have in-room meal service in which staff can serve trays to resident rooms. In the event of a COVID positive resident, the resident would isolate in their room for a minimum of 5 days. The facility marks the room as a Red Zone, and staff are able to provide meals, medications, cleaning, and supervision to residents in isolation. Meal service is provided with disposable cutlery. All staff are trained in donning and doffing PPE. Licensee informed LPA the facility uses carts to store PPE outside of isolation rooms and trash cans with tight fitting lids remain inside the isolation room. LPA observed a laundry room downstairs near the kitchen, and Licensee noted staff are able to sanitize the machines between loads. The facility coordinates with CVS to provide on-site vaccination and testing.the state’s words, verbatim · CDSS document, Jan 27, 2022

Allegation investigated: Financial Abuse Staff are not assisting resident with bathing needs Staff do not safeguard a resident's property

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit. Financial Abuse It is alleged that resident #1 (R1) has not been receiving their portion of their social security funds and that R1 has never received their amount. LPA conducted an interview with the administrator regarding this allegation from 11-11:30am. LPA was not able to interview R1 who was not at the facility and does not have a telephone. LPA reviewed R1's file which included R1's cash resources from 11:30-12pm. A review of R1's facility file revealed that Brilliant Corners pays R1's rent and sends the balance of R1's social security to the facility. LPA was able to obtain the cash resource log and verify the cash noted on the log with the cash the facility has for R1. LPA also observed that R1 did withdraw from their account twice in November of 2021. Based on the information obtained this allegation is deemed Unsubstantiated at this time. LPA was able to verify that no money was missing from R1's funds and that R1 does have access to their funds. Unsubstantiated Staff are not assisting resident with bathing needs It is alleged that facility staff are not assisting R1 with their bathing needs. LPA conducted an interview with the administrator regarding this allegation. LPA also reviewed R1's physician report and needs and service plan from 11:30-12pm. Information obtained from R1's file revealed that R1 is able to bath on their own. Information from interviews with facility staff and the complainant indicated that R1 leaves the facility at approximately 5 am in the morning and does not return until after 6 pm and has rejected any assistance when they have come back to the facility. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time. Staff do not safeguard a resident's property It is alleged that R1's stuff goes missing from their room when staff cleans it. LPA conducted an interview with R1's roommate regarding this allegation from 12:15-12:30pm. LPA obtained and reviewed R1's personal valuables and property list. LPA also interviewed the administrator regarding this allegation. Information obtained from interviews revealed that there has been no items taken from R1's room. A review of R1's valuables and property list show everything on their is still in the room. R1 has not informed the facility of any items missing from their room. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 21, 2022 · control 31-AS-20220118094523

Allegation investigated: Staff is not obtaining medical care for resident in a timely manner

This is an amendment of the report issued on 07/29/2020 to add more information. Licensing Program Analyst (LPA) Gary Tan conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Monique Lopez. It was alleged that the facility staff did not deal with resident medical issue. LPA conducted virtual physical plant tour at 1:30 PM, requested relevant facility records at 2:20 PM and conducted interview with administrator, staff and attempted interview with resident of the facility between 2:20 PM to 3:00 PM. LPA record review of medical record of Resident #1 (R1) on 07/29/20 and today at 2:30 PM, revealed that R1 had no medical condition that required immediate medical attention. LPA's interview with R1 today at 12:30 PM confirmed that R1 had no medical emergency at the time of this complaint but had emergency sometime in February 2020 which the staff sent R1 to the hospital. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA interview with the staff on 07/29/20 at 2:01 PM, and today with the licensee and staff between 1:00 PM to 3:00 PM also revealed that R1 never complained of any medical condition that may require immediate medical attention. Moreover, LPA's record review today at 2:30 PM also revealed that R1 had an emergency on 02/24/20 with trouble breathing and choking and was sent to the hospital the same day. Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 8, 2022 · control 31-AS-20200430135701

Allegation investigated: Illegal drugs on the premises Facility failed to provide a comfortable temperature for residents Facility is in disrepair Facility has an infestation of rats and roaches Staff failed to respond to residents’ call assistance button in a timely manner Facility failed to provide adequate food service Staff opened resident’s mail without his consent Staff failed to protect resident from being harmed by other residents Staff failed to take precautions for COVID-19

At approximately 9:50 AM on 01/05/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted a subsequent visit for Complaint Control Number 31-AS-20211222154322. LPA met with Administrator Monique Lopez and disclosed the reason for the visit. Resident census was 105. From 9:55 AM to 11:21 AM, LPA interviewed residents. From 11:23 AM to 11:34 AM, LPA conducted a physical plant tour. Regarding the allegation “Illegal drugs on the premises”, it was alleged that residents at the facility take illegal drugs (Crystal Methamphetamine) on the premises and the facility is aware of it. LPA interviewed staff and residents on 12/28/2021 and 01/05/2022 about this allegation. Based on interviews, LPA determined there are no illegal drugs on the premises. LPA also conducted two physical plant tours on 12/28/2021 and 01/05/2022. LPA did not observe any illegal drugs on the premises. Based on information obtained, the allegation is deemed unsubstantiated at this time. Unsubstantiated Regarding the allegation “Facility failed to provide a comfortable temperature for residents”, it was alleged that the facility is freezing cold, all residents wear layers of clothing, and the facility does not turn the heater on. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, facility staff adjust the thermostat upon request, turning the heater or air conditioner on or off as needed. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Facility is in disrepair”, it was alleged that the structure of a room is damaged; the room has a large draft and the cold wind comes in from there. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, the Administrator fixes the building when it is reported or needed. LPA conducted a physical plant tour on 01/05/2022. LPA inspected the room alleged to have a large draft. Based on LPA inspection, there is no draft in the room. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Facility has an infestation of rats and roaches”, it was alleged that the facility has an infestation of rats and roaches. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, there is no infestation of rats and roaches in the facility. From physical plant tours on 12/28/2021 and 01/05/2022, LPA observed no roaches, rats, or signs thereof. Based on physical plant tours, there is no infestation of rats and roaches. LPA conducted a Records Review on 12/28/2021 of the 4 previous months’ fumigation receipts. Based on Records Review, the Licensee fumigates the facility regularly. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Staff failed to respond to residents’ call assistance button in a timely manner”, it was alleged that each residents’ room has an emergency call assistance button and whenever any of the resident press the emergency call button, the staff don’t respond to it and simply shut it off. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, the staff promptly attend to calls for assistance. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Facility failed to provide adequate food service”, it was alleged that the facility serves is poor quality, the portions are very small. LPA conducted a physical plant tour on 12/28/2021 and observed the kitchen area, menu, and prepared food portions. Based on LPA observations, the facility serves food of adequate nutrition and size. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, the facility’s food service is adequate. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Staff opened resident’s mail without his consent”, it was alleged that several times the staff opened a resident’s mail and threw it away without consent. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, residents receive their mail from the office or from staff. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Staff failed to protect resident from being harmed by other residents”, it was alleged a resident was punched several times in the face and head by other residents. LPA interviewed at least 10% of residents and at least 10% of staff. Based on LPA interviews, there are no incidents of violence, though there are arguments and yelling. When arguments happen, staff separate residents until they are calm and safe. Based on information obtained, the allegation is deemed unsubstantiated at this time. Regarding the allegation “Staff failed to take precautions for COVID-19”, it was alleged that the facility staff are not taking any precautions for COVID-19 and are not practicing social distancing. LPA conducted a physical plant tour on 12/28/2021 and observed signs throughout the facility promoting mask wearing and social distancing. LPA also observed staff wearing masks throughout the facility. Based on LPA observations, the facility takes adequate precautions for COVID-19. Based on information obtained, the allegation is deemed unsubstantiated at this time. LPA conducted exit interview and issued reportthe state’s words, verbatim · CDSS document, Jan 5, 2022 · control 31-AS-20211222154322

Allegation investigated: Resident developed a pressure injury while in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with Licensee Marilyn Nguyen and explained the reason for the visit. It was alleged that while in the facility, for the last couple of weeks, Resident #1 (R1) had an infected open sore. The complaint was referred to and accepted by Community Care Licensing Division’s Investigations Branch (IB) and assigned to the IB investigator Laura Garcia. The investigation of the allegation was initiated on 04/16/2021 at 9:07 AM, by LPA Tan and completed by the IB investigator Garcia. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) On 04/16/21 LPA conducted physical plant tour at 9:45 AM, interviewed residents, staff and administrator at 10:30 AM and obtained copies of the facility records relevant to the investigation at around 12:00 PM. During subsequent investigation, Investigator Garcia interviewed staff, administrator and residents on multiple occasion. In addition, Investigator Garcia requested and reviewed medical records of R1’s recent hospitalization on 03/31/21, LPA’s interview with R1 on 04/16/21 at 9:45 AM revealed that R1 was not aware as to the cause or origin of R1’s shoulder wound and expressed suspicion that it could have been caused by an insect bite. Investigator Garcia’s interview with R1 on 04/21/21 at approximately 12:00 PM, revealed that R1 is independent and capable of self-care. R1 had a boil/cyst on left shoulder, which was already healed. R1 did not report to the staff about the wound on their shoulder as it would heal on its own. Investigator Garcia’s interview with three (3) staff on 08/17/21 between 12:30 PM to 5:50 PM also confirmed the information received from R1. Investigator Garcia’s medical record review, conducted on 05/26/21, revealed that R1 was diagnosed with “cellulitis” and there was no diagnosis of pressure injury. Based on the information gathered during the course of the investigation, there is no relevant information to support the allegation. Therefore, the allegation is deemed unsubstantiated at this time. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Dec 12, 2021 · control 31-AS-20210415121055

Allegation investigated: Facility is not meeting resident's care needs

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with Licensee Marilyn Nguyen and explained the reason for the visit. It was alleged that Resident #1 (R1) was diagnosed with malnutrition and dehydration upon hospitalization on 12/01/2020 though R1’s condition could be a result of self-neglect. On 12/04/2020 at 1:02 PM, LPA Tan initiated the complaint visit via virtual visit. At around 1:20 PM, LPA interviewed the administrator telephonically and requested copies of the facility records relevant to the investigation at around 2:00 PM. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA’s record review on 08/21/21 at around 10:00 AM, revealed that R1 was admitted at the facility on 08/11/2020 with the medical diagnosis and medication therapy causing loss of appetite and dehydration. Further record review today between 9:00 AM to 10:30 AM also revealed that prior to admission, R1 had an ongoing underweight issue and was sent to the hospital by the staff while at the facility on 10/23/20 for failure to thrive. R1 was also on strict diet of limited intake due to R1's medical condition. Medication record review revealed that R1 was on vitamin supplements. LPA's interview with staff on 08/21/21 at around 10:00 AM and today between 10:30 AM to 12:00 PM revealed that the staff provided food supplement (i.e. Ensure) and a gallon of drinking water on R1's bedside for hydration. LPA's observation today at 1:24 PM, during physical plant tour confirmed that staff provided a gallon of drinking water to residents who need hydration. LPA’s interview with R1’s roommate on 08/21/21 at around 10:15 AM revealed that R1 barely eat own food and was so skinny since admission. LPA’s interview with the administrator on 12/04/20 at around 1:05 PM, also revealed that R1 was hospitalized on 12/01/20 due to low blood sugar and prior to hospitalization R1 was consuming only around 15% of food served. R1's malnutrition and dehydration was caused mostly by R1's health problems that required appropriate care and supervision. Appropriate care and supervision was provided to R1 as required. Based on information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Dec 12, 2021 · control 31-AS-20201203101436

Allegation investigated: Facility staff did not seek medical attention in a timely manner Facility staff do not ensure that resident has access to food Facility staff are not assisting resident with ADLs

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted physical plant tour at 9:00 AM, requested copies of facility documents relevant to the investigation at 9:35 AM and conducted interview with staff and residents between 10:00 AM to 12:30 PM. Regarding the allegation that Facility staff did not seek medical attention in a timely manner, it was alleged that Resident #1 (R1) has an open sore wound for two (2) weeks. LPA's record review today at 12:35 PM, revealed that a facility visiting nurse provide wound treatment to R1 everyday from 03/25/21. R1 however, refused treatment on 03/27/21 and 03/29/21 and was hospitalized on 03/31/21. Further review also revealed that R1 was capable of self care and refused all hospital/doctor visit prior to 03/31/21. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that the Facility staff do not ensure that resident has access to food, it was alleged that no staff is bringing food to R1's room. LPA's record review today at 12:30 PM, revealed that R1 was ambulatory and has the capability of self care including but not limited to feeding, dressing/grooming, toileting and bathing. Moreover, LPA's interview with staff on 04/16/21 between 10:00 AM to 12:00 PM and today at 12:15 PM, revealed that R1 was provided trays upon request based upon R1's condition but not on a regular basis because R1 was capable of self care and regularly went out to buy own stuff. Regarding the allegation that Facility staff are not assisting resident with ADLs, it was alleged that R1 took an hour to get dressed prior to a medical appointment. LPA's record review today at 12:30 PM revealed that R1 was capable of self care and did not need any assistance with ADLs. LPA's interview with six (6) staff on 04/16/21 between 10:00 AM to 12:00 PM and today at 12:15 PM, revealed that R1 was independent and was able to capable of self care. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 4, 2021 · control 31-AS-20210415121055

Allegation investigated: Illegal Eviction.

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit. LPA was joined on the visit by Long Term Care Ombudsman (LTCO) Velvet Tabb. LPA met with administrator Monique Lopez and licensee Marilyn Nguyen and explained the reason for this visit. Regarding the allegation it is alleged that resident #1 (R1) was illegally evicted from the facility. LPA conducted a previous visit on 11/16/21 where LPA reviewed R1's facility file and obtained copies of pertinent information. During today's visit LPA conducted interviews with the administrator and licensee from 1:00-2:45 pm regarding the allegation. LPA had previously interviewed R1 over the telephone regarding this allegation. Information from interviews reveal that R1 went to the hospital on 10/27/21 due to not feeling well. Interviews reveal before going to the hospital and while at the hospital R1 was told they were not going to be able to come back to the facility. LPA was able to verify that staff from Department of Health Services was contacted and told that R1 was not allowed to come back to the facility and that new placement was needed for R1. Based on the information obtained through interviews this allegation is deemed Substantiated. Substantiated Deficiency cited on LIC 9099 D. Appeal Rights explained. Exit Interview conducted.the state’s words, verbatim · CDSS document, Dec 3, 2021 · control 31-AS-20211112090642

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d) · Plan of correction due date: Dec 6, 2021

Eviction Procedures. The licensee shall state in the notice to quit the reasons for the eviction with specific facts about the date, place, witnesses and circumstances concerning those reasons. This requirement was not met as evidenced by: Based on interviews conducted facility failed to provide R1 with a proper eviction notice and informed R1 and the hospital that R1 would not be welcome back to the facility.the state’s words, verbatim · CDSS document, Dec 3, 2021

Plan of correction: Administrator will submit statement that all residents will be provided proper eviction notices and all procedures will be followed throughout the eviction process based on Title 22 regulations and Health and Safety code regulations.

Allegation investigated: Facility staff did not safeguard resident's personal belongings

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez for an initial complaint visit, to investigate the allegation mentioned above. The following was determined: From 11am to 1215pm, LPA conducted interviews and obtained documentation pertaining to the allegation mentioned above. It was reported that a client's bike was stolen on the property, behind the facility. The bike was chained and locked; but the intruder entered the property at a gate that is used mainly for emergency purposes. The Administrator reported the incident to Licensing, and the facility reimbursed monetary funds to purchase another bike. Although, the bike was stolen on the grounds at the facility, the facility attempted to secure client's belongings by designating an area for bikes. The intruder who stole the bike, brought a tool to break the chain. The Administrator reported to LPA that client's are allowed to keep there Unsubstantiated personal belongings on there back patio, instead of the biking stations. Therefore the allegation, "Facility staff did not safeguard resident's personal belongings" is UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Nov 22, 2021 · control 31-AS-20211117095435

Allegation investigated: Air conditioner in residents' room is not working.

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with the administrator and explained the reason for this visit. It is alleged that the air conditioner in resident #1 (R1) room is not working. At approximately 1:30pm LPA conducted a tour of R1's room and interviewed R1 regarding the allegation. LPA also interviewed the administrator regarding the allegation at 1:15pm. Information revealed that air conditioning unit that controls R1's room also controls two other rooms and the television room. LPA observed the air conditioning unit to be a 72 degrees during the visit. LPA interviewed resident's whose rooms are also controlled by the same unit that controls R1's from 2-2:20pm. Interviews revealed that the air conditioner is working properly and no one besides R1 has an issue with the air conditioning. Facility has offered to move R1 to a different room but R1 has refused. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 16, 2021 · control 31-AS-20211115112448

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility staff is not ensuring that resident receives a change of clothing. Facility staff is not meeting resident's hygiene needs.

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit. It is alleged that facility staff are not ensuring that resident # 1(R1) receives proper changes of clothing and that they don't ensure that R1's hygiene needs are met. LPA conducted an interview with the administrator and reviewed R1's file from approximately 10:10am-10:45am. LPA interviewed R1 from approximately 10:50-11:15am. A review of R1's file and interviews reveal that R1 does get assistance with bathing twice a week and has been regularly getting bathed. R1 does not need assistance with hygiene and feels they are good with their hygiene. During today's visit LPA observed R1 to be clean and well kept. Based on the information obtained through interviews and record review both of these allegations are deemed Unsubstantiated at this time. Exit Interview conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 10, 2021 · control 31-AS-20211102131707

Allegation investigated: Staff did not safeguard resident's personal items

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced initial complaint visit to investigate the allegations above. LPA met with the administrator and explained the reason for this visit. LPA conducted a physical plant walk through of the facility from 11:30-11:45am. Staff did not safeguard resident's personal items It is alleged that staff stole resident #1 (R1) refrigerator and when R1 got it back it was broken. LPA conducted an interview with R1 and the administrator. LPA went to R1's room and observed R1's refrigerator to be working fine. Administrator stated that no one has ever taken R1's refrigerator or had it sold to anyone else. R1 stated that the refrigerator is working fine. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 10, 2021 · control 31-AS-20211104100914

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

Allegation investigated: Facility staff refused to call 911 for resident. Staff failed to observe changes in resident's condition Facility retaliates against resident for filing complaints Facility staff discriminate against resident Facility is withholding mail

Licensing Program Analyst (LPA) conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted physical plant tour at 8:50 AM. At 9:30 AM, LPA requested facility documents relevant to the investigation and between 10:30 AM to 1:00 PM, LPA conducted interview with staff and residents. Regarding the allegation that Facility staff refused to call 911 for resident, it was alleged that Resident #1 (R1) was so sick and was lying in a pool of own vomit and one of male staff from the office (name not provided) happened to see R1 and asked the staff to call 911 but staff said they don't call 911. LPA's interview with R1 on 06/08/2021 at around 3:43 PM revealed that R1 was not able to identify the facility staff who was asked to call 911. LPA's interview with Staff #1 (S1) today at 12:38 PM however, revealed that sometime in 2019, S1 found R1 lying on the floor of the basement near the vending machine with own vomit reeking of alcohol. S1 called 911 and R1 was picked up by the paramedics. S1 denied having asked by R1 to call 911. (continued on 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff failed to observe changes in resident's condition, it was alleged that despite a note from R1's doctors about R1's weight loss since living at the facility, the facility did not provide double portion of meals to R1. LPA's interview with R1 on 06/08/2021 at around 3:43 PM, revealed that R1 failed to provide any note from the doctor about providing double portion of meals LPA's record review today between 9:30 AM to 10:30 AM, revealed that there was no doctor's note on R1's file stating the same. Regarding the allegation that Facility retaliates against resident for filing complaints, it was alleged that upon R1's return from the hospital, R1 was served eviction notice. LPA's interview with Resident #1 (R1) on 07/29/21 at around 2:00 PM and attempted interview today at 11:45 AM revealed that R1 was not aware that the source of complaint and/or complainant against any facility under Community Care Licensing (CCL) is strictly confidential and was never divulged to the facility and/or staff so that the facility could not retaliate nor take action against the complainant (be it resident/staff or any person who has an association with staff/resident of the facility). LPA's record review today between 9:30 AM to 10:30 AM revealed that R1 was being evicted for non-payment of R1's portion of rent to stay at the facility. Further review also revealed that R1 has not paid portion of R1's rent for more than two (2) years amounting to an approximate total of $23,284.41 to date. Regarding the allegation that Facility staff discriminate against resident, it was alleged that some of the staff make grocery runs for the residents for a little cash but that the staff were told by management “Do not go to the store for R1" LPA's interview with R1 on 06/08/2021 at around 3:43 PM revealed that R1 was not able to identify the staff who told R1 that the management did not allow the staff to go to store for R1. LPA's interview with four (4) staff today revealed that there was only one (1) staff who used to run errands for the residents and that staff no longer works for the facility. Further, said staff only do the errands after own shift and at the staff's own discretion. Moreover, no staff is allowed to run errands for any resident during their shift. (continued on LIC 9099-C) (continued from LIC 9099-C) Regarding the allegation that the Facility is withholding mail. It was alleged that the staff are either throwing R1's mail out or returning it to sender. LPA's interview with the licensee and administrator on 06/03/2021 between 11:00 AM to 3:00 PM, revealed that no one is withholding mail for any resident nor there is anyone throwing away mail for the resident and the facility only sent back mail to sender when the resident no longer reside at the facility. LPA observation on 06/03/21 at 9:53 AM revealed that the facility has an incoming and outgoing mail box and R1 has mail in the incoming box. LPA's interview with staff today between 10:30 AM to 1:00 PM revealed that residents usually get their own mail everyday and if unclaimed for a number of days, whenever the resident get their medication, staff gave their mail too. LPA's interview with eleven (11) residents or 10% of the current census on 06/08/2021 between 1:30 PM to 3:30 PM revealed that eleven (11) out of eleven (11) residents get their mail regularly. Based on the information gathered during this and prior visits the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 6, 2021 · control 31-AS-20210602091923

Allegation investigated: Facility did not release resident's records to resident's responsible party

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit, pertaining to the allegation mentioned above. LPA met with Administrator Monique Lopez and Licensee Marilyn Nguyen; the following was determined: Concerns were expressed that “Facility did not release resident’s records to resident’s responsible party”. On 11/02/2021, from 930am to 1215pm, LPA conducted interviews, and reviewed documentation pertaining to the complaint. According to the Administrator, on 10/22/2021, the facility received notification to provide medical records for resident # 1 (R1) to a legal service, who was to copy records. The Administrator reported to LPA, that she informed the legal service, that the facility did not receive the 1st request and to re-fax. On 10/25/2021, the Administrator contacted the legal service, and informed them, the records Unsubstantiated were ready to be copied. On 10/28/2021, the copier service visited the facility and copied records. On 11/01/2021, the copier service contacted the Administrator and requested (2) documents to be re-faxed, due to not being led gable to read. The Administrator informed them; the documents will be ready on 11/02/2021. Based on documentation and interviews conducted, there is insufficient evidence to prove, the “Facility did not release resident’s records to resident’s responsible party”, therefore the allegation is deemed UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 2, 2021 · control 31-AS-20211025160627

Allegation investigated: Staff seeking retribution for resident calling in complaints

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted physical plant tour at 9:45 AM, requested facility records relevant to the investigation at 10:13 AM and interviewed resident at 1:45 PM. It was alleged that the facility is seeking retribution for resident calling in complaints. LPA's interview with Resident #1 (R1) on 07/29/21 at around 2:00 PM, attempted interview today at 1:45 PM and attempted interview by LPA Lacy on 10/12/21 at around 1:15 PM revealed that R1 was not aware that the source of complaint and/or complainant against any facility under Community Care Licensing (CCL) is strictly confidential and was never divulged to the facility and/or staff so that the facility could not retaliate nor take action against the complainant (be it resident/staff or any person who has an association with staff/resident of the facility). Further, R1 could not identify any specific action by the facility that could be deemed retaliatory against the complainant except the eviction notice issued to R1. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's record review today at 1:55 PM, revealed that R1 was served eviction notice for non-payment for over a year now. LPA's interview with the administrator today at 2:30 PM also revealed that R1 went to Unlawful Detainer process and the Court had evicted R1 but not until January of next year or if R1 found a suitable living arrangement prior to the eviction date. Based on the information gathered during this and prior visit. The allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 16, 2021 · control 31-AS-20210726153616

Allegation investigated: Resident social security checks are still coming to this facility even though resident has been gone for 6 months.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted physical plant tour at 9:45 AM, requested facility records relevant to the investigation at 10:13 AM and interviewed staff at 10:45 AM. Regarding the allegation that Resident's social security checks are still coming to this facility even though resident has been gone for 6 months. LPA's record review on 07/29/21 at around 10:30 AM and today at 11:30 AM, revealed that R1 left the facility on 11/26/2020 and SSA benefits payments were sent to the facility via direct deposit until May 2021. LPA's interview with the Licensee today at 12:05 PM, revealed that once a resident or any person has designate a payee, SSA do not change the payee until that resident or person designate another payee, hence, the continuation of payment to the facility despite formal notice to discontinue payment, which the facility did on 12/20/2020 through the SSA local office. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further, LPA's interview with the Administrator today at 1:00 PM revealed that the she has been following up with Social Security Administration (SSA) office to send the overpayment bill to pay back the money to SSA, but has not received the bill to date. It is necessary to receive the bill in order to pay the exact amount to be refunded to SSA. Moreover, LPA's interview with the Licensee today at 12:05 PM also revealed that it is disadvantageous to the facility to get this payment as this will be considered as revenue and may be subject to tax, when in fact they have to return the money, so the facility had to close the bank account receiving the payment to avoid further payment to the facility. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 16, 2021 · control 31-AS-20210723161912

Allegation investigated: . Facility staff are not ensuring resident receives food 2. Facility staff are not assisting resident with showering needs

Licensing Program Analysts (LPA)(s) Tuesday Cabiness, LaQueena Lacy, and Eleza Jackson, conducted an unannounced complaint investigation, and met with Administrator Monique Lopez. LPAs informed her the reason of the visit. The following was determined: Allegation # 1: Facility staff are not ensuring resident receives food: During today's visit, from 10am to 115pm, LPA (s) conducted interviews with residents and staff, as well as obtained facility and client file records pertaining to the complaint. Through the information obtained, it was reported that resident # 1 (R1) receives (3) meals a day. R1, also confirmed to LPA, that the facility provides food for R1. Although R1 has occasionally refused meals; it was reported facility does ensure R1 receive food. Also,R1 confirmed to LPA (s) that the faciliy provides R1 with meals inside R1's room. And through additional interviews with residents, it was revealed that the facility provides food to all residents. Therefore, based on interviews, the allegation Unsubstantiated the allegation "Facility staff are not ensuring that resident receives food" is UNSUBSTANTIATED at this time. Allegation # 2: Facility staff are not assisting resident with showering needs: During today's visit, from 10am to 1pm, LPA (s) conducted interviews with residents and staff, as well as obtained facility and client file records pertaining to the complaint. Through the information obtained, it was reported that resident # 1 (R1) receives two assisted showers a week, including an additional shower if requested. R1 also confirmed to LPA that R1 receives showers weekly, and staff assist . Interviews with additional residents, reported that staff assist residents with showers if needed; while others are independent and do not need assistance. Therefore, the allegation "Facility staff are not assisting resident showering needs", is UNSUBSTANTIATED at this time. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 31-AS-20211008102848

Allegation investigated: COVID: staff and residents do not wear a mask in common area COVID: staff were not taking residents temperature Facility staff do not respond to residents call button Facility is not clean Facility is cold Resident's drawers do not have knobs Facility does not provided hand soap/towels for residents

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Licensee Marilyn Nguyen and explained the reason for the visit. LPA conducted physical plant tour at 9:00 AM, requested facility documents relevant to the investigation at 9:38 AM and conducted interview with staff and residents between 10:30 AM and 1:50 PM. Regarding the allegation that the staff and residents do not wear mask in common areas. LPA's observation during physical plant tour on 07/13/21 at 9:20 AM, Virtual physical plant tour on 12/18/2020 at 2:38 PM and today's visit at 9:38 AM, revealed that all the staff were wearing mask while working in the facility. Based on the information gathered during this and prior visits, the allegation is deemed unsubstantiated at this time. (continued on LIC 9099-C) Unsubstantiated Regarding the allegation that staff were not taking residents temperature, LPA's record review today at 10:00 AM, revealed that the facility staff regularly take the temperature of all residents especially during the outbreaks at the facility, records shows however that some residents refused to do so. LPA's interview with staff on 07/13/21 at 11:35 AM and today at 11:12 AM revealed that facility abide by the guidance provided by the Los Angeles County Department of Public Health but can't force any resident if they refused. Regarding the allegation that the staff do not respond to call button, LPA's interview with eleven (11) residents or more than 10% of current census on 07/13/21 between 10:50 AM and 12:35 PM and today between 10:30 AM and 1:50 PM, revealed that staff come in within reasonable time when called upon whether by call button, by phone or in person in the office. Regarding the allegation that facility is not clean, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM and today's visit at 9:00 AM, revealed that all the common areas are clean and in proper order. Regarding the allegation that the Facility is cold, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM and today's visit at 9:00 AM revealed that the temperature setting on the air conditioning all over the facility was set between 70°F to 75°F and within the required range. Regarding the allegation that Resident's drawers do not have knobs, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM and today's visit at 9:38 AM revealed that the random residents' drawer visited are in good repair. During LPA's visit for another complaint (cc no.: 31-AS-20210726153616) on 07/26/2021 at 1:35 PM, LPA's interview with Resident #1 (R1) at 2:00 PM revealed that R1 did not report the broken knob to the administrator or staff of the facility, while interviewing R1, LPA summoned the facility handyman and observed that the knob was immediately replaced by the staff and even changed the non-working lamp of R1. Regarding the allegation that Facility does not provided hand soap/towels for residents, LPA's observation during physical plant tour on 07/13/21 at 9:20 AM, 05/12/21 at 9:15 AM, 04/16/21 at 2:35 PM and today's visit at 9:00 AM revealed that R1's room has a fresh towel and hand soap on R1's bathroom. Based on the information gathered during this and prior visits, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 25, 2021 · control 31-AS-20210708160740

Allegation investigated: Resident is being left soiled for extended periods of time while in care Staff do not respond timely to a resident's requests

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations, LPA met with staff Marcelo Nogar and explained the reason for the visit. LPA conducted physical plant tour at 9:00 AM. Requested and reviewed facility documents relevant to the investigation at 9:30 AM. LPA conducted interviews with staff and residents between 10:50 AM and 2:00 PM. Regarding the allegation that Resident is being left soiled for extended periods of time while in care, LPA's record review between 9:30 AM to 10:50 AM, revealed that Resident #1 (R1's) diapers are being changed regularly at least three (3) times a day and as needed. LPA's interview with R1 on 05/12/21 at 2:30 PM, also revealed that R1's diapers are being changed regularly. LPA's interview with three (3) care staff on 05/12/21 at 3:00 PM and today between10:50 AM to12:15 PM, confirmed that R1 is being changed at least twice on each shift, i.e., morning (6:00 AM to 2:30 PM) and afternoon (2:30 PM to 10:30 PM) shift and did not receive any report nor observed that R1 was left soiled for extended period of time. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff do not respond timely to a resident's requests, LPA's interview with R1 on 05/12/21 at 2:30 PM, revealed that staff come to his room whenever R1 called for assistance but there are times that staff took a while before coming but did not exceed an hour. LPA's interview with three (3) care staff on 05/12/21 at 3:00 PM and today between 10:50 AM to12:15 PM revealed that when R1 called during meal time, all of the care staff are assisting other residents who need assistance on feeding which usually cause the delay for less than an hour but during normal routine hours, staff always within reasonable time. LPA's interview with ten (10) residents between 10:50 AM and 3:00 PM also revealed that the staff always come within reasonable time whenever they needed assistance. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 18, 2021 · control 31-AS-20210505135153

Allegation investigated: Staff do not provide resident with proper assistance Resident's hygiene needs are not being met Staff refuse to give resident medication

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with administrator Marilyn Nguyen and explained the reason for the visit. LPA conducted physical plant tour at 9:30 AM. Requested facility documents relevant to the investigation at 10:30 AM and conducted interview with staff and residents between 10:30 AM to 2:00 PM. Regarding the allegation that the Staff do not provide resident with proper assistance, LPA record review at 2:00 PM, revealed that Resident #1 (R1) was able to bathe, dress/groom and care for own toileting needs and able to leave the facility unassisted. LPA's interview with Resident #2 (R2) who is the room mate of R1 for eight (8) months at 1:35 PM, revealed that R1 always leave the facility early in the morning and arrive at between 6:00 PM to 7:00 PM every day of the week and that staff always assist R1 with all of R1's needs and always attend to R1 whenever R1 needed assistance. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's closed circuit television (CCTV) footage review at 10:55 AM, confirmed that R1 leaves early in the morning and arrives at the facility between 6:00 PM to 7:00 PM. Moreover, LPA's interview with care staff between 11:00 AM to 2:00 PM, also revealed that whenever R1 arrived at the facility, staff assist R1 to clean and provide R1's medication. Regarding the allegation that resident's hygiene needs are not being met, LPA's record review revealed that R1 is able to bathe, dress/groom and care for own toileting needs. LPA's interview with R2 revealed that R2 reminded R1 daily to stay to have shower and clean but R1 refused and leave the facility early in the morning everyday of the week. Further, staff always clean R1 upon arrival at the facility but sometime R1 refused. LPA interview with staff also revealed that when cleaning R1, staff offered R1 to shower but sometimes refused. Regarding the allegation that Staff refuses to give resident medication, LPA's record review revealed that all of R1's prescribed medication were given to R1, but LPA's interview with R2 revealed that R1 refused to bring medication when leaving the facility early in the morning. Further, all of the six (6) medications of R1 are prescribed to be taken once a day and could be taken any time of the day except for one that needed to be taken during bedtime. LPA's review with three (3) care staff also revealed that R1 always take own medication upon arrival at the facility before going to own room. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 4, 2021 · control 31-AS-20210310104813

Allegation investigated: Facility does not have hot water. Facility is dirty and unkempt.

Licensing Program Analyst (LPA) conducted an unannounced visit on this day in response to the above allegation. As part of this investigation, on 8/26/21 at 11:00am, LPA interviewed 11 residents and observed the hot water temperature in their rooms to be between 105 and 120 degrees Fahrenheit. Allegation #1, that "facility does not have hot water" has been unsubstantiated based on observations and interviews. 11/11 residents interviewed confirmed that the hot water is currently working, and 9/11 stated that they have never experienced any problems with the water or hot water functioning properly. At 1:00pm Administrator stated that there are upcoming plumbing repairs planned, and confirmed that all residents are given notice of any planned water turnoffs. Administrator stated that she does not recall any confirmed instances, or credible claims, of the facility's hot water not working. Unsubstantiated Allegation #2, that "Facility is dirty and unkempt" has been unsubstantiated based on the interviews conducted an observations made. 10/11 of the residents interviewed at 11:00am stated that they do not have any problems or concerns with the facility's cleanliness. Throughout LPA's visit housekeepers were observed doing rounds and cleaning various parts of the facility. Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.the state’s words, verbatim · CDSS document, Aug 26, 2021 · control 31-AS-20210824153455

Allegation investigated: Staff did not provide proper care for resident Resident does not have reasonable access to telephone

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted physical plant tour at 11:30 AM, requested facility documents relevant to the investigation at 12:15 PM and interviewed residents between 12:15 PM to 2:30 PM. Regarding the allegation that Staff did not provide proper care for resident, LPA's interview with Resident #1 (R1) on 01/20/21 at 12:30 PM and today at 12:20 PM, revealed that staff are providing appropriate care and attending to R1's needs. LPA's interview with R1's room mate, Resident #2 (R2) confirmed that the staff are monitoring and attending to R1's needs and provide proper care. LPA interview with staff at 1:00 PM today, also revealed that staff are checking on R1 regularly to change R1's diapers when needed and to ensure R1's well being. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Resident does not have reasonable access to telephone, LPA's interview with R1 revealed that R1 did not have any problem using the telephone and has own cell phone to use. LPA's interview with eleven (11) residents or more than 10% of the current census, revealed that residents have access to the facility phone anytime and did not have any problem using the facility phone. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 21, 2021 · control 31-AS-20210112082952

Allegation investigated: Staff failed to assist resident with wheel chair

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Marilyn Nguyen and explained the reason for the visit. LPA conducted physical plant tour at 11:05 AM. LPA requested facility documents relevant to the investigation at 11:40 AM and interviewed staff and residents between 12:00 Noon to 2:00 PM. LPA's interview with Resident #1 (R1)'s room mate at 1:30 PM today, revealed that R1 always get assistance transferring to and from R1's wheelchair from the staff all the time and that R1 called 911 whenever R1 requested to be attended by a particular staff that R1 liked but was not able to show up as the staff rotates all the time. LPA interview with the administrator on 10/13/2020 at 11:30 AM, revealed that R1 calls the office using own cell phone whenever R1 requests for staff assistance and never used the call button. R1 also called 911 through own cell phone. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with staff at 1:20 PM today, also revealed that staff never refused any call for assistance from R1 but admitted that there are times that there are some delay during busy times of the day because care staff are also attending to other residents. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 14, 2021 · control 31-AS-20201009110658

Allegation investigated: Facility staff are not providing a comfortable environment Lack of supervision resulting in residents engaging in a physical altercation Lack of supervision resulting in residents engaging in verbal altercations Facility staff did not prevent a resident from smoking in the facility

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit to this facility to further investigate the above allegations. LPA met with licensee Marilyn Nguyen and explained the reason for the visit. LPA conducted physical plant tour at 9:00 AM. Requested copy of facility documents relevant to the investigation at 9:30 AM and conducted interviews with staff and residents between 10:00 AM to 1:30 PM. Regarding the allegation that the facility are not providing a comfortable environment, It was alleged that Resident #1 (R1)'s neighbor, Resident #2 (R2), disturbed R1 by being loud and shouting in R2's room, in the balcony and hallway. LPA interview with six (6) residents between 10:00 AM to 1:30 PM, living near and beside the rooms of R1 and R2 revealed that no one witnessed or heard R2 shouting in R2's room or in the balcony or hallway. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA interview with Resident #3 (R3) who is R2's room mate for more than a year, confirmed that R3 did not witness R2 shout in their room, in their balcony or in the hallway. Moreover, LPA interview with the administrator on 07/27/2020 at 11:00 AM and two (2) staff at 1:05 PM today, also revealed that they did not receive any report nor there is any record of R2 misbehaving or shouting in the facility disturbing any resident. Regarding the allegation that lack of supervision resulting in residents engaging in a physical altercation. It was alleged that R2 has beaten up a resident. LPA interview with six (6) residents living near and beside the rooms of R1 & R2, revealed that they did not witness R2 beating up anyone at the facility. In addition, LPA interview with R1 on 08/20/20 at 11:07 AM revealed that R1 was not able to identify the resident who was allegedly beaten up by R2. R2 denied the allegation during interview today at 10:55 AM. Further, interview with the administrator on 07/27/2020 at 11:00 AM and two (2) staff today at 1:05 PM, also revealed that they did not receive any report nor there is any record of R2 having a physical altercation nor assaulted anyone at the facility. Regarding the allegation that lack of supervision resulting in residents engaging in verbal altercation. It was alleged that R2 was "going around threatening and physically assaulting people". LPA interview with six (6) residents living near and beside the rooms of R1 & R2, revealed that they did not witness R2 having a verbal altercation nor threaten anyone at the facility. In addition, LPA interview the administrator on 07/27/2020 at 11:00 AM and with two (2) staff today at 1:05 PM, also revealed that they did not receive any report nor there is any record of R2 having a verbal altercation nor threaten anyone at the facility. Regarding the allegation that Facility staff did not prevent a resident from smoking in the facility, LPA interview with six (6) residents living near and beside the rooms of R1 & R2, revealed that they did not witness R2 smoking inside the facility. LPA interview with R3 who is R2's room mate for more than a year, revealed that R2 did not smoke in their bathroom. LPA interview with the administrator on 07/27/2020 at 11:00 AM and two (2) staff today at 1:05 PM, also revealed that they did not receive any report nor there is any record of R2 smoking inside the facility. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 7, 2021 · control 31-AS-20200723141416

Allegation investigated: There is no hot water in residents room The drain outside where buckets of dirty water are poured is plugged and running over Staff are not providing adequate supervision

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigated the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 1:35 PM. Requested copies of facility documents relevant to the investigation at 2:00 PM. Between 2:00 PM to 4:00 PM, conducted interview with the administrator, staff and residents of the facility. Regarding the allegation that there is no hot water on the facility, LPA observation during physical plant tour revealed that the temperature of hot water in Resident #1 (R1)'s room was measured at 117.9°F. LPA also checked the water temperature on the entire wing where R1's room was located. A total of eight (8) rooms were checked and the hot water was measured at a range of 113.1°F to 119.6°F (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that the drain outside where buckets of dirty water are poured is plugged and running over. LPA observation during physical plant tour at 1:35 PM, revealed that there was no drain existing just outside the facility near the kitchen, the water visible are water from the kitchen whenever they scrubbed the floor once a day in the afternoon and would easily dry out. Regarding the allegation that staff are not providing adequate supervision, LPA interview with R1 at 2:00 PM revealed that R1 was not punched in the face but in the back, LPA interview with Resident #2 (R2) at 3:00 PM, however, revealed that R2 did not possess any knife and denied even touching R1. Further, it was R1 who went off on R2 and cussed R2 when R1 opened the door when R2 knocked on the door because R2 left own room key inside the room. LPA record review revealed that there was no Police/911 call or visit on the the day that R2 allegedly punched R1. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 29, 2021 · control 31-AS-20210726153616

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility staff disposed of resident belongings.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigated the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:15 AM. Requested copies of facility documents relevant to the investigation at 10:00 AM. Between 10:15 AM to 12:40 PM, conducted interview with the administrator, licensee and staff. Regarding the allegation that facility staff disposed of resident belongings, LPA record review at 10:00 AM, revealed that Resident #1 (R1) is self responsible and signed the admission agreement on 08/12/19 which includes the provision that in case of leaving the facility such as hospital or rehabilitation, "any belongings left behind the facility, and not removed by residents or legal guardian will be held for 21 days only then discarded". LPA interview with administrator revealed that the administrator called the case worker of R1 on 12/08/20 and 12/15/20 but did not pick up or sent a representative to pick up R1's belongings and it was only after thirty (30) days that R1's belongings were discarded. (continued) Unsubstantiated (continued on LIC 9099-C) Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 29, 2021 · control 31-AS-20210723161912

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident was left outside in the sun resulting in hospitalization

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 12:45 PM, reviewed facility records at 1:30 PM and conducted interview with the administrator and staff of the facility at 2:55 PM. LPA observation during physical plant tour revealed that Resident #1 (R1) collapsed and fell at the side walk near the front entrance of the neighboring Skilled Nursing and Rehabilitation facility approximately one hundred fifty (150) meters away from the front door of this facility. LPA record review also revealed that R1 left the facility at 10:25 AM on 07/19/20. Further, R1 was able to leave the facility unassisted. LPA interview with the administrator also confirmed that R1 was independent and was never left outside and regularly went out of the facility to shop or ran own's errand. Based on the information gathered during this and prior visit. The allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 13, 2021 · control 31-AS-20200721163341

Allegation investigated: Staff did not provide adequate supervision resulting in resident disturbing other resident's in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:35 AM. At 10:05 AM, LPA conducted interview with the administrator and staff. At 11:30 AM, LPA requested facility documents relevant to the investigation. At 1:33 PM, LPA conducted interview with the residents. LPA interview with seven (7) residents who used to be neighbor of Resident #1 (R1) revealed that five (5) of them did not see or hear Resident #2 (R2) knocked on their doors nor went to R1's room but on R2's friend at two (2) different rooms near R1's room. Two (2) residents interviewed also revealed that R2 hangs out with them so there are times that R2 may have knocked on other resident's door by mistake to get to their room as R2 is visually impaired. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA interview with the administrator at 10:05 AM today also revealed that she did not receive any report of any resident being bothered by R2. LPA interview with staff at 1:45 PM today also revealed that if R2 reported astray, staff would immediately pick up R2 and redirect to the proper place. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 29, 2021 · control 31-AS-20200623100307

Allegation investigated: Staff did not keep the facility free from bed bugs Staff did not properly maintain the facility Staff is withholding food from residents Staff is withholding residents medications Illegal eviction

Licensing Program Analysts (LPAs) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with licensee Marilyn Nguyen and explained the reason for the visit. On 12/18/2020 LPA conducted virtual visit at the facility. LPA conducted virtual physical plant tour, obtained relevant facility records and interviewed administrator. During this visit, LPA conducted physical plant tour at around 9:45 AM and interviewed residents and staff of the facility at 10:45 AM. Regarding the allegation that the facility keep the facility free from bed bugs, LPA observation on Resident #1 (R1)'s room revealed that there was no bed bugs on R1's bed. LPA record review also revealed that the facility has contracted a pest control to visit monthly to prevent any infestation. Further, pest control invoices showed all common areas and fifteen (15) rooms are being treated monthly. LPA interview with administrator also revealed that if they received a report from resident about any infestation, the pest control gives priority to the reported room and/or area. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that the staff did not properly maintain the facility, LPA interview with twelve (12) residents revealed that eleven (11) out of twelve (12) residents stated that their room is being cleaned everyday and LPA observation on multiple visit, virtual and physical, observed that the common areas are generally clean and organized. Regarding the allegation that staff withheld food with resident, LPA interview with R1 revealed that by R1's own admission, that R1 did not eat at the facility and bought own food. LPA interview with staff confirmed that R1 does not eat at the dining area but was never refused any food if and when R1 asked for it. R1 also confirmed that although R1 does not receive food from the facility, when R1 is hungry, food will be provided to R1. Regarding the allegation that Staff withheld medication, LPA interview with R1 revealed that R1 kept most of own medication except for PRN. LPA record review revealed that R1 is able to administer own and PRN medication. Further, medication log review also revealed that R1 refused to take own medication. Regarding the allegation of Illegal eviction, LPA record review revealed that R1 was given an eviction notice due to non-payment, but was never evicted and still living at this facility to date. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted, copy of this report issued.the state’s words, verbatim · CDSS document, May 15, 2021 · control 31-AS-20201215102218