Atherton

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Case Management visit to inspect temporary housing for 14 residents while their units are remodeled. LPA met with Administrator Joelle Medina and explained the purpose of the visit. The facility is licensed as a Continuing Care Residential Community (RCFE-CCRC) to serve 518 residents, 60 years and above, of which 259 may be non-ambulatory. The hospice waiver is approved for 10 residents. There are currently 26 Assisted Living residents, including 14 in temporary Joselyn wing, 2 residents in the Memory Care unit. LPA toured the Joselyn wing with the Administrator. LPA inspected all 14 rooms and all the rooms met department regulations. No deficiencies observe in the Joselyn wing observed during visit. Fire department will make visit on Monday to re-inspect the temporary units, Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Mar 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced required annual inspection. LPA met with Administrator Joelle Medina and explained the purpose of the visit. The facility is licensed as a Continuing Care Residential Community (RCFE-CCRC) to serve 518 residents, 60 years and above, of which 259 may be non-ambulatory. The hospice waiver is approved for 10 residents. There are currently 26 Assisted Living residents, including 14 in temporary Joselyn wing, 2 residents in the Memory Care unit, 60 residents in Skilled Nursing, and 254 residents in Independent Living. LPAs toured the community with the Administrator for the Assisted Living and Memory Care units, in addition to some of the common areas of the facility. The Assisted Living unit and Memory Care unit are detached from the main building. The Assisted Living unit consists of 32 individual apartments, of which 19 are being remodeled and 14 residents are being temporary housed at Joselyn wing, with their own bathrooms and a shared dining area. The Memory Care unit consists of 4 bedrooms, one TV room, 1 full bathroom and ½ bathroom, living room, dining room, small visiting room and kitchen. Currently there are two (2) resident residing in memory. There is an alert system installed on all the doors. Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an infection Control Plan at facility. Operational Requirements: The facility does accept patients with dementia. There are 0 bedridden residents residing at the facility. The facility has enough liability insurance covering injury to residents and guest. (continued on 809C) (continued from 809) Physical Plant & Environment Safety: There is a pool on the premises, and it is secured as required. Facility has operable smoke and carbon monoxide detectors located in each room and hallways and central fire alarm that were all tested. The memory Care was missing carbon monoxide detectors. Facility staff promptly installed them during visit. Knives, cleaning solutions, and disinfectants are locked and inaccessible to residents. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in the resident’s bathrooms and kitchen sink. The hot water temperature in the bathrooms was measured between 112.6-118.8 degrees F, which is within required range of 105-120 degrees F. Staffing: There appears to be sufficient staffing at the facility. The administrator's (Joelle Medina) certificate expires, 06/11/2027 Staff employed are all over the age of 18. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Identification & Emergency Information, Original Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Some residents files need Physicians reports. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visitors can visit anytime. Incidental - Medical Dental: Some medications were missing from cart and some did not have labels. Most of the medications are administered as ordered. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Disaster Preparedness: The facility has an Emergency Disaster Plan but requires updating. Fire and disaster drills are conducted monthly. Last one was 3/02/2026 Facility will find additional evacuation location outside the immediate area and update Emergency Disaster plan. Residents with Special Health Needs: The facility does not accept and retains residents with special health needs. Exit interview conducted, deficiencies cited, technical advisories provided, 809D and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 6, 2026

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to inspect the temporary relocation site of 15 assisted living residents from the assisted living section of facility to the skilled nursing section while renovations are being completed in the assisted living section. LPA met with Joelle E Medina, Administrator and Ruth Diehl, Assistant Director. LPA took tour of section of facility were residents will be relocated with Joelle E Medina, Administrator and Ruth Diehl, Assistant Director. LPA observed the following: 1) All rooms were missing all beds, chairs, dressers, and lamps. 2) Two (2) showers rooms were missing shower heads and non slip mats. 3) Two (2) shower was missing grab bars for toilet and shower. 4) All the rooms were missing smoke/carbon monoxide detectors 5) Water temperature measured within range. Facility will correct the above #1 - #4 and send proof to LPA. Once corrections have been completed, facility will move in residents and notify the department. No deficiencies cited, exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Alberto Lopez made subsequent unannounced visit to complete the annual inspection started on 03/10/2025. LPA met with Director of Assisted Living Daniella Doromal and discussed the purpose of the visit. Today LPA reviewed the following. Staffing: There appears to be sufficient staffing at the facility. The Administrator's (Angela Lee) certificate expires 03/28/2025. Administrator retired unexpectedly and facility is in process of hiring new administrator. Proof of renewal Staff employed are all over the age of 18. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Identification & Emergency Information, Original Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Some residents files need current Physicians reports. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visitors can visit anytime. Food Service: There are sufficient food supplies of 2-day perishable. Seven-day non-perishable in storage. The food is properly stored in the refrigerator to avoid cross contamination Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed 4 residents' medication, and all medication is administered according to doctor’s orders. However, some PRN medications are missing labels. Disaster Preparedness: The facility has an Emergency Disaster Plan but requires updating. Residents with Special Health Needs: The facility accepts and retains residents with special health needs. Two residents with special health needs resides at facility. The staff received training on appropriately caring for residents with special health needs. Exit interview conducted with Director of Assisted Living Daniella Doromal copy of report, 809D and appeal rights provided along with one technical advisory.the state’s words, verbatim · CDSS document, Mar 17, 2025

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.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Alberto Lopez and Sakinah Madyun conducted an unannounced required annual inspection. LPA met with Assistant Director Ruth Diehl and explained the purpose of the visit. The facility is licensed as a Continuing Care Residential Community (RCFE-CCRC) to serve 518 residents, 60 years and above, of which 259 may be non-ambulatory. The hospice waiver is approved for 10 residents. There are currently 31 Assisted Living residents, 3 residents in the Memory Care unit, 66 residents in Skilled Nursing, and 254 residents in Independent Living. LPAs toured the community with the Assistant director for the Assisted Living and Memory Care units, in addition to some of the common areas of the facility. The Assisted Living unit and Memory Care unit are detached from the main building. The Assisted Living unit consists of 32 individual apartments with their own bathrooms and a shared dining area. The Memory Care unit consists of 4 bedrooms, one TV room, 1 full bathroom and ½ bathroom, living room, dining room, small visiting room and kitchen. There is an alert system installed at all the doors. Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and have an infection Control Plan at facility. Operational Requirements: The facility does accept patients with dementia. There 0 bedridden residents residing at the facility. The facility has enough liability insurance covering injury to residents and guest. (continued on 809C) (continued from 809) Physical Plant & Environment Safety: There is a pool on the premises, and it is secured as required. Facility has operable smoke and carbon monoxide detectors located in each room and hallways. Knives were locked and inaccessible to residents. Cleaning solutions were not locked in the common laundry area and accessible to residents. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in random resident’s bathrooms and laundry room and were measured between 107.6 -112.4 degrees F which is within required range of 105-120 degrees F. Skid mat was missing in room #27 Deficiencies cited on 809D, exit interview conducted and copy of report and appeal rights provided. Due to time constraints, LPA will return another day to complete annual inspection.the state’s words, verbatim · CDSS document, Mar 10, 2025

Type of visit: Case Management - Annual Continuation

LPA made subsequent unannounced visit to complete the annual assessment started on 02/27/2024. LPA met with administrator Angela Lee and discussed the purpose of the visit. Today LPA reviewed the following. Operational Requirements: The facility does not accept patients with dementia There 0 bedridden residents residing at the facility. The facility has the sufficient amount of liability insurance covering injury to residents and guest. Physical Plant & Environment Safety: There is a pool on the premises and it is secured as required. Facility has operable smoke and carbon monoxide detectors located in each room and hallways. Knives, cleaning solutions, and disinfectants are locked and inaccessible to residents. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in the resident’s bathrooms and kitchen sink. The hot water temperature in the bathrooms were measured between 121.8 – 129.1 degrees F which is not within required range of 105-120 degrees F. Staffing: There appears to be sufficient staffing at the facility. The administrator's (Angela Lee) certificate has expired, Proof of renewal reviewed. Staff employed are all over the age of 18. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Identification & Emergency Information, Original Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Some residents files need Physicians reports. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visitors can visit anytime. Continue on 809C Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Disaster Preparedness: The facility has an Emergency Disaster Plan but requires updating. Residents with Special Health Needs: The facility accepts and retains residents with special health needs. One resident with special health needs resides at facility. The staff received training on appropriately caring for residents with special health needs. Exit interview conducted, deficiency cited, technical advisories, 809D and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 5, 2024

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced required annual inspection. LPA met with Administrator Angela Lee, and explained the purpose of the visit. The facility is licensed as a Continuing Care Residential Community (RCFE-CCRC) to serve 518 residents, 60 years and above, of which 259 may be non-ambulatory. The hospice waiver is approved for 10 residents. There are currently 30 Assisted Living residents, 2 residents in the Memory Care unit, 77 residents in Skilled Nursing, and 254 residents in Independent Living. LPA Lopez toured the community with the Administrator for the Assisted Living and Memory Care units, in addition to some of the common areas of the facility. The facility has a universal screening at the front lobby for staff and visitors. Temperature is taken and documented on the sign in log. LPA observed Coronavirus (COVID-19) signage posted throughout the facility. The Assisted Living unit and Memory Care unit are detached from the main building. The Assisted Living unit consists of 32 individual apartments with their own bathrooms and a shared dining area. The dining room tables are socially distanced. The Memory Care unit consists of 4 bedrooms, one TV room, 1.5 bathroom, living room, dining room, and kitchen. There is an alert system installed at all the doors. Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and have an infection Control Plan at facility. continued... Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed 4 residents' medication, and all medication is administered according to doctor’s orders. However, the PRN medications are missing labels. Food Service: There are sufficient food supplies of 2-day perishable. Seven day non-perishable in storage. The food is properly stored in the refrigerator to avoid cross contamination. Due to insufficient time, LPA will return another day to complete inspection. Deficiency cited (see 809D) , copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 27, 2024