Palos Verdes Villa

Type of visit: Annual/Random

On 10/01/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct the annual inspection. LPA met with Linda Cardenas/Assistant Administrator who was informed of the purpose of today’s visit. At approximately 10:30 AM, Seth Bienstock arrived. During the visit the department did not have an option in FAS to select annual inspection, however the inspection tool was available. The facility is licensed to serve (116) elderly adults aged 60 and above, of which (116) can be non-ambulatory. The facility has an approved hospice waiver for (10). Currently the facility has (92) residents. The facility is a three story building located in a residential neighborhood. It consists of (71) bedrooms, (77) full bathrooms, and (2) 1/2 baths, and a shaded front yard. The first floor contains the following: medication room, nurses office, main lobby, laundry room, janitor closet, kitchen, dining room, activities lounge, TV room, beauty salon, and public telephone. The second floor contains the following: laundry room, linen closet, and game room/computer room. The third floor contains the following: linen closet, activity storage, and 3 miscellaneous storage closets. At 9:30 AM, LPA Bernadette and Linda toured the physical plant. There were no bodies of water or obstructions on the premises. The kitchen was inspected; there was a 5-day supply of perishables and a 7-day supply of non-perishables food items which were adequately maintained and stored. The department also observed an adequate supply of emergency food supplies. There was a menu available for review. The department inspected a total of (6) bedrooms and (6) bathrooms. The beds and bedding supplies appeared to be in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be operational with working wash basins and toilets. The water temperature ranged between 105.0°F and 120.0°F, and the facility and room temperatures ranged from 72°F to 75°F. The smoke and carbon monoxide detectors were in operable condition. The department observed fire extinguishers fully charged and operable. The last Fire/Disaster Drills were conducted on 8/28/2026. During the visit, the department observed that the facility appeared to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. At 10:37 AM, the department also reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings, which appeared to be current and four (4) residents files for admission agreements, updated physician reports, needs and services plan which appeared to be up to date. During the visit the department was informed that there were 5 active cases of Covid. The department observed the facility's infection control practices being followed by staff members during the visit. All mandated inspection control posters were displayed throughout the facility. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted where this report was discussed and provided to Linda Cardenas/Assistant Administrator at the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Oct 1, 2026

Allegation investigated: Staff did not provide proper meals to resident in care resulting in weight loss. Staff did not change resident’s bedsheets. Facility is unkept.

On 02/11/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit to gather information regarding the above allegation. LPA met with Administrator Assistant Linda Cardenas and the purpose of the visit was explained. LPA introduced herself to the Executive Director Seth Bienstock. Investigation consisted of the following: On 02/11/2026, LPA obtained Personnel Report (dated 12/01/2025), Register of Residents, Resident #1’s (R1) Records. LPA interviewed Staff #1 – 8, Residents #1 – 7, and observed lunch. Investigation revealed the following: Allegation: Staff did not provide proper meals to resident in care resulting in weight loss. Record review of R1’s Admission Agreement (01/03/2023) revealed basic services include three nutritious meals daily and snacks, special diets if prescribed by a doctor, and no additional meal services are provided. Continue to LIC9099-C. Unsubstantiated Review of Physician Order (03/25/2025) revealed R1 was to start taking medication A and it was discontinued on 07/02/2025. Review of weight records revealed R1 weighed 208lbs (May 2025), 210lbs (June 2025), 209lbs (July 2025), 206lbs (Aug 2025), 201lbs (Sept 2025), 196lbs (Oct 2025), 190.6 lbs (Nov 2025), 186.6lbs (Dec 25), and 182lbs (Jan 2026). Record review of Physician Order (09/29/2025) revealed R1 to start taking medication A at the lowest dose and it was discontinued on 12/10/2025. Medical Assessment (12/10/2025) revealed R1 weighed 187lbs, is able to care for own toileting needs, able to feed self, but not able to leave the facility unsupervised. R1 is ambulatory. Summary visits revealed R1 was seen by doctor on 01/05/2026 and 01/21/2026 to address R1’s concerns. R1 was hospitalized from 01/31/2026 – 02/08/2026 to address R1’s concerns. Interview with both Chefs (S5 – S6), S1, Staff #4 (S4) indicated Mexican food is served at least weekly. Interview with S6 indicated Mexican food has been specifically purchased for R1 but R1 complained about the authenticity and quantity of food. Interview with S1 - S2 also indicated R1 eventually refused Mexican meals because R1 did not like the taste so Boost drinks was provided as a supplement. R1 stopped drinking the Boosts due to diarrhea. Interview with S1 - S2 indicated Resident #1 (R1) has been taking medication A that causes weight loss and decreased appetite. Six out of seven resident interviews (R1 – R7) indicated they are satisfied with the meals. LPA observed lunch (BBQ pulled pork on bun or grilled cheese, an Italian soup, coleslaw, and sweet potato fries) being served around 11:50 AM. LPA observed monthly menu posted in the dining room. Regarding the allegation, “Staff did not provide proper meals to resident in care resulting in weight loss,” based on record reviews, observation and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation: Staff did not change resident’s bedsheets. Record review of R1’s Admission Agreement (01/03/2023) revealed basic services include clean bed and bath linens weekly, or as often as needed and cleaning of resident's room. Plus bedside care and tray service for minor temporary illnesses or recovery from surgery. Four out of four staff interviews (S2 – S3, S7 – S8) indicated residents bed linen are changed weekly or whenever soiled. S2 indicated Resident #1 (R1) never complained about soiled linen. S2 indicated S3 notified S2 on 01/29/2026 that Resident #1’s (R1) toilet contained blood. R1 toilets independently and did not report toileting issues until S2 spoke with R1. Continue to LIC9099-C. S2 indicated staff observed blood on R1’s bed linen on 01/31/2026. S3 indicated R1’s linen was clean on 01/29/2026 but observed blood on 02/01/2026. Six out of seven resident interviews (R1 – R7) indicated bed linen is changed weekly and whenever soiled. LPA observed R1 sitting on bed that contained a white fitted sheet, a light green cushion pad, a sheet, blanket, and other items. Regarding the allegation, “Staff did not change resident’s bedsheets” based on record reviews, observations, and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation: Facility is unkempt Record review of R1’s Admission Agreement (01/03/2023) revealed basic services includes cleaning of resident's room. Interview with S1 – S2, S7 – S8 indicated the rooms are deep cleaned weekly. Six out of seven resident interviews (R1 – R7) indicated housekeeping is completed weekly and they are satisfied. LPA observed the common areas to be clean and housekeepers cleaning residents’ rooms. Regarding the allegation, “Facility is unkempt,” based on record reviews, observations and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. An exit interview was conducted and a copy of this report was provided to Administrator Assistant Linda Cardenas.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 11-AS-20260203133219

Allegation investigated: Staff does not ensure resident is spoken to in an appropriate manner

On 12/22/25 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced complaint visit at the facility. LPA was met by staff one Linda Cardona, Administrator (S1) and the purpose of the visit was explained. The investigation consisted of the following: LPA requested and reviewed resident one through three's (R1-R3) medical assessment(s) (dated: various) and staff one through three's training folders (dated: various). LPA interviewed four (4) residents (R1-R4) and four (4) staff (S1-S4). The investigation revealed the following: Regarding the allegation "Staff does not ensure resident is spoken to in an appropriate manner", it is being alleged that staff speak inappropritately to residents in care. Record reviews revealed the following: S1-S3 have valid training hours for the year of 2025 and have completed Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. Interviews revealed the following three (3) out of four (4) residents and all four (4) staff have denied the allegation has taken place Report continues, please see LIC9099C Unsubstantiated Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. An exit interview was held with Linda Cardona and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Dec 22, 2025 · control 11-AS-20251216114619

Type of visit: Required - 1 Year

On 9/21/2025, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Linda Cardenas/Assistant Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (116) elderly adults aged 60 and above, of which (116) can be non-ambulatory. The facility has an approved hospice waiver for (10). Currently the facility has (92) residents. The facility is a three-story building located in a residential neighborhood. It consists of (71) bedrooms, (77) full bathrooms, and (2) 1/2 baths, and a shaded front yard. The first floor contains the following: medication room, nurses office, main lobby, laundry room, janitor closet, kitchen, dining room, activities lounge, TV room, beauty salon, and public telephone. The second floor contains the following: laundry room, linen closet, and game room/computer room. The third floor contains the following: linen closet, activity storage, and 3 miscellaneous storage closets. LPA Iniguez and the Admin/Assistant toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (5) bedrooms and (5) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged between 105.0°F and 118.0°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 8/26/25. A review of (4) residents' service files and (4) staff personnel files was maintained in order. LPA reviewed (4) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance will be emailed to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Linda Cardenas/Assistant Administrator.the state’s words, verbatim · CDSS document, Sep 21, 2025

Allegation investigated: Resident was hit by another resident while in care.

On 05/29/25 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with (S1) Administrator Assistant Linda Cardenas as the purpose of today’s visit was explained. The investigation consisted of the following: On 05/29/25 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1-2 (R1-R2) face sheet, admission agreement, physicians report, resident appraisal, medication list, and MAR for May 2025. On 05/29/25 from 10:00 am- 11:30 am LPA conducted Interviews with Resident #1-7 (R1-R7), from 1pm-1:15pm LPA conducted review of video footage from incident that occured on 5/19/25, and from 1:25pm-2pm interviews were conducted with staff #1-5 (S1-S5). The investigation revealed the following: Allegation: Resident was hit by another resident while in care. Unsubstantiated It is being alleged that R2 yelled at and hit R1 on the arm. On 05/29/25 from 10:00 am- 10:15am LPA conducted interview with R1 regarding the allegation above, R1 confirmed the allegation and reported being hit on the arm while being yelled at by R2. On 5/29/25 LPA attempted to conduct interview with R2 regarding the allegation above, R2 refused to be interviewed. On 5/29/25 from 10:20am- 11:30 am LPA conducted Interviews with R3-R7 regarding the allegation above, 5 of 7 residents interviewed denied the allegation above and reported feeling safe at Palos Verdes Villa LLC. On 5/29/25 from 1pm-1:15pm LPA conducted review of video footage from incident on 5/19/25, LPA observed R2 tapping on R1's left arm. On 5/29/25 from 1:25pm-2pm interviews were conducted with staff S1-S5, 5 of 5 staff denied the allegation above and reported that staff will intervene right away if the safety of any resident was in jeopardy. On 5/29/25 LPA confirmed and reviewed the incident report that was submitted to CCLD on 5/21/25 regarding the 5/19/25 incident between R1 and R2, per incident report, licensee and administrator conducted video review, interviews with staff and R1 and R2, and It was determined that R2 was tapping R1's arm, R1 was not observed asking/telling R2 to stop. On 5/29/25 LPA conducted a review of R1 and R2's physician reports, and resident appraisal, per documents neither resident has a history of aggression. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 29, 2025 · control 11-AS-20250521124007

Allegation investigated: Facility has bed bugs. Facility has lice. Staff do not ensure that resident's hygiene needs are being met while in care. Staff do not ensure that resident's diapering needs are being met while in care.

On 04/30/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit. LPA was met by Linda Cardenas, Administrator (S1), and the purpose of the visit was explained. S1 and LPA toured the first floor of the facility. The investigation consisted of the following: On 04/30/25 LPA requested and reviewed facility documents, including the following: resident roster (dated: 04/21/25), staff roster (dated 04/21/25) six (6) SIR's (LIC624) (dated from 04/15/25 - 04/19/25), Care logs of residents (dated 04/01/25 - 04/29/25), Palos Verdes Villa 24 Hour (24HR) report (dated 04/01/25 - 04/29/25), AM/PM/Graveyard laundry schedule, Monday-Sunday morning shift shower schedule and eight (8) pest control service reports (dated: 01/02/25 - 04/24/25). LPA interviewed six (6) out of eighty-seven (87) residents and five (5) out of thirty-six (36) staff. The investigation revealed the following: Regarding the allegation, “Facility has bed bugs.”. It has been alleged that a resident was observed to have bed bugs, which led to a concern for resident's neglect. On 04/30/25 a wellness check was completed by community care licensing division’s (CCLD) LPA. Report continues, see LIC9099-C. Unsubstantiated Record reviews have revealed that a pest control service conducts semi-monthly visits. The monthly reports have not made any note for the room in question, nor any mention of bedbugs. Between 09:00AM and 10:00AM, LPA checked rooms twelve (RM12), 16 (RM16), 17 (RM17) & 19 (RM19) and no insects were observed to be present within the rooms or on the bed(s). Between 10:00AM & 12:00PM LPA interviewed R1-R5, R6 denied LPA's interview. Five (5) out of five (5) residents (R1-R5) have not agreed the allegation has taken place. Between 12:00PM and 1:00PM, LPA interviewed S1-S5. All five (5) staff (S1-S5) have not agreed the allegation has taken place. Based on record reviews, interviews and observations conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “Facility has lice.” It has been alleged that a resident was observed to have lice, which led to a concern for resident's neglect. On 04/30/25 a wellness check was completed by community care licensing division’s (CCLD) LPA. Record reviews have revealed that a pest control service conducts semi-monthly visits. The eight (8) monthly reports have not made any note for the room in question, nor any mention of lice. Between 09:00AM and 10:00AM, LPA checked rooms twelve (RM12), 16 (RM16), 17 (RM17) & 19 (RM19) and no insects were observed to be present within the rooms or on the bed(s). Between 10:00AM & 12:00PM LPA interviewed R1-R5, R6 denied LPA's interview. Five (5) out of five (5) residents (R1-R5) have not agreed the allegation has taken place. Between 12:00PM and 1:00PM, LPA interviewed S1-S5. All five (5) staff (S1-S5) have not agreed that the allegation has taken place. Based on record reviews, interviews and observation conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “Staff do not ensure that resident's hygiene needs are being met while in care.”. It has been alleged that residents were not provided a suitable hygiene plan. Record reviews have revealed that the facility follows a Monday-Sunday morning shift shower schedule, noting the resident in question is marked to receive a shower three times (3x) per week (/week). Care logs of residents have revealed that the resident in question receives a shower 3x/week. Between 10:00AM & 12:00PM LPA interviewed R1-R5, R6 denied LPA's interview. Four (4) out of five (5) residents (R1-R4) have not agreed that the allegation has taken place. Between 12:00PM and 1:00PM, LPA interviewed S1-S5. All five (5) staff (S1-S5) have not agreed the allegation has taken place. Report continues, see LIC9099-C. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “Staff do not ensure that resident's diapering needs are being met while in care.”. It has been alleged that residents were not provided an incontinence plan. Record reviews have revealed that the facilities' Care logs of residents (dated 04/01/25 - 04/29/25) have displayed the resident in question to have received incontinence checks within a two-hour interval. Between 10:00AM & 12:00PM LPA interviewed R1-R5, R6 denied LPA's interview. Four (4) out of five (5) residents (R1-R4) have not agreed that the allegation has taken place. Between 12:00PM and 1:00PM, LPA interviewed S1-S5. All five (5) staff (S1-S5) have not agreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There has been zero deficiencies cited during today’s visit. An exit interview was held with staff one, Linda Cardenas (S1) Administrator, and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 11-AS-20250422145802

Allegation investigated: Staff are not meeting resident's needs. Staff are not preventing residents from smoking in non-designated smoking areas. Staff are not meeting residents' level of care needs.

On 4/23/25, at 09:30am, the department conducted an initial complaint visit to the facility and was greeted by Seth Bienstock, Executive Director, and Hermelinda Cardenas, Administrator. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/residents, and deliver findings for the allegations mentioned above. The investigation consisted of the following: The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R8) from 10:00am-2:00pm. The department received the following: Resident Roster (Dated: 04/23/2025), Staff Roster (Dated: 02/26/2025), Resident Service Plan (Dated: 03/17/25, 03/24/25), Physicians Report (Dated: 06/03/2024, 06/11/2024, 03/07/2025 & 07/03/2024), Identification and Emergency Information (Dated: 10/16/2024, 02/02/2022, 06/24/2021, & 10/31/2023), Resident Appraisal (Dated: 02/17/2025, 02/06/2024, 09/28/2024 & 03/07/2025), House Rules (Dated: 09/11/2023) and Admission Agreement (Dated: 03/01/2023, 09/15/2024, 06/24/2021, & 01/01/2024) from the facility. Report Continued on LIC9099-C Page 1 of 3 Unsubstantiated The investigation revealed the following: Allegation #1-Staff are not meeting resident's needs. The details of the complaint alleged that the staff does not assist resident with dressing and putting on back support for an injury. On 4/23/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. Staff (S1-S4) denied the allegation that the Staff are not meeting resident's needs. Staff (S1-S4) stated that the facility does help residents with any assistance that is needed. They stated that each resident has a phone and a call button in their room to use if assistance is needed, day or night. They further state that the facility is sufficiently staffed to meet the needs of all their residents. The department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff are not meeting resident's needs. The majority of residents interviewed (7 of 8) stated that the staff are meeting their needs and are satisfied with the care and supervision they are receiving at the facility. The Department reviewed the Resident Service Plan (Dated: 03/17/25, 03/17/25, 03/24/25), Physicians Report (Dated: 06/03/2024, 06/11/2024, 03/07/2025 & 07/03/2024), Identification and Emergency Information (Dated: 10/16/2024, 02/02/2022, 06/24/2021, & 10/31/2023), Resident Appraisal (Dated: 02/17/2025, 02/06/2024, 09/28/2024 & 03/07/2025) and observed that the residents interviewed have a documented service plan in place and a supportive team to assist them with their individualized needs for care in the facility. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff are not meeting resident's needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation #2- Staff are not preventing residents from smoking in non-designated smoking areas. The details of the complaint alleged that the facility is not preventing residents from smoking all over the facility without restriction and smoke comes into the building. On 4/23/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. Staff (S1-S4) denied the allegation that Staff are not preventing residents from smoking in non-designated smoking areas. All staff (S1-S4) stated that the facility does enforce restricted smoking. They state that there is a non-smoking and a smoking patio area for residents to sit outside of the facility. They state that smoking is not allowed in the building and if residents are caught smoking in the building, they are reminded of the house rules and given a warning that it is grounds for eviction if not followed. The department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff are not preventing residents from smoking in non-designated smoking areas. The majority of residents that were interviewed stated that the staff does enforce smoking only in designated areas. They state that smoking is only allowed in the smoking only section patio and in the outer parking lot of the facility. They further state that they have not seen residents smoking inside the facility. Report Continued on LIC9099-C Page 2 of 3 The Department reviewed the House Rules (Dated: 09/11/2023) and observed that in the rules of the facility, it is documented that smoking is not permitted in buildings or in rooms, and designated areas are available. Additionally, it states that failure to follow the house rules are grounds for eviction. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff are not preventing residents from smoking in non-designated smoking areas. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation #3- Staff are not meeting residents’ level of care needs. The details of the complaint alleged that the staff are not meeting the level of care for residents in the facility. On 4/23/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. Staff (S1-S4) denied the allegation that Staff are not meeting residents’ level of care needs. All staff (S1-S4) stated that the facility has individualized resident service plans for each resident and deny that they are not meeting the residents care needs. They also stated that each resident has a call button and a telephone in their room if assistance is needed and they have enough staff to meet the needs of all their residents in the facility. The department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff are not meeting residents’ level of care needs. The majority of residents interviewed (7 of 8) stated that they were satisfied with the level of care being provided to them by the staff at the facility and had no complaints. The Department reviewed the Resident Service Plans (Dated: 03/17/25, 03/24/25) and Resident Appraisals (Dated: 02/17/2025, 02/06/2024, 09/28/2024 & 03/07/2025) and observed that the facility has service plans in place for the residents and they have been appraised before admittance into the facility. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff are not meeting residents’ level of care needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No citations were issued. An exit interview was conducted with Hermelinda Cardenas, Administrator, and a hard copy of this Complaint Investigation Report was provided. Page 3 of 3the state’s words, verbatim · CDSS document, Apr 23, 2025 · control 11-AS-20250414112446

Allegation investigated: Staff does not provide a variety of food.

On 03/20/25 The Department of Social Services, Community Care Licensing Division (CCLD) conducted an initial complaint visit to gather information regarding the above allegation(s). CCLD met with staff one, Linda Cardenas, Administrator (S1) and the purpose of the visit was explained. CCLD was granted entry to the facility. The investigation consisted of the following: On 03/20/25 CCLD requested Resident Roster (dated 03/20/2025), staff roster (dated 11/19/24), Admissions agreement, Needs and Services plan and Physician's Report for Resident two, four and five.(R2, R4-R5). CCLD was provided the facility's menus (dated 03/17/2025-03/23/2025), and the always available "alternative menu". CCLD also reviewed Dietician's Consultant Report (dated 02/19/25) and was provided six (6) certificates of training under Food Safety Training & Certification. CCLD interviewed nine (9) residents (R1-R9) and three (3) staff, and toured the first floor, the kitchen and the dining room. Report continues, see LIC9099C. Unsubstantiated The investigation revealed the following: The investigation revealed the following: Regarding the allegation, "Staff does not provide a variety of food.", it has been alleged that a resident was not served their request during their breakfast visit. On 03/20/2025, between 8:37am-1pm, CCLD interviewed residents #1-9 (R1-R9) and five (5) out of nine (9) residents interviewed do not agree with the allegation. On 03/20/2025, between 1pm-4pm, CClD interviewed Staff #1-3 (S1-S3) and three (3) out of three (3) staff interviewed denied the allegation has taken place. Record reviews revealed that there are two choices of food available for the meals of lunch and dinner, and that Milk or other beverages are provided during meal times. CCLD reviewed six (6) staff certificate of training under Food Safety Training & Certification, all which are valid and that the nearest certificate to expire is August 06, 2025. The "Dietician's Consultant Report" (dated 02/19/25) rated the facilities' kitchen as valid under the Dietician inspection and that the Dietician visits the facility monthly and that the facility was last visited on 03/19/25. CCLD also observed that the seating in the dining room is arranged and that each resident has a label of their name on their chair. Furthermore, each resident with a special diet has their special diet paperwork, under their seat's glass tabletop, to ensure staff are made aware of each resident's special diet. Based on interviews, record reviews and CCLD's observation, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There has been zero deficiencies cited during today’s visit. An exit interview was held with staff one, Linda Cardenas (S1) Administrator, and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Mar 20, 2025 · control 11-AS-20250318085530

Type of visit: Required - 1 Year

On 08/17/24 Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Activities Director Cynthia Partida. LPA explained the purpose of today’s visit. The facility is licensed to serve (116) non-ambulatory elderly adults ages 60 and above. Facility waiver approved for (10) hospice residents. The facility is a three-story structure located in a residential neighborhood. It consists of (71) bedrooms, (77) full bathrooms, and (2) 1/2 bath, and shaded front yard. The first floor contains the following: medication room, nurses office, main lobby, laundry room, janitor closet, kitchen, dining room, activities lounge, TV room, beauty salon, and public telephone. The second floor contains the following: laundry room, linen closet, and game room/computer room. The third floor contains the following: linen’s closet, activity storage, and 3 miscellaneous storage closets. The Activities Director accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. Resident bedrooms (room #1, 16, 29, 29A, 30, 45, 58, 59, 66, 68) had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Continue to LIC 809-C. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured at 111.6 (room 1), 113.7 (room 30), and 111.3 degree F (room 59). Resident bath towels and linen supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. First Aid kit was available. Fire extinguishers, last serviced February 20, 2024 was observed on each floor. Fire Inspection re-test was completed on 11/14/23. Nine staff records were reviewed, 9 out of 9 staff records had required criminal record clearances or criminal record exemptions. Nine resident records were reviewed and, 9 out of 9 resident records had medical assessments and pre-appraisal or reappraisals. Two medications were reviewed. No deficiencies are being cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with Licensed Vocational Nurse Valeria Garcia.the state’s words, verbatim · CDSS document, Aug 17, 2024