Downey Retirement Center

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Jason Perez (Assistant Administrator) and explained the purpose of today's visit. The investigation consisted of the following: During initial visit on 6/18/24 LPA obtained copies of staff & resident rosters. LPA toured facility along side of Jason Perez, various resident rooms were entered and phone lines were tested. LPA interviewed 7 staff (S1-S7) and 9 residents (R1-R9). Due to time constraints, the above allegations needed further investigation. During todays subsequent visit LPA inspected exterior of facility once again, met with Asssistant Administrator Jason Perez and delivered findings. (Continued on LIC9099-C) UnsubstantiatedRead the full finding— CDSS inspection report, June 20, 2024 · control 28-AS-20240613141505

Licensing Program Analyst (LPA's) Tena Herrera and Daniel Konishi conducted an unannounced subsequent complaint visit regarding the above allegation. LPA's met with Administrator Brandie Mendibles and explained the purpose of the visit. The investigation consisted of the following: During initial visit dated 9/15/23 LPA Zaragoza conducted a tour of the facility and also obtained copies of the Resident and Staff Rosters, further investigation was needed. During todays visit LPA's toured facility along side Administrator, received copies of Staff and Resident Rosters, Copy of Admission agreement with House Rules that contained Smoking Policy, SOC341 and special incident report. LPA's interviewed a total of 10 Residents (R1-R10) and 5 Staff (S1-S5). (Continued on 9099-C) UnsubstantiatedRead the full finding— CDSS inspection report, April 9, 2024 · control 28-AS-20230914162807

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced 10-day complaint visit regarding the above allegation. LPA met with Jason Perez, Assistant to the Administrator and explained the purpose of the visit. Shortly after, Brandie Mendibles, Administrator arrived and assisted LPA with the investigation. The investigation consisted of the following: LPA toured the facility and obtained copies of the resident and staff rosters. LPA reviewed R1's files such as: Identification and Emergency Information, Admission Agreement, Physician report (9/14/2023), Medication Administration Record (MAR) for Jan. 2024, and Charting Notes (Nov. 2023-Jan 2024). LPA also interviewed Staff #1 - Staff #5 (S1 – S5), Resident #1 - Resident #10 (R1 – R10) and Home Health Nurse (telephonically). *****CONTINUED ON LIC9099-C***** UnsubstantiatedRead the full finding— CDSS inspection report, January 16, 2024 · control 28-AS-20240109164819

Licensing Program Analysts (LPA's) Nicol Wesley conducted an initial 10 day complaint visit and met with Administrator Brandie Mendibles to discuss the reason for today's visit. Investigaton consisted of: Interviews with staff, interviews with residents, interviews with R1 husband, obtained a copy of the resident roster, staff roster, and charting notes. LPA Wesley look at the file for resident #1 and file for LVN Olusola "Henry" Awolpe. Regarding allegation: Staff did not seek timely medical attention for a resident. R1 indicated that she and her husband went to have her vitals taken and the African American med tech was falling asleep while taking her vitals. LPA Wesley saw a video and it did not seem as though the Nurse was falling asleep. He blinked his eyes for 1 second and he was wearing a mask and he was also walking around and attentive. Staff and Continued on LIC 9099c. UnsubstantiatedRead the full finding— CDSS inspection report, October 5, 2023 · control 28-AS-20230925142442

Licensing Program Analyst (LPA) Galarza conducted a subsequent visit to deliver findings on the investigation conducted by DSS Investigation Branch Investigator Laura Garcia. LPA met with Administrator Brandie Mendibles and explained the purpose of the visit. The investigation consisted of the following: On 3/30/21, LPA Cynthia Chan initiated a telephonic visit with former Administrator Michele Goodney due to COVID-19 pandemic. A Facetime virtual tour of common areas and rooms #101, #106, #148, #224, #239, #246, and #275 was conducted. Resident (R1's) file documents were requested. Administrator emailed the following documents: Emergency and Identification form, current Physician's Report, Appraisal/Needs and Services Plan, Medication logs from January 2021 through Present, and recent hospital admission/discharge paperwork. ***Narrative summary continues next page. SubstantiatedRead the full finding— CDSS inspection report, September 7, 2023 · control 28-AS-20210329085008

Licensing Program Analyst(s)(LPA) Mary Flores conducted a subsequent investigation visit at the facility to deliver findings on the above allegation(s). LPA met with Brandie Mendibles Administrator and explained the reason for the visit. The investigation consisted of the following: On 5/15/22 LPA Flores and Maldonado conducted an initial visit investigation. LPAs tour facility's commercial kitchen and 10 resident rooms. LPAs requested a copy of resident roster and staff roster, 4 weeks of menu, invoices for food deliveries for a month, staff's warning notice, dining service director's application, incident reports for residents that have fallen in the past month. LPAs conducted medication review for 11 residents. On 6/7/23 LPA Flores interview 5 staff and requested a copy of cooks’ food handler certificate. On 6/19/23 LPA interviewed 8 residents over the phone. On 6/23/23 LPA interviewed 1 resident over the phone. On 7/7/23 LPA interview one additional resident. (CONTINUED LIC 9099C)Read the full finding— CDSS inspection report, July 7, 2023 · control 28-AS-20220510113455

LPA Lopez made subsequent unannounced visit to investigate the above allegations. LPA met with front desk receptionist Olga Mejia and explained the purpose of the visit. Administrator Brandie Mendibles arrived a short time later and assisted with the investigation. On initial visit on 11/08/2022 LPA conducted interviews with residents 1-10 (R#1 -R#10) Administrator Michelle Goodney and 1 facility staff (S#1-S#2). LPA obtained and reviewed staff and resident rosters. On subsequent visit on 7/6/2023, LPA interviewed 6 additional staff members Including new Administrator (S#3-S#8) 2 additional residents. (R#11-R#12) and reviewed and obtained updated rosters of staff and residents. Allegation: Staff speak inappropriately to residents in care. It is alleged that staff (Administrator Michelle Goodney) speak inappropriately to residents in care. LPA interviewed twelve residents and eight of twelve residents could not collaborate the allegations. (Continued on (9099C) UnsubstantiatedRead the full finding— CDSS inspection report, July 6, 2023 · control 28-AS-20221104111642

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with Jason Perez (Assistant Administrator) and explained the purpose of the visit. During the initial visit on 11/10/21, LPA obtained a copy of the Staff schedule, Resident roster and food menu. LPA interviewed Staff #1 in the office at 10:14am, toured the kitchen with Staff #1 at 10:35am, interviewed Residents #2 to #9 in the office between 10:57am to 12:36pm and interviewed Resident #10 and #11 in their bedrooms between 12:45pm to 1:13pm. During today's visit, LPA obtained/reviewed a copy of the Staff Schedule/Resident Roster, Shower schedule and the food menu. LPA toured the kitchen with Staff #2 and interviewed Staff #2 to #10 in room 101. Continue to LIC9099C.... UnsubstantiatedRead the full finding— CDSS inspection report, June 29, 2023 · control 28-AS-20211105102142

***This investigation report LIC9099 supersedes report LIC9099 dated 04/25/23.*** Licensing Program Analyst (LPA) Kruz Long conducted a visit to supersede the report dated 04/25/23 for the allegation listed above. LPA met with Veronica De Hoyos (Activities Director) and explained the purpose of the visit. The investigation consisted of the following: During a visit conducted on 04/25/23, LPA obtained a copy of the Staff/Resident rosters, interviewed Staff #1 to Staff #5 in room #101 and interviewed Residents #1 to Residents #10 in room #101. In regards to the allegation: Staff handle resident in a rough manner. Interviews with 5 of 5 Staff denied handling a Resident in a rough manner and have never witnessed other Staff handle Residents in a rough manner. 2 out of 10 Residents interviewed indicate Staff has handled them in a rough manner. 8 of 10 Residents indicate they have never been handled in a rough manner by Staff nor have they seen Staff handle Residents in a rough manner. ContiRead the full finding— CDSS inspection report, May 30, 2023 · control 28-AS-20230417092501

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Brandie Mendibles (Administrator) and explained the purpose of the visit. During today's visit, LPA obtained a copy of the Staff/Resident rosters, interviewed Staff #1 to Staff #5 in room #101 and interviewed Residents #1 to Residents #10 in room #101. In regards to the allegation: Staff handle resident in a rough manner. Interviews with 5 of 5 Staff indicate they have never handled a Resident in a rough manner nor have they witnessed other Staff handle Residents in a rough manner but 2 out of 10 Residents interviewed indicate Staff has handled them in a rough manner. Continue to LIC9099C..... SubstantiatedRead the full finding— CDSS inspection report, April 25, 2023 · control 28-AS-20230417092501

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Jason Perez, Assistant Administrator and explained the reason for the visit. Administrator, Brandie Mendibles arrived at 11:15am and assisted with the investigation. The investigation consisted of the following: LPA toured the facility including Memory Care Unit and common areas, R1's room and obtained copies of Staff & Resident Rosters, Staff Daily Shift Reports and Notes (March 2023), Random Resident's Room Checks Reports (March 2023). LPA reviewed Resident #1 (R1) file and obtained copies of the following Face Sheet, Physician's Report, Admissions Agreement, Pre-placement Assessment, Transfer/Discharge Report, Incident Reports (3/22/23, 3/24/23, 3/25/23 and 3/26/23). LPA interviewed Resident #2 (R2) - Resident#10 (R10) and Staff #1 (S1)- Staff #7 (S7). R1 could not be interviewed as R1 is currently living with a family member outside the facilitRead the full finding— CDSS inspection report, March 30, 2023 · control 28-AS-20230328091709

On 2/7/2023 at 12:17 p.m., Licensing Program Analyst (LPA) Jewel Baptiste made an unannounced subsequent complaint visit to the facility regarding the above-mentioned allegations. LPA Baptiste met with Assistant Administrator Jason Perez and explained the purpose of the visit. Administrator Brandie Mendibles arrived at 1:16 p.m. and assisted with the rest of the visit. On 01/31/23, LPA Baptiste made an initial visit and completed the following: A physical plant tour and interviews with the Administrator, and residents (R2- R7). R1's file was reviewed. The following documents were obtained: Staff Roster, Resident roster, and Physician Report. On today’s visit LPA Baptiste interviewed Resident#1 (R1) and Resident#8 through Resident #11 (R8-R11). LPA also interviewed Staff#1 and Staff#2 (S1-S2). LPA also obtained a copy of Resident #1 shower schedule. Report continued on 9099c UnsubstantiatedRead the full finding— CDSS inspection report, February 7, 2023 · control 28-AS-20230125085536

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to facility for the purpose of investigating the allegation above. LPA met with Administrator Brandie Mendibles and explained the reason for the visit. The purpose of the visit is to investigate the above allegation. LPA conducted interview with Administrator at 1:45 P.M. LPA obtained and reviewed staff and resident rosters. Interview was conducted with Staff S 1 at 2:00 P.M. and Staff S 2 at 2:20 P.M. Interviews were conducted with Resident's R1 - R 7 from 2:25 P.M. to 3:10 P.M. R 1 and R 2 were limited in their response to questioning. LPA reviewed R 1's file and Physician's Report, Emergency ID page and Special Incident Report were submitted. In regards to the allegation Resident sustained unexplained injuries while in care, based on interviews conducted and information gathered staff stated that R1 had fallen and hit her eyebrow bone on another residents wheelchair in the dining room. Staff stated that first aiRead the full finding— CDSS inspection report, January 19, 2023 · control 28-AS-20230113163211

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to facility for the purpose of investigating the allegations above. LPA met with Administrator Michele R Goodney and explained the purpose of the visit. LPA conducted interviews from 10:00 AM to 11:15 AM with residents 1-8 (R1 -R8) Administrator and 1 facility staff S1. LPA obtained and reviewed staff and resident rosters. Documentation from PIH hospital for R1 was reviewed. LPA along with Assistant Administrator S2 toured the following Rooms at 11:15 AM: 102, 118,125, 201, 203 and 246. In regards to the allegation Facility staff are not addressing resident's medical condition, based on interviews conducted and information gathered it was revealed through discharge papers from PIH hospital that R1 on 11/20/2022 was observed by a medical doctor who prescribed Elmite topical cream 5% with a diagnosis of rash on body/itchy. Facility charting notes specify that R1 received Elimite Treatment for itchy skin and housekeepRead the full finding— CDSS inspection report, December 14, 2022 · control 28-AS-20221208153132

On 10/21/2022 at 8:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the allegations listed above. The initial complaint visit was conducted by LPA Baptiste on 08/22/2022. LPA met with Administrator Michele Goodney and explained the reason for the visit. During the initial visit LPA Baptiste toured the facility with administrator, obtained resident/ staff roster, and infection control plan. LPA Interviewed administrator, Staff S1, and S2. During today’s visit LPA obtained staff and resident roster and tested the phone system in rooms 104,107,206,209 and 233. LPA interviewed Residents R1 through R12. Report continued on 9099c UnsubstantiatedRead the full finding— CDSS inspection report, October 21, 2022 · control 28-AS-20220818134917

Licensing Program Analyst (LPA) V. Maldonado made an unnanounced subsequent complaint visit to the facility regarding the above mentioned allegations. LPA Maldonado met with adminstrator Michele Goodney and explained the purpose of the visit. On 08/16/22, LPA Maldonado made an initial visit and interviewed the Administrator and Staff# 2-#4, (S2-S4). No resident interviews were conducted due to a COVID outbreak in the facility. LPA also requested staff and resident rosters, as well as the following documents from Resident #1's (R1) file: Physicians report, Needs and Services Plan, Resident Appraisal, Identification and Emergency Information, and incident reports for November 2020, and any police reports available. During today's visit, LPA Maldonado requested a copy of the staff and resident rosters, and interviewed Residents #2- #10 (R2-R10). A telephone interview was conducted with R1 due to resident no longer residing at the facility. (Report Continued on LIC9099-C...) UnsubstantiateRead the full finding— CDSS inspection report, September 8, 2022 · control 28-AS-20201116165416

***This LIC9099 report supersedes LIC9099A report dated 12/13/21.*** Licensing Program Analyst (LPA) Kruz Long re-delivered complaint findings for the above allegations. LPA met with Michele Goodney (Administrator) and explained the purpose of the visit. During a site visit conducted on 12/13/21, LPA obtained a copy of the Staff Schedule/Resident Roster, Medication Plan of Operation, Resident #1's medication administration record (Nov/Dec 2021), Face sheet and Charting notes. LPA also interviewed Staff #1 in the office at 10:44 am and Resident #1 in the office at 11:19 am. In regards to the allegation: Resident did not receive their prescribed medications for an extended period of time. Based on record review and interviews, Resident #1 did not receive their medication from Dec. 01, 2021 to Dec. 06, 2021 because facility was not able to obtain refill authorization from doctor. Continue to LIC9099C.. UnsubstantiatedRead the full finding— CDSS inspection report, August 31, 2022 · control 28-AS-20211207131830

On 5/17/22 at 9:05 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint to the facility. Upon arrival LPA met with Michele Goodney (Administrator) and explained the purpose of the visit. During today’s visit, LPA toured the facility with administrator, maintenance director and housekeeping supervisor. LPA obtained resident/ staff roster, Kitchen cleaning schedule, weekly deep cleaning schedule, Janitors duties, housekeeping duties, Oasis (memory care unit) deep cleaning schedule, Restroom daily cleaning log, breakroom cleaning log, Elevator cleaning log. LPA interviewed residents R1 - R8. LPA Interviewed administrator and Staff S1- S9. Report continued on 9099c UnsubstantiatedRead the full finding— CDSS inspection report, May 17, 2022 · control 28-AS-20220511165338

Licensing Program Analyst (LPA) Vasallo conducted a subsequent complaint visit to investigate the allegation listed above. LPA met with Administrator, Michele Goodney and explained the reason for the visit. The initial complaint visit was conducted by LPA Rivas on 6/18/20. LPA Rivas conducted a subsequent visit on 6/23/20. The investigation consisted of the following: LPA Rivas conducted interviews with 10 residents and 2 staff. LPA Vasallo conducted interviews with 10 residents and 5 staff including Med Techs and Administrator. LPA reviewed 7 residents medications and medication records. The investigation revealed the following: It's alleged staff do not have their fingerprints associated to the facility. LPA obtained a staff roster from June 2020. LPA observed Staff #1's (S1) name on the roster. LPA researched S1's fingerprints and it revealed that S1's fingerprints were never associated to the facility. S1 was hired on 10/4/19. S1's file has a fingerprint transfer request on file daRead the full finding— CDSS inspection report, April 5, 2022 · control 28-AS-20200612152308