Savant Of Norwalk

Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Elizabeth Martinez Assistant Administrator of the facility and explained the reason for the visit. Administrator Chanel Sanchez arrived shortly thereafter. The investigation revealed the following: during the initial visit conducted on 04/27/2023, LPA Kruz Long conducted a tour of the facility, obtained staff and client files, obtained Resident #1's (R1) Records (Physician Report, FACE Sheet, Admission Record, Resident Assessment Form, Shower Log), and also interviewed R1 and the Administrator. During today's visit, LPA Zaragoza interviewed Residents #2 - 9 (R2, R3, R4, R5, R6, R7, R8, R9) and Staff #1 - 6 (S1, S2, S3, S4, S5, S6) . LPA attempted to interview Resident R1, however R1 moved out of the facility and into a Skilled Nursing Facility on 6/9/2023. LPA also obtained copies of the following documentation for C#1: Most Recent Shower LogsRead the full finding— CDSS inspection report, August 18, 2023 · control 28-AS-20230421144604

Licensing Program Analyst (LPA) Angelica Rea conducted an initial complaint visit in response to the allegation listed above. LPA met with Administrator, Chanel Sanchez, and Elizabeth Martinez, Business Office Manager. Regarding the allegation that: Staff did not report unusual incidents as required. The investigation consisted of interviews with Reporting Party, Administrator, and Staff #1 and review of staff roster, and resident roster. Reporting Party (RP) stated that there was an altercation in October 2022, involving resident #1 and resident #2.The RP also stated that the incident was observed by Staff #2 and Staff #3, and was not reported as required. Resident #1 and Resident #2 are no longer residents of the facility, and were not interviewed. Staff #2 is no longer working at the facility and was not interviewed. Staff #3 was not working at the facility when the alleged incident occured. Staff #3 began working at the facility in February 2023, and therefore was not at the faciliRead the full finding— CDSS inspection report, July 31, 2023 · control 28-AS-20230727155003

**** This amended report supersedes report dated 06/12/2023. It was created to remove identifing information. The additional revision did not change any other aspects of the report and all aspects including the findings remain the same. *** Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Chanel Sanchez and explained the reason for the visit. The investigation consisted of: LPA conducted interviews with Administrator Chanel Sanchez, Staff 1-6 (S1-6) and Resident 1-7 (R1-7). LPA collected copies of Staff and Resident Rosters. LPA also reviewed R1 admission agreement, physicians report, other pertinent medical records for R1, and sign in/sign out sheets. LPA also conducted a tour of facility which included lobby, random rooms, outside patio area, and common areas. (Continued on 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, June 12, 2023 · control 28-AS-20230608093038

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Chanel Sanchez and explained the reason for the visit. The investigation consisted of: LPA conducted interviews with Administrator Chanel Sanchez, Staff 1-6 (S1-6) and Resident 1-7 (R1-7). LPA collected copies of Staff and Resident Rosters. LPA also conducted a tour of facility which included lobby, dining room, medication room, outside patio area, fitness room (located on the 2nd floor), common areas on both 1st and 2nd floors, and two designated smoking areas. LPA additionally toured a random selection of resident rooms. (See LIC9099C for continuation) UnsubstantiatedRead the full finding— CDSS inspection report, May 23, 2023 · control 28-AS-20230517140233

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint visit on 04/24/23 stemming from initial complaint visit conducted by LPA Wesley on 01/13/2022. LPA was met by Staff(S1) and explained the purpose of the visit. LPA and S1 were later met by Administrator Chanel Sanchez. LPA conducted a physical tour of facility, requested, and obtained Personnel Report (LIC 500), Resident Roster, copy of Resident 1(R1) Face sheet and other pertinent documents regarding this investigation. See LIC 9099-C for continuation Unsubstantiated— CDSS inspection report, April 24, 2023 · control 28-AS-20220104123415

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint visit on 04/24/23 stemming from initial complaint visit conducted by LPA Wesley on 03/22/2022. LPA was met by Staff(S1) and explained the purpose of the visit. LPA and S1 were later met by Administrator Chanel Sanchez. LPA conducted a physical tour of facility, requested, and obtained Personnel Report (LIC 500), Resident Roster, copy of Resident 1(R1) Face sheet and other pertinent documents regarding this investigation. See LIC 9099-C for continuation Unsubstantiated— CDSS inspection report, April 24, 2023 · control 28-AS-20220318145550

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA Flores met with Elizabeth Martinez - Assistant Executive Director and explained the reason for the visit. The investigation consisted of the following: LPA Flores requested copies of staff and resident roster. LPA conducted interviews with resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6) and staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5), reviewed file for resident #7(R7) and requested copies of admission agreement, physician's report, face sheet, authorization agreement for payment, preplacement appraisal information, assisted living waiver form, identification and emergency information, letter of notification of increase, acknowledgement of discharge and payment plan. LPA requested a copy of in-service training on resident rights. (CONTINUED ON LIC 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, April 7, 2023 · control 28-AS-20230330100849

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint visit to deliver findings from previous subsequent complaint visit on 03/02/23, stemming from initial 10-day complaint visit conducted on 06/08/2021, by LPA Wesley and LPA Mora. LPA Ramirez was met by Administrator Chanel Sanchez and explained the purpose of the visit. The investigation consisted of: An inspection of the interior and exterior physical plant was conducted. Staff (S1-S5) and residents (R1- R4) were interviewed. Resident (R1) was not present and was interviewed telephonically. Resident file documents: [Identification and Emergency Information, Preplacement Appraisal, and Physician's Reports, medication orders, any other pertinent documents that may assist in this investigation were reviewed and obtained. LPA requested and obtained: LIC 500 Personnel Report, and Resident roster. See LIC 9099-C for continuation. UnsubstantiatedRead the full finding— CDSS inspection report, March 3, 2023 · control 28-AS-20210611101304

Licensing Program Analyst (LPA) Ashley Calderon conducted subsequent complaint investigation for the allegation listed above. LPA met with Assistant Administrator Elizabeth Martinez and explained the purpose for todays visit. On 2/17/22, LPA Nicol Wesley conducted the initial investigation. LPA Wesley requested copy of the: staff roster, resident roster, copy of admission agreement, Unusual Incident Report(SIR) for month a January. LPA Wesley interviewed staff and attempted to interview resident #1. On 2/27/23, the subsequent visit by LPA Calderon consisted the following: LPA Calderon requested copy of the: staff roster, resident roster, Resident #1 (R1) Facesheet, Admission Agreement, Physician Report, Acknowledgement of Discharge Form, Supporting Email Documentation, and check stub issued to R1. LPA Calderon interviewed Assistant Administrator Elizabeth Martiniez, and telephonically interviewed R1 and Financial Representative of R1. (Continuation on 9099-C) UnsubstantiatedRead the full finding— CDSS inspection report, February 27, 2023 · control 28-AS-20220211124405

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Chanel Sanchez (Executive Director) and explained the purpose of the visit. During today's visit, LPA obtained a copy of the Staff/Resident rosters, hospital records, shift records and physician's order report. LPA interviewed Staff #1, #2 in the conference room, interviewed Staff #3 in the medication room and interviewed Residents #1 to #7 in various locations of the facility. In regards to the allegation: Facility staff did not ensure that resident received their dialysis treatment while in care. Interviews with Staff and Resident indicate Resident #1 refused to attend dialysis treatments on numerous occasions. Transportation service is automatically scheduled by the dialysis center. Record review indicate refusals are documented. Facility Staff notified the dialysis center and Resident #1's doctor after each refusal. Interviews with 6 of 7 ResidentsRead the full finding— CDSS inspection report, January 31, 2023 · control 28-AS-20230126120043

Licensing Program Analyst (LPA) Tao conducted unannounced 10-day complaint investigation for the allegations listed above. During today’s visit, LPA met with and explained the purpose of today's visit to Administrator assistant, Elizabeth Martinez. At the end of the visit, LPA met with Administrator, Lisa Pham. Investigation consisted of the following: interviews of Staff from Staff #1 through Staff #5; interviews of residents from resident #1 through resident #7; facility record reviews, and a facility tour. LPA obtained copies of staff and resident rosters; and resident files for resident #1 (R1) with relevant information. The investigation revealed the following: In regard to allegation "staff are not providing residents with adequate food service", it was alleged that facility was not providing the 2nd round of food to resident#1 when resident requested more food. (-continued in LIC 9099 C-) UnsubstantiatedRead the full finding— CDSS inspection report, November 29, 2022 · control 28-AS-20221121101152

Licensing Program Analyst(s) (LPA) Mary Flores and Kimberly Ramirez conducted an unannounced complaint investigation visit at the facility regarding the above allegation(s). LPA Flores met with Alize Solar Med Tech and explained the reason for the visit. Corporate Board Member Cynthia Flores arrived 15 minutes after. The investigation consisted of the following: On 5/10/22 LPA Flores conducted a complaint investigation visit and requested a resident/staff roster. LPA conducted interviews with resident #1(R1), #2(R2), #3(R3), #4(R4), staff #1(S1), #2(S2),#3(S3)#4(S4). LPA requested copies of admission's agreement, face sheets, physician's reports, and notices provided to residents for R1,R2,R3,R4. LPA conducted a tour of supplies storages in first and second floor and medication room. On 11/1/22 LPAs conducted a subsequent visit to deliver findings. (CONTINUED ON LIC 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, November 1, 2022 · control 28-AS-20220503160955

Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint visit regarding the allegations above. LPA met with Assistant Administrator Elizabeth Martinez and the purpose of the visit was discussed. On todays visit LPA toured the physical plant. LPA reviewed and collected copies of files from resident #1's (R1) file. LPA interviewed residents #1-#5 (R1-R5) and staff #1-#4 (S1-S4) during todays visit. The investigation revealed the following: In regards to the allegation "Staff did not provide resident with admissions agreement when requested." it was alleged that R1 requested a copy of their admissions agreement and explanation for how monthly rent is calculated but did not receive it. (4) of (4) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation. Continued on LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, October 31, 2022 · control 28-AS-20221025093815

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Asst. Administrator (A2: Elizabeth Martinez). LPA/RA spoke to A2 prior to entering the facility to conduct a risk assessment. A2 informed LPA/RA that the facility has no COVID cases nor do any of the residents or staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegation(s). An initial 10-Day visit was conducted by LPA Nicol Wesley on 01/13/22 who interviewed staff and resident #1. LPA/RA Ceniceros interviewed (between 1:00 p.m - 1:45 p.m.) three (3) staff members and three (3) residents in care. LPA/RA reviewed (between 1:45 p.m. – 2:00 p.m.) the requested documents: Face Sheet (dated 12/31/21), Emergency I.D. & Information (dated 01/13/22), Physician’s Report (12/21/21), Medication Administrator Record (January 2022), Acknowledgement of Discharge (dated 01/Read the full finding— CDSS inspection report, October 27, 2022 · control 28-AS-20220112084432

On 7/25/22 at 9:00 A.M., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with Lisa Pham (Administrator) and Elizabeth Martinez (Assistant Administrator). LPA explained the purpose of the visit and toured the facility with Assistant Administrator. During today’s visit LPA toured the facility, reviewed files of four residents (R1- R4) and obtained resident/ staff roster, R1 face sheet, physician report and admission agreement. LPA interviewed four residents (R1- R5), Administrator and three staff (S1- S3). The investigation reveals the following: Regarding "Facility staff did not ensure that resident was properly dressed at night" it was alleged that staff did not dress S1 for the night. Report conintued on 9099c UnsubstantiatedRead the full finding— CDSS inspection report, July 25, 2022 · control 28-AS-20220719124719

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit at the facility regarding the above allegation(s). LPA Flores met with Angelica Amador Activity Director and explained the reason for the visit. Assistant administrator Elizabeth Martinez arrived 15 minutes later. The investigation consisted of the following: LPA Flores requested a resident/staff roster. LPA conducted interviews with resident #1(R1), #2(R2), #3(R3), #4(R4), staff #1(S1), #2(S2),#3(S3)#4(S4). LPA requested copies of admission's agreement, face sheets, physician's reports, and notices provided to residents for R1,R2,R3,R4. LPA conducted a tour of supplies storages in first and second floor and medication room. The investigation revealed the following: Regarding allegation: Facility does not provide hygiene items for residents. It is alleged the facility does not provide residents with razors. 4 out of 4 residents stated to receive basic hygiene supplies such as shampoo,Read the full finding— CDSS inspection report, May 10, 2022 · control 28-AS-20220503160955

Licensing Program Analyst (LPA) Alberto Lopez conducted a subsequent 10 day complaint investigation for the allegations listed above. LPA met with Assistant Administrator Elizabeth Martinez and Administrator Lisa Pham and discussed the purpose for today’s visit. The investigation consisted of the following: LPA interviewed residents #1-#4 (S1-S4) between 10:39 am-12:14pm, LPA Toured the physical plant with Assistant Administrator and found no health or safety concerns. LPA Interviewed Administrator and Assistant Administrator from 12:14-12:48pm. LPA also reviewed the following documents: staff roster, resident roster, LPA interviewed Staff #1 -Staff #4 (SI-S4) from 1:37 - 2:58pm The Investigation revealed the following: In regard to the allegation, "Facility has insufficient staffing to meet the residents' need" Administrator and Assistant Administrator denied the allegations and (4) of (4) staff interviewed denied the allegations. The staff interview stated that all residents’ needs aRead the full finding— CDSS inspection report, March 2, 2022 · control 28-AS-20211229160311

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint viist to investigate the above allegations. Upon arrival, LPA met with Assistant Administrator Elizabeth Martinez and discused the purpose of the visit. Shortly after, the administrator Lisa Pham arrived. The investigation consisted of the following: On today's visit, LPA interviewed four residents (R2-R5) , assistant adminstrator, administrator and three staff (S1-S3). The following documents were collected which included: staff and resident roster and documents for Resident#1 (R1) - face sheet, physicaian report, Medication Adminsitration Record (MARs), Admission agreement and Pre-Placmenet. LPA also toured R1's room. The investigation revealed of the following: Allegation#1 "Faciltiy staff did not provide a safe environment." LPA interviewed four residents and all reported they feel safe living in the facility. (See LIC 9099C for continuation) UnsubstantiatedRead the full finding— CDSS inspection report, March 2, 2022 · control 28-AS-20220224103531

Licensing Program Analyst (LPA) Christine Wong conducted an unanncounced complaint visit to address the above allegations. LPA met with Corporate Assitant Cynthia Flores and explained the purpose of the visit and she also assisted LPA with the visit. The investigation consisted of the following: LPA interviewed assistant administrator and four staff (S1-S4), four residents (R2-R5) and obtained documents included resdient rosters, staff rosters and copy of Resident#1 (R1) face sheet, preplacement appraisal information and physician report. The investigation revealed of the following: Allegation#1 "Staff prevents resident from having access to wheelchair while in care." LPA interviewed four residents and all reported that they can move their wheelchair all around the facility. They do have any restrictions on that. LPA interviewed staff and all denied the allegation and reported the residents can even bring the wheelchair back to their room and bedside. (See LIC9099C for continuation) UnRead the full finding— CDSS inspection report, January 5, 2022 · control 28-AS-20211229154455