Savant of Norwalk

Allegation investigated: Staff did not provide resident with meals. Staff stole money from a resident.

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint visit to investigate the above allegations. LPA met with Elizabeth Martinez (Business Office Manager/Assistant Administrator) and discussed the purpose of today’s visit. During this visit, LPA obtained a copy of the resident and staff rosters and reviewed Resident #7’s (R-7) file and obtain relevant documentation. LPA also interviewed Staff #1 (S-1) through Staff #5 (S-5) and Resident #1 (R-1) through Resident #7 (R-7). Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Staff did not provide resident with meals. It has been alleged that when a resident misses a meal, the facility will not feed the resident. Staff interviews revealed that the facility provides (3) meals and (2) snacks per day. Staff interviews revealed that meal times are as follows: breakfast is from 7:45 A.M. to 9:30 A.M.,lunch is from 11:30 A.M. to 1:30 P.M. and dinner is from 4:30 P.M. to 5:45 P.M. Per staff interviews, when a resident shows up after the meal times, staff still provide a meal for them. Interviewed staff indicated they have not received any complaints/concerns in regards to residents not receiving their meals. Interviewed residents indicated meals are available (after the meal times) as well. Interviewed residents indicated they have not heard anyone complaining about staff not providing residents with meals. Staff and resident interviews do not corroborate this allegation. Allegation: Staff stole money from a resident. It has been alleged that a staff member stole money from a resident. Staff interviews revealed that staff do not steal money from residents. Interviewed staff indicated they have not received any complaints/concerns in regards to this matter. Interviewed staff indicated they are trained in resident rights and mandated reporting. Interviewed residents indicated staff do not steal their money. Interviewed residents indicated they have not heard other residents complaining about staff stealing their money. Interviewed residents indicated they do not any concerns in regards to this matter. Staff and resident interviews do not corroborate this allegation. Based on record review and interviews conducted the findings indicate, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview conducted, appeal rights and a copy of this report was provided to Elizabeth Martinez.the state’s words, verbatim · CDSS document, Nov 6, 2023 · control 28-AS-20231101121819

Allegation investigated: Resident sustained an unexplained fracture while in care of staff Staff did not transfer resident properly resulting in dropping the resident

Licensing Program Analyst (LPA) Angelica Rea conducted another visit to issue the final results of the investigation. LPA met with Administrator Chanel Sanchez who assisted with today's visit. Regarding the allegation that : Resident #1 sustained an unexplained fracture while in care of staff. The investigation was conducted by the department, and consisted of interviews with staff, residents, review of resident #1's file and review of medical records. The investigation revealed that resident #1 resided at the facility from 1/30/23 - 3/20/23. On 3/5/23, facility sent resident #1 to emergency room due to complaint of right knee pain. A CT scan was done, and was negative for any acute fracture. Resident #1 also mentioned shoulder pain, and medical records indicate that resident #1 did not have a fractured shoulder. Regarding the allegation that : Staff did not transfer resident properly resulting in dropping the resident. The investigation was conducted by the department, and consisted of interviews with staff, residents, review of resident #1's file and review of medical records. Unsubstantiated Staff interviewed denied that resident #1 was dropped. Staff stated that while transferring resident into wheelchair, resident #1 became still and was lowered onto the floor. Resident #1 was not consistent in statements made regarding being dropped. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 2, 2023 · control 28-AS-20230407114427

Allegation investigated: Staff left resident in soiled incontinence briefs. Unlawful eviction. Staff did not update SSI on residents living situation for payment(s). Facility providing confidential information to unauthorized party. Facility not assisting resident with medication orders. Facility not assisting resident with wound care orders.

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint visit to investigate the above allegations. LPA met with Elizabeth Martinez (Business Office Manager/Assistant Administrator) and Chanel Sanchez (Executive Director/Administrator) and discussed the purpose of today’s visit. During this visit, LPA obtained a copy of the resident and staff rosters and reviewed Resident #1’s (R-1) file and obtain relevant documentation. LPA also interviewed Staff #1 (S-1) through Staff #5 (S-5) and Resident #2 (R-2) through Resident #4 (R-4). Resident #1 (R-1) refused to be interviewed. Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Staff left resident in soiled incontinence briefs. Staff interviews and documentation reviewed revealed that R-1 refuses to allow staff to change R-1’s soiled incontinence briefs. Per staff interviews, R-1 also refuses to allow staff to clean R-1’s room (in general and anything involving incontinence). Per staff interviews, staff ensure that R-1 has plenty of incontinence supplies such as adult incontinence briefs, wipes, ect. (beside R-1’s bed) as R-1 is independent in incontinence care. Resident interviews revealed that R-1 refuses to allow staff to clean R-1’s room and is often yelling and/or cursing at staff and hitting the walls. Per resident interviews, staff clean resident rooms daily. Interviews and documentation review does not corroborate this allegation. Allegation: Unlawful eviction. Staff interviews and file review for R-1 revealed that an eviction notice was issued to R-1 on 08/31/23 due to repeatedly violating house rules. Staff interviews and documentation review does not corroborate this allegation. Allegation: Staff did not update SSI on residents living situation for payment(s). Staff interviews and file review for R-1 revealed that on 02/08/23 this facility notified the Social Security Administration office of R-1’s admission to this facility and requested the board and care rate to be implemented. Per staff interviews, the board and care rate was implemented effective 06/01/23 (as R-1 had an overpayment from the previous placement/facility). Staff interviews and documentation review does not corroborate this allegation. Allegation: Facility providing confidential information to unauthorized party. Staff interviews and file review for R-1 revealed that R-1’s family member is noted as R-1’s “primary” contact. Per staff interviews, the listed family member for R-1 (noted on R-1’s face sheet) is the only person that is contacted. Staff interviews and documentation review does not corroborate this allegation. Allegation: Facility not assisting resident with medication orders. Staff interview revealed that R-1 went to a medical appointment with R-1’s primary physician on 09/05/23 (on R-1’s own) and allegedly received orders for new medication. Per staff interview, this was discovered during a meeting that was held with R-1 on 09/15/23. Per staff interview, R-1 did not provide staff with any new medication orders. Staff have reached out to R-1’s primary physician to obtain clarification and have been unsuccessful in reaching R-1’s primary physician. Staff interview and documentation review does not corroborate this allegation. Refer to LIC 9099C for the continuation of this report. Allegation: Facility not assisting resident with wound care orders. Staff interview revealed that R-1 went to a medical appointment with R-1’s primary physician on 09/05/23 (on R-1’s own). Per staff interview, this was discovered during a meeting that was held with R-1 on 09/15/23. Per staff interview, R-1 did not inform staff of any orders for wound care. Staff interview and documentation review does not corroborate this allegation. Based on record review and interviews conducted the findings indicate, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview conducted, appeal rights and a copy of this report was provided to Chanel Sanchezthe state’s words, verbatim · CDSS document, Sep 21, 2023 · control 28-AS-20230913084158

Allegation investigated: Staff does not ensure food is of good quality. Facility does not have a posted legible emergency evacuation plan. Facility does not ensure monthly fire drills are conducted. Facility does not ensure residents have planned activities.

Licensing Program Analyst (LPA) Kruz Long made an unannounced complaint visit at the facility. Upon arrival, LPA met with Administrator Chanel Sanchez and explained the purpose of the visit. During the initial visit conducted on 04/19/23, LPA Villalobos toured the physical plant with the administrator including, but not limited to the following: the interior and exterior of the facility. LPA did not observe any path obstructions or health and safety hazards. Sufficient food supply was observed and all toxins and sharps were observed to be stored and locked away properly, inaccessible to residents in care. LPA requested and obtained a copy of the staff and resident roster as well as copies of documents from residents #1-#4 (R1-R4) file. No immediate health and/or safety concerns were noted during the visit. During today's visit, LPA obtained/reviewed a copy of the Staff/Resident rosters, food menu, emergency evacuation plan, fire drill log, and activity calendar. LPA also toured the facility with Staff #1, interview Staff #1 in the conference room and interviewed Residents #3 to #9 (R3-R9) in the conference room. Continue to LIC9099C... Unsubstantiated Regarding allegation: Staff does not ensure food is of good quality. LPA toured the kitchen and reviewed the food menu and observed foods to be of good quality. Interview with Staff #1 indicate food is of good quality. Interviews with 7 of 7 Residents also indicate food is of good quality. Regarding allegation: Facility does not have a posted legible emergency evacuation plan. LPA reviewed a legible copy of the emergency evacuation plan posted on the lobby wall. Interview with Staff #1 indicate the emergency evacuation plan has been posted since the facility began operations. Interviews with 7 of 7 Resident indicate they are aware of an emergency evacuation plan which is legible and where it is posted. Regarding allegation: Facility does not ensure monthly fire drills are conducted. LPA reviewed copies of scheduled fire drills dated 04/20/23 and 01/19/23 and observed fire drills are conducted every 3 months which is required by department regulations. Interview with Staff #1 indicate fire drills are conducted every 3 months. Interviews with 7 of 7 Residents also indicate fire drills are conducted. Regarding allegation: Facility does not ensure residents have planned activities. LPA toured the facility and observed the activities calendar posted on the second floor. Interview with Staff #1 indicate Residents have planned activities. Interviews with 7 of 7 Resident also indicate planned activities are provided. Based on LPA's record review, observations and interviews, the investigation revealed: Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted with Chanel Sanchez (Administrator) and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 25, 2023 · control 28-AS-20230418144527

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 are not showering resident timely Staff are not getting resident out of bed Staff are not providing resident with special diet Staff are not offering food if resident misses meals due to dialysis

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 Logs, Shower Schedule, and Admission Agreement along with the current staff and resident rosters. Unsubstantiated The investigation revealed the following: in regards to the allegation "Staff are not showering residents timely", it is alleged by R1 that staff was providing R1 a bath once every 2 weeks at most, and that they were not keeping R1 clean. During interviews with the residents, seven (7) out of eight (8) could not corroborate the allegation that staff do not help residents with showering needs in a timely manner. The residents who require assistance with bathing state that there is a schedule to keep track of when their shower days are, and that staff always make sure to offer them assistance with showering on their designated days. Interviews with the Staff along with Review of R1's admission agreement revealed that residents are scheduled to be showered at least two times per week at a minimum, and that residents can always request another an additional shower if they want by calling the front desk. Staff state however that they do not force residents to shower, and offer them assistance with showering three (3) times before they document in the resident's shower log that they refused to take a shower on their designated shower day. In regards to the allegation "Staff are not getting resident out of bed ", R1 alleged that staff were not repositioning or offering to take R1 out of bed often, and that when using the Call Light to notify staff that R1 wanted to get out of bed, R1's calls went willingly ignored. During interviews with the residents, none of them could corroborate the allegation that staff were not getting residents out of bed often or ignoring their needs to get out of bed. R2 explained that staff are very responsive to any request that residents make for assistance and that they are always very helpful, and R6, R7, R8, and R9 explained that while they do not require assistance getting out of bed themselves, they often see staff offering assistance in getting out of bed to their roommates and other residents. Interviews with staff revealed that for bedridden residents they make sure to reposition them once every two (2) hours in order to prevent bed sores from developing. Additionally Staff explained that they always offer assist bedridden residents out of bed for all meal times and for planned activities as well, but will not remove them from bed forcibly if they do not wish to get out of bed. In regards to the allegation "Staff are not providing resident with special diet", it was alleged by R1 that staff were not meeting R1's specialized renal diet, and continued to feed R1 bacon and hash browns for breakfast even though they were not supposed to be eating it according to their physician. In interviews with the residents, none of them could corroborate the allegation that staff do not met the dietary needs of residents who have specialized diets. According to R4 who is also on a Renal Diet and also goes to dialysis, the facility staff are made aware of their dietary requirements and that they do not eat meat, and the kitchen staff always make sure to provide alternatives for R4. All other residents similarly expressed that residents who have specialized diets are accommodated when they inform the kitchen staff of their needs. In an interview with S6 the Dietary Cook for the facility, S6 explained either staff or the resident themselves inform him of their specialized diets if they have any and he makes sure to provide them food alternatives if necessary. Other staff members explained that they are informed of specialized diet through the resident's physician's report, which they then provide the kitchen staff so they are aware of any foods the residents of the facility need to avoid. In regards to the allegation "Staff are not offering food if resident misses meals due to dialysis", it was alleged by R1 that staff were not offering R1 breakfast before they went to dialysis at 9 AM nor lunch after they returned around 3 PM because the kitchen was closed. R1 explained that they only had one meal per day while staying at the facility and that was dinner. During interviews with the residents, none of them could corroborate the allegation that staff do not provide breakfast or lunch to residents who go to dialysis in the morning. In an interview with R4 who was the only resident available who currently goes to dialysis, R4 explained that the staff do offer R4 breakfast before they go to dialysis, and that the staff always make sure to provide R4 food to take with them to the dialysis center. In interviews with the facility staff, they explained that they always offer breakfast to residents before they go to dialysis, and residents have the option to take something with them to-go from the kitchen before they leave for dialysis. Additionally S3 and S6 stated that there is always plenty of food leftover from lunch so residents can also get lunch when they return as well. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 18, 2023 · control 28-AS-20230421144604

Allegation investigated: Staff did not report unusual incidents as required Staff did not adhere to resident's admission agreement regarding payments Resident has an exposed pipe in his bedroom

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 facility on the date of the alleged incident. Administrator and Staff #1 stated that they were not aware of the incident. Unsubstantiated Regarding the allegation that: Staff did not adhere to resident #3's admission agreement regarding payments. The investigation consisted of interviews with Administrator, Staff #1, resident #3, and review of resident #3's admission agreement and Payment Plan. Administrator and Staff #1 stated that the facility has developed a payment plan for resident #3, due to the fact that resident #3 has an outstanding balance, and is not current on their rent. Resident #3 did not dispute the admission agreement or payment plan that is in place at the facility. Regarding the allegation that: Resident #3 has an exposed pipe in their bedroom. The investigation consisted of interviews with Administrator, Staff #1, resident #3, and tour of resident #3's room. Administrator and Staff #1 stated that they were unaware of an exposed pipe in resident #3's room. LPA toured room and did not observe an exposed pipe. LPA asked Resident #3 where the exposed pipe was, and resident #3 went to the room, and lifted a trash can on the floor, to show LPA the pipe. LPA observed on the right hand side of the room, a small area on the floor, next to the wall that has a partially exposed pipe. LPA did not observe that this is a health and safety hazard to resident(s). Administrator and Staff #1 stated that this had not been brought to their attention. They stated that they will move resident #3 to another room, if resident #3 would like to be moved. When asked if resident #3 would like to be moved to another room, he stated "I don't care". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted with Ms. Sanchez, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 31, 2023 · control 28-AS-20230727155003

Allegation investigated: Wrongful Eviction. Staff did not safeguard resident's belongings. Staff do not ensure that resident is accorded privacy Staff do not ensure that resident is receiving medical attention as needed. Staff do not ensure that resident's room is maintained at a comfortable temperature. Staff do not respond to requests for communication about resident in a timely manner.

**** 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) Unsubstantiated Investigation revealed the following: Regarding allegation, Wrongful Eviction. It is alleged that R1 is being evicted due to being behind on rent. LPA interviewed Administrator and five staff (S1-S6) and all 6 staff denied that R1 has being given eviction notice. Administrator explained that RI owes back rent and has been asked how R1 would like to get current, and that eviction is a possibility if R1 does not work with facility to catch up but that no eviction notice has been given to R1. R1 collaborated what Administrator stated and confirmed that R1 has not being given an eviction notice. Based on interviews conducted with facility staff, facility residents, and record review there was not enough supportive evidence to concur with the reported allegation. Regarding allegation, Staff did not safeguard resident's belongings. It is alleged that facility lost R1 dentures, a shirt and pair of pants. LPA interviewed six staff and all six staff denied the allegations. Administrator stated that R1 did not have any dentures when R1 arrived at facility. Administrator stated that R1 refused to inventory R1 belongings. R1 stated that R1 believes that facility R1 was at prior to this forgot to send dentures with R1. R1 stated R1 not sure regarding any clothing is lost. Six of seven residents stated they have never lost any personal items. Based on interviews conducted with facility staff, facility residents, and record review there was not enough supportive evidence to concur with the reported allegation. Regarding Allegation: Staff do not ensure that residents is provided privacy. It is alleged that other residents are using R1 room as a passageway to get outside. Six of six staff denied the allegation and stated they have never heard of this. R1 could not collaborate the allegation and six of six residents stated they have never had anyone use their room as a passageway or heard of any resident complain of this. Based on interviews conducted with facility staff, facility residents, and record review there was not enough supportive evidence to concur with the reported allegation. Regarding Allegation, Staff do not ensure that resident is receiving medical attention as needed. It is alleged that R1 is not receiving the medical attention R1 requires. Six of six staff denied the allegations. Administrator stated that resident does see his doctor regularly. Documentation shows that R1 was seen by MD on 02/23/23, 03/08/23, 04/15/23 and 5/13/23. R1 stated that R1 asked Administrator for podiatrist the day R1 arrived and has not yet seen a podiatrist. S3 (nurse) stated that podiatrist comes every two months or on an emergency basis. According to S3, R1 never required emergency podiatrist service and will be seen on June 20th. Administrator stated that podiatrist is scheduled to make visit on June 20th, 2023, and R1 is on the list to be seen. Six of seven residents stated they get all the medical attention they need and have not heard of any resident being denied medical attention. Based on interviews conducted with facility staff, facility residents, and record review there was not enough supportive evidence to concur with the reported allegation. (continued on 9099C) Regarding Allegation: Staff do not ensure that resident's room is maintained at a comfortable temperature. It is alleged that room is to cold due to door left open by roommate of R1. R1 stated the R1 is comfortable in R1 room and has no complaints about the temperature. Six of six staff denied the allegation. Maintenance man S6 stated that AC units at facility are for 3 rooms and that sometimes the residents of the three rooms cannot agree on a temperature but S6 stated he has not heard of any complaints about being uncomfortable in their rooms. Seven of seven residents could not collaborate the allegations. Based on interviews conducted with facility staff, facility residents, and record review there was not enough supportive evidence to concur with the reported allegation. Regarding Allegation, Staff do not respond to requests for communication about resident in a timely manner. It is alleged that facility does not return calls when inquiring about a resident. Six of Six staff denied the allegation and stated they return all calls even if they are unable to provide information due to HIPPA laws and that is explained to callers. R1 could not collaborate this allegation. Six of six residents could not collaborate the allegation and have never heard of any issue with callers getting a returned call from the facility. Based on interviews conducted with facility staff, facility residents, and record review there was not enough supportive evidence to concur with the reported allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held. A copy of the report was provided to Administrator Chanel Sanchez.the state’s words, verbatim · CDSS document, Jun 12, 2023 · control 28-AS-20230608093038

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 12, 2023

87303) a Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Room 19A sliding door was in disrepair and did not close properly until today 6/12/2023 and screen door in room 19A does not close properly and requires repair and replacement as it posed/poses a health and safety issue to persons in care.the state’s words, verbatim · CDSS document, Jun 12, 2023

Plan of correction: Administrator will have screen door rails repaired or replaced by POC date and send proof to LPA by POC date.

Allegation investigated: Staff do not prevent residents from smoking in undesignated smoking areas Staff do not maintain facility in good repair Staff do not maintain passageway free from obstruction

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) Unsubstantiated Investigation revealed the following: Regarding allegation, Staff do not prevent residents from smoking in undesignated smoking areas, it is alleged that facility residents smoke cigarettes and marijuana inside and outside of the facility. Residents allegedly smoke cigarettes/ marijuana inside of their rooms (including inside rooms where there are oxygen in use signs posted outside of the room), on their balconies, and at the front entrance/exit door of the facility, which are not designated smoking areas. Marijuana and cigarette smoke allegedly also come into through air vents into resident rooms. Interview with Administrator Sanchez and facility staff revealed that smoking of either cigarettes or marijuana is not allowed in resident rooms and resident's have a designated smoking area outside of the building. Administrator and facility staff stated that there are ash trays, a seating area and trash cans available for residents use in the designated smoking area. Facility staff stated that if a concern is brought up of any resident smoking either marijuana or cigarettes inside a room, staff will immediately address and follow up on the reported incident. Staff stated that clients who do smoke do so in the designated smoking areas that are located outside of the facility, which are located in the outside patio area and out in the front of the facility. The smoking area outside of the front of the facility is marked off by a blue tape to remind the residents where they can smoke. They also stated that there are some residents that smoke marijuana but they do not smoke in the facility and go out and take a walk when they smoke marijuana and when they return to the facility their clothing has a strong marijuana odor. Staff deny that there are any residents that smoke inside of rooms that have oxygen in use or in rooms that have balconies. Staff stated that they are not aware of marijuana or cigarette smoke coming into residents rooms from air vents. Interviews conducted with 6 out of 7 residents revealed that residents do not smoke marijuana or cigarettes inside their rooms and only smoke in the outside designated smoking areas. 1 out of 6 residents stated that they think that some residents might smoke out in their balconies but they have not seen it. LPA observed outside designated smoking areas and observed residents smoking only in those areas. LPA observed trash cans, benches/ chairs and ash trays available for resident use. LPA did not observe any resident smoking in their rooms and did not smell any trace of either marijuana or cigarettes smoke in resident rooms or the facility during the tour. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation. For allegation, Staff do not maintain facility in good repair, it is alleged that the air conditioning and heating unit, located on the second floor is broken and recently had a temperature that measured approximately 79 degrees F on the second floor when the temperature outside was 74 degrees F. During today's visit, LPA toured the entire facility and observed that the facility air conditioning and heating unit was working on both the first and second floor and observed that the facility's temperature on both floors was comfortable. LPA observed the temperature to be at 78 degrees. LPA observed the temperature to be set at a comfortable temperature for facility residents. Based on the statements obtained from the interviews conducted with Administrator and S1-6, LPA learned that the air conditioner/ heater is working properly and has not been out of service. They stated that some residents like the rooms to be cooler and some like their rooms to be a little warmer so the temperature has to be set at an appropriate temperature that meets the residents needs as well as meet Title 22 regulations. Interviews conducted with 5 out of 7 residents revealed that they do not have any concerns and that the facility contains a comfortable temperature at all times. 2 out of 7 residents stated that the facility temperature can be cold at times and they have to let staff know to adjust the temperature. Based on statements gathered from interviews conducted with facility staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation. For allegation, Staff do not maintain passageway free from obstruction, it is alleged that there are residents who ambulate via wheelchairs that congregate at the front entrance/exit door smoking cigarettes, which results in the entrance/exit door passageway being obstructed by the residents sitting in wheelchairs. During today's visit, LPA toured the facility which included observations of the facility entrance/ exit door and observed that the door was not obstructed and residents, visitors were able to come in and out without a problem. Interviews conducted with 6 out of 7 residents revealed that the facility front door is not obstructed by residents in wheelchairs and 1 out of 7 residents stated that there have been a couple of times when they have asked residents on wheelchairs to clear the way when they want to exit the door. They stated that the residents are not smoking but are just hanging out and once they ask them to move they will move away from the door. Interviews conducted with facility staff revealed that the front door is not obstructed by residents. They stated that residents who smoke do so in the designated smoking areas. 1 staff stated that if they notice more than one resident congregating by the front door they will ask the residents to clear the area so that the door will not be obstructed to people that want to either exit or enter the facility. Based on statements gathered from interviews conducted with facility staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held. A copy of the report was provided to Administrator Chanel Sanchez.the state’s words, verbatim · CDSS document, May 23, 2023 · control 28-AS-20230517140233

Allegation investigated: Resident with Covid-19 is not getting sufficient care. Food prepared and served to resident was unsafe. Facility is dirty. Untrained staff.

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 Allegations: · Residents with COVID-19 is not getting sufficient care. It is alleged on or around December 28, 2021, Resident 1(R1) was ill with an infectious disease. R1 was not properly checked on in a timely manner and ignored by staff when R1 requested assistance. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. LPA Ramirez obtained and reviewed Special Incident Report (SIR) dated 12/28/2021. Per facility Mitigation Plan, staff will check on COVID-19 positive residents every 2 hours. LPA observed signage around the facility hallways promoting social distancing and the use of face masks. · Food prepared and served to resident was unsafe. It is alleged on or around December 28, 2021, R1 was provided food that was not properly heated and contained a wire. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. LPA toured facility kitchen while staff was finishing serving breakfast. LPA observed staff wearing hair nets and gloves. LPA observed various commercial refrigerators with temperature reading at 36 degrees F. LPA observed raw meats in metal trays wrapped with plastic wrap. Per Staff 6 (S6) meals are prepared fresh on site. Facility groceries are delivered every Wednesday. Per S6, residents with infectious diseased are provided meals in red trays and given disposable plates and utensils. LPA verified three (3) food handler certificates for staff in kitchen during visit. · Facility is dirty. It is alleged on or around December 28, 2021, R1’s temporary room for isolation was dirty and had feces in the toilet. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. LPA toured random rooms on second floor. Rooms were observed to clean, and no hazards were seen. Per Administrator Sanchez, housekeeping disinfects and cleans resident rooms on the daily. · Untrained staff. It is alleged on or around December 28, 2021, staff did not know how to properly assist a resident that may have fallen or dispense medications. LPA verified medications training, and CPR/First Aid training certificates for two (2) of the facility senior staff. LPA verified Administrator’s Certificate for Chanel Sanchez. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided via email due to printer problem.the state’s words, verbatim · CDSS document, Apr 24, 2023 · control 28-AS-20220104123415

Allegation investigated: Staff did not prevent strangers from breaking into residents room. Staff did not notify the police of incident. Staff did not notify residents authorized representative of incident. Financial fraud. Facility phone is in disrepair.

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 Allegations: · Staff did not prevent strangers from breaking into residents’ room. It is alleged on or around November or December of 2021, Resident 1(R1) room was broken into and used by strangers to take a shower and use the restroom. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. Per Staff 1 (S1) the facility has always maintained unarmed patrol. LPA obtained security service agreement dated January 05, 2022, and it states unarmed patrol of three stops per day between 8pm to 8am, 7 days a week. Patrol officer will remove loiters, transients, report graffiti, property damages or hazards observed during patrol. LPA could not locate any SIR on or around November or December of 2021, that indicated this facility had been broken into. · Staff did not notify the police of incident. It is alleged on or around November or December of 2021, staff did not notify the police of alleged break-in into resident’s room. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. LPA verified with Norwalk Sheriff’s Department if any calls were placed on or about November or December to report any break-ins into the facility, per Ofr. Montiel, no calls log to that location was made for break-ins. · Staff did not notify residents authorized representative of incident It is alleged on or around November or December of 2021, family of R1 was not notified of strangers breaking into R1’s room. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. R1 has since been relocated and LPA was unable to interview. LPA was able to interview Witness 1 (W1). LPA could not find any documentation that an alleged break in occurred in R1’s room on or around November or December of 2021. · Financial fraud. It is alleged that R1’s money was being sent to an unknown bank account and only contained $1 on R1’s “Direct Express” card. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. LPA reviewed R1’s file and could not locate anything out of the ordinary. LPA located a signed document from R1 stating R1 collected all his belongings when R1 vacated the facility. · Facility phone is in disrepair. It is alleged that the facility phone is in disrepair and residents’ families cannot get a hold of staff. Six (6) out of six (6) staff interviewed all deny this allegation. Three (3) out of the four (4) residents interviewed deny this allegation. LPA dialed facility listed phone number and staff answered with a greeting. LPA also observed resident using the phone to make a call during visit. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided via email due to printer problem.the state’s words, verbatim · CDSS document, Apr 24, 2023 · control 28-AS-20220318145550

Allegation investigated: Facility staff did not treat resident with dignity and respect.

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) Unsubstantiated The investigation revealed the following: Regarding allegation: Facility staff did not treat resident with dignity and respect. It is alleged staff's reply was disrespectful and blatant attitude towards resident. Interviews with residents revealed 6 out of 6 residents interview stated staff treats and speaks to the residents in a respectful and mindful manner. Interviews with staff revealed 5 out of 5 staff stated staff use respectful language and communication when speaking to the residents. Documents reviewed revealed R7 signed and initialed admission agreement on 8/22/22, a preplacement assessment was signed on 8/22/22, physician's report dated 8/19/22 notes R7 is ambulatory and can manage finances, acknowledgement of discharge was signed on 3/30/23 and R7 moved out of the facility on 3/30/23. Per executive director, R7 did not disclosed the reason to move out. Facility provided an in-service training to all staff on Resident Rights on 1/19/23. 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. Exit interview was conducted with Chanel Sanchez Executive Director and Elizabeth Martinez Assistant Executive Director and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 7, 2023 · control 28-AS-20230330100849

Allegation investigated: Staff are mismanaging residents medication. Staff are not providing adequate food service. Staff did not safeguard residents belongings. Staff did not prevent resident from making inappropriate comments towards another resident. Staff did not seek medical attention for resident. Facility phone is in disrepair.

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. Unsubstantiated Allegation: “Staff are mismanaging residents’ medication.” It is alleged that staff are mismanaging residents’ medications according to residents needs.” Five (5) out of the five (5) Staff (S1 – S5) interviewed, deny this allegation. Three (3) out of the four (4) residents (R2 – R4) interviewed, denied staff mismanaging their medications. LPA reviewed medication orders for R1 however, due to R1 no longer being at the facility, LPA could not verify Medication Administration Record (MAR) from 05/01/2021 through 06/30/2021. At 2:25 pm, LPA Ramirez observed S4 pushing medication cart through facility hallway and stopped at near by resident room to administer medication. LPA observed S4 to be wearing gloves, and a surgical mask while administering medication to resident. A pitcher with a clear liquid was also observed on the medication cart. Allegation: “Staff are not providing adequate food service.” It is alleged that food is being improperly handled by staff. Five (5) out of the five (5) Staff (S1 – S5) interviewed, deny this allegation. Three (3) out of the four (4) residents (R2 – R4) interviewed, denied staff are not providing adequate food service. LPA Ramirez conducted kitchen tour at 10:45 am while kitchen staff was preparing lunch. Kitchen staff were observed wearing hair nets and gloves while preparing food. LPA Ramirez verified Food Handler Certifications for three (3) of the kitchen staff that were present. At 12:07 pm, LPA Ramirez observed kitchen wearing gloves and hair nets while plating dishes and placing meals on dining cart. LPA observed servers wearing gloves and hair nets while serving meals to residents’ tables. Allegation: “Staff did not safeguard residents’ belongings.” It is alleged that staff did not safeguard residents’ belongings. Five (5) out of the five (5) Staff (S1 – S5) interviewed, deny this allegation. Three (3) out of the four (4) residents (R2 – R4) interviewed, denied staff did not safeguard residents’ belongings. At 11:37 am, while LPA Ramirez and Administrator Sanchez were conducting tour, LPA overheard R2 telling staff that R2’s hamper was missing from their room. LPA Ramirez observed Administrator Sanchez and another staff, go into R2’s to try and locate the alleged missing hamper. Administrator Sanchez and staff found the hamper in R2’s room. The hamper had been moved to a different area of the room by staff, to clean R2’s room. Allegation: “Staff did not prevent resident from making inappropriate comments towards another resident.” It is alleged staff did not prevent resident from making harassing comments towards resident. Five (5) out of the five (5) Staff (S1 – S5) interviewed, deny this allegation. Three (3) out of the four (4) residents (R2 – R4) interviewed, denied staff did not prevent resident from making inappropriate comments towards another resident. Although three (3) out of the four (4) residents deny this allegation, they confirm having hearing and seeing residents say inappropriate comments to each other but, residents (R2 – R4) all confirm staff will immediately redirect involved residents’ and diffuse the situation. Allegation: “Staff did not seek medical attention for resident.” It is alleged staff did not seek emergency medical attention for resident R5 on or about 06/15/21. Five (5) out of the five (5) Staff (S1 – S5) interviewed, deny this allegation. Three (3) out of the four (4) residents (R2 – R4) interviewed, denied staff did not seek emergency medical attention for resident in care. LPA verified resident R5 Special Incident Report (SIR) and could not find any pertinent documentation that suggests R5 required immediate emergency services on or about 06/15/21. Allegation: “Facility phone is in disrepair.” It is alleged facility phone is in disrepair and unable to receive voicemails. Five (5) out of the five (5) Staff (S1 – S5) interviewed, deny this allegation. Three (3) out of the four (4) residents (R2 – R4) interviewed, denied facility phone was in disrepair. At 11:11 am, LPA Ramirez observed a telephone located on second floor of facility community room. A second telephone was observed on the first floor of the lobby area. LPA picked up receiver of phones and heard dial tones. LPA tested phones and observed both phones to operable. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 3, 2023 · control 28-AS-20210611101304

Allegation investigated: Resident denied rent refund

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) Unsubstantiated Based on the Allegation: Resident denied rent refund. The investigation reveled the following: LPA Calderon conducted interview with staff Assistant Administrator Elizabeth Martinez: interview indicated R1 was issued a check for a pro-rated amount, name on check is R1's payee representative and a refund confirmation via email/verbal was conducted by Norwalk Retirment Villa LLC Staff Consultant Linda Estrada . LPA conducted interview with R1, R1 interview conducted telephonically states Norwalk Villa does not owe a rent refund, and everything is okay. LPA telephone interviewed R1 financial representative stated R1 was issued a refund check by the above facility upon self-discharge. LPA collected, reviewed and observed supportive documentation email/ pay check stub of refund issued to R1's payee represenative by Corporation Nowalk Retirement Villa LLC. 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. An exit interview was conducted and a copy of this report was provided to Assistant Administrator Elizabeth Martinezthe state’s words, verbatim · CDSS document, Feb 27, 2023 · control 28-AS-20220211124405

Allegation investigated: Facility staff did not ensure that resident received their dialysis treatment while in care.

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 Residents indicate they are receiving medical assistance. Continue to LIC9099C...... Unsubstantiated Based on LPA's interviews and record review, the investigation revealed: 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. Exit interview conducted with Chanel Sanchez and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 31, 2023 · control 28-AS-20230126120043

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced site visit for the Required - 1 Year inspection focusing on infection control. Upon arriving at the facility, LPA met with Administrator Lisa Pham and assistant administrator Elizabeth Martinez and stated the purpose of the visit.. LPA conducted inspection using Infection Control Domain Tool. Last fire drill was September 16, 2022. Administrator certificate expires 03/01/24 Structure: The facility property is a two story commercial building, licensed to serve 80 non-ambulatory residents ages 60 and above, of which 10 can be bedridden. The designated rooms for bedridden residents are rooms 1, 3, 5, 7, and 9, The facility has an approved hospice waiver for 30 residents. There are a total of 40 resident rooms. The following were observed/inspected: · COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept. · LPAs was screened for this visit. · Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing. · Facility has two designated isolation room. · 7 client rooms, common areas, bathrooms, and outdoor physical plant was inspected. · Client rooms were equipped with alcohol-based hand sanitizer. · Four (4) centrally stored client medication records were reviewed. · Staff responsible for direct care and supervision were observed wearing masks. · Clients were not observed wearing masks but adhering to public health social distance guidelines. · Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. · A posted Emergency Disaster Plan was posted but was at facility. · PPEs were observed. · Staff and resident files were not reviewed during today's visit. · Deficiencies cited per Title 22 Health and safety code, See 809D for details. · Exit interview was conducted with Assistant Administrator Lisa Pham. A copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Dec 6, 2022

Allegation investigated: Staff are not providing residents with adequate food service. Staff do not treat residents with dignity.

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-) Unsubstantiated Six (6) out of seven (7) interviewed residents indicated that they were able to get a 2nd round of food when requested. The quality of food was acceptable to residents. One (1) out of seven (7) interviewed residents stated resident was unable to get 2nd round of food sometimes. All staff interviewed were denied the allegation. Staff interviews revealed they made and prepared food based on residents' needs and facility's certified dietitian's menu. During lunch time, LPA observed that residents were able to get a second round of food per their requests. Facility's food supplies were sufficient. Per record review, facility had weekly menu and alternate food selections. The facility had alternative options for residents if they do not like what was being served for the day. Based on records reviewed and interviews conducted, the facility would provide 2nd round of food to residents when requested. Therefore, food services provided at the facility was adequate. In regard to allegation "staff do not treat residents with dignity", it was alleged that staff laughed at resident#1 when requesting 2nd round of food. Six (6) out of seven (7) interviewed residents indicated that facility staff treated residents nicely, of which one resident stated resident loved the staff's services. One (1) out of seven (7) interviewed residents stated staff did not treat resident with respect. All staff interviewed denied the allegation. LPA observed that staff were nice to residents and talked to residents with respect. Therefore, the investigation showed staff treat residents with respect. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated. An exit interview was conducted with Administrator, Lisa Pham. A hard copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 29, 2022 · control 28-AS-20221121101152

Allegation investigated: Facility does not adhere to Admissions Agreement

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) Unsubstantiated The investigation revealed the following: Regarding allegation: Facility does not adhere to Admissions Agreement. It is alleged facility increased rent without a 60 notice prior to increasing rent, the facility began charging $1099.00 per month, as of January 1, 2022, the facility raised resident's rent to $1234.00 per month. Interviews with residents revealed 2 out 4 residents stated rent was increased within the last year to about $1200 per month without notice. 1 out of 4 residents stated rent has not been increased and is new to facility, and 1 out of 4 residents stated to not know about admissions agreement or increases. Interviews with staff revealed 1 out of 4 staff stated rent increased written notices were provided to the residents that applied on December 14, 2021 due to cost of living increase of five percent and according to Supplemental Security Income (SSI). 3 out of 4 staff interview were not familiar with residents admissions agreement and have not heard of residents complaining of rate increased. Documents reviewed revealed the following 3 out of 4 SSI recipient residents received a written letter dated 12/13/21 of rate increase as of January 1st, 2022. Admissions agreement for R4 was signed on 4/6/21 notes total monthly fees for basic services fee to be $1099.37. R4 initialed a 3% rate increase history: January 2020 rate increase addendum noted on 4/6/21. Based on interviews conducted with staff, residents and documents reviewed, the preponderance of evidence standard has been met, therefore the above stated allegation is found to be UNSUBSTANTIATED. Exit interview was conducted with Lisa Pham Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 1, 2022 · control 28-AS-20220503160955

Allegation investigated: Staff did not provide resident with admissions agreement when requested.

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 Unsubstantiated Interviews show that R1 was provided a copy of the admissions agreement once signed and was given an explanation of the price set by the admissions agreement. Staff interviewed do not confirm that R1 requested further copies or explanations after moving into the facility. LPA was not provided with documentation or proof that R1 requested the admissions agreement from the facility at any time. Based on interviews and observations, 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 this allegation is unsubstantiated. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 31, 2022 · control 28-AS-20221025093815

Allegation investigated: Staff do not assist resident with self-administration medication. Staff do not repond to resident's call for assistance.

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 01/13/22) for Resident #1 (R1); facility's staff roster and resident resident. Regarding Allegation #1: this investigation revealed based on interviews conducted corroborated that the Med Techs administer the residents' medications in a timely manner for breakfast, lunch, dinner and/or Unsubstantiated bedtime. Facility staff have not received complaints from residents or responsible person/family member that the Med Techs are not assisting residents in administering their medication(s). LPA/RA toured the medication room and observed the medications to be in a secured, locked cart. LPA/RA observed the medication administration record (MAR) to be documented under QUICK MAR system once medications are administered to the residents by the Med Techs. A review of R1's physician's report documented under: Medication Management that the resident is able to administer own prescription medications, able to administer own PRN medications, and able to store own medications. A review of (former) Resident #1's medication administration record for the month of January 2022 documented that the resident was administered the medication (Abilify) once daily at 8:00 a.m. from 01/01/22 thru 01/16/22; resident was out of the facility 01/14/22 to 01/16/22 and did not return to the facility. After three (3) days, facility will remove the resident from the QUICK MAR system - just in case the resident decides to return. In this case, Resident #1 moved out on 01/13/22; and, the pharmacy provided a service to destruct the medication(s). Based on the evidence gathered and interviews conducted and records reviewed, 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 of MEDICATIONS: Staff do not assist resident with self-administration medication is found to be UNSUBSTANTIATED. Regarding Allegation #2: this investigation revealed based on interviews conducted corroborated that the Receptionist has answered calls made by the residents whenever they've called the front desk from their room phones or personal cell phones. Facility staff have not received complaints from residents or responsible person/family member that the staff member manning the front Receptionist desk does not answer residents' incoming calls in a timely manner. LPA/RA observed the front desk answering incoming calls during this visit and called the facility directly at (562) 379-2000; and, the call was answered within two (2) rings. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PERSONAL RIGHTS: Staff do not respond to resident's call for assistance found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report provided to Assistant Administrator, Elizabeth Martinezthe state’s words, verbatim · CDSS document, Oct 27, 2022 · control 28-AS-20220112084432

Allegation investigated: Facility staff did not ensure that resident was properly dressed at night.. Staff member was verbally abusive toward resident. Facility does not provide a safe environment for resident.

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 Unsubstantiated During the investigation LPA conducted a walk through with assistant administrator and did not observed inappropriately dressed residents. File review revealed S1 need assistance with getting dressed. S1 confirmed facility staff has always made sure they were properly dressed and cleaned at night. 2/5 residents stated they do not need assistance getting dressed and have not heard residents complained about not receiving staff assistance at night. 3/5 residents stated they do need assistance getting dressed and staff has always ensured they were properly dressed for bed. Administrator confirmed staff has always ensured residents are dressed appropriately. Administrator also confirmed that the facility has not received complaints from residents being left inappropriately dressed at night. 3/3 staff stated residents are always dressed appropriately. The investigation reveals the following: Regarding " Staff member was verbally abusive toward resident." it was alleged that a staff member lied on a resident. 4/5 residents stated that staff has never verbally abuse residents and has never witness other residents being verbally abused by staff. 1/4 residents stated staff lied in an incident, but they are getting along now. Administrator confirmed they have not received complaints from residents stating staff verbally abused them, but if they did, they would do an internal investigation. 3/3 staff stated they have not witness staff verbally abusing residents. The investigation reveals the following: Regarding " Facility does not provide a safe environment for resident”. It is alleged that R1 do not feel safe at the facility following the incident where staff lied. 4/5 residents stated that they feel safe at the facility. 1/4 resident stated facility has to many glass windows, which leads them to feel unsafe. Administrator confirmed facility has security personnel and conducts wellness checks. 3/3 staff feel the facility provides safe environment because of security staff, wellness checks, and staff dedication. Based on LPA's interviews, observation and file review, the investigation revealed: 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. Exit interview conducted with Administrator Lisa Pham and Assistant Administrator Elizabeth Martinez, A copy of this record provided.the state’s words, verbatim · CDSS document, Jul 25, 2022 · control 28-AS-20220719124719

Type of visit: Case Management - Other

***This LIC 809/809D supersedes LIC 809/809D issued on 05/13/2022*** Licensing Program Analyst (LPA) Nicol Wesley conducted a case management inspection and met with Assistant Administrator Elizabeth Martinez to discuss the purpose for todays visit. On 05/13/22 Licensing Program Analyst (LPA) Nicol Wesley initiated a case management inspection upon the completion of an initial 10 day complaint visit at the facility and Administrator Lisa Pham and Assistant Administrator Elizabeth Martinez. The following deficiencies were observed and cited according to the California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 809D. Appeal rights were given. A copy of the LIC 809/LIC 809D was given during the exit interview.the state’s words, verbatim · CDSS document, May 17, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 27, 2022

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 was not med at evidence by: During todays visit, LPA observerd that the facility does not have their business name on the building, markee, or attached to anyplace on the building. This deficiency was previously cited on 06/18/21 which poses a health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, May 17, 2022

Plan of correction: The Licensee/Administrator will have a permanent sign attached to the building/markee to identify the facility name by POC date 05/27/2022. In the event of a back order, the facility will show proof of purchase for the order of a permanent sign and will place a temporary banner identifying the facility business name on the building until the permanent sign has been installed on the building/markee by POC date 05/272022.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nicol Wesley initiated a case management inspection upon the completion of an initial 10 day complaint visit at the facility and Administrator Lisa Pham and Assistant Administrator Elizabeth Martinez. The following deficiencies were observed and cited according to the California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 809D. Appeal rights were given. A copy of the LIC 809/LIC 809D was given during the exit interview.the state’s words, verbatim · CDSS document, May 13, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 27, 2022

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 was not med at evidence by: During todays visit, LPA observerd that the facility does not have their business name on the building, markee, or attached to anyplace on the building. This deficiency was previously cited on 06/25/21 which poses a health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, May 13, 2022

Plan of correction: The Licensee/Administrator will have a permanent sign attached to the building/markee to identify the facility name by POC date 05/272021. In the event of a back order, the facility will show proof of purchase for the order of a permanent sign and place a temporary banner on the building until the permanent sign has been ordered by POC date 05/272021.

Allegation investigated: Facility does not provide hygiene items for residents Facility does not maintain testing equipment for residents

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, soap, toilet paper. 2 out of 4 residents interviewed stated to not received razors at the facility. (CONTINUED ON LIC 9099C) Unsubstantiated 4 out of 4 staff interviewed stated residents are provided basic hygiene products such as shampoo, body wash, soap, toilet paper, toothpaste, toothbrushes, and razors are provided to those residents that are independent upon request but residents are notify that razors must be keep under lock to avoid residents getting hurt. Admission agreement reviewed by LPA revealed facility is to provide basic hygiene items such as general use soap and toilet paper and resident or responsible party is responsible for "personal toilet articles, i.e. toothpaste, kleenex, mouthwash, shampoo, etc." LPA observed facility maintained some body wash, shampoo, toothbrushes and sufficient toilet paper and hand soap in storage areas. Assistant administrator staed there is grooming services provided to male residents. 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. Regarding allegation: Facility does not maintain testing equipment for residents. It is alleged facility does not maintain a blood pressure, or blood sugar testing machines for residents to check their blood pressures and blood sugar levels. Interviews with residents revealed, 3 out 4 residents stated facility has equipment to check blood pressure or sugar levels. 1 out of 4 residents stated facility does not have working equipment as facility may run out of batteries. Interviews with staff revealed, 4 out of 4 staff stated facility has working equipment for blood pressure or blood sugar testing for residents that require it. Assistant administrator stated that the facility does not provide blood pressure checks to all residents as the facility does not provided skill nursing level of care. However, does maintain equipment for residents that need services. LPA observed facility had sufficient blood sugar equipment for residents with prescription and two blood pressure machines available and in working condition at the time of the visit. 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. Exit interview was conducted with Elizabeth Martinez Assistant Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 10, 2022 · control 28-AS-20220503160955

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

LPA Nicol Wesley conducted a Case Management inspection, after completing an unannounced initial 10 day complaint investigation at the facility(Complaint Control #28-AS-20220318145550). LPA Wesley met Assistant Administrator Elizabeth Martinez.and Licensee Adam Zenou. During todays visit, LPA Wesley observed there to be an exterior painting project taking place. During the interview with the Assistant Administrator Martinez and Licensee Zenou, LPA Wesley was informed that the painting project has been taking place since March 4th 2022. The Facility Licensee/Administrator did not notify Community Care Licensing Division(CCLD) that they were planning to complete a painting project for the month of March 2022. The following deficiency is cited per California Code of Regulations, Title 22, Division 6 and Chapter 8 on the attached LIC 809D. Appeal rights were given along with a copy of this report during the exit interview.the state’s words, verbatim · CDSS document, Mar 24, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Mar 24, 2022

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. During todays visit, LPA Wesley observed all the facility windows on the 1st and 2nd level, all of the sliding glass exit doors in all of the residents rooms and the emergency exit doors by rooms 19 and 20, the TV room on the southwest side of the facility near Firestone Blvd near the residents rooms were covered in masking and tape which prohibits exiting and entering. This poses a health and safety isssue for the residents in care.the state’s words, verbatim · CDSS document, Mar 24, 2022

Plan of correction: The facility Licensee will review the regulations and avoid obstructing the windows and exit doors while the residents are in care which can pose a health and safety issue. ** Corrected at the time of visit** Licensee Adam Zenou had all of the taping, masking and plastic coverings removed from all of the residents sliding glass doors, exit doors, and emergency exit doors at the time of visit.

Allegation investigated: Facility has insufficient staffing to meet the residents' needs.

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 are being met daily. (4) of (4) residents could not corroborate the allegation. Review of staff roster shows that facility keeps enough staff per shift. Unsubstantiated 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 UNSUBSTANTIATEDthe state’s words, verbatim · CDSS document, Mar 2, 2022 · control 28-AS-20211229160311

Allegation investigated: Facility staff did not provide a safe environment. Resident is being over medicated. Resident not being provided adequate hygiene services. Staff did not safeguard resident personal information.

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) Unsubstantiated They never saw any strangers came or walked around the facility. No other resident would walk into their rooms. LPA interviewed staff and staff reported the front door from outside is always locked and visitor has to ring the bell and staff would open the door for them for signing in or screening for COVID-19 procedure. Staff also reported they never saw any strangers walked around from the facility. LPA also toured R1's room, no one would be able to come in from the patio door unless the resident open the patio door and the screen door. Allegation#2 "Resident is being over medicated." LPA interviewed four residents and all reported staff always give them correct medication and dosage and on the right time too. They never messed up their medication. They also stated that no residents ever over medicated in the facility. LPA also interviewed staff and reported they always follow doctor's order for resident medication, they would only give resident medication which doctor prescribed or approved and its never happened for a resident in the facility got over medicated. LPA also reviewed the residents' medication and they are accurate and updated. Allegation#3 "Resident not being provided adequate hygiene services." LPA interviewed four residents and all reported staff are taking good care of them. They always get shower on schedule weekly. And residents reported they have never seen any residents smelled bad or being dirty in the facility. LPA interviewed staff and reported they usually shower residents twice a week or as needed. Staff also reported R1 is independent in all his Activities of Daily Living (ADLs) including showering, dressing and grooming..etc. Its R1's choice not to shower daily or change his clothes. Staff did encourage R1 but they cannot force R1 because it's R1's personal right. Allegation#4 "Staff did not safeguard resident personal information. " LPA interviewed four residents and all reported they never lost anything in the facility and it's safe to live in the facility. Staff are taking good care of them, LPA interviewed staff and no one reported they lost or got stolen any personal information in the facility. Staff reported they would not give out any personal information to anyone unless they got the verbal permission or consent from the residents who are self responsible. If they are not self responsible, they would contact family or conservator and follow the protocol. Based on the interviews conducted, documents reviewed and observation, 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 allegations are UNSUBSTANTIATED. Exit interview conducted. The copy of the report and appeal right was provided to Administrator- Lisa Pham.the state’s words, verbatim · CDSS document, Mar 2, 2022 · control 28-AS-20220224103531

Allegation investigated: Staff prevents resident from having access to wheelchair while in care. Resident's diapering needs are not being met. Resident is not treated with dignity or respect.

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) Unsubstantiated Allegation#2 "Resident's diapering needs are not being met. " LPA interviewed residents and denied the allegation and reported it usually does not take long for staff to assist with changing diapers, only once a while, it takes about 20 minutes. LPA interviewed staff and reported they never got any complaints from residents about issues with diaper changing. Staff stated that they usually assist with residents' diaper changing every two hours or as needed and most of the residents, they are able to express their needs for diaper changing. Allegation#3 "Resident is not treated with dignity or respect. " LPA interviewed four residents and reported staff are nice and wonderful in the facility. Staff never being disrespect or treated them without dignity. LPA interviewed staff and denied the allegation and reported all the staff are nice and they are not tolerated any staff being disrespectful to the residents. Based on the interviews conducted, 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 allegations are UNSUBSTANTIATED. Exit interview conducted. The copy of the report and appeal right was provided to Corporate Assistant-Cynthia Flores. Based on the interviews were conducted, the preponderance of evidences standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC 9099D. Exit interview conducted and a copy of the report and appeal right was provided to Corporate Assistant- Cynthia Flores.the state’s words, verbatim · CDSS document, Jan 5, 2022 · control 28-AS-20211229154455

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87459(a)(1)(B) · Plan of correction due date: Jan 18, 2022

87459 Functional Capabilities (a)The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living (1)Bathing including need for assistnace (B) In bathing one or more parts of the body The requirement is not met as evidenced by Based on interviews by residents and reported their showering needs were not met due to staff would get mad when they take too long or staff only watched them without providing any assistance.the state’s words, verbatim · CDSS document, Jan 5, 2022

Plan of correction: The administrator will ensure the residents's showering needs are being met by reassessing them and determine their ability. The administrator will send LPA a letter and how to ensure the residents' showering needs are able to meet in the facility.

Type of visit: Required - 1 Year

12/23/2021 12:30 p.m. Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with assistant administrator Elizabeth Martinez and stated the purpose of the visit. LPA later met with Administrator Lisa Pham and stated the purpose of the visit. LPA conducted inspection using Infection Control Domain Tool. The facility property is a two story commercial building, licensed to serve 80 non-ambulatory residents ages 60 and above, of which 10 can be bedridden. The designated rooms for bedridden residents are rooms 1, 3, 5, 7, and 9. The facility has an approved hospice waiver for 30 residents. There are a total of 40 resident rooms. The facility phone number is 562 379 9200. LPA toured facility with assistant administrator and S1. On the 1st floor LPA observed: medication room, conference room, 3 common restrooms, office, lounge/TV room, dining room(seating for 55), kitchen with pantry, outside patio area, janitor supply room and 20 resident bedrooms(including the one's designated for bedridden residents). On the 2nd floor LPA observed the laundry room, 4 common restrooms, activity room w/ break room, fitness room, telephone room, janitor supply room, and 20 resident bedrooms. LPA toured a random selection of resident rooms. Resident rooms were furnished appropriately. The bathrooms were observed to be clean and operational w/grab bars. The resident rooms have a signal system located by the resident bed. The signal system was tested in various locations and is operable. The hot water temperature was tested throughout the facility and met Title 22 Regulation guidelines. CONTINUED 809-C The kitchen, food supply and emergency food and water supply were observed. There was a sufficient amount of perishable and non-perishable food supplies. No pesticides or poisons were stored in the food areas. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA reviewed resident medications records and stored medication. All medications were properly labeled and administered as directed by the physician. The fire extinguishers were observed to be fully charged. Smoke/carbon monoxide detectors were observed to be fully operational. An outdoor shaded area is available in the outside patio area. There was no pool or bodies of standing water observed in the exterior of the facility property. Exits and passageways were free of obstructions. Per the California Code of Regulations, Title 22 no deficiencies observed. Exit interview held, copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 23, 2021