Country View Assisted Living

Allegation investigated: Staff are not transporting resident to appointments Staff are not providing residents with mail in a timely manner

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint vist to provide additional information for report dated 6/13/23. investigation visit regarding the above allegations. LPA met with Fatima Hernandez and explained the reason for the visit. The investigation consisted of the following: On 10/6/22 LPA Katrdzhyan conducted an initial investigation visit and requested pertaining documents. On 6/13/23 LPA Katrdzhyan conducted a subsequent complaint investigation visit and delivered findings for the above allegations. On 6/14/23 LPA Katrdzhyan delivered findings for additional allegations regarding this complaint. On 10/9/23 LPA Flores conducted interviews over the phone with 8 residents and 5 staff to obtain additional information regarding the above allegations. On 10/14/23 LPA Flores delivered and obtained signatures for this report. (CONTINUED ON LIC 9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff are not transporting resident to appointments. It is alleged facility staff keep canceling resident’s rides to appointments. Interviews conducted with residents revealed 8 out of 8 residents stated to received assistance with transportation to appointments. Residents stated appointments to medical or dental services are only cancel when the residents are not feeling well. When their transportation is late, facility staff either reschedule their appointment or if possible, they provide an Uber for them to make it to their original appointment. Interviews with staff revealed 5 out of 5 staff stated residents transportation depends on their medical insurance. Transportation is provided for their medical appointments and if their transportation is late, facility schedules an Uber ride to their appointments. The only time residents miss an appointment is if the residents stated they don’t feel well to go to their appointment or when their scheduled transportation is late, and the medical offices is not able to take them because they are late. Facility then reschedules the appointment for the residents. Per interviews conducted when a resident misses an appointment it is rescheduled to ensure the resident goes to their medical or dental appointments. 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. Regarding allegation: Staff are not providing residents with mail in a timely manner. It is alleged that residents don’t get their mail timely. Interviews conducted with residents revealed 8 out of 8 residents stated that they received their mail in a timely manner, delivered by facility staff. Interviews conducted with 5 out of 5 staff revealed that the activity director delivers residents mail during mealtimes or take it to their rooms Monday through Friday and a Med-Tech provides their mail on the weekends. Administrator stated the mail comes to the facility and they pull out mail for the facility, it is then given to the activity director or Med-Tech who provides it to the residents on the same day. The activity director stated that the only time mail is not delivered to the residents is when the residents are out in the hospital. Per interviews conducted there are no concerns about mail being provided late to the residents. 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. *All findings concerning this complaint were addressed on 6/14/23 and remained the same. * Exit interview was conducted with Fatima Hernandez and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 14, 2023 · control 28-AS-20220927150112

Allegation investigated: : Questionable death of residents. 2: Staff made an inappropriate comment towards residents. 3: Staff not responding to calls for assistance in a timely manner. 4: Staff not treating resident's equal. 5: Meals are not of quality or quantity. 6: Meals are served on damaged plates. 7: Staff not ensuring that resident's are fed. 8: Facility not providing activities for residents. 9: Resident's are threatened with eviction notices. 10: Staff are not properly managing resident's medications. 11: Staff disposing of resident's medication. 12: Medication records are inaccurate. 13: Staff teasing resident's.

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Dennise Torres (Administrator) and explained the purpose of the visit. During the initial complaint visit conducted on 03/28/22, LPA obtained/reviewed a copy of the Staff Roster, Resident Roster, Resident #13's death report and death certificate. LPA interviewed Staff #1 and #2 in the office, toured the kitchen and dining room with Staff #2 and interviewed Residents #1 to #12 in the office. During today's visit, LPA obtained a copy of the Staff/Residents rosters, food menu, activity calendar, interviewed Staff #1 to #8 in the office and reviewed medication records for 12 random Residents. Continue to LIC9099C.... Unsubstantiated Regarding allegation #1: Questionable death of residents. Record review and interviews with Staff and Residents indicate there was one Resident (R#13) death within the time frame of this complaint. LPA reviewed death certificate for R#13 which does not indicate death to be questionable. LPA reviewed facility death reports and does not indicate alleged multiple Resident deaths within the time frame of this complaint. Regarding allegation #2: Staff made an inappropriate comment towards resident's. Interviews with 8 of 8 Staff indicate they have never made an inappropriate comment towards a Resident and never witnessed other Staff making inappropriate comments towards Residents. Interviews with 12 of 12 Resident also indicate Staff has never made inappropriate comments towards them or witnessed Staff making inappropriate comments towards Residents. Regarding allegation #3: Staff not responding to calls for assistance in a timely manner. LPA verified the facility alert system to be operable. Interviews with Staff responsible for providing assistance to Residents indicate calls are being responded in a timely manner. Every care giving Staff is provided with a walky talky for notifications when a Resident is in need of assistance. Interviews with Residents who uses the call cord also indicate Staff is responding to Resident's calls in a timely manner. Regarding allegation #4: Staff not treating resident's equal. Interviews with 8 of 8 Staff indicate they are treating Residents equally. Interviews with 12 of 12 Residents also indicate they are being treated equally. Regarding allegation #5: Meals are not of quality or quantity. LPA toured the kitchen and observed meals are of good quality and quantity. Food menu indicate meals are of good quantity and quality. Interviews with Staff responsible for food service and Staff who witness food services indicate food is of good quality and quantity. Interviews with 12 of 12 Residents also indicate meals are of good quality and quantity. Regarding allegation #6: Meals are served on damaged plates. LPA toured the kitchen and did not observe damaged plates. Interviews with kitchen Staff and Staff who witness food services indicate meals are not served on damaged plates. Kitchen Staff indicate damaged plates are discarded and replaced. Interviews with 12 of 12 Residents indicate meals are not served on damaged plates. Continue to LIC9099C... Regarding allegation #7: Staff not ensuring that resident's are fed. Interviews with 8 of 8 Staff indicate Residents are ensured to be fed. Interviews with 12 of 12 Resident also indicate Staff ensures they are fed. Regarding allegation #8: Facility not providing activities for resident's. Review of the activity calendar indicate Residents are provided with activities. Interviews with Staff indicate Residents are being provided with activities. Interviews with 12 of 12 Residents also indicate activities are provided. Regarding allegation #9: Resident's are threatened with eviction notices. Interviews with Staff indicate Residents have never been threatened with eviction. Interviews with 12 of 12 Resident also indicate Staff has never threatened them with eviction. Regarding allegation #10: Staff are not properly managing resident's medications. Interviews with Staff responsible for medication assistance indicate medication are properly managed. Review of medication records also indicate medications are properly managed. Interviews with 12 of 12 Resident also indicate their medications are properly managed. Regarding allegation #11: Staff disposing of resident's medication. Medication record review indicate Staff dispose of medications based on physician's order. Interviews with Staff responsible with medication assistances indicate medications are disposed based on physician's order or Residents who may have refused to take their medications or Resident was in the hospital and Staff was unable to provide them with medications. Regarding allegation #12: Medication records are inaccurate. Review of medication records for random Residents indicate medication assistance is documented accurately. LPA did not observe any discrepancies. Interviews with Staff responsible with medication assistance also indicate medication records are accurately documented on the computer or on paper. Regarding allegation #13: Staff teasing resident's. Interviews with 8 of 8 Staff indicate they have never teased a Resident or have they witnessed other Staff tease a Resident. Interviews with 12 of 12 Resident also indicate they have never been teased by Staff nor have they witness Staff tease other Residents. Continue to LIC9099C... Based on LPA's record review, observations and interviews, the complaint 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 Dennise Torres (Administrator) and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 23, 2023 · control 28-AS-20220324140017

Allegation investigated: Staff are stealing resident's personal possessions.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Staff, Eliana Lopez. The purpose of the visit was explained. The assistant administrator, Dennise Torres, arrived at 9:20 a.m. to assist with the visit. The investigation consisted of the following: LPA obtained copies of the staff and resident rosters and the Thief and Loss Policy. Interviews were held with the Assistant Administrator, 4 Staff, and 12 Residents. The investigation revealed the following: Allegation - Staff are stealing resident's personal possessions. LPA interviewed Staff and Residents regarding this allegation. Per Assistant Administrator, there has not been any recent reports from residents about missing items in their rooms. The items that were reported missing in the past were mainly articles of clothing. Unsubstantiated If a resident's clothing goes missing during laundry, the facility will replace the item with a new one. She stated that residents fill out the personal property and valuable form when they move in and will update if needed. Staff interviewed stated they have not taken any of the residents' possessions nor heard any residents mentioning items missing to them. When they clean, some of the items are moved but staff will put them back afterwards. LPA interviewed 12 residents today. One of the residents felt that staff have taken some of the trinkets from the room. 11 out of the 12 stated they have not had any of their belongings taken from them. They lock their rooms to prevent anything from being stolen. 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. An exit interview was conducted with the Assistant Administrator. A copy of this report along with the appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 18, 2023 · control 28-AS-20230710102613

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted an annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA met with the Assistant Administrator, Dennis Torres, who assisted with the visit. The facility is licensed to serve 136 non-ambulatory residents ages 60 and over, of which 34 may be bedridden. There is a hospice waiver approved for 20 residents. LPA observed the following: Infection Control: The facility staff are using appropriate hand hygiene. Staff are continuing to clean/disinfect at least 4 times a day. Facility has submitted the Infection Control Plan. Facility is aware to report any outbreaks to the appropriate agencies. Operational Requirements: The facility does not accept or retain residents with dementia. There are currently 117 residents residing at the facility. The facility has the sufficient amount of liability insurance covering injury to residents. Physical Plant & Environment Safety: The facility has 68 resident rooms with own bathrooms. There are no swimming pool or bodies of water on the premises. LPA selected 12 random rooms to inspect: #1, #2, #9, #12, #18, #23, #34, #47, #49, #52, #53, and #67. The bedrooms have the required furniture and sufficient lighting. The smoke detectors are interconnected and there are 2 operable carbon monoxide detectors. The facility has a signal system in place. Staffing: Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. There is at least one staff who has CPR and First Aid training on duty and at the premises at all times. There are awake staff during the overnight shift. Personnel Records-Training: Staff files are maintained at the facility. The administrator (Samuel Deutsch) has renewed his certificate but is pending review by the ACS Licensing Division. LPA reviewed 5 personnel records and they have the required documents in file. Continue on LIC809C. Resident Records-Incident Reports: Resident files are maintained at the facility. LPA reviewed 5 resident records and they have the following documents in their files such as Admission Agreements, Identification & Emergency Information, Physician's Report with TB test results, Pre-admission appraisal, and Resident rights. Resident Rights-Information: The Complaint poster, Local Ombudsman, and Residents personal rights are posted by the front entrance. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's capability. There is a full-time Activity Director. Food Service: LPA observed sufficient food supplies of 2-day perishable and a week of non-perishable items. Incidental Medical & Dental: The medications are centrally stored in the med room. The facility uses an electronic Medication Administration Record (MAR) log to document medications given. During the visit today, LPA reviewed 5 resident medications and they are being administered as prescribed by the physician. Disaster Preparedness: The facility has the updated Emergency Disaster Plan which can be easily accessible by staff. They are conducting different types of emergency drills once a month for various shifts. Residents with Special Health Needs: The facility does not have a dementia care plan and does not accept any residents with dementia. There are some residents utilizing home health services but none on hospice. The residents who receive insulin injections are able to self administer. No deficiencies were issued today. An exit interview was held and a copy of this report was given to the assistant administrator.the state’s words, verbatim · CDSS document, Jul 18, 2023

Allegation investigated: Resident fell while in care Facility is forcing resident to use their physicians and dentist Staff are not providing a comfortable environment for residents Staff are not providing adequate food service for resident Resident is scared to leave the facility due to facility staff not letting Resident back in

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced follow up visit to this facility to deliver findings on the above-mentioned allegations. Upon arriving at the facility, LPA met with Case Manager / Eliana Lopez and was later joined by the Administrator / Dennise Torres who assisted with the visit. LPA explained the purpose of today's visit. LPA Katrdzhyan conducted prior visits to this facility on 10/6/22 and 6/13/23, in reference to the allegations listed above. During the course of the investigation, interviews were conducted of various persons to include the Administrator, Wellness Director / Claudia Cordoba, Residents 2 - 6 (R2 - R6) and Staff members 1 and 2 (S1 and S2). LPA made an attempt to interview Resident 7 (R7) but R7 refused. LPA was unable to interview Resident 1 (R1) because R1 expired on 1/4/22. LPA toured the facility kitchen, main hallway and nearby activity rooms. Also, copies of the following documents were obtained and reviewed in reference to R1; • Identification and Emergency Information • Resident Appraisal • Physician's Report • Medical Reports Unsubstantiated • Discharge Instructions from Emanate Health Queen of the Valley Hospital dated 1/3/22 • Facility Menu • Alternate food slip The investigation revealed the following; Allegation: Resident fell while in care. Based on interviews conducted and records reviewed, LPA discovered that R1 sustained unwitnessed and unforeseen falls. The fall incidents occurred during period 1/2/22 – 1/4/22. R1 had an unwitnessed fall on 1/2/22 in the dining room. The paramedics were called and arrived but R1 refused to go to the hospital. On 1/3/22, R1’s sister was contacted by staff to help convince R1 to go to the hospital for further evaluation, at which time R1 agreed. An ambulance was called and R1 was transported to Emanate Health Queen of the Valley Hospital (EHQVH). R1 was evaluated at EHQVH and diagnosed with a supracondylar fracture of the humerus (left elbow). R1 was released shortly after in stable condition and asked to follow up with primary care physician (PCP) in 1 -2 days. R1 sustained a second fall in her room on 1/3/22, at around 8:30pm. No visible injuries were noted by staff. R1 refused to go to the hospital. R1 sustained a third fall in her room on 1/4/22, at 6:30am. No visible injuries were noted by staff and R1 refused to be sent to the hospital. R1 expired on 1/4/22, at 8:40am. According to the Death Certificate, the cause of death was noted as Cardiopulmonary Arrest and Chronic Obstructive Pulmonary Disease (COPD). Per the Administrator, the family of R1 and R1’s PCP were notified after each fall. After reviewing the file of R1, it was noted that R1 was ambulatory and did not require assistance with her activities of daily living. Based on interviews conducted and records reviewed, R1 was not a fall risk resident and did not have a history of prior falls. The facility provided proper treatment to R1 after her falls; observation and medical attention by staff. Law Enforcement was on scene at the time of R1’s passing but no further action was taken. Based on the investigation conducted, no evidence of Neglect/Lack of Supervision was found. Allegation: Facility is forcing resident to use their physicians and dentist. Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with the allegation. Staff and residents interviewed stated that residents are not forced by staff to use the in-house facility physicians and dentist. Staff offer residents to use the in-house physicians and dentist in order to make it easier and convenient for the residents, but residents are never forced. Residents have the option of using an outside physician and dentist if they wish. According to the Administrator, there are many residents at the facility who use outside physicians and dentists. Based on interviews conducted, there is insufficient evidence to support this allegation to be true. Allegation: Staff are not providing a comfortable environment for residents. The details of this allegation states that facility staff leave the air condition on all day and night and it’s freezing. During the visit conducted on 6/13/23, at 11am, LPA toured the main hallway area and the nearby activity rooms and measured the temperature inside the facility at 75 degrees F. Staff and residents interviewed denied staff having the air condition on all day and night making it uncomfortable/freezing for the residents. Residents interviewed stated that the facility temperature is comfortable during the summer time and winter time. Based on LPA’s observation and interviews conducted, there is insufficient evidence to support this allegation to be true. Allegation: Staff are not providing adequate food service for resident. Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with the allegation. Staff and residents interviewed denied staff not providing adequate food service for residents and residents having to wait 15 minutes or more for items requested during meals. Residents stated that facility staff are nice about providing room service. Staff and residents stated that the meals served during breakfast, lunch and dinner are of variety and residents are not rushed during meals. LPA verified on the facility food menu that the meals served daily are not the same and there is a variety during each serving. According to the Administrator, everything listed on the menu is approved by a dietician. In the event, a resident refuses to eat what is listed on the daily menu, there is a substitute which consists of a bologna/ham & cheese sandwich, peanut butter and jelly sandwich, grilled cheese, quesadilla, salad, fruit plate and cottage cheese. The kitchen is also open for coffee, water, juice and ice. During the visit conducted on 6/13/23, LPA toured the facility kitchen and observed an ample supply of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed meats, fruits, vegetables, eggs, juice, milk and snacks at the facility. Based on LPA's observation, interviews conducted and records reviewed, there is insufficient evidence to support this allegation to be true. Allegation: Resident is scared to leave the facility due to facility staff not letting Resident back in. Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with the allegation. Staff and residents interviewed denied residents being scared to leave the facility due to facility staff not letting residents back inside the facility. The facility has a ring system which notifies staff when someone is at the front door and statements obtained from residents stated that there is always a staff person available to open the door and let residents back inside the facility. Based on interviews conducted, there is insufficient evidence to support this allegation to be true. 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. An exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 14, 2023 · control 28-AS-20220927150112

Allegation investigated: Staff are not transporting resident to appointments Staff are not providing residents with mail in a timely manner

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Wellness Director / Claudia Cordoba and was later joined by the Administrator / Dennise Torres, who assisted with the visit. LPA explained the purpose of today’s visit is to discuss the above-mentioned allegations of Staff are not transporting resident to appointments and Staff are not providing residents with mail in a timely manner. • The allegation of “Staff are not transporting resident to appointments” was previously investigated and addressed by LPA David Sicairos on 12/22/21, Control #28-AS-20211214161817 and on 8/27/21, Control #28-AS-20210820151018. The findings were delivered as Unsubstantiated, during both visits. Please refer to Control #28-AS-20211214161817 and #28-AS-20210820151018 for additional information. • The allegation of “Staff are not providing residents with mail in a timely manner” was previously investigated and addressed by LPA Luis Mora on 10/12/21, Control #28-AS-20211004094822. The finding was delivered as Unsubstantiated. Please refer to Control #28-AS-20211004094822 for additional information. An exit interview was conducted and a copy of this report was provided to the Administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 13, 2023 · control 28-AS-20220927150112

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are refusing to let residents go to appointments Staff denied resident food Staff smashed residents plate of food Staff don't treat residents with dignity

Licensing Program Analysts (LPAs) Christine Wong and Tena Herrera conducted the “Initial 10-Day” visit to ascertain information pertaining to the above-mentioned allegations and to establish the validity of the complaint. LPAs met with Staff #1 Wellness Director Claudia Cordoba who allowed entry into the facility and was later met by Assistant Administrator Denise Torres who assisted with the visit. The investigation consisted of the following: On today's date, LPAs interviewed administrator, five staff (S1-S5) and eleven residents (R2-R13) and obtained copy of documents include resident and staff roster and some documents for Resident#1 (R1) include face sheet, resident appraisal, physician report, needs and service plan and progress notes and incident reports dated on 11/28/22 and 11/30/22, faciltiy menu and staff training log on food service and sexual harrassment. (See LIC 9099C for continuation) Unsubstantiated The investigation revealed of the following: Allegation#1 "Staff are refusing to let residents go to appointments." LPAs interviewed 11 residents and 10 out of 11 residents denied the allegation and stated they can go in and out the facility freely. Staff never refused them to go to the appointments and staff never asked any questions as residents would let the staff where they are going or when they would be back to the facility. It is because sometimes staff may have to pack residents' medication if they go out for a longer time. Staff also denied the allegation and reported the facility is an open facility and residents have their right to go in and out the facility freely. Assistant Administrator indicated that unless residents' are not permitted to go out alone and its documented on residents' physician report. Allegation#2 "Staff denied resident food" LPAs interviewed 11 residents and 10 out of 11 residents denied the allegation and reported they never had any issues for food in the facility. They are always able to get sufficient food in the facility. They get three meals a day and snacks. They are also able to get second if they want more. Staff never denied resident food. LPAs interviewed staff and they all denied the allegation. Staff reported residents always can get second if they want and they would offer alternative menu for residents if residents do not like the menu of the day. Staff never denied food for residents. Allegation#3 "Staff smashed residents plate of food" LPAs interviewed 11 residents and 10 out of 11 residents denied the allegation and reported they never witnessed any staff smashed residents the plate of food. Residents stated only residents would do it if they were not able to get what they want or residents would spill the food or drinks on the floor. LPAs interviewed staff and all denied the allegation and reported they never witnessed any staff doing it and staff would have never done it to the residents. Allegation#4 "Staff don't treat residents with dignity" LPAs interviewed 11 residents and 10 out of 11 residents denied the allegation and reported staff are nice and respectful and staff had never being mean or yelled at them. LPAs interviewed staff and denied the allegation and reported they never witnessed any staff in the facility not treat residents with dignity. Every staff in the facility are very respectful to residents. No staff in the facility would allow not being respectful or mean to the residents. Based on statements, record reviews and interviews conducted with staff and residents, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did nor did not occur, therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of the report and appeal rights was provided to the Assistant Administrator, Denise Torresthe state’s words, verbatim · CDSS document, Mar 24, 2023 · control 28-AS-20230321094926

Allegation investigated: Staff do not follow proper food handling procedures Staff are not taking universal precautions to maintain a clean environment

*This is a corrected version for report dated 1/26/23 to add information in LIC 9099D* On 1/26/23 Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Claudia Cordoba Wellness Director an explained the reason for the visit. Administrator arrived 20 minutes later. The investigation consisted of the following: LPA Flores requested a copy of staff/resident roster, conducted a tour of the facility's kitchen with Claudia Cordoba wellness director at around 9:45am and 12:00pm and observed refrigerator(s), freezer's, pantry, and staff preparing/serving meals. LPA Flores interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6), staff #1(S1),#2(S2),#3(S3),#4(S4), administrator, and review 4 staff files and requested copies of food handling certificates. The investigation revealed the following: Staff do not follow proper food handling procedures. It is alleged cooking, cooling and holding temperatures of food are not maintain. (CONTINUED LIC 9099C) Substantiated Interviews with residents revealed 6 out of 6 residents interview stated to not have been sick due to digested food or have been food poison in the last couple of months. Interviews with 5 out of 5 staff interview revealed staff have received food handling training and 2 out of the 5 staff interviewed were aware of proper temperatures for food cooling and maintaining. During the tour of the kitchen at around 12:00pm, LPA Flores requested cook to test the meat tray in steamer maintaining meat warm and temperature tested at 75 degrees F. which is not within department of public health's recommendations for maintaining food warm which is above 135 degrees F. Documents reviewed revealed 4 facility cooks have current/up to date food handling training certificates on file. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding allegation: Staff are not taking universal precautions to maintain a clean environment. It is alleged facility is not maintaining equipment sanitation, employee hygiene, and general sanitation guidelines. Interviews with residents revealed 6 out of 6 residents interview stated to observed staff maintaining cleanness in the dining room and wearing gloves, hairnets, and a face mask when serving meals. Interviews with 5 out of 5 staff interview revealed staff have received food handling training, are aware of proper hygiene, and maintain cleanliness within the kitchen and dining are. During the facility's tour at around 9:45am LPA Flores observed coffee maker's drip tray to have build up mold in the corners and seams. Kitchen's cleaning closet next to the sink area was observed and three live roaches were found two in the floor and one in mopping bucket. In the pantry LPA observed 2 pasta boxes open without properly covering them or storing pasta properly to prevent pest or contaminants from entering. Documents reviewed revealed 4 facility cooks have current/up to date food handling training certificates on file. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 8 are being cited. Exit interview was conducted with Dennise Torres Administrator and a copy of this report, LIC 9099D, and appeal rights was provided. This report was email for signature.the state’s words, verbatim · CDSS document, Mar 8, 2023 · control 28-AS-20230123142717

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(9) · Plan of correction due date: Mar 8, 2023

87555 General Food Service Requirements: (b) The following... shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidence by: Based on observation, and interviews conducted licensee did not ensure food serve to residents in care is maintain at a proper temperature, temperature in meat tray tested at 75 degrees F., open pasta not stored properly, and equipment not clean properly which poses an immediate health, safety, or personal rights violation to the persons in care.the state’s words, verbatim · CDSS document, Mar 8, 2023

Plan of correction: Administrator will ensure equipment is in working condition to maintain the temperature of food above 135 degrees F., and will provide in-service training to food handling staff regarding proper cooling, cooking, maintaining food temperatures, storing, and cleaning/sanitizing kithchen by POC due date 1/27/23. Deficiency cleared as of 2/13/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Mar 8, 2023

87555 General Food Service Requirements: (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidence by: Based on interviews conducted licensee did not ensure kitchen was free of insect as 3 roaches were observed in the kitchen's closet which poses a potential health, safety, or personal rights risk to the persons in care.the state’s words, verbatim · CDSS document, Mar 8, 2023

Plan of correction: Administrator will provide a copy of pest control service receipt for treatment of roaches in the kitchen to the department by POC due 2/9/23. Deficiency cleared as of 2/13/23.

Allegation investigated: Staff do not follow proper food handling procedures Staff are not taking universal precautions to maintain a clean environment

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Claudia Cordoba Wellness Director an explained the reason for the visit. Administrator arrived 20 minutes later. The investigation consisted of the following: LPA Flores requested a copy of staff/resident roster, conducted a tour of the facility's kitchen with Claudia Cordoba wellness director at around 9:45am and 12:00pm and observed refrigerator(s), freezer's, pantry, and staff preparing/serving meals. LPA Flores interviewed resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6), staff #1(S1),#2(S2),#3(S3),#4(S4), administrator, and review 4 staff files and requested copies of food handling certificates. The investigation revealed the following: Staff do not follow proper food handling procedures. It is alleged cooking, cooling and holding temperatures of food are not maintain. (CONTINUED LIC 9099C) Substantiated Interviews with residents revealed 6 out of 6 residents interview stated to not have been sick due to digested food or have been food poison in the last couple of months. Interviews with 5 out of 5 staff interview revealed staff have received food handling training and 2 out of the 5 staff interviewed were aware of proper temperatures for food cooling and maintaining. During the tour of the kitchen at around 12:00pm, LPA Flores requested cook to test the meat tray in steamer maintaining meat warm and temperature tested at 75 degrees F. which is not within department of public health's recommendations for maintaining food warm which is above 135 degrees F. Documents reviewed revealed 4 facility cooks have current/up to date food handling training certificates on file. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding allegation: Staff are not taking universal precautions to maintain a clean environment. It is alleged facility is not maintaining equipment sanitation, employee hygiene, and general sanitation guidelines. Interviews with residents revealed 6 out of 6 residents interview stated to observed staff maintaining cleanness in the dining room and wearing gloves, hairnets, and a face mask when serving meals. Interviews with 5 out of 5 staff interview revealed staff have received food handling training, are aware of proper hygiene, and maintain cleanliness within the kitchen and dining are. During the facility's tour at around 9:45am LPA Flores observed coffee maker's drip tray to have build up mold in the corners and seams. Kitchen's cleaning closet next to the sink area was observed and three live roaches were found two in the floor and one in mopping bucket. In the pantry LPA observed 2 pasta boxes open without properly covering them or storing pasta properly to prevent pest or contaminants from entering. Documents reviewed revealed 4 facility cooks have current/up to date food handling training certificates on file. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 8 are being cited. Exit interview was conducted with Dennise Torres Administrator and a copy of this report, LIC 9099D, and appeal rights was provided.the state’s words, verbatim · CDSS document, Jan 26, 2023 · control 28-AS-20230123142717

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(a) · Plan of correction due date: Jan 27, 2023

87555 General Food Service Requirements: (b) The following food service requirements shall apply: (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement is not met as evidence by: Based on observation, and interviews conducted licensee did not ensure food serve to residents in care is maintain at a proper temperature, temperature in meat tray tested at 75 degrees F., open pasta not stored properly, and equipment not clean properly which poses a health, safety, or personal rights violation to the persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Administrator will ensure equipment is in working condition to maintain the temperature of food above 135 degrees F., and will provide in-service training to food handling staff regarding proper cooling, cooking, maintaining food temperatures, storing, and cleaning/sanitizing kitchen by POC due date 1/27/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Feb 9, 2023

87555 General Food Service Requirements: (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidence by:the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Administrator will provide a copy of pest control service receipt for treatment of roaches in the kitchen to the department by POC due 2/9/23.

Allegation investigated: Staff threw an object at resident Staff intimidates resident.

Licensing Program Analyst (LPA), Alberto Lopez conducted the initial complaint investigation for the allegations listed above. LPA met with Wellness Director, Claudia Cordoba and explained the purpose of the visit. Assistant Admistrator Denise Torres arrived a short time later and assisted LPA with the investigation. During the visit today, LPA toured the facility and obtained copies of the staff/resident roster, Resident #1 (R1) Physician’s report (LIC602A), and SIR dated 11/28/22 and 11/30/22. LPA interviewed Staff #1-Staff #7 (S1-S7) and Resident #1-#12 (R1-R12) and attempted to interview Resident #13 (R13 but declined to speak with the LPA. ****REPORT CONTINUED ON LIC 9099-C*** Unsubstantiated Regarding Allegation: Staff threw an object at resident. It is alleged that S2 threw boxes at R1 and took R1 tablet and hit R1 with it. R1 stated that it did occur and provided name of witnesses (S6-S7). During phone interview, R1 recanted all the allegations and stated R1 did not say anything to anyone and to erase everything. R1 refused to be seen in person during phone call and told LPA she will not open her door. S2 denied the allegations and stated that she has no interaction or responsibilities with R1 due to ongoing false accusations. S6 stated she did not witness any incidents that included residents getting boxes thrown at them or being hit as S6 would have reported it immediately. S7 denied that she witnessed any staff hitting or throwing objects at R1. S7 stated she would have reported the incident right away. 7/7 staff denied the allegations. 11/12 staff did not collaborate the allegations. 11/12 residents stated that they have never witness any staff striking a resident or throwing objects at them. Regarding Allegation: Staff intimidates resident. It is alleged that staff intimidates resident because they want to kick her out. R1 recanted this allegation during phone interview and 12/12 residents could not collaborate the allegations. 7/7 staff interviewed denied the allegations. Staff stated that R1 has history of making false accusations and later recanting them. Based on statements, record reviews and interviews conducted with staff and residents, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did nor did not occur, therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of the report and appeal rights was provided to the Assistant Administrator, Denise Torresthe state’s words, verbatim · CDSS document, Dec 1, 2022 · control 28-AS-20221128102150

Allegation investigated: Staff do not open door for residents to enter facility. Staff do not give resident hot water for coffee.

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial investigation for the above allegations. LPA met with Claudia Cordoba/S-1 and discussed the purpose of today's visit. Dennise Torres/S-3 (Assistant Administrator) arrived at approximately 9:50 A.M.. During this visit, LPA obtained a copy of the staff roster, resident roster, interviewed Staff #1 through Staff #4 (S-1 through S-4) and interviewed Resident #1 through Resident #7 (R-1 through R-7). LPA also conducted a facility tour. LPA collected documents relevant to this investigation. Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Staff do not open door for residents to enter facility. During this investigation , LPA interviewed Staff #1 through Staff #4 (S-1 through S-4) and interviewed Resident #1 through Resident #7 (R-1 through R-7). Staff interviews revealed that staff open the front door for residents and visitors. Staff interviews revealed that the front door is equipped with a camera/doorbell which is connected to the staff tablet. Per staff interviews, the tablet receives alerts when there is someone at the front door and it is also connected to the doorbell. Staff interviews revealed that at times there are some residents around the entrance "beat" the staff in opening the door. Staff indicated they have not received any complaints/concerns in regards to the staff not opening doors for residents. Resident interviews revealed that staff open the door promptly. Resident interviews revealed that they have not heard anyone complain about the staff not opening the door. During this visit, LPA observed staff opening the front door promptly, observed a sign on the door stating "NOTICE PLEASE RING BELL FOR SERVICE" and LPA reviewed the live feed of the front door and tested the doorbell and the notification to the staff tablet. Staff and resident interviews also revealed that the Assistant Manager is present at this facility and has "banking hours" posted to receive payments and provide money to residents that have this facility handle their monies. Per Assistant Administrator, there has not been any eviction notices given to any resident. Staff, resident and observation does not corroborate this allegation. Allegation: Staff do not give resident hot water for coffee. During this investigation , LPA interviewed Staff #1 through Staff #4 (S-1 through S-4) and interviewed Resident #1 through Resident #7 (R-1 through R-7). Staff interviews revealed that staff provide residents with hot water. Per Staff interviews, the coffee machine dispenses coffee, hot water and luke temperature water. Resident interviews revealed that staff provide hot water for tea or coffee. Staff nor residents have heard anyone complaining about staff not providing hot water for coffee. Staff and resident interviews do not corroborate this allegation. Although the allegations 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 allegations are unsubstantiated Exit interview was conducted and a copy of this report and appeal rights were provided to Dennise Torres.the state’s words, verbatim · CDSS document, Oct 20, 2022 · control 28-AS-20221013112249

Allegation investigated: Licensee did not report change of condition to responsible party Staff verbally abused resident Licensee did not accommodate resident's privacy during telephone call

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced subsequent visit regarding the above stated allegations. LPA met with Dennise Torres and explained the reason for the visit. Initial visit on 12/8/20 consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA collected documents from Resident #1 (R1) file. LPA interviewed Staff #1-#2 (S1-S2). On todays visit, LPA interviewed Staff #3-#5 (S3-S5) and residents #2-#12 (R2-R12). R1 is no longer in the facility and was unable to be interviewed. The investigation revealed the following: In regards to the allegation "Licensee did not report change of condition to responsible party", it is alleged that R1 had a fall and was later hospitalized, but the facility did not report to R1's responsible party. (5) of (5) staff interviewed denied the allegation. (11) of (11) residents interviewed could not corroborate the allegation. Unsubstantiated Interviews show that R1 was taken to the hospital in November 2020 and did not return to the facility. According to interviews, the last update was that the resident was transferred to a skilled nursing facility. Interviews do not show that R1 had a witnessed fall or that R1 went to the hospital because of a fall. Review of incident reports shows that R1 was taken to the hospital on 11/27/20 for weakness and confusion. Documents do not show R1 had a fall in the facility. Review of documents does not show that R1 has a responsible party on file as they are self responsible. Based on interviews and file review conducted, there was not enough supportive evidence to concur with the reported allegation. 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. In regards to the allegation "Staff verbally abused resident", it is alleged that S3 yelled at R1 while R1 was on the phone. (5) of (5) staff interviewed denied the allegation. (11) of (11) Residents interviewed could not corroborate the allegation. Interviews do not show that S3 yelled at R1. LPA was not provided with a date on when alleged incident would have occurred. LPA was unable to interview R1 to verify information. Based on interviews conducted, there was not enough supportive evidence to concur with the reported allegation. 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. In regards to the allegation "Licensee did not accommodate resident's privacy during telephone call ", it is alleged that S3 and S4 did not allow R1 privacy while R1 used the phone and took R1's phone away. (5) of (5) staff interviewed denied the allegation. (11) of (11) residents interviewed could not corroborate the allegation. Interviews do not show that staff invaded R1's privacy on the phone. S4 denies ever taking R1's phone. LPA was not provided with a date on when alleged incident would have occurred or further information. LPA was unable to interview R1 to verify information. Based on interviews conducted, there was not enough supportive evidence to concur with the reported allegation. 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 and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 6, 2022 · control 28-AS-20201203083044

Allegation investigated: Staff speaks inappropriately to resident in care

This report is amended to remove confidential information. There is no change to findings and supporting evidence. LIC9099s delivered on 10/28/22 is a duplicate. LPA Trueman delivered amended report on 4/11/23 and obtained signatures. Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Administrator Dennise Torres and explained the reason for the visit. The purpose of the visit is to investigate the above allegation. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) & Resident #2 (R2) file and obtained copies of FACE Sheet, Physician's Report, and Resident Appraisal. LPA also interviewed Staff #1 - Staff #3 and Resident R #3 - Resident R # 8. Resident # 1 and Resident # 2 refused to be interviewed stating that they gave all information to LPA here on a previous complaint. The investigation revealed the following: in regards to the allegation Staff speaks inappropriately to resident in care. Staff members interviewed denied the allegation. Staff members interviewed indicated that they treat all residents equally and with respect and have not yelled, laughed or called R1 bad names. Staff members interviewed indicated that R1 will make various complaints to licensing and Ombudsman and will call police on many occasions. Unsubstantiated States R 1 has difficulty getting along with staff and residents. Physician's Report dated 04/20/2022 is checked yes for inappropriate behavior. Interviews with residents revealed that 6 of 6 who were interviewed stated that staff are professional and speak appropriately to residents. They have never observed staff laughing, yelling or calling residents bad names. Stated they always treat them nicely. Stated that S1-S3 are nice to them and treat them with respect. 2 of the 6 residents know R 1 and stated that R 1 will complain alot and call on things that have not happened. Stated that police have been called many times and 1x for the air conditioning not working. Stated that R1 was observed going crying into S2's office and S2 helped to calm her and tried to help her. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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.the state’s words, verbatim · CDSS document, Sep 21, 2022 · control 28-AS-20220914084616

Allegation investigated: Staff caused injuries to a resident while in care. Untrained staff. Staff member mismanages residents' medication. Staff failed to provide adequate food service. Staff failed to provide a comfortable environment for residents in care. Staff threatened resident. Staff failed to treat residents with dignity and respect.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced subsequent complaint visit regarding the above stated allegations. LPA met with Dennise Torres and explained the reason for the visit. Investigation consisted of the following: during initial visit conducted on 03/14/22, LPA obtained copies from Resident #1 and Resident #2 files such as Identification and Emergency Information Sheets, Physician Reports, Resident Appraisals, eMAR's for February & March, and Incident Reports. During today's visit LPA toured the facility including the common areas and kitchen and interviewed the Assistant Administrator, Staff #1 - Staff #5 and Resident #1 - Resident #10. The investigation revealed the following: in regards to the allegations "staff caused injuries to a resident while in care" and "untrained staff", it is alleged that on 03/03/22 a facility staff member scratched R1's arms all over while taking her blood pressure. Staff members are allegedly untrained on how to take residents blood pressure. Interviews conducted with staff members denied the allegations. Staff members interviewed indicated some residents are on blood thinners which cause residents to bruise easily. (CONTINUED ON 9099C) Unsubstantiated Staff members interviewed indicated they do not purposely injure or harm residents. Staff members interviewed indicated they received on the job training at the facility and continue to receive ongoing training. Staff members interviewed denied scratching R1's arm while taking their blood pressure. 8 out of 10 residents interviewed indicated staff have not hurt or injured them while receiving assistance from staff. LPA reviewed random sample of staff training on file and observed staff training to be up to date. Therefore there was insufficient evidence to corroborate with these allegations. In regards to the allegation "staff member mismanages residents' medication", it is alleged that staff members make errors while passing out medication. No other details available. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated they ensure they are passing out the correct medication to the residents by double checking the medication and asking the resident for their name before passing out the medication. Staff members interviewed indicated medications are logged in their computer system and are given to residents as prescribed by their physicians. LPA selected a random selection of resident medications for review and observed medications were at facility, logged properly, and given as prescribed. 8 out 10 residents interviewed indicated they have no issues with receiving their medications. Therefore there was insufficient evidence to corroborate with the allegation. In regards to the allegation "staff failed to provide adequate food service", it is alleged that the quality of food at the facility is not good. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated there is a Dietary Supervisor that comes in and ensure meals provided to residents are well balanced. Staff members interviewed indicated they follow the food menu and will provide alternate meals if residents do not want to eat what is being served. LPA toured the kitchen and observed sufficient 2 day supply of perishables and 7 day supply of non-perishables for the number of residents in care. 8 out 10 residents interviewed indicated they are happy with the food service. Therefore there was insufficient evidence to corroborate with the allegation. In regards to the allegation "staff failed to provide a comfortable environment for residents in care", it is alleged that facility staff will wake up residents at 5am to take their temperatures. Interviews conducted with staff members denied the allegation. Staff members interviewed indicated temperature checks are usually done when medications are being passed around. Some residents need to take medication a few hours prior to eating breakfast, and facility staff will check those residents temperatures as they pass their meds. If residents don't need to take early morning medications, staff will check their temperatures when they are eating breakfast in the dining room. Staff indicated they do not wake residents up to check their temperatures. Therefore there was insufficient evidence to corroborate with the allegation. (CONTINUED ON 9099C) In regards to the allegations "staff threatened resident" and "staff failed to treat residents with dignity and respect", it is alleged that staff members are mean and speak inappropriately towards residents. Staff members interviewed denied the allegations. Staff members interviewed indicated they don't threaten the residents or speak to the residents inappropriately. 8 out of 10 residents interviewed indicated they are happy with staff and they don't feel threatened or disrespected by staff. Therefore there was insufficient evidence to corroborate with the allegations. Based on statements and interviews conducted with staff, residents, review of resident 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 allegation are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 18, 2022 · control 28-AS-20220311155840

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with staff Leslie Rivas. Assistant Administrator Dennise Torres arrived shortly after. LPA explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and the plan has been approved. The facility cares for elderly residents and is allowed to have 20 hospice residents. LPA and Administrator toured the facility which included a random sample of resident rooms along with the kitchen, dining room, both laundry rooms, storage room, and large/movie room. The patio area is well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. The common areas are clean and have the required furniture. There is a screening station at the entrance of the facility. Staff conducted a routine symptom screening of LPA at the time of entrance and have a sign-in policy as required per COVID-19 procedures. Randomly chosen resident bedrooms were toured. Each bedroom has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms. The hot water was between 106.6 - 113.7 degrees which is within the required 105 - 120 degrees. Cleaning supplies were observed inaccessible to residents. The kitchen was inspected. There is sufficient perishable and non-perishable food. All the appliances are clean and seem to be operating properly. Smoke detectors and carbon monoxide detector were working properly, fire extinguishers were fully charged and operational. LPAs observed the centrally stored medication area to be locked and inaccessible to clients. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. Continue 809C LPA reviewed 6 resident records to confirm emergency contact is updated, physician's reports are on file, and admission agreements are complete. Five staff records were reviewed to confirm health screenings, training and fingerprint clearances. LPA reviewed 3 residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 2, 2022

Allegation investigated: Staff do not treat residents with dignity and respect.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Dennise Torres and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) & Resident #2 (R2) file and obtained copies of FACE Sheet, Physician's Report, and Resident Appraisal. LPA also interviewed Staff #1 - Staff #4 and Resident #1 - Resident #10. The investigation revealed the following: in regards to the allegation "staff do not treat residents with dignity and respect", it is alleged that facility staff laugh and are rude to the residents. Facility staff allegedly will also slam doors. Staff members interviewed denied the allegation. Staff members interviewed indicated that they treat all residents equally and with respect. Staff members interviewed indicated that they do not slam doors or make fun of residents. Staff members interviewed indicated resident bedroom doors will make a loud noise if not closed carefully and slowly due to their weight and size. (CONTINUED ON 9099C) Unsubstantiated 8 out of 10 residents interviewed denied the allegation. 8 out of 10 residents interviewed indicated facility staff treat them with respect and dignity. 8 out of 10 residents interviewed indicated that they are happy with their interactions and the services they receive from facility staff. LPA did not observe any staff members slamming doors during today's visit. Therefore there was insufficient evidence to corroborate with the allegation. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 11, 2022 · control 28-AS-20220502154528

Allegation investigated: Staff pushed resident. Staff made inappropriate comments towards resident. Staff did not provide transportation for resident. Staff did not safeguard residents personal belongings. Staff are not providing resident with their mail.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Assistant Administrator Dennise Torres and explained the reason for the visit. The investigation consisted of the following: LPA requested copies of Resident & Staff Rosters and conducted a tour of facility and common areas. LPA reviewed files for Resident #1 (R1) - Resident #2 (R2) and requested copies of the following documents: Identification and Emergency Information Sheets, Physician Reports, Resident Personal Property and Valuables Sheet, Resident Appraisals, Transportation Log for March, and Incident Reports for the months of February & March. LPA also interviewed Resident #1 - Resident #10 and Staff #1 - Staff #4. The investigation revealed the following: in regards to the allegation "staff pushed resident", it is alleged that a facility staff member pushed R1 without R1 suffering any injuries. Specific details of the alleged incident were not provided. Interview conducted with 4 of 4 staff members all denied the allegation. (CONTINUED ON 9099C) Unsubstantiated Staff members interviewed indicated that they have never pushed any resident nor have they observed any other staff member push any of the residents. 8 out of 10 residents interviewed also denied the allegation. 8 out of 10 residents interviewed indicated that facility staff treat them with dignity and they feel safe at the facility and residents interviewed indicated they have never observed staff members push any of the residents. Therefore there was insufficient evidence to corroborate with the allegation. In regards to the allegation "staff made inappropriate comments towards resident", it is alleged that facility staff are mean and make inappropriate comments such as calling residents "unbalanced and crazy". Interviews conducted with 4 out of 4 staff members all denied the allegation. Staff members interviewed indicated they have not made inappropriate comments towards residents. 8 out of 10 residents interviewed denied the allegation. 8 out of 10 residents interviewed indicated facility staff treat them with respect and have not made inappropriate comments towards them. Therefore there was insufficient evidence to corroborate with the allegation. In regards to the allegation "staff did not provide transportation for resident", it is alleged that facility staff keep cancelling R1 rides to doctor's appointments. Interviews conducted with 4 of 4 staff members denied this allegation. Staff members interviewed indicated that they have not canceled any resident transportation appointments. Facility staff usually assist residents with arranging transportation services via their medical providers, however facility staff will also arrange Uber/Lyft transportation if necessary. R1 confirmed that she arranges her own transportation to medical appointments and does not require assistance from facility staff. 8 out of 10 residents interviewed indicated facility staff assist them with arranging transportation services to their medical appointments. LPA obtained a copy of Resident Appointments that the facility keeps on file which documents the transportation services that have been arranged by facility staff for resident appointments. Therefore there was insufficient evidence to corroborate with this allegation. In regards to the allegations "staff did not safeguard residents personal belongings" and "staff are not providing resident with their mail", it is alleged that R1 and R2 are not getting their mail and that it is being returned to sender. It is also alleged that facility lost R2 phone bill. Interviews conducted with 4 out of 4 staff members revealed that facility staff distribute the mail to residents the same day received and that there have been no issues or complaints brought to their attention regarding mail. 8 out of 10 residents interviewed indicated that they do not have any issues with receiving mail at the facility. R2 also confirmed during interview that she did receive her phone bill from facility. Therefore there was insufficient evidence to corroborate with this allegation. Based on statements and interviews conducted with staff, residents, review of resident 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, Mar 29, 2022 · control 28-AS-20220321100914

Allegation investigated: Facility failed to meet resident's medical needs Facility is falsifying resident's documents

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Assistant Administrator, Dennise Torres who assisted with today's visit. Regarding the allegation that (1) Facility failed to meet resident #1's medical needs and (2) Facility is falsifying resident #1's documents, the investigation consisted of the following: Interviews with Assistant Administrator and Staff #1, Interviews with Resident #1 - Resident #9, and review of specific documents from Resident #1's file. Facility staff interviewed stated that they do not refuse any medical personnel from coming to see any of the residents. Staff denied that they have refused any medical personnel from coming to see Resident #1. Staff interviewed stated that they assist residents with their medical needs. Staff denied that they have falsified any residents documents. Residents interviewed were unable to corroborate the allegations. They stated that the facility does assist them with their medical needs. Residents interviewed stated that the facility does allow medical personnel to see residents in the facility. Residents interviewed stated that the facility is not falsifying their documents to their knowledge. Unsubstantiated 8 out of 9 residents stated that the facility does assist them with their medical needs. 9 out of 9 residents stated that facility is not falsifying their documents. Based on LPA's observations and interviews, investigation revealed: 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. No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Assistant Administrator, Dennise Torres.the state’s words, verbatim · CDSS document, Mar 7, 2022 · control 28-AS-20220228145210

Allegation investigated: Staff refuses to schedule transportation services for residents' medical appointments.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Assistant Administrator Dennise Torres and Administrator Samuel Deutsch and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) & Resident #2 (R2) file and obtained copies of FACE Sheet, Physician's Report, and Resident Appraisal. LPA interviewed Administrator, Assistant Administrator, Staff #1 (S1) - Staff #3 (S3) and Resident #1 (R1) - Resident #9 (R9). The investigation revealed the following: in regards to the allegation "staff refuses to schedule transportation services for residents' medical appointments", it is alleged that facility staff are canceling R1 and R2 medical transportation appointments and staff refuse to help residents schedule any other type of transportation. (CONTINUED ON 9099C) Unsubstantiated R1 and R2 both confirmed that they arrange their own transportation to medical appointments and do not require assistance from facility staff. 7 out of 9 residents interviewed indicated facility staff will assist them with scheduling transportation to their medical appointments. 7 out of 9 residents interviewed indicated facility staff have not canceled their transportation to their medical appointments. All staff members interviewed indicated that they have not canceled transportation for residents. Residents will usually use their insurance transportation services for their medical appointments, but facility will also arrange Uber/Lyft transportation for residents if needed. LPA reviewed a "Transportation Log" that the facility keeps on file which documents arrangements of transportation services that facility staff have assisted residents with. Assistant Administrator also provided LPA with Uber Invoice dated 12/16/21 indicating that transportation was arranged for R1's most recent medical appointment after the insurance transportation service failed to show up. R1 confirmed this as being accurate. Therefore there was insufficient evidence to corroborate with the allegation. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 22, 2021 · control 28-AS-20211214161817

Allegation investigated: Facility staff made inappropriate comments to residents in care.

Licensing Program Analyst (LPA) David Sicairos conducted an initial complaint investigation regarding the allegation listed above. LPA met with Assistant Administrator Dennise Torres and explained the reason for the visit. The investigation revealed the following: LPA obtained copies of Resident & Staff Rosters and interviewed the Assistant Administrator, Resident #1 - Resident #10, and Staff #1 - Staff #4. The investigation revealed the following: in regards to the allegation "facility staff made inappropriate comments to residents in care", it is alleged that facility staff are telling residents not to leave the facility so often and not to bring the virus in. There were no witnesses to this allegation. Interviews conducted with staff members all denied this allegation. Interviews conducted with staff members revealed that they treat all residents with dignity and respect. Interviews conducted with staff members revealed residents are free to come and go from the facility. Residents are screened upon their return to the facility. Facility staff request residents wash their hands and/or use hand sanitizer upon return from the community. (CONTINUED ON 9099C) Unsubstantiated LPA observed a group of residents going into the community during the visit.8 out 10 residents interviewed denied this allegation. 8 out 10 residents interviewed indicated that staff members treat them with respect and dignity. 8 out 10 residents interviewed denied staff make inappropriate comments towards them. 8 out 10 residents interviewed indicated that they are free to come and go from the facility as they please. Residents confirmed they are screened upon return to the facility. Therefore there was insufficient evidence to corroborate with this allegation. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 7, 2021 · control 28-AS-20211130132816

Allegation investigated: Staff did not administer resident's medication as prescribed. Staff spoke to resident inappropriately.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above allegations. LPA met with Med-Tech Lilian Centeno and explained the reason for the visit. Assistant Administrator Dennise Torres arrived shortly thereafter. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) file and obtained copies of FACE Sheet, Physician's Report, and Resident Appraisal. LPA interviewed Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #10 (R10). LPA also reviewed a random sample of resident medications during today's visit. The investigation revealed the following: in regards to the allegation "staff did not administer resident's medication as prescribed", it is alleged that on 10/11/21 a staff member provided a resident with the incorrect medication. Details of the medication error were not provided. Medication error allegation was previously investigated on 10/12/21 and was found to be Unsubstantiated. (CONTINUED ON 9099C) Unsubstantiated 9 out of 10 residents interviewed indicated that they receive their medications as prescribed. Residents interviewed indicated that the facility always has a sufficient supply of their medications available to them. Interviews conducted with staff members denied giving R1 the incorrect medication. Staff members interviewed indicated that they provide residents with their medications as prescribed following doctors orders. Staff members interviewed indicated that they check resident medications to ensure it is correct before it is given to the residents. LPA reviewed a random sample of 6 resident medications and observed medications to be documented properly and given as prescribed. Facility provides ongoing medication training to their medication technicians on an ongoing basis and most recently completed training on 08/26/21. Therefore there was insufficient evidence to corroborate with this allegation. In regards to the allegation "staff spoke to resident inappropriately" it is alleged that on 10/12/21 a staff member told one of the residents "you should be grateful that you got your half tablet". No other details were provided. 9 out of 10 residents interviewed indicated that facility staff have not spoken to them inappropriately. Residents indicated that facility staff treat them with dignity and respect. Interviews conducted with staff members all denied this allegation. Staff members interviewed indicated that they treat all residents with dignity and respect and do not make inappropriate comments towards residents. Staff members interviewed also indicated that they have not observed other staff members speak to residents inappropriately. Therefore there was insufficient evidence to corroborate with this allegation. Based on statements and interviews conducted with staff, residents, review of resident 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 allegation are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 26, 2021 · control 28-AS-20211018104517

Allegation investigated: Staff interferes with resident receiving mail.

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit regarding the above allegation. LPA met with Assistant Administrator Denise Torres and explained the reason for the visit. The investigation consisted of the following: LPA obtained a resident and staff roster. LPA interviewed Resident #1 (R1) - Resident #8 (R8) and Staff #1 (S1) - Staff #3 (S3). The investigation revealed the following: it's alleged that Resident #1's (R1) is not receiving mail and it is being returned from the facility. Interviews conducted with residents revealed that 9 out of 10 do not have any issues with receiving mail. R1 stated the mail is being delivered to her, but it is delivered late. Interviews conducted with staff revealed that they distribute the mail to residents the same day received and that there has been no issues or complaints brought to their attention regarding mail. (CONTINUED TO LIC 9099C) Unsubstantiated Based on statements and interviews conducted with staff and review of staff training 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 was held with Assistant Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 28-AS-20211004094822

Allegation investigated: Staff mismanaged resident's medication.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above allegation. LPA met with Assistant Administrator Dennise Torres and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) file and obtained copies of FACE Sheet, Physician's Report, and Resident Appraisal. LPA interviewed Staff #1 (S1) - Staff #2 (S2) and Resident #1 (R1) - Resident #10 (R10). LPA also reviewed a random sample of resident medications during today's visit. The investigation revealed the following: in regards to the allegation "staff mismanaged resident's medication", it is alleged that facility staff members gave R1 the wrong medication. R1 is unable to recall the name of the medication or the day of the alleged incident. 9 out of 10 residents interviewed indicated that they receive their correct medications as prescribed. Residents interviewed indicated that facility has their prescribed medication available to them at all times. (CONTINUED ON 9099C) Unsubstantiated Interviews conducted with staff members denied giving R1 the incorrect medication. Staff members interviewed indicated that they provide residents with their medications as prescribed based on doctors orders. LPA reviewed a random sample of 5 resident medications and observed medications to be documented properly and given as prescribed. S1 and S2 receive ongoing medication training and most recently completed 8 hours of Med Aide Certification training on 08/26/21. Therefore there was insufficient evidence to corroborate with the allegation. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 28-AS-20211007160645

Allegation investigated: Staff denied resident food. Staff did not give resident medication in a timely manner. Staff speaks rudely to residents. Facility has roaches.

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to this facility. The purpose of the visit was to gather information regarding the allegations and to complete the investigation. LPA met with Dennise Torres (Administrator) and explained the reason for the visit. During the initial visit on 01/16/20, LPA obtained/reviewed a copy of the Staff/Resident roster, Medications administration log for all Resident who are prescribed evening medications and pest control service record, interviewed Staff #1 in the office at 11:23 am, toured the facility (including the kitchen and laundry rooms) with Staff #1 at 11:46 am, interviewed Resident #1 through #11 between 1:23 pm to 3:19 pm in the office. During today's visit, LPA obtained a copy of the Staff/Resident Roster, toured the facility with Staff #1 at 10:20 am and interviewed Staff #2 to #11 in the office from 10:35 am to 11:20 am. Continue to LIC9099C......... Unsubstantiated In regards to the allegation: Staff denied resident food. LPA interviewed 11 of 11 Residents who indicated they were not denied food. Interviews with 11 of 11 Staff indicate that they did not denied Resident food nor do they know of any Residents being denied food. In regards to the allegation: Staff did not give resident medication in a timely manner. LPA interviewed 11 of 11 Residents who indicated they receive their medications on time. Interviews with 11 of 11 Staff indicate that they don't know of any Residents who were not given their medications on time. Review of medication logs indicate that administration of medications are properly documented. In regards to the allegation: Staff speaks rudely to residents. Interviews with 11 of 11 Residents indicate they have not been spoken to rudely by Staff. Interviews with 11 of 11 Staff indicate they have never spoken to Residents rudely nor have they witnessed other Staff speak to Residents rudely. In regards to the allegation: Facility has roaches. LPA toured the facility during the initial complaint visit and during the subsequent complaint visit and did not observe cockroaches in the facility. Review of pest control documents indicate facility is receiving pest control services on a regular basis. Interviews with 11 of 11 Resident indicate there are no cockroaches in the facility and interviews with 11 of 11 Staff indicate there are no cockroaches in the facility. Based on LPA's observations, record review and interviews, 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 Dennise Torres and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 11, 2021 · control 28-AS-20200113091619

Allegation investigated: Staff handled resident in a rough manner

Licensing Program Analysts (LPAs) Angelica Rea and Jewel Baptiste conducted an unannounced complaint visit in response to the above allegation. LPA met with Assistant Administrator, Dennise Torres who assisted with today's visit. Regarding the allegation that Staff handled resident in a rough manner, the investigation consisted of interviews with Assistant Administrator, Staff #1 - #3, and interviews with Residents #1 - #10. Assistant Administrator and Staff interviewed denied the allegation. They stated that they have not observed any staff handle residents in a rough manner. Staff indicated that they have been trained on how to treat the residents. Staff stated if they observed any staff treat residents in a rough manner, they would report it immediately. Residents interviewed were unable to corroborate the allegation. 10 out of 10 residents stated that they have not observed staff handle resident(s) in a rough manner. Residents stated that staff treat them well. Unsubstantiated Based on LPA's observations and interviews, investigation revealed: 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. No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Assistant Administrator, Dennise Torres.the state’s words, verbatim · CDSS document, Sep 1, 2021 · control 28-AS-20210826112627

Allegation investigated: Facility staff speak inappropriately to resident. Facility staff are not assisting resident with transportation to medical appointments.

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Med-Tech Lilly Centeno and explained the reason for the visit. Assistant Administrator Dennise Torres arrived shortly thereafter. The investigation consisted of the following: during today's visit, LPA obtained copies of Resident & Staff Rosters. LPA also reviewed Resident #1 (R1) file and obtained copies of Physician's Report, FACE Sheet, and Needs & Services Appraisal. LPA also conducted interviews with Resident #1 - Resident #11, and Staff #1 - Staff #4. The investigation revealed the following: in regards to the allegation "facility staff speak inappropriately to resident", it is alleged that facility staff "criticize" R1. LPA attempted to obtain additional information from R1, however R1 refused to provide any information. (CONTINUED ON 9099C) Unsubstantiated Interviews conducted with residents revealed that facility staff members treat them with respect and dignity. Residents interviewed revealed that facility staff do not speak to them inappropriately. Interviews with staff members revealed that they do not speak inappropriately to any of the residents. Therefore there was insufficient evidence to corroborate with this allegation. In regards to the allegation "facility staff are not assisting resident with transportation to medical appointments", it is alleged that facility staff canceled R1's rides to her doctors appointments. LPA attempted to obtain additional information from R1, however R1 refused to provide any information. Interviews conducted with facility staff revealed that R1 schedules her own transportation to her doctors appointments. Residents will usually use insurance transportation services for their medical appointments, but if residents miss their transportation facility will arrange transportation services for residents via Uber/Lyft for residents at no extra cost. Assistant Administrator provided Uber receipt dated 08/19/21 for R1 showing transportation services to R1's medical appointment. Interviews conducted with staff members revealed that they have not canceled transportation services for any residents and will assist residents with arrangement of transportation services to medical appointments as needed. Interviews conducted with residents revealed that facility staff will assist them with arranging transportation to medical appointments. LPA also observed facility keeps a "Transportation Log" for the residents who have received assistance from the facility with transportation services to their medical appointments. Therefore there was insufficient evidence to corroborate with this allegation. Based on statements and interviews conducted with staff, residents, review of resident 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 27, 2021 · control 28-AS-20210820151018

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) David Sicairos and Luis Mora conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPAs met with Med-Tech Lilly Centeno and explained the reason for the visit. Assistant Administrator Dennise Torres arrived shortly thereafter. Physical Plant was toured, sample record of medications were reviewed, and food supply was inspected. The following were observed/inspected: LPAs and Assistant Administrator toured the facility which included a random sample of resident rooms along with the kitchen, dining room, both laundry rooms, storage room, and large/movie room. The patio area is well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. The water temperature was tested in a random selection of resident bathrooms and measured between 112.1F - 119F. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and the linen is in good condition. Smoke detectors were observed throughout the facility and were tested and operable during the visit. There is several carbon monoxide detectors throughout the hallways of the facility. There are several fire extinguisher located throughout the facility. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the kitchen and are inaccessible to residents. Cleaning supplies and toxins are locked in a storage room and are inaccessible to residents. First Aid kit was fully stocked with current manual. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. (10) resident medications were reviewed at random. Medications are documented properly and given as prescribed. Staff and Resident files were not reviewed during today's visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 16, 2021

Allegation investigated: Staff is putting a foreign substance in resident's bed. Facility is not maintaining an odor free environment. Resident has had items from her room stolen. Resident sustained a fracture. Resident medications are mixed with something foreign.

*This is an amended version of the report dated 06/08/21. The reason for amendment is the initial report contained confidential information that has now been removed. No other changes have been made to the report.* Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above allegations. LPA met with Assistant Administrator Dennise Torres and explained the reason for the visit. The investigation consisted of the following: during the initial televisit conducted on 03/23/21, LPA interviewed Assistant Administrator and Staff #1 (S1) - Staff #3 (S3). LPA also requested copies of resident & staff rosters and documents from Resident #1's file. During today's visit, LPA once again interviewed S1 - S3 and additionally interviewed Staff #4 - Staff #5 and Resident #1 - Resident #9. The investigation revealed the following: in regards to the allegation "staff is putting a foreign substance in resident's bed", it is alleged that staff spray something on R1's bed which is a thin glass that sticks to her skin and hurts. During today's visit, LPA toured R1's bedroom and did not observe any foreign substance on R1's bed. (CONTINUED ON 9099C) Unsubstantiated Interviews conducted with staff members revealed that they do not spray any foreign substance on R1's bed. Interviews conducted with residents revealed that facility staff does not spray their beds with any type of foreign substance. Therefore there was insufficient evidence to corroborate this allegation. In regards to the allegation "facility is not maintaining an odor free environment", it is alleged that R1's roommate puts her dirty diapers in the garbage can and the room smells bad. During today's visit, LPA toured R1's bedroom and a random sample of resident bedrooms and did not smell a bad odor coming from any of the rooms. R1 does not currently have a roommate. Interviews conducted with staff members revealed that staff is required to place dirty diapers in a sealed plastic bag and remove the diaper from residents rooms. Trash cans located in resident bedrooms are also cleaned out daily. Interviews conducted with residents revealed that facility is odor free. Therefore there was insufficient evidence to corroborate with this allegation. In regards to the allegation "resident has had items from her room stolen", it is alleged that R1 sleeps during the day and people come in and steal her things. It is unknown if it is staff or residents who steal R1's belongings. LPA obtained a copy of R1's Resident Personal Property and Valuables Inventory List. During tour of R1's bedroom, LPA observed R1 has a locked cabinet in her bedroom to which she has they key for. Interviews conducted with staff members revealed that they do not steal from any of the residents. Interviews conducted with residents R2 - R9 have not had any items stolen from their room. Therefore there was insufficient evidence to corroborate with this allegation. In regards to the allegation "resident sustained a fracture", it is alleged that R1 has tripped on the facility sprinklers and has been injured, the last time she broke some ribs. Per interview with Assistant Administrator, it was revealed that on 02/02/21 R1 was hospitalized due to chest pain from an alleged unwitnessed fall she had suffered about 3 or 4 months prior. R1 was transported to Queen of The Valley Hospital were she was diagnosed with a fractured rib. Prior to this hospitalization, facility was unaware of the fall as R1 had not informed staff. Facility staff did not observe this fall. Based on information available, facility took the proper steps by calling 911 immediately and notified R1's Conservator and Primary Care Physician of the incident once facility was aware of the incident. Therefore there was insufficient evidence to corroborate with this allegation. (CONTINUED ON 9099C) In regards to the allegation "resident medications are mixed with something foreign", it is alleged that R1's medications are mixed with something foreign. No other details provided. LPA reviewed a random sample of resident medications and observed that medications are documented properly and given as prescribed. LPA also observed medications to be placed in their original packaging/containers. Interviews conducted with staff members revealed that resident medications are not mixed with anything foreign. Interviews conducted with residents revealed that they receive their medications as prescribed. Therefore there was insufficient evidence to corroborate with this allegation. Based on statements and interviews conducted with staff, residents, review of resident 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, Jun 8, 2021 · control 28-AS-20210315135219