Henrietta's Leven Oaks

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced annual inspection visit. LPA met with the Administrator, Claudia Sanchez and the purpose of the visit was explained. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an updated Infection Control Plan in place. Operational Requirements: A hospice waiver for 15 residents has been approved. A fire clearance for 48 ambulatory, 32 non-ambulatory, of which 7 may be bedridden is in place. A hospice and Dementia waiver is in place. LPA observed the valid Surety Bond in place. LPA observed the Valid Liability Insurance in place. Fire and disaster drills were last conducted on 04/22/2026. Physical Plant/Environment Safety: The facility consists of 48 resident rooms in a two-story main building and two (2) detached buildings, activity room, dining room, laundry area, two (2) courtyard patio areas, and one 2nd floor balcony. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The fireplace is closed and inaccessible to residents. The facility has fully charged fire extinguishers that were last inspected on 11/14/2025. The Carbon Monoxide Detectors were tested and is operational. [Continue to LIC809-C] Physical Plant/Environment Safety [Cont.]: LPA inspected eight (8) residents' rooms and each resident bedroom has the required furniture such as the bed, bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. The outdoor area has a shaded area for activity purposes. Resident beds have the required linen, and the linen is in good condition. The bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, skid mat/strips and shower chair. LPA tested hot water temperature in eight (8) random resident rooms (Rooms: 6, 8, 10, 12, 14, 17, 26, and 32) in the 1st and 2nd floors. Water temperature readings measured between 105.2 degrees F - 127.7 degrees F, which is not within the required temperature 105 to 120 degrees F. Stairwell evacuation chairs were observed. Staffing: There are sufficient staff members to provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and are associated to the facility. Personnel Records/Staff Training: LPA reviewed six (6) staff files which include: Personnel Record, health screening, TB test results, Employee Rights, valid First Aid/CPR/AED Training, ongoing staff and Dementia training. The administrator’s certificate is valid and expires on 04/25/2028. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted in the 1st floor. Facility provides internet services to all residents and they have access to the facility phone. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted. Food Service: Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept clean and stored properly. Sufficient food supply is stored in the kitchen and pantry areas consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Per Administrator, there are Four (4) residents on modified diets. Physician orders are on file and special diet lists are kept in the kitchen area. [Continue to LIC809-C] Incident Medical and Dental: LPA reviewed five (5) centrally stored resident medications which contain a 30-day supply of medications. Medical and dental transportation is provided. Based on Record Review, LPA observed and confirmed with the Administrator that Resident #1 (R1) is missing the following medications: Atorvastatin, Aripiprazole, Levofloxacin, Ferrous Sulfate, Ciclopirox, Ammonium Lactate, Selenium Sulfide, Nystatin, and Diclofenac Sodium. Based on Record Review, LPA observed that per Resident #2 (R2’s) physician’s report dated 2/6/2026, R2 is unable to administer their own medications and unable to administer their own injections. R2 requires injections for diabetes. Additionally, per Administrator interview, the facility has no skilled medical professional to administer injections. Resident Records/Incident Reports: LPA reviewed five (5) resident files that include the face sheet, Identification and Emergency Information Form, Admission Agreements, Physician's Reports, Ambulatory Status, TB clearance, Physician's Orders, Preplacement Appraisal, Resident Appraisal, and Personal Rights. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least two (2) relocation sites. Facility maintains documentation of the required emergency drills. The facility has a First Aid Kit with all required items. Residents with Special Health Needs: Per Administrator, there are two (2) residents that receive hospice services and five (5) resident receives home health services. Per Administrator, there are 14 residents have a Dementia diagnosis and are located in the 1st floor. Postural support physician orders are on file. Full bed rails for mobility assistance were observed in some resident rooms and LPA reviewed resident files with bed rail orders. No residents have prohibited health conditions. $ 250.00 Civil Penalty is being issued during today's visit as a result of a repeat violation within a 12-month period ( 87303(e)(2) ). LIC421FC provided to the Administrator during today's visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the Administrator, Claudia Sanchez.the state’s words, verbatim · CDSS document, Jun 15, 2026

Allegation investigated: Staff are financially abusing resident

The purpose of the visit today 5/8/2026 is to issue citation for Personnel Operations which is a better fit to replace the personal rights citation issued 3/26/2026. Initial visit 3/26/26 included the following: Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint investigation for the allegation listed above. LPA met with Administrator Claudia Sanchez, and explained the purpose of the visit. The initial visit was conducted on 3/5/25 and included the following: LPA toured the facility and obtained copies of the Staff and Resident rosters, and Monrovia PD Case # 26-003923 and contact information. File of Staff S1 was reviewed and various documents were submitted. At today's visit Resident's R1-R8, Administrator and Staff S2 were interviewed. In regards to the allegation Staff are financially abusing resident, based on interviews conducted and information gathered Resident R1 stated that regarding the credit card there were charges on the credit card statement. Stated that the Administrator helped with the process and was able to find out that it was Staff S1 who used R1's credit card to purchase equipment. Administrator confirmed that Resident R1 came to her and told of suspicious charges on the credit card statement. Stated she took all the steps to be in compliance. Said Resident R1 called the bank who then gave a report to R1 of where the charge occurred at. Said the report was clear as day that it was Staff S1 Substantiated who purchased items with R1's credit card. Stated S1 did not deny it. Stated then Staff S1 signed separation papers. Staff S2 stated that Resident R1 informed S2 that Staff S1 took money from R1 and it wasn't fair. Stated was in the room when R1 told the Administrator. Document Charge back Reversal Request shows the amount of $173,20 being disputed. It lists delivery to customer address on 12/12/2025. Document Order Summary lists customer name as Staff S1 and that the item was shipped to S1's home address. Document dated 2/25/26 states R1 reported suspicious activity on R1's credit card. Report lists the following information regarding Staff S1- Name, Address, e-mail address, cellphone number, IP address, amount sent, items purchased. Also states that Staff S1 was removed from the work schedule immediately. Based on observation, record review, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D. Exit interview was conducted with Administrative Assistant Claudia Sanchez. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, May 8, 2026 · control 28-AS-20260302114239

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(2) · Plan of correction due date: Mar 27, 2026

Personnel Operations Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement is not met as evidenced by: Based on interviews conducted and information gathered Licensee failed to ensure that R1 was free from physical or verbal abuse, exploitation or prejudice with S1 using R1's credit card which was an Immediate Health and Safety Risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Facility to submit a plan by POC due date which outlines how facility will handle going forward on how to safeguard residents finances. Deficiency cleared 03/26/26.

Allegation investigated: Staff neglect resulted in resident sustaining a fracture

Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent complaint visit in response to the above-mentioned allegation. LPA met with the Administrator, Claudia Sanchez and explained the reason for the visit. On 12/16/2025, the initial investigation visit was conducted. The investigation consisted of the following: LPA requested a copy of staff and resident rosters. LPA conducted a tour of facility and common areas with the Assistant Administrator. LPA also requested copies from Resident#1 (R1’s) file such as the Face Sheet, Physician’s Report, Admissions Agreement, and other pertinent documents. LPA observed the residents to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns. Unsubstantiated During today's visit the investigation revealed the following: in regard to the allegation, “Staff neglect resulted in resident sustaining a fracture.” It is alleged that on 12/01/2025, R1 fell out of bed and sustained a broken right hip. This allegation was investigated by the Investigation Bureau (IB) and was assigned to Investigator Salant. LPA reviewed IB interviews which revealed the following: There is not enough evidence to suggest that the staff members were neglectful or demonstrated lack of care and supervision resulting in R1 falling out of bed. At the time R1 fell out of R1’s bed, there were no specific doctors' orders on file recommending that R1 have a bed with rails or any type of specialized supervision. R1 was known and allowed to ambulate on and off R1’s bed on R1’s own, prior to R1’s fall without assistance. There is not enough sufficient evidence to substantiate. 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 is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was held and a copy of this report was provided to the Administrator, Claudia Sanchez.the state’s words, verbatim · CDSS document, May 7, 2026 · control 28-AS-20251215140448

Allegation investigated: Staff are financially abusing resident

Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint investigation for the allegation listed above. LPA met with Administrator Claudia Sanchez, and explained the purpose of the visit. The initial visit was conducted on 3/5/25 and included the following: LPA toured the facility and obtained copies of the Staff and Resident rosters, and Monrovia PD Case # 26-003923 and contact information. File of Staff S1 was reviewed and various documents were submitted. At today's visit Resident's R1-R8, Administrator and Staff S2 were interviewed. In regards to the allegation Staff are financially abusing resident, based on interviews conducted and information gathered Resident R1 stated that regarding the credit card there were charges on the credit card statement. Stated that the Administrator helped with the process and was able to find out that it was Staff S1 who used R1's credit card to purchase equipment. Administrator confirmed that Resident R1 came to her and told of suspicious charges on the credit card statement. Stated she took all the steps to be in compliance. Said Resident R1 called the bank who then gave a report to R1 of where the charge occurred at. Said the report was clear as day that it was Staff S1 Substantiated who purchased items with R1's credit card. Stated S1 did not deny it. Stated then Staff S1 signed separation papers. Staff S2 stated that Resident R1 informed S2 that Staff S1 took money from R1 and it wasn't fair. Stated was in the room when R1 told the Administrator. Document Chargeback Reversal Request shows the amount of $173,20 being disputed. It lists delivery to customer address on 12/12/2025. Document Order Summary lists customer name as Staff S1 and that the item was shipped to S1's home address. Document dated 2/25/26 states R1 reported suspicious activity on R1's credit card. Report lists the following information regarding Staff S1- Name, Address, e-mail address, cellphone number, IP address, amount sent, items purchased. Also states that Staff S1 was removed from the work schedule immediately. Based on observation, record review, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D. Exit interview was conducted with Administrative Assistant Claudia Sanchez. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 28-AS-20260302114239

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Mar 27, 2026

Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on interviews conducted and information gathered Licensee failed to ensure that R1 was free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature with S1 using R1's credit card which was an Immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Facility to submit a plan by POC due date which outlines how facility will handle going forward on how to safeguard residents finances.

Allegation investigated: Staff is hitting a client Staff yells at a client Staff pulls on a client's hair Staff is mishandling a client's personal funds Staff unlawfully evicted a client Staff mishandled a client's personal belongings of Clients

The purpose of the report is to include additional information not included on the initial report dated 10/10/2025. At today's visit 2/24/2026 Resident's R2- R3 and R5-R6 were interviewed Resident R4 is no longer at the facility as of 2/3/2026. The initial visit was conducted on 10/10/2025 and included the following: Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint visit for the allegations listed above. LPA met with Claudia Sanchez, Administrator and explained the purpose of the visit. At today's visit the Resident and Staff Roster was submitted. Interviews were conducted with Administrator Claudia Sanchez, and Staff S1-S2. Interviews were conducted with Resident's R1-R6. R1 was interviewed telephonically by Spanish Translator LPA Galarza. File for Resident R1 was reviewed. Admission Agreement, Physician's Report and Appraisal Needs and Services were submitted. Unsubstantiated Special Incident Report (SIR) and Record of Resident's Safeguard Cash Resources were submitted. Case Manager for Resident R1 was interviewed telephonically. In regards to the allegations Staff is hitting a client, Staff yells at a client, and Staff pulls on a client's hair based on interviews conducted and information gathered R1 stated that staff are great and they like her. Also stated staff are honorable and trustworthy and have not hit, yelled or pulled her hair. Interview with Case Manager who stated that none of the allegations happened. Stated the Administrator is good with the residents and that R1 has multiple scenarios in her head and vocalizes it and it is not true. Staff S1 and Staff S2 both stated that the allegations are untrue and there is always another staff with the Administrator when interacting with R1. R1-R6 all stated that the allegations didn't happen and that staff are professional. 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. In regards to the allegation Staff is mishandling a client's personal funds, based on interviews conducted and information gathered R1 stated that the Administrator manages her money and that staff are trustworthy. Always gets P and I each month, but not sure of the amount. Interviews were conducted today 2/24/2026 with Resident's R2, R3, R5 and R6 who all stated that the facility has never mishandled their finances. Stated it has always gone smoothly and there has never been a problem. Resident R4 no longer resides at the facility as of 2/3/2026. Case Manager stated that they are working with R1 so she doesn't give away her money and not spend it not knowing where it is going. Said there is always additional staff with the Administrator when money is dispersed. Staff S1-S2 both stated that they have both been witnesses when R1 is receiving money from the Administrator. Said that R1 lends money and forgets. At store she will want to buy too much. She has lent money to another resident and say it is missing having forgotten. Administrator stated that there is a P and I Log here. Said R1 would say money is missing. Stated that with the Case Manager it was decided that R1 will let her know she needs money and she will give to her because she has misplaced before. They make her bring back receipts to track it. Also stated that R1 has a memory issue so they safeguard her money. 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. Resident's R2- R6 stated they had never heard of anyone being threatened with eviction. Staff S1-S2 stated that R1 works with her Case Manager on relocating and there is no eviction from the facility. 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. In regards to the allegation Staff mishandled a client's personal belongings, based on interviews conducted and information gathered R1 stated that another resident gave her jewelry and she didn't want to be accused of stealing so she gave it to the Administrator. Resident's 2-6 all stated that they have never had staff mishandle their personal belongings. Nothing has been stolen or missing. Staff S1-S2 stated that no belongings have been mishandled and anything missing from a resident it has been located and given back. Administrator stated that a former resident gave her belongings to R1 and she had told R1 she was holding it until the family says it is ok to give away. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 28-AS-20251006124649

Allegation investigated: Staff do not safe guard resident's personal belongings.

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced complaint investigation visit regarding above allegations. LPA met with Administrator Claudia Sanchez and explained the reason for the visit. The investigation consisted of the following: LPA requested a copy of resident/staff roster, copies of R1’s identification and emergency information, physician’s report (602), inventory list, special incident report (SIR), and appraisal needs and service plan for resident. SEE LIC 9099C Unsubstantiated In regard to the allegation “Staff do not safeguard resident's personal belongings”. It is alleged that staff went through R1’s personal valuables resulting in R1 having to carry around a satchel. During interviews with Administrator and staff four (4) out of four (4) staff stated that they have never taken a resident belonging or went through their stuff. Administrator stated that R1 was given a lock to place items of value in because he/she stated that electronics had gone missing before. S1 stated that they were told by R1 to go into his/her room to get a can of corn for them and later was accused of going through drawers. During interviews with residents three (3) out of (4) residents stated that they have never had anything missing from their room. R1 stated he/she told S1 to go to their room to get a can of corn at dinner time but later when R1 returned to room drawers looked like someone had gone through them and S1 was the only one who had been in there. R1 stated nothing was missing. Based on interviews conducted and records reviewed, there is insufficient evidence to support the 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. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 16, 2025 · control 28-AS-20251010112505

Allegation investigated: Staff is hitting a client Staff yells at a client Staff pulls on a client's hair Staff is mishandling a client's personal funds Staff unlawfully evicted a client Staff mishandled a client's personal belongings of Clients

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint visit for the allegations listed above. LPA met with Claudia Sanchez, Administrator and explained the purpose of the visit. At today's visit the Resident and Staff Roster was submitted. Interviews were conducted with Administrator Claudia Sanchez, and Staff S1-S2. Interviews were conducted with Resident's R1-R6. R1 was interviewed telephonically by Spanish Translator LPA Galarza. File for Resident R1 was reviewed. Admission Agreement, Physician's Report and Appraisal Needs and Services were submitted. Special Incident Report (SIR) and Record of Resident's Safeguard Cash Resources were submitted. Case Manager for Resident R1 was interviewed telephonically. In regards to the allegations Staff is hitting a client, Staff yells at a client, and Staff pulls on a client's hair based on interviews conducted and information gathered R1 stated that staff are great and they like her. Unsubstantiated Also stated staff are honorable and trustworthy and have not hit, yelled or pulled her hair. Interview with Case Manager who stated that none of the allegations happened. Stated the Administrator is good with the residents and that R1 has multiple scenarios in her head and vocalizes it and it is not true. Staff S1 and Staff S2 both stated that the allegations are untrue and there is always another staff with the Administrator when interacting with R1. R1-R6 all stated that the allegations didn't happen and that staff are professional. 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. In regards to the allegation Staff is mishandling a client's personal funds, based on interviews conducted and information gathered R1 stated that the Administrator manages her money and that staff are trustworthy. Always gets P and I each month, but not sure of the amount. Case Manager stated that they are working with R1 so she doesn't give away her money and not spend it not knowing where it is going. Said there is always additional staff with the Administrator when money is dispersed. Staff S1-S2 both stated that they have both been witnesses when R1 is receiving money from the Administrator. Said that R1 lends money and forgets. At store she will want to buy too much. She has lent money to another resident and say it is missing having forgotten. Administrator stated that there is a P and I Log here. Said R1 would say money is missing. Stated that with the Case Manager it was decided that R1 will let her know she needs money and she will give to her because she has misplaced before. They make her bring back receipts to track it. Also stated that R1 has a memory issue so they safeguard her money. 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. In regards to the allegation Staff unlawfully evicted a client, based on interviews conducted and information gathered R1 stated that the Administrator is not asking her to leave. Said she has told her Case Manager she wants to move out to be with a friend. Case Manager stated that they are working on relocation. Said that there was a meeting regarding relocating and R1, Case manager and Administrator attended the meeting. Stated it is not true about eviction. Administrator stated that R1 is not being evicted and her Case Manager would be the one to relocate her. Resident's R2- R6 stated they had never heard of anyone being threatened with eviction. Staff S1-S2 stated that R1 works with her Case Manager on relocating and there is no eviction from the facility. 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. In regards to the allegation Staff mishandled a client's personal belongings, based on interviews conducted and information gathered R1 stated that another resident gave her jewelry and she didn't want to be accused of stealing so she gave it to the Administrator. Resident's 2-6 all stated that they have never had staff mishandle their personal belongings. Nothing has been stolen or missing. Staff S1-S2 stated that no belongings have been mishandled and anything missing from a resident it has been located and given back. Administrator stated that a former resident gave her belongings to R1 and she had told R1 she was holding it until the family says it is ok to give away. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Oct 10, 2025 · control 28-AS-20251006124649

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced annual inspection visit. LPA met with the Administrator Claudia Sanchez and the purpose of the visit was explained. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has an updated Infection Control Plan in place. Operational Requirements: A hospice waiver for 15 residents has been approved. A fire clearance for 48 ambulatory, 32 non-ambulatory, of which 7 may be bedridden is in place. A hospice and Dementia waiver is in place. LPA observed the valid Surety Bond in place. LPA observed the Valid Liability Insurance in place. Fire and disaster drills were last conducted on 07/15/2025. Physical Plant/Environment Safety: The facility consists of 48 resident rooms in a two-story main building and two (2) detached buildings, activity room, dining room, laundry area, two (2) courtyard patio areas, and one 2nd floor balcony. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The fireplace is closed and inaccessible to residents. The facility has fully charged fire extinguishers. The Carbon Monoxide Detectors were tested and is operational. LPA inspected eight (8) residents' rooms and each resident bedroom has the required furniture such as the bed, 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. Physical Plant/Environment Safety [Cont.]: The bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, skid matt/strips and shower chair. LPA tested hot water temperature in eight (8) random resident rooms (Rooms: 1, 7, 9, 11, 14, 22, 30 and B-1) in the 1st and 2nd floors. Water temperature readings measured between 107.9 degrees F - 121.6 degrees F, which is not within the required temperature 105 to 120 degrees F. Stairwell evacuation chairs were observed. The outdoor area has a shaded area for activity purposes. Staffing: There are sufficient staff members to provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and are associated to the facility. Personnel Records/Staff Training: LPA reviewed six (6) staff files which include: Personnel Record, health screening, TB test results, Employee Rights, valid First Aid / CPR/AED Training, ongoing staff and Dementia training. The administrator’s certificate is valid and expires on 04/25/2026. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted in the 1st floor. Facility provides internet services to all residents and they have access to the facility phone. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted. Food Service: Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept clean and stored properly. Sufficient food supply is stored in the kitchen and pantry areas consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Eight (8) residents are on modified diets. Physician orders are on file and special diet lists are kept in the kitchen area. Incident Medical and Dental: LPA reviewed five (5) centrally stored resident medications which contain a 30-day supply of medications. Medical and dental transportation is provided. There were no issues. Resident Records/Incident Reports: LPA reviewed five (5) resident files that include the face sheet, Identification and Emergency Information Form, Admission Agreements, Physician's Reports, Ambulatory Status, TB clearance, Physician's Orders, Preplacement Appraisal, Resident Appraisal, Centrally Stored Medication Destruction Record, and Personal Rights. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Evacuation chairs are in place. All non-ambulatory residents are on the 1st floor. The facility has a First Aid Kit with all required items. Residents with Special Health Needs: Four (4) residents receive hospice services and six (6) resident receives home health services. 10 residents have a Dementia diagnosis and are located in the 1st floor. Postural support physician orders are on file. Full bed rails for mobility assistance were observed in some resident rooms and LPA reviewed resident files with bed rail orders. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the Administrator, Claudia Sanchezthe state’s words, verbatim · CDSS document, Aug 25, 2025

Allegation investigated: Staff threw away residents personal belongings. Staff are not treating resident with respect.

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced 10-day complaint visit for the above-mentioned allegations. LPA met with Claudia Sanchez, Interim Administrator and explained the purpose of the visit. The investigation consisted of the following: LPA obtained copies of the Resident & Staff Rosters, Staff in-service training about Safeguarding Personal belongings, Personal Rights, Residents Rights and Zero Tolerance Policy and House rules. LPA also obtained copies of Resident #1 (R1) files such as Face Sheet, Physician's Report (02/26/2024), Admission Agreement, Appraisal/Needs and Services Plan (11/25/2024) and Daily log (Nov. 2024). R1 opted out on completing a list of Property and Valuables. At 11am, LPA conducted a tour of the physical plant with focus on R1’s room. LPA also interviewed Administrator, Staff #1 (S1) - Staff #4 (S4), Resident #1 (R1) – Resident #7 (R7) and telephonically interviewed Witness #1 (W1). ***CONTINUED ON LIC9099-C*** Unsubstantiated Allegation: “Staff threw away resident’s personal belongings.” It is alleged that on 11/28/2024, R1 moved in from a different facility and that staff discarded R1’s belongings, including important documents, due to claims of rat droppings. Interviews conducted with the Administrator and (4) staff members denied the allegation. All staff stated that they would never throw away any residents personal belongings without the residents' permission. Staff interviewed also stated that in-service training regarding Safeguarding Personal belongings, Personal Rights, Residents Rights and Zero Tolerance Policy are being conducted to staff members regularly. All staff interviewed stated that there have been no complaints about the disposal of personal belongings have been reported by residents. . Administrator stated that when R1 moved in on 11/28/2024, R1 had many personal items and was asked to consolidate her items due to insufficient space in her room. Administrator stated that R1 sorted out the belongings in the presence of (2) Social workers and another staff member. Administrator stated that R1 gave her consent to discard some items, which W1 confirmed. W1 also indicated that R1 was prepped about the need to downsize before her move to the facility. A total of (7) residents were interviewed, (6) out of (7) residents interviewed indicated that they do not have any issues with their personal belongings being thrown away by staff members. (6) interviewed residents indicated that the facility staff respect their belongings and have never disposed of any of their belongings. Therefore there was insufficient evidence to corroborate with this allegation. Allegation: “Staff are not treating resident with respect.” It is alleged that R1 feels discriminated against by a staff member and continues to feel " uncomfortable and unsafe" at facility and suffers mental distress. Administrator and (4) staff members interviewed stated that they have never heard of or witnessed any staff discriminate against or treat residents unfairly. Administrator mentioned that the facility has a zero tolerance policy regarding such behavior and that personal rights training is being regularly conducted for staff members. Administrator stated that R1 never expressed any issues to her when she interacts with R1. (4) of (4) staff members interviewed stated that they treat residents with dignity and respect. (6) out of (7) residents that were interviewed indicated that staff members treated them with dignity and respect. (6) residents stated that they have good relationships with staff members here and they feel safe and comfortable. Therefore, there was not enough supportive evidence to corroborate 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 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 conducted and a copy of this report was provided to Claudia Sanchez, Interim Administrator.the state’s words, verbatim · CDSS document, Apr 29, 2025 · control 28-AS-20250421082118

Allegation investigated: Facility staff handled resident in a rough manner. Facility staff did not ensure wheelchair was accessible to resident. Facility staff covered resident's mouth with their hand.

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit for the allegations listed above. LPA met with Claudia Sanchez, Interim Administrator and explained the purpose of the visit. The investigation consisted of the following: On 03/27/2025, LPA toured the facility and obtained copies of the staff/resident roster, facility records and Resident #1 (R1) pertinent files that are relevant to the investigation. LPA also interviewed Staff #1-Staff #2 (S1-S2) and Resident #3 (R3) - Resident #6 (R6). Interview with Resident #2 (R2) was unsuccessful due to cognitive abilities. Prior to today's visit, LPA telephonically interviewed Staff #3 (S3) - Staff #4 (S4) and attempted to interview Staff #7 (S7) - Staff #8 (S8) but no response received. During today’s visit, LPA obtained staff & resident rosters and copy of Monrovia PD information (investigated on 03/21/2025). LPA checked Resident #1’s bedroom and interviewed Resident #1 (R1), Resident #7 (R7) and Staff #5 (S5) - Staff #6 (S6). ****REPORT CONTINUED ON LIC 9099-C*** Unsubstantiated The investigation revealed the following: In regards to the allegation: “Facility staff handled resident in a rough manner.” It is alleged that on Wednesday 3/19/25 between 4:30pm and 5pm, a staff "threw R1 on the bed" during a change. It is also alleged that this was not the first time a staff handled R1 in a rough manner. No other details provided including staff names or descriptions. All staff interviewed denied the allegation. LPA interviewed (3) staff members who were scheduled to work during the specified time frame and denied ever treating any resident, including R1, in a rough manner. Interviewed staff stated that throwing a resident onto a bed during care would be considered abuse and emphasized that all residents are treated with dignity and respect. Interviewed staff also stated they receive regular training on residents' rights and abuse prevention, and they have not heard any complaints about rough treatment. S1 indicated that on 03/21/2025, Monrovia PD came to investigate and determined that no further action was necessary. (5) out of (6) residents interviewed stated they are treated well and have no issues or concerns. Interviewed residents stated they have never been touched roughly. LPA’s observations of staff-resident interactions showed no concerns, and no visible bruises were seen on any residents interviewed, including R1. Therefore, there was not enough evidence to support the allegation. In regards to the allegation: “Facility staff did not ensure wheelchair was accessible to resident.” It is alleged that a staff placed R1’s wheelchair "far away from his bed" which caused R1 to fall when he attempted to get out of bed and into his wheelchair. No injuries reported or other details provided including staff names or descriptions. All staff interviewed denied the allegation and stated they always position wheelchairs close to the residents’ beds. Interviewed staff stated they place wheelchairs on the side of their beds to allow safe transfers for residents and ensure they are easily accessible to prevent falls during transfers from bed to wheelchair. Staff also indicated that they receive training on safe transfer techniques and how to assist residents with transfers. (3) out of (6) residents interviewed are wheelchair bound and they denied the allegation. Some residents interviewed stated that their wheelchairs are kept close to their beds for easy access and within a comfortable reach. Additionally, some residents stated that staff always assist them in transferring from bed to wheelchair. Therefore, there was not enough evidence to support the allegation. In regards to the allegation: “Facility staff covered resident's mouth with their hand.” It is alleged that a staff covered R1’s mouth with their hand so that R1 could not breathe. No specific details about the staff member were given, and no injuries were reported. Interviewed staff members denied the allegation, stating they have never covered R1’s or any other residents’ mouth with their hands. Interviewed staff stated that doing so is considered abuse or neglect. Some staff stated they would report such actions to the Administrator immediately if they witnessed them. Staff indicated that covering a resident’s mouth could be dangerous and could lead to choking. (5) out (6) residents interviewed denied the allegation and stated that staff have never placed their hands over their mouths and have not witnessed any staff doing this to other residents. Some residents stated that they feel safe and comfortable in the facility. Therefore, there was not enough evidence to support 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 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 conducted and a copy of this report was provided to Claudia Sanchez, Interim Administrator.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 28-AS-20250321140301

Allegation investigated: Staff does not ensure facility is in good repair. Staff does not provide a safe environment for residents.

Licensing Program Analyst (LPA) Daniel Konishi conducted an subsequent unannounced 10-day complaint visit at the facility and met with Claudia Sanchez, Administrator to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegations. On 02/07/2025, the initial investigation visit was conducted. The investigation consisted of the following: LPA interviewed the Assistant Administrator, Staff #1 (S1) - Staff #4 (S4). LPA also interviewed Resident #1 (R1) – Resident #5 (R5). LPA obtained copies from Resident #1 (R1) to Resident #3 (R3) file such as Physician's Report, Face Sheet, and Special Incident Reports. LPA toured the facility with the Assistant Administrator. LPA also obtained the staff and residents rosters, weekly menu schedule and staff training. On 02/19/2025, LPA conducted phone interviews with Resident #6 (R6) to Resident #8 (R8). During today's visit, LPA obtained the following documents: Staff and Client roster. Substantiated The investigation revealed the following: in regards to the allegation "Staff does not ensure facility is in good repair.” It is alleged that there are mass problems with plumbing with many bathrooms that don’t work and have sufficient heat for water. The Assistant Administrator, three (3) out of four (4) staff denied the allegation. One (1) out of four (4) staff did not know so did not provide an answer to the allegation. Six (6) out of eight (8) residents denied the allegation. LPA checked 9 residents’ bathrooms hot water measured between 105 to 120 Degrees F which is within Title 22 Regulations. However, water temperature in bathroom #5 was measured at 142.1 Degrees F. This deficiency will be addressed on a separate case management report. LPA observed that all 9 bathrooms observed have working toilets. However, the bathroom in Rm#11 had a showerhead that was not working properly with water pressure was insufficient for a resident to take a shower. The bathroom in Rm#29 also was clean and well-kept but had a very foul odor from an unknown source. Based on observations, record review, and interviews conducted with facility staff, and facility residents, there was sufficient supportive evidence to concur with the reported allegation. Allegation: “Staff does not provide a safe environment for residents.” It is alleged that there were workers peeling the previous stuff on the wall creating a mess and endangering the residents to fall. All staff interviewed denied the allegation. Seven (7) out of eight (8) residents denied the allegation. One (1) out of eight (8) residents stated while moving belongings from one room to another, the resident slipped on a pad that was placed by a staff due to a leak which caused the resident to sustain an injury. LPA also observed during the initial visit dated on 2/7/2025, construction workers working on the 2nd floor and noticed tools such as hammers, mallets, drills, vacuum cleaners, wires, and vinyl flooring tiles in the hallway which are potential trip and fall hazards. LPA confirmed that there are residents living in these areas and residents potentially have access to these items. LPA observed workers working inside of the rooms and there is no staff ensuring that the residents are not grabbing or accessing these items. LPA took pictures of all of these tools during the visit dated 2/7/2025. In addition, there are no posters, warning signs or items giving a residents a heads up of the issues of these items in the hallway. Based on observations, record review, and interviews conducted with facility staff, and facility residents, there was sufficient supportive evidence to concur with the reported allegation. Based on LPA's interviews conducted with the residents and staff, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 1 are being cited on the attached LIC 9099D. Exit interview held with the Administrator, Claudia Sanchez, and a copy of this report and appeal rights were provided. During today's visit, LPA obtained the following documents: Staff and Client roster. Allegation: “Staff do not provide adequate food service to residents.” It is alleged that there is a lack of food and nourishment in the facility, and if residents request more food, they don't get it. During today’s visit, LPA interviewed the Administrator and all staff denied the allegation. All staff interviewed indicated that all residents at the facility receive three meals and three snacks per day. All staff interviewed also indicated that facility provides a sufficient amount of food to all of the residents in care. LPA interviewed eight (8) out of eight (8) residents all claim they get enough food from the facility staff and are provided food, snack, or drink when they request it. LPA toured the kitchen and dining area. LPA observed that there is an sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. LPA also received and reviewed the weekly meal schedule which indicate well balanced meals. LPA observed residents eating their meal at the dining hall during lunch time from 12:15pm to 12:45pm. LPA observed eating the following items for lunch during the visit: Grilled chicken, white rice, vegetables, and sweet tea or water. Residents were in a pleasant mood while continuing to eat lunch. Assistant Administrator and all staff interviewed also mentioned that residents are provided alternative meal options, snacks, and sandwiches if residents asks for it. LPA observed no concerns regarding residents not getting enough food from the facility. Therefore, there was insufficient evidence to corroborate with the allegations. Allegation: “Staff do not provide a comfortable temperature for residents.” It is alleged that there is no heat or air conditioner on the whole top floor. All staff interviewed denied the allegation. Six (6) out of eight (8) residents denied the allegation. Two (2) out of eight (8) residents stated that the bedroom was either too hot or too cold. According to the resident interview, one of the residents temporarily moved to the first floor. The other resident has a portable heater which helps manage to keep the bedroom at a warm temperature. During the visit, LPA noticed the facility temperature on the 1st and 2nd floor to be at an appropriate temperature and not at a temperature of concern. Based on staff interview, the Assistant Administrator stated that there have been no current issues with the air conditioner and heater. Assistant Administrator stated that if there were any complaints, the facility maintenance department would be informed and the problem would be resolved. Based on observations, record review, and interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation. Allegation: “Staff does not treat residents with dignity and respect.” It is alleged that the staff harassed a resident multiple times. Interviews conducted with the Assistant Administrator and four (4) out of four (4) staff denied the allegations. Eight (8) out of Eight (8) residents interviewed denied the allegations and stated that they are not harassed by the staff and are satisfied with the services they receive at the facility and stated that staff treat them with dignity and respect. No paperwork observed in the files that showed the staff have been reprimanded for mistreating, harassing, or disrespecting staff. LPA also reviewed staff training on Proper Hygiene Practices, Dignity and Privacy date of training 1/16/2025 and Dementia Residents and Resident Rights date of training 4/24/2024. Based on observations, record review, and interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held with the Administrator, Claudia Sanchez and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 3, 2025 · control 28-AS-20250206090424

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Apr 4, 2025

(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation during the initial visit dated on 2/7/2025, LPA observed construction workers working on the 2nd floor and noticed tools such as hammers, mallets, drills, vacuum cleaners, wires, and vinyl flooring tiles in the hallway which are potential trip and fall hazards which poses an immediate health, safety, or personal rights in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Administrator will ensure to keep indoor passageways clear and free of obstruction and provide a photo of the hallways to the LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 17, 2025

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement is not met as evidenced by: Based on observation, the bathroom in Rm#11 had a showerhead that was not working properly with water pressure was insufficient for a resident to take a shower. The bathroom in Rm#29 also was clean and well-kept but had a very foul odor from an unknown source. This poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Administrator will submit a photo of the showerhead working properly and photo of the clean bathroom in rm#29 to the LPA by the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Daniel Konishi conducted a complaint visit at 3:22pm. During the course of the investigation related to Complaint Control Number: 28-AS-20250206090424, LPA observed that the water temperature in bathroom #5 measured at 142.1 Degrees F on the first floor which is not within Title 22 Regulations Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit are documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided to the Administrator, Claudia Sanchez.the state’s words, verbatim · CDSS document, Apr 3, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Apr 4, 2025

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on observation, LPA measured water temperature in bathroom #5 at 142.1 Degrees F which is not within Title 22 Regulations. This poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Administrator shall immediately adjust water temperature. Licensee to check water temperature at various different times throughout the day and maintain and submit a water temperature log to the LPA for the next 3 days to ensure that hot water temperature falls within 105 degree F and 120 degrees F. Administrator will provide a copy of the log to the LPA once water temperature falls within Title 22 guidelines.

Allegation investigated: Staff does not assist resident to shower. Staff does not maintain resident’s hygiene.

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with staff Madeline Sanchez and the purpose of the visit was discussed. LPA contacted administrator Claudia Sanchez via phone call and informed of the visit. LPA conducted the following on todays visit; LPA toured the physical plant, interviewed Residents #1-#5 (R1-R5), interviewed staff #1-#5 (S1-S5), collected copies of the staff and resident roster, reviewed and collected copies of documents from R'1s file related to the allegations. The investigation revealed the following: In regards to the allegation "Staff does not assist resident to shower" it is alleged that staff are not assisting R1 with showers as needed. (5) of (5) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation... Continued on LIC 9099-C Unsubstantiated Staff interviewed stated that R1 is approached 2-3 times weekly for shower assistance but refuses assistance often. Staff stated R1 has shown to have a favorite staff and would request specific assistance only from them. Interviews showed that due to R1's continued shower refusal, the staff had begun logging the assistance refusal. LPA reviewed the log started on 3/1/25 and shows multiple shower refusals by R1 since then. File review of R1's appraisal shows that R1 only requires assistance to get into a shower but is able to shower themselves. R1 confirmed this via interview. LPA was unable to find evidence that staff refused or neglected to shower R1. Based on interviews, observations, and file review; 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 does not maintain resident’s hygiene." it is alleged that staff do not assist R1 with changing and using the restroom. (5) of (5) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. Staff interviewed stated to provide R1 with clean linen and clothing weekly. Staff stated they will assist R1 with changing when R1 allows staff to assist. Interview with R1 stated they maintain their hygiene themselves and does not need staff assistance to change or use the restroom. LPA observed R1 to be in clean clothing and no odors in their room were observed. Based on interviews, observations, and file review; 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 and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 11, 2025 · control 28-AS-20250304103203

Allegation investigated: Staff does not meet resident’s bathroom needs.

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Madelene Sanchez Med tech and explained the reason for the visit. The investigation consisted of the following: LPA requested a copy of staff/resident rosters. LPA interviewed 5 residents and 5 staff. LPA reviewed 3 resident files and requested copies of physician’s report, pre-appraisal assessment, appraisal, and staff in-service training. The investigation revealed the following: Regarding allegation: Staff does not meet resident’s bathroom needs. It is alleged a resident who requires assistance with all activities of daily living (ADLs) was not assisted in using the restroom resulting in resident having dry feces stuck to the body in more than one occasion. (CONTINUED ON LIC 9099C) Unsubstantiated Interviews conducted with residents revealed staff are assisting residents with ADLs and changing them as needed. Interviews conducted with staff revealed caregivers assist residents with bathroom reminders and changing residents with incontinence at least every two hours or as needed. Per administrator, residents are change every two hours. Staff have been provided training prior to employment and have provided in-service training regarding hygiene practices. Administrator added that they will be implementing a protocol to ensure that there are records regarding care provided to resident #1 (R1). Per document review R1 does require assistance with all ADLs, including toileting. On 1/16/25 Staff In-Service Training was provided on Proper Hygiene Practices. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Madelene Sanchez and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 11, 2025 · control 28-AS-20250306144620

Allegation investigated: Staff are not meeting resident's hygiene needs.

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the above allegation. LPA met with Assistant Administrator, Maggie Sanchez, to explain the purpose for the visit. On 1/16/25, LPA Chan made the initial visit and obtained copies of the staff roster, resident roster, and documents pertaining to Resident #1. LPA also conducted interviews with Staff #1 - #5, and Residents #1 - #6. Additional 2 staff were interviewed on another date. For allegation, Staff are not meeting resident’s hygiene needs. It is alleged that Resident #1 (R1) has feces stuck to the bottom and is extremely difficult to remove. Seven staff interviewed indicated that they meet the needs of all residents daily. R1 and other residents are cleaned thoroughly. They stated their protocol is to check residents every 2 hours and change their diapers if needed. R1 is changed frequently due to incontinence, and they have not noticed any feces stuck on R1’s bottom during changes or showers. Unsubstantiated Per staff, R1 also has bowel movements a few times a day and use baby wipes to clean the bottom. Staff do not know about the stool being stuck to the resident’s bottom as it had never been seen. R1 also had not reported or shown any discomfort during changes. Per the med tech, there were no reports of R1 having stuck feces on any doctor’s visits. All the residents interviewed feel that the staff meet their needs and change them when needed. They also feel that they do a good job cleaning them. 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 held. A copy of this report along with the appeal rights was provided to the Assistant Administrator.the state’s words, verbatim · CDSS document, Jan 28, 2025 · control 28-AS-20250110152829

Allegation investigated: Staff did not provide adequate food service to resident. Staff ignored resident's request for assistance.

Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Madelene "Sasha" Sanchez and discussed the purpose of today's visit. Claudia Sanchez arrived at approximately 9:50 A.M.. On 10/26/23, LPA Irra conducted the initial visit. During this visit, LPA obtained a copy of the staff roster(including staff contact information),resident roster, list of residents with special diets and menus. LPA reviewed Resident #1 (R-1's) file and obtained relevant documentation. LPA also interviewed Claudia Sanchez. During the course of this investigation, LPA also interviewed Staff #1 (S-1) through Staff # 4 (S-4) and Resident #1 (R-1) through Resident #5 (R-5). LPA conducted a tour of the kitchen. Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Staff did not provide adequate food service to resident. It has been alleged that this facility provides food that R-1 cannot eat (not provided with vegetarian options) and that the food portions served are not enough. Staff interviews revealed that staff provide adequate food service (including vegetarian options and food portions) to residents. Interviewed staff indicated that the kitchen has food items that accommodate residents with vegetarian requests. LPA conducted a tour of the kitchen. LPA observed the kitchen to be stocked with vegetarian options such as vegetarian egg rolls, vegetarian lentils, Indian food, cauliflower rice, Pad Thai vegetarian noodles and fresh vegetables (carrots, cabbage, celery, asparagus, broccoli). Resident interviews revealed that the facility provides adequate food service. Interviewed residents indicated that they are provided with adequate food servings and are given the option to substitute food items (upon request). Interviewed residents did not have any concerns pertaining to this matter. Interviews do not corroborate this allegation. Allegation: Staff ignored resident's request for assistance It has been alleged that when R-1 asks for coffee, R-1 has to keep asking staff and is being ignored. Staff interviews revealed that staff do not ignore resident requests (including R-1). Interviewed staff indicated they provide residents with assistance in a timely manner. Resident interviews revealed that staff do not ignore residents’ requests. Interviewed residents indicated staff provide residents with assistance in a timely manner. Interviewed residents did not have any concerns pertaining to this matter. 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 violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview, appeal rights and a copy of this report was provided to Claudia Sanchez. NOTE: LPA was experiencing technical difficulties during this visit.the state’s words, verbatim · CDSS document, Aug 15, 2024 · control 28-AS-20231018094803

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza and Research Data Analyst Michael Moriel conducted an unannounced annual inspection visit. The purpose of the visit was explained to Designee Administrator Claudia Sanchez. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. It consists of 48 resident rooms in a 2 story main building and 2 detached buildings, 1 activity rooms, dining room, laundry area, 2 courtyard patio areas, and one 2nd floor balcony. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: A hospice waiver for 15 residents has been approved. A fire clearance for 48 ambulatory, 32 non-ambulatory, of which 7 may be bedridden is in place. Facility handles resident P & I monies for a total of 10 residents. However, the licensee does not have a Surety Bond. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 8/26/2024. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The last fire drill was conducted on 6/17/2024. The facility has fully charged fire extinguishers. The signal system was tested and is operational. Water temperature readings did not measured within the required 105 - 120 degrees Fahrenheit. Water temperature readings measured between 92.8 DF - 136.9 DF. Stairwell evacuation chairs were observed. *Note: Blue tarps were observed on the roof. Elevator is not operable at this time. Staffing: A total of 15 staff members provide care and supervision to the clients. Administrator Stephany Perez is a corporate office staff. Designee Administrator Claudia Sanchez is in charge of daily on-site operations. Personnel Records/Staff Training: Administrator certificate is current. Staff have criminal background clearance and training. Six (6) staff files were reviewed. Proof of staff training, health clearance, food handling certificates, and 1st Aid/CPR training was observed. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent, and medication records. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies.11 residents are on modified diets. Physician orders are on file and special diet lists are kept in the kitchen area. The freezer door thermometer is not operable, but 2 portable thermometers were observed inside. Incident Medical and Dental: Six (6) centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by Access or insurance transportation services. Facility has one (1) van for resident transport, but is presently not working. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Evacuation chairs are in place. The elevator is inoperable. All non-ambulatory residents are on the 1st floor. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: Four (4) residents are receiving hospice services and one (1) resident receives home health services. Nine (9) residents have a Dementia diagnosis and are located in the 1st floor. Postural support physician orders are on file. Full bed rails for mobility assistance were observed in some resident rooms. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Claudia Sanchez A copy of the report and appeal rights was issued.the state’s words, verbatim · CDSS document, Jul 11, 2024

Allegation investigated: Facility staff mistreated resident.

Licensing Program Analyst (LPA) Tao conducted an unannounced 10-day complaint visit to this facility. Upon arriving at the facility, LPA met with staff#2, staff in charge. LPA explained the purpose of today’s visit and discussed the allegations mentioned above to staff#2 and administrator over the phone. The investigation consisted of resident interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster, staff’s training records and residents’ facility files. The investigation revealed the following. In regards of facility staff mistreated resident, it was alleged staff covered the resident#1 (R1)’s mouth and nose during morning dressing. LPA interviewed residents, four (4) out of five (5) residents interviewed could not corroborate the allegation. One (1) out of five (5) residents corroborated the allegation. Residents interviews revealed staff did not cover resident’s mouth and nose when dressing them. All four (4) staff interviewed denied the allegation. Staff stated R1 had a history of feeling irritated when changing clothes. (-continued in LIC 9099C-) Unsubstantiated Staff stated they were being careful while providing care and dressing residents. Staff had in-service training on providing care the residents. Per LPA’s observation, residents looked happy during the physical plant. Thus, the facility did not mistreat resident while in care. Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with staff#2. The findings were discussed. A copy this report was provided at time of visit.the state’s words, verbatim · CDSS document, Apr 22, 2024 · control 28-AS-20240418152247

Allegation investigated: Illegal eviction without proper notice Staff retaliating against the RP for filing a complaint with CCLD

Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent visit to deliver findings for the above allegations. LPA met with Claudia Sanchez (Interim Administrator) and discussed the purpose of today's visit. During today's visit, LPA interviewed Department of Health Services Representative (Placement Agency) telephonically at 1:35 PM. The initial visit was conducted on 12/12/2023 and included the following: LPA obtained a copy of the staff roster and resident roster and Special Incident Reports (SIR's). LPA reviewed Resident #1 (R-1's) file and obtained relevant documentation. LPA also interviewed Claudia Sanchez from 9:30 to 9:55 AM. Resident's R 1- R 6 were interviewed from 10:30 AM to 11:30 AM. In regards to the allegation Illegal eviction without proper notice, based on interviews conducted and information gathered it was revealed by Department of Health Services Representative (Placement Agency) Program Manager that they prevent an eviction from happening. Stated that they will try to relocate if Unsubstantiated they assess that the resident is not compatible and not a good fit. Said they avoid eviction and ensure the resident is relocated to a safe environment. Interview with Interim Administrator who stated that Resident R 1 has never faced eviction. Stated that there is an internal relocation that is done by Department of Health Services. Also stated that any special incident reports are sent to Department of Health Services. LPA reviewed e-mail exchange between Administrator and Department of Health Services Representative who communicated to family member of R 1 that she can relocate R1 or take home. Review of R1's file shows that R1 does not have a POA or Conservator. It should also be noted that R1 is still currently residing at this facility. Interviews with 6 of 6 resident's who all stated they had not seen or heard of anyone being evicted and all stated staff all act professionally. 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 retaliating against the RP for filing a complaint with CCLD, based on interviews conducted and information gathered it was revealed by Department of Health Services Representative (Placement Agency) Program Manager that they have worked closely with the facility and find no reason to corroborate the allegation. Stated they never heard of anyone complain that the facility was threatening anyone who complained as a retaliation tactic. Interview conducted with Interim Administrator who stated the last complaint in November was Unsubstantiated and R 1 was not being evicted as retaliation because it was an internal relocation by Department of Health Services. Interview with 6 of 6 residents who all stated that staff do not engage in wrong doing and that they are professional and work really well with the residents. All 6 have not heard of any retaliation if someone complained to CCLD. R 1 stated that employees had done no wrong doing to her or retaliated against her. It should be noted that R 1 still currently resides at the facility. 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.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 28-AS-20231207103650

Allegation investigated: Staff do not ensure residents have adequate night time supervision.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with Administrator Claudia Sanchez and explained the reason for the visit. The investigation consisted of the following: During initial visit dated 1/16/24 LPA obtained copies of staff/resident rosters, copy of In-Service Medication Administration Training, reviewed 6 staff files, conducted interviews with 6 staff and 5 residents and toured facility including 8 resident bedrooms. During todays subsequent visit LPA obtained copies of staff/resident rosters and reviewed video surveillance. (Continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff do not ensure residents have adequate night time supervision. It is alleged that staff have been found sleeping at the desk during the night hours. LPA interviewed 5 staff (2 of which work nights) and 5 out of 5 staff denied the above allegation. 4 out of 5 Staff interviewed stated that they have never fallen asleep during their shift nor have they ever witnessed/heard of another staff sleeping during the night shift. LPA interviewed 5 residents and 4 out of 5 residents denied the above allegation and stated that they have never seen or heard of staff sleeping at night. Interviews with administrator and 2 night staff indicated that there are 3 night staff during each night shift. 5 out of 5 residents stated that they are provided with adequate night time supervision and are assisted if needed in a timely manner at night. LPA reviewed night surveillance footage from dates 12/22/23-12/25/23, 12/29/23-1/2/24 and 1/19/24-1/21/24, there were no signs of staff sleeping at the front desk/TV area or dining area during the night time hours of 6pm-6am. Based on statements and interviews conducted with staff and residents, and review of surveillance footage, 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 to Claudia Sanchez.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 28-AS-20240109123456

Allegation investigated: Facility staff did not prevent a resident from being harmed by another resident in care.

***This report superseads report dated 1/9/24. The reason for superseading is to include missing additonal supportive information in the original 9099. The unsubstantiated findings remain the same.*** Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Claudia Sanchez and explained the reason for the visit. The investigation consisted of the following: During the initial visit dated 1/9/24 LPA obtained copies of staff/resident rosters, Physician Reports for both R1 and R2, Incident Report for Altercation between both parties, Police Information and Report Number. LPA interviewed 5 Staff and 5 Residents, and toured dining during lunch hour. (Continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegation: Facility staff did not prevent a resident from being harmed by another resident in care. It is alleged that on 1/2/24 R1 and R2 had an altercation in which staff not prevent. R2 had allegedly spilled coffee on R1. During interview with R1, resident stated that when leaving dining in passing R2 threw coffee and a tray of food on them for no apparent reason. R1 further stated that staff arrived as soon as it happened separated the two and asked R1 if they were injured during incident, in which there were none, authorities were called, no charges were filed and there have been no further incidents between the two parties since then. LPA interviewed staff and 5 out of 5 staff denied the above allegation and stated that when there is an altercation they intervene, separate residents, allow time for them to calm down and then management will speak to each resident individually to provide the best care that is needed. 5 out of 5 staff stated that they are aware that R1 and R2 have a history and try their best efforts to keep them separate and keep a close eye on them when they are within the same area. Interview with S1, staff stated that they have offered residents to switch rooms as they both reside on the same floor and to prevent residents from passing by one another, a switch of room has been offered, however, neither resident want to switch rooms. S1 further stated that R1 and R2 have had exchange of words in the past but it had never turned physical until now, authorities were called, a police report was taken, there have not been any further incidents since, and both residents are encouraged to keep distance from each other. LPA interviewed 5 residents and 5 out of 5 residents state they feel staff responds as quick as possible when there is an argument or altercation, although, at times it happens too fast for staff to arrive right away they feel staff does their best. During interview with R1, resident stated they do not want to switch rooms, Interview with R2 stated the same, both parties stated that there were no injuries during altercation, and that there have been no other incidents. R1 & R2 stated that they avoid each other and keep distance between one another and know that this is the best way to avoid future altercations. Both R1 and R2 stated that staff have been helpful in keeping both parties separate. LPA toured dining during visit and observed R1 finishing their food in the outside patio and R2 was in the office. Dining area appears large enough to be able to create a good distance between the two parties if both parties wish to eat in the dining area. There are least 2 staff monitoring dining during meal time. Based on statements and interviews conducted with staff and residents, review of resident files and incident report, 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 to Claudia Sanchez.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 28-AS-20240103165532

Allegation investigated: Staff do not ensure resident rooms are kept clean. Staff do not have appropriate training.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Madelene "Sasha" Sanchez - MedTech and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of staff/resident rosters, copy of In-Service Medication Administration Training, reviewed 6 staff files, conducted interviews with 6 staff and 5 residents and toured facility including 8 resident bedrooms. (Continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff do not ensure resident rooms are kept clean. It is alleged that staff do not clean, take out trash or make beds for residents. LPA toured facility a total of 8 resident rooms were checked, beds in each room were observed to be made and rooms appeared to be clean and trash was emptied. LPA interviewed 6 staff and 5 out of 6 staff stated that rooms are maintained daily, trash is thrown out and beds are made, with a deep cleaning that includes mopping, scrubbing and dusting 2 times a week or as needed. LPA interviewed 5 residents and 5 out of 5 residents denied the above allegation and stated their rooms are cleaned daily, deep cleaning is done 2-3 times a week and trash is emptied daily. Allegation: Staff do not have appropriate training. It is alleged that the cook and/or janitor are assisting with medication administration and do not have proper training to do so. LPA reviewed 4 staff files that assist with medication and each file had the required medication administration training was documented in their personnel files. LPA interviewed 6 staff and 2 of 6 staff stated they administer medication and are trained, LPA reviewed their files and training was documented. LPA interviewed 5 residents and 5 out of 5 residents stated that the staff that administers medication is the same staff daily and have never been given medicine by a cook/janitor.(LPA reviewed files of staff mentioned, each had proper training documented) Based on statements and interviews conducted with staff and residents, review of staff files and in-service 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 held, and a copy of this report was provided to Sasha Sanchez.the state’s words, verbatim · CDSS document, Jan 16, 2024 · control 28-AS-20240109123456

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility staff restrained resident. Facility staff do not ensure residents are appropriately clothed. Facility staff are not properly dispensing medication as prescribed. Facility staff do not intervene when residents engage in physical altercations.

Licensing Program Analyst (LPA) Tao conducted an unannounced 10-day complaint visit to this facility. Upon arriving at the facility, LPA met with interim administrator, Claudia Sanchez. LPA explained the purpose of today’s visit and discussed the allegations mentioned above. The investigation consisted of resident interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster, staff’s training records and residents’ facility files. The investigation revealed the following: In regards of facility staff restrained resident, it was alleged staff tied resident to a chair overnight. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents revealed they had never been tied to a chair ever and never seen any residents being tied to a chair. All four (4) staff interviewed denied the allegation. (-continued in LIC 9099C-) Unsubstantiated Staff stated they were not allowed to tie residents to a chair and restrained resident was against Title 22 regulation. Per LPA’s observation, no residents were tied to their chairs during the physical plant. Thus, the facility did not restrain resident while in care. In regards of facility staff do not ensure residents are appropriately clothed, it was alleged that residents were being left under dressed under cold temperatures. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents revealed staff clothed them appropriately and kept them warm. All four (4) staff interviewed denied the allegation. Staff stated caregivers would dress residents in layers accordingly and check residents if they were warm. Per LPA’s observation, residents were dressed in layers with sweaters, hats, socks, and gloves. Therefore, the residents were dressed appropriately to keep them warm. In regards of facility staff are not properly dispensing medication as prescribed, it was alleged that medication was not administered to residents on time. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents stated staff administered their medication as prescribed and dispensed medication to them every morning, afternoon and bedtimes depending on their needs. All four (4) staff interviewed denied the allegation. Staff stated Med techs administered medication according to residents’ medication record and doctors’ orders. Per record reviews, residents’ medications were administered as prescribed, and medication matched with records with no discrepancy. Therefore, facility staff dispensed medication as prescribed. In regards of facility staff do not intervene when residents engage in physical altercations, it was alleged that some residents would get into agreements and act aggressively towards others, but staff did not intervene. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents stated staff would intervene and separate the residents if residents got agitated or act aggressively toward others. All four (4) staff interviewed denied the allegation. Staff stated staff were trained to handle residents with aggressive behavior and residents with dementia. Staff would intervene, separate and re-direct residents to do other activities. Per record reviews, staff had in-service training on handling aggressive residents and residents with dementia. Per observation, the residents were peace and calm. Therefore, there was not preponderance evident to show staff does not intervene when residents were being aggressive towards others or engaged in physical altercation. (-continued in LIC 9099C-) Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED. An exit interview was conducted with interim administrator, Claudia Sanchez. The findings were discussed. A copy this report was provided to Claudia at time of visit.the state’s words, verbatim · CDSS document, Jan 11, 2024 · control 28-AS-20240110104253

Allegation investigated: Facility staff did not prevent a resident from being harmed by another resident in care.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Claudia Sanchez and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of staff/resident rosters, Physician Reports for both R1 and R2, Incident Report for Altercation between both parties, Police Information and Report Number. LPA interviewed 5 Staff and 5 Residents, and toured dining during lunch hour. (Continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegation: Facility staff did not prevent a resident from being harmed by another resident in care. It is alleged that on 1/2/24 R1 and R2 had an altercation in which staff not prevent. R2 had allegedly spilled coffee on R1. LPA interviewed staff and 5 out of 5 staff denied the above allegation and stated that when there is an altercation they intervene and separate residents, allow time for them to calm down and then management will speak to each resident individually to provide the best care that is needed, if any. 5 out of 5 staff stated that they are aware that R1 and R2 have a history and try their best efforts to keep them separate and keep a close eye on them when they are within the same area. Interview with S1, staff stated that they have offered residents to switch rooms as they both reside on the same floor and to prevent residents from passing by one another a switch of room has been offered, however, neither resident want to switch rooms. S1 further stated that R1 and R2 have had exchange of words in the past but it had never turned physical until now, authorities were called, a police report was taken, and there have not been any further incidents since. LPA interviewed 5 residents and 5 out of 5 residents state they feel staff responds as quick as possible when there is an argument or altercation, although, at times it happens too fast for staff to arrive right away they feel staff does their best with response time. Interview with R1, resident stated they do not want to switch rooms, Interview with R2 stated the same, both parties stated that there were no injuries during altercation. R1 & R2 stated that they avoid each other and keep distance between one another and know that this is the best way to avoid future altercations. Both R1 and R2 stated that since this last incident no other incidents have happened and are hopeful that no further incidents will occur as they are staying distant from one another. Based on statements and interviews conducted with staff and residents, review of resident files and incident report, 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 to Administrator Claudia Sanchez.the state’s words, verbatim · CDSS document, Jan 9, 2024 · control 28-AS-20240103165532

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tena Herrera conducted a case management visit as a result of a deficiency observed during a complaint investigation, under complaint control # 28-AS-20240103165532. LPA met with Administrator Claudia Sanchez. During complaint investigation it was revealed that facility did not submit a special incident report on an incident that occurred on 1/2/24 to licensing. The incident was an altercation between R1 and R2 where R2 threw food and coffee on R1 and resulted in authorities being called and police report being taken (no injuries were reported). Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit are documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided to Administrator Claudia Sanchez.the state’s words, verbatim · CDSS document, Jan 9, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jan 16, 2024

Reporting Requirements - (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: During complaint investigation it was revealed that facility did no submit a Special Incident Report to Licensing as Administrator stated they were waiting for instructions from DHS on how to proceed.the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: Administrator to review Reporting Requirements as specified in Title 22 Regulations and complete the LIC9098 stating that they are knowledgeable in all reporting requirements once reviewed and submit completed LIC9098 to LPA via email by POC due date. Administrator to practice reporting requirements moving forward and submit a speical incident report to licensing pertaining this insident via fax.

Allegation investigated: Facility staff did not safeguard resident's property.

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Claudia Sanchez and explained the reason for the visit. The investigation consisted of the following: LPA requested staff/resident rosters. Interviewed Staff #1- #4 (S1-S4) and Residents #1 - #4(R#1 - R#4). LPA also toured R1's room and reviewed R1's file. LPA requested a copy of physician's report, identification and emergency information sheet, admission agreement for R1. The investigation revealed the following: Regarding allegation: Facility staff did not safeguard resident's property:It is alleged that R1’s Agave sweetener was missing from the closet where the sweetener was stored and the lock on the cabinet was not locking. Cont. 9099C Unsubstantiated During LPA's interview with R1, R1 stated that they really cannot remember when and how the sweetener is missing and indicated that the cabinet lock is working in their room now. Staff fixed already and showed the LPA the key for the lock. LPA toured the R1's room with S1 assistance and observed that lock for the cabinet where R1 is keeping their food / cleaning supplies is working. At the time of tour R1 was present in the room. During interviews with residents, 3 out of 4 residents stated to not have lost or missing items from their rooms. They stated sometimes they misplaced items and staff help to look and find them. They did not hear that someone complains about missing items. Interviewed staff stated residents usually misplaced items and staff looks and will find items in residents' rooms. Interviewed staff indicated that R1 is often giving items away and after complaints about missing items. Items like water, juice, nuts R1 offer to residents and to staff. Staff stated that they never take any items from R1 or from other residents. They kindly decline the offers. Staff stated that they respect the residents, they do not go inside the resident's room without permission and do not touch their items. Based on the observation and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the 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 to Claudia Sanchez.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 28-AS-20231214115437

Allegation investigated: Facility staff does not ensure that residents have hot water. Facility is in disrepair. Facility staff does not meet resident's dietary needs. Facility staff does not maintain resident's room clean and free of trash.

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to deliver complaint investigation findings. LPA met with Assistant Administrator Claudia Sanchez and explained the purpose for the visit. The investigation consisted of: On 01/19/23, LPA Gonzalez conducted interviews with Assistant Administrator Claudia Sanchez, and R1. LPA collected copies of Staff and Resident Rosters, Facility Menu for Week 1/15/23 - 1/21/23, Diabetic Menu Options and a list of diabetic residents. LPA conducted a tour of entire facility inside and out. The tour included observations of facility kitchen, food supply and resident rooms. The following resident rooms were toured/ inspected, and water temperature was measured in each room: # 12, #6, #32, and #24. On 11/27/23, LPA requested and received copies of Staff and Resident Rosters, interviewed Staff 1-4 (S1-4) and R2-5. LPA also conducted a tour of the facility which included observations (See LIC9099C for continuation) Unsubstantiated of the kitchen, food supply, observation of facility elevator and a random selection of resident rooms. LPA measured the water temperature in the resident rooms. LPA additionally reviewed R1’s facility file and collected copies of documents pertinent to the investigation and conducted a phone call to Silverado Hospice. Investigation revealed the following: Regarding allegation, Facility staff does not ensure that residents have hot water, it is alleged that the facility does not have hot water as of 01/11/23 and resident(s) only received a sponge bath as there was no hot water in the building. Facility also allegedly did not notify resident’s family or responsible parties of the issue with the water. It is also alleged that resident(s) are retaliated against if they speak up when things are not right in the facility. Interviews conducted with facility administrator and staff revealed that the facility does have hot water at all times. Administrator stated that water is checked weekly to ensure that the water is always set at the required temperature that is between 105 F - 120F and stated that family members and responsible parties are notified of any important issues or problems, if any, when they arise. Staff interviewed denied that residents are retaliated against if they bring up any concerns. Interviews conducted with 5 out of 5 residents revealed that the facility always has hot water. 1 out of 5 residents stated that when it is cold the water takes longer to heat up and it might be due to where their room is located which is in the rear of the facility. 5 out of 5 residents denied that staff retaliate against residents if they bring up any concerns. On 01/19/23 and 11/27/23, LPA measured the water temperature in a total of six (6) resident bathrooms and the reading for all bathrooms ranged between 110F - 115F which is between Title 22 regulation requirement. Based on interviews conducted with facility staff, facility residents, and LPA observations, there was not enough supportive evidence to concur with the reported allegation. For allegation, Facility is in disrepair, it is alleged that there is no alarm in the rear exit of the facility and there should be one as the facility provides services to residents with dementia, and the facility does not have a working elevator for the residents that live upstairs. Interviews conducted with Administrator Harvey and Assistant Administrator Claudia Sanchez revealed that the facility has 1 nonoperational elevator. They stated that the facility was licensed like that, and the facility was cleared by the Monrovia City Fire Department as well as Department of Industrial Relations (DIR). LPA Gonzalez reviewed approved STD 850 Facility Fire Inspection Request which was approved on 08/25/22 and indicates that all nonambulatory residents are to reside on the 1st floor and all ambulatory residents are to reside on the 2nd floor. This information is reflected on the facility license. On 11/10/22, LPA Katrdzhyan spoke to DIR Senior Inspector who informed LPA Katrdzhyan that DIR does not require the building to have an operable elevator. Senior Inspector also stated that the facility elevator is recorded as dormant, and the power record has been landed which means that the elevator is inoperable. DIR will not visit the facility unless the facility decides to make the elevator operable again. Administrator and facility staff stated that the alarm in the rear exit of the facility does work. 4 out of 5 residents interviewed confirmed that the alarm in the rear exit door does work. 1 resident stated that the alarm is located right next to their room and they hear the alarm go off at times. 1 resident was not able to answer the question. LPA observed that the alarm in the rear exit door of the facility was operating properly during the visits that were conducted on both 01/19/23 and 11/27/23. LPA observed that nonambulatory residents are located in the first floor and did not observe any nonambulatory residents on the second floor during the visits conducted on 01/19/23 and 11/27/23. Based on interviews conducted with facility staff, facility residents, and LPA observations, there was not enough supportive evidence to concur with the reported allegation. For the allegation, Facility staff does not meet resident's dietary needs, it is alleged that the facility has not been able to meet a resident(s) special dietary need such as a diabetic diet as it was stated on the resident(s) admission agreement and it is also alleged that resident(s) are supposed to get 3 meals a day and the facility has not met food needs. LPA observed the food supply on 01/19/23 and 11/27/23 and observed residents having lunch. LPA observed that the facility had an ample supply of a variety of fresh fruits, vegetables, proteins, and carbohydrates. LPA also observed facility's food storage and observed sufficient food for 2 days worth of perishables and 7 days worth of non-perishables, which consisted of different meats, vegetables and fruits, breads, dairy, cereals, and variety of canned foods. Interviews conducted with 3 out of 5 residents stated that they follow a special diet and the facility does provide them with alternate meals. 1 resident did not want to continue their interview, 1 resident stated that the food could be tastier but is overall satisfied with the food service. 5 out of 5 residents stated the food that is served is healthy and well balanced and they are served three meals a day which consist of a variety of foods. Interviews with Administrator and staff revealed if any resident follows a special diet they are provided with modified diets. LPA reviewed the food menu and toured the kitchen and observed a healthy selection of foods. LPA reviewed 5 resident's Physician's Reports and 3 reports did not indicate that the residents require a special diet. 2 Physician's Reports did indicate that the resident requires a special diet, and these reports belong to the residents that stated that the facility follows their diet. R1 is no longer a resident of the facility. Based on LPA observations, LPA review of facility menus, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation. For allegation, Facility staff does not maintain resident's room clean and free of trash, it is alleged that resident(s) room is always dirty and on 01/12/23 trash that had been observed the previous week was observed again under a resident(s) bed even after the housekeeper had just vacuumed the room. It is also alleged that the blinds in the resident(s) room are also broken and that they had allegedly been previously broken by staff when they were changing the resident(s). On 01/19/23 and 11/27/23, LPA toured the facility and did not observe that the facility or any residents' room were dirty and did not observe any trash under beds or any broken blinds. There are trash cans placed around the property for residents to use to throw their trash in. The dining tables and floors are wiped and clean. There are no obstructions to the passageways. LPA did not smell any urine nor unpleasant odor around the facility. Administrator and staff stated that the facility is cleaned on a daily basis and as needed and also stated that staff do not break any blinds when assisting residents. Staff stated that if a resident breaks the blinds in their rooms the blinds will be replaced by maintenance staff. 4 of 5 residents interviewed stated that the facility staff clean their rooms daily. 1 resident stated that their room is cleaned regularly but their daughter is the one that does not like certain things. LPA Gonzalez conducted a tour of the entire facility including 6 resident rooms including bathrooms, dining room, kitchen, TV room, outside common area, and backyard and observed the facility to be clean. LPA observed 1 staff cleaning resident rooms/restrooms. Based on interviews conducted with facility staff, facility residents, and LPA observations, there was not enough supportive evidence to concur with the reported allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held. A copy of the report was provided to Assistant Administrator Claudia Sanchez.the state’s words, verbatim · CDSS document, Nov 27, 2023 · control 28-AS-20230112084458