Long Life Living Inc. III

Allegation investigated: Lack of staff supervision resulting in resident sustaining a fracture while in care Staff did not address resident's fall risk

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegations and met with Staff Member, Tess Tuviera. Designated Representative, Justine Hererra, arrived during visit at approximately 9:30AM. During the investigation, the Department reviewed documents, conducted interviews, and made observations. The following allegations were investigated, "Lack of staff supervision resulting in resident sustaining a fracture while in care," and "Staff did not address resident's fall risk." Complaint alleged that that Resident 1 (R1) was observed to have a bruise on their right leg when being assisted with dressing. Report further stated that (R1) was found to have a leg fracture and had a history of falls. Continued on LIC9099C Unsubstantiated Continued from LIC9099 "Lack of staff supervision resulting in resident sustaining a fracture while in care" - Interviews were conducted with Involved Parties. 2 of 2 interviews revealed that R1 had severe osteoporosis and stated the medical professionals informed them that R1's bones were "like glass." Per interviews, because of the severity of R1's bones, they were told that any small bump could have caused the fracture. Interviews also revealed that while R1 had a history of falls, they did not require one-on-one supervision and did not need a caregiver with them at all times. Interview conducted with Administrator revealed that R1 had been observed on the morning of 05/30/2026 to have a swollen knee and couldn't get out of bed. Facility sent R1 to the hospital for further evaluation and it was found that R1 had a fracture. Per Administrator, based on where the fracture was located, the doctor didn't think that R1 had a fall and said that R1 had a severe case of brittle bones. Administrator further revealed that the doctor said that due to R1's brittle bones, R1 could have sustained their fracture just by knocking it against something hard like their bed or their bedroom wall. "Facility failed to address R1's fall risk" - Interviews were conducted with Involved Parties. 2 of 2 interviews revealed that R1 had a history of falls but that R1 did not require one-on-one supervision and did not need a caregiver with them at all times. R1's care plans were reviewed. Previous care plans for R1 stated that they were able to ambulate using a walker and required supervision while transferring or walking. R1's care plan for 2026 stated that R1 was a fall risk but was able to get around their bedroom somewhat independently by using their walker. This care plan also stated that they preferred to stay in bed or in their room. This care plan did not state that one-on-one supervision was required. Based on documents reviewed, interviews conducted, and observations made, these allegations are Unsubstantiated. A finding that a complaint allegation is Unsubstantiated means that 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. Exit interview conducted. Copy of report discussed and provided to Designated Representative. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 24, 2026 · control 21-AS-20260609072603

Type of visit: Required - 1 Year

At approximately 9:10AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Tess Tuviera. Designated Representative, Justine Herrera, arrived during visit at approximately 9:30AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 6 non-ambulatory residents of which 1 may be bedridden. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Designated Representative. The following was observed: facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility is a 1 story building with 6 Resident bedrooms, 3 bathrooms, and common spaces. Facility has a total of ten (10) alarmed doors. All door alarms were observed to be operational during visit. Facility had emergency lighting. Facility has an Infection Control plan on file. Facility has a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins and dangerous items were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for resident use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected July 2026. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted August 2026. Facility's emergency disaster plan was last reviewed and updated January 2026. Facility was observed to have an adequate supply of emergency water in the event facility needed to shelter in place for 72 hours. LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and Continued on LIC809C Continued from LIC809 contained the required documentation. Staff files had current First Aid and CPR certification. Resident files were found to have updated appraisals. During medication review, it was observed that some medications were missing information such as refill date and 1 of 3 residents did not have their Tylenol medication logged appropriately. It was observed that all other medications identified in the audit were logged per regulation. Administrator's Certificate for Faye Chang (7004709740) was current with an expiration date of 06/06/2028. Administrator's Certificate for Justine Herrera (7027363740) was current with an expiration date of 10/23/2026. LPA and Designated Representative discussed Change of Administrator from Faye Chang to Justine Hererra. Administrator Documents · LIC 308 (Designation of Facility Responsibility) · Active and Current Administrator Certificate · First Aid Certificate · Administrator Resume · LIC 500 (Personnel Report) · LIC 501 (Personnel Record) · LIC 503 (Health Screening Report - personnel) · LIC215 (Applicant Information) · Proof of Negative TB test · Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Personnel Report (LIC 500) Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 10/24/2026. No Deficiencies Cited during visit. Exit interview conducted. Copy of report and LIC9102 (technical advisories/violations) discussed and provided to Designated Representative. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 24, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Tess Tuviera. Administrator, Justine Herrera, arrived during visit at approximately 9:45AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 6 non-ambulatory residents of which 1 may be bedridden. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff members on-site. At approximately 9:40AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Administrator and observed the following: Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility is a 1 story building with 6 Resident bedrooms, 3 bathrooms, and common spaces. Facility had emergency lighting. Facility had an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected July 2025. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted July 2025 (deficiency cited, LIC809D, health and safety code 1569.695(c)). LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Administrator's Certificate for Justine Herrera (7027363740) was current with an expiration date of 10/23/2027. Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC308) Emergency Disaster Plan (LIC610E) Updated Personnel Report (LIC500) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 10/04/2025. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Required - 1 Year

At approximately 11:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Justine Herrera. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for 6 non-ambulatory of which 1 may be bedridden for a total capacity of 6 residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff members on-site. At approximately 11:55AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:00PM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 6 Resident bedrooms, 2 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected August 2024. Smoke detectors and carbon monoxide detectors were tested and operational. The last facility disaster drill was conducted in July 2024. At approximately 12:30PM, LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Administrator's Certificate for Justine Herrera (7027363740) was current with an expiration date of 10/23/2024. Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 10/19/2024. No Deficiencies Cited during Visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Sep 19, 2024