Pacific Grove Senior Living

Type of visit: Case Management - Other

On 06/04/2026, Licensing Program Analyst (LPA) V Gorban conducted an unannounced facility visit. LPA stated the purpose of the visit and was allowed entry. During this visit LPA met with facility administrator (AD) Jessica Sanchez. LPA toured the facility conducting health and safety checks. LPA requested facility records to be provided to Licensing office or LPA's email by end of the day, June 4th, 2026. No deficiencies were observed or cited during this visit. Exit interview was conducted, report signed and copy of this report provided to administrator for facility records.the state’s words, verbatim · CDSS document, Jun 4, 2026

Allegation investigated: Staff does not ensure residents' accommodations are being met.

On 05/27/2026 Licensing Program Analyst (LPA) Gorban unannounced visited the facility to commence complaint investigation and deliver findings. LPA introduced self and met with administrator Jessica Sanchez and was allowed entry. During this complaint investigation LPA toured the facility conducting health and safety checks, reviewed facility records, and interviewed administrator. Allegation: Staff does not ensure residents' accommodations are being met. Base on observation during facility visit exit doors observed operational. Records review revealed the facility has disaster plan in place. Although the alleged violation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occur, therefore the allegation is Unsubstantiated. Exit interview conducted, report signed and copy of this report provided to health services director for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 27, 2026 · control 24-AS-20260521085826

Type of visit: Case Management - Incident

On 04/23/25 Licensing Program Analyst (LPA) V Gorban conducted an unannounced Case Management visit regarding a self reported incident report that was received in Fresno Regional Office (RO) on 04/16/2026. LPAs met with resident services director and toured the facility. Per incident report received in Fresno Regional Office on 04/16/2026, resident did exhibit signs of hallucinations. When asked by staff, resident responded did not receive its prescribed medications and at later time, was transported to the Hospital for medical evaluation. LPA requested facility files for review to be provided to licensing office, Fresno by April 27th, 2026, 12PM pacific time. Exit interview conducted. A copy of report provided for facility records.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Facility is unsanitary. Facility is in disrepair. Lack of staff

On 03/20/2026, Licensing Program Analyst (LPA) V Gorban visited the facility regarding complaint investigation to deliver findings. LPA met with the administrator and explained the purpose of this visit. During multiple visits of the complaint investigation, LPA conducted a tour of the facility, interior and exterior to ensure there is no potential or immediate health and safety risk at the facility, documents were reviewed, interviews conducted, and information gathered. Allegation: Facility is unsanitary, Facility is in disrepair, and Lack of staff. Based on observation during facility visits on 10/24/25 and 12/30/25 staff, administrator, and staff interviews revealed the above allegations are Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred. Exit interview conducted, report signed and copy of this report with appeal rights provided to administrator for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 20, 2026 · control 24-AS-20251022085722

Allegation investigated: Staff do not ensure kitchen is cleaned properly Staff do not ensure food is at proper temperature

On 03/20/2026, Licensing Program Analyst (LPA) V Gorban visited the facility regarding complaint investigation and deliver findings. LPA met with administrator and explain the purpose of the visit. During multiple visits of this complaint investigation, LPA conducted a tour of the facility, interior and exterior to ensure there is no potential or immediate health and safety risk at the facility, documents were reviewed, interviews conducted, and information gathered. Allegation: Staff do not ensure kitchen is cleaned properly and Staff do not ensure food is at proper temperature. Based on observation during facility visits on 09/16/ and 12/30/25 LPA interviewed staff, administrator, and residents which revealed the above allegation is Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred. Exit interview conducted, report signed and copy of this report provided to administrator for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 20, 2026 · control 24-AS-20250916085905

Type of visit: Required - 1 Year

On 12/16/2025, Licensing Program Analysts (LPAs) Vadim G. and Shawna D. arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator (AD) Jessica Sanchez, certification number 6072416740 and expiration date 10/01/2026. LPA conducted tour inside and out of facility with AD. Residents observed at the facility during lunch. The facility was observed to be at a comfortable temperature of 67 to 80 degrees, clean, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 05/02/2025 Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in walk-in freezer, walk-in refrigerator, and pantry. Food is delivered twice a week, on Tuesdays and Fridays. Refrigerator temperature was maintained at 42.0 degree F. and freezer was maintained at 20.1 degree F. Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. LPA observed securely fastened grab bars and non-skid mat in all shower areas. Water temperature tested at 112 Degrees F. Medications were stored in a locked medication room in a medication cart. Medications records were reviewed with med errors observed and recorded. First Aid Kit was stored in medication room and observed with all required items. Adequate PPE supplies was observed. LPA toured laundry room and observed chemicals were unlocked. Continued on LIC 809C Facility courtyard was toured and observed to be free from debris although wall paint repair needed. There was outdoor seating available for the residents. Residents’ and staff files were reviewed with missing required records. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate and up to date information for your facility. In an effort to maintain your facility file, please submit the most current and complete forms and or information as identified below: Residential Care Facility for the Elderly (RCFE): LIC 308 Designation of Facility Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly LIC 9020 Register of Facility Clients/Residents Copy of current Liability Insurance Copy of current Administrator Certificate Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 12/20/2025 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. Exit interview was conducted with the ED. Deficiencies were provided with appeal rights. A copy of this report was signed by Selena Alba, care giver, whose signature on this form confirm receipt of these reports.the state’s words, verbatim · CDSS document, Dec 16, 2025

Allegation investigated: Residents are exposed to harmful chemicals.

On 09/16/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to administrator Jessica Sanchez and was allowed entry. During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records. The Department has investigated the allegation: Residents are exposed to harmful chemicals. Based on interviews and record reviews, once facility administrator was notified on August 25th, of smell in residents’ room, painting was terminated. During the facility tour, on August 26th, LPA did not observe the harmful smell or smell of the paint. 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 above allegation is UNSUBSTANTIATED. No deficiencies issued. Exit interview conducted. Report signed on-site. A copy of this report provided to the facility representative. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 24-AS-20250826101508

Type of visit: Case Management - Other

On 08/25/2025, Licensing Program Analyst (LPA) V Gorban conducted a Health and Safety check to the facility regarding a news article that was published on 8/20/25. The article states that a staff at the Skilled Nursing Facility, located inside the facility, was arrested on felony charges of sexual assault. LPA met with Pacific Grove administrator Jessica Sanchez. LPA toured the facility and confirmed that the Skilled Nursing Facility is separate entity with different main entrance . Based on observations and interviews staff from the Skilled Nursing facility enter and exit in separate doors. LPA confirmed that there is no interaction with Skilled Nursing Staff and the residents of the facility. LPA confirmed that S1 has never worked at the facility and never had contact with any of the residents. LPA interviewed the Administrator regarding the new article and reporting. Exit interview was conducted, report signed and provided for facility records.the state’s words, verbatim · CDSS document, Aug 25, 2025

Allegation investigated: Licensee does not ensure that a qualified administrator is present at the facility Licensee does not ensure enough staff are available to meet resident needs during meal times

On 07/30/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to administrator Jessica Sanchez. During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records. The Department has investigated the allegation: Licensee does not ensure that a qualified administrator is present at the facility. Based on interviews and records review, when the Administrator is not in the facility, there is a designated substitute who is responsible and accountable for the management of the facility, therefore the allegation is UNSUBSTANTIATED. The department has investigated the allegation: Licensee does not ensure enough staff are available to meet resident needs during mealtimes. Based on observations, interviews conducted, and records review, there are two staff members present during each shift that are available to serve meals in the dining area to residents in care, therefore the allegation is UNSUBSTANTIATED. No deficiencies issued. Exit interview conducted. Report signed on-site, copy of this report provided to administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 30, 2025 · control 24-AS-20250509160506

Type of visit: Case Management - Other

On 07/30/25 Licensing Program Analyst (LPA) V Gorban completed unannounced case management visit. LPA met with administrator Jessica Sanchez, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check tour and observed residents in common area. This case management visit is being conducted due to the incident on April 20th, 2025 when fire department conducted facility visit responding to fire alarm. Based on interview fire alarm went off at or around 8:30AM. File review disclosed S1 has missing training /education. Deficiency cited per Title 22 on attached LIC809-D. If not corrected, this poses a health, safety and or personal rights risk to residents in care. A plan of correction was developed by administrator Jessica Sanchez. A copy of this report deficiency and appeal rights provided. Exit interview conducted , report signed and copy of this report provide for facility records.the state’s words, verbatim · CDSS document, Jul 30, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412 · Plan of correction due date: Jul 28, 2025

87412 Personnel Records. (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not observed as evidenced by: During file review, staff (S1) records missing staff training regarding fire response / disaster response, which poses potential health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: The facility administrator ensure each staff member file include necessary / required records including staff education /training for emergency fire and natural disaster.

Allegation investigated: Facility does not employ a qualified food service consultant

On 07/10/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to commence a complaint investigation. LPA explained the purpose of the visit to the administrator and was allowed entry. During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records. The Department has investigated the allegation Facility does not employ a qualified food service consultant. Interviews were conducted with facility residents, staff and administrator. Based on the information obtained during the interview and records provided, the facility employs licensed food dietitian. The allegation Facility does not employ qualified food service consultant in Unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted report signed and copy of this report provided to administrator for facility records. Unfoundedthe state’s words, verbatim · CDSS document, Jul 10, 2025 · control 24-AS-20250418160456

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(c) · Plan of correction due date: Jul 14, 2025

Emergency Plans. (c) A facility shall conduct a drill at least quarterly for each shift...... Documentation of the drills shall include the date, the type of emergency covered by the drill. This requirement was not observed as evidenced by: Based on interviews and records review the facility have not conducted recent emergency disaster drill and or maintained the records of last emergency disaster drill conducted recently, which poses potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Administrator will conduct emergency disaster drill according to regulation and once completed to be provide to Licensing agency or LPA to email. Anticipated disaster drill July 31st.

Allegation investigated: Staff are not adhering to residents contract

On 07/10/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to the administrator, and was allowed entry. During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records. The Department has investigated the allegations: Staff are not adhering to residents’ contract. Based on LPA’s observations, interviews conducted, and record review the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies issued. Exit interview conducted. Report signed on-site. A copy of this report with appeal rights was discussed and provided to the facility representative. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 10, 2025 · control 24-AS-20250327101054

Allegation investigated: Facility staff is interfering with resident receiving notification and watching upcoming event

This is an amended repot On 06/05/2025, Licensing Program Analyst (LPA) V Gorban conducted complaint commencement visit to the facility on above allegation. LPA met with Administrator (AD) Jessica Sanchez and stated the purpose of the visit. During the course of the investigation, LPA conducted a facility tour, interviewed administrastor and residents. The Department has investigated the allegation: Facility staff in interfering with resident receiving notification and watching upcoming event. Through interviews conducted with residents, it was discovered that facility staff interfered with residents receiving memo in mailboxes, although facility staff allowed resident to watch upcoming event. Based on observations and interviews, the preponderance of evidence standard has been met therefore the allegation is SUBSTANTIATED. A deficiency is being cited with civil penalty assessed on the attached LIC9099-D. Exit interview conducted. Report was not signed. A copy of this report and appeal rights were discussed and provided to the facility records. Substantiatedthe state’s words, verbatim · CDSS document, Jun 5, 2025 · control 24-AS-20250604143222

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(3) · Plan of correction due date: Jun 6, 2025

87468.2 (a)(3) Personal rights (3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section 887468.2 (a)(3) when facility failed to provide residents free from discrimination their personal rights by refusing residents to their personal mail boxes for distributing memos, which is a potential health and safety risk to person’s in care.the state’s words, verbatim · CDSS document, Jun 5, 2025

Plan of correction: Licensee stated the complaint allegation will be submitted for appeal.

Allegation investigated: Unlawful Eviction Facility changed its Plan of Operation without Department Approval

On 5/30/25 at 2:00 pm Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Jessica Sanchez. The Department conducted interviews and reviewed records. The records reviewed included the resident’s Admission Agreement and Eviction Notice that was issued to the residents. The Eviction Notice was not submitted to the Department and there was no proof that it was submitted. The facility is operating under a plan that was not approved by the Department. The above allegations are Substantiated according to Title 22 Regulations and are cited on the attached 9099-D. An exit interview was conducted and Appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, May 30, 2025 · control 24-AS-20250529135712

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(f) · Plan of correction due date: Jun 13, 2025

87224 (f) Eviction Procedures - A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidence by: Based on records reviewed and interviews conducted, the facility failed to notify the Department of the eviction, which poses a potential health, safety, and personal rights to the residents in care.the state’s words, verbatim · CDSS document, May 30, 2025

Plan of correction: Licensee agrees will submit 5 day notice to CCLD upon eviction notices to residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Jun 13, 2025

87208 (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 30, 2025

Plan of correction: Licensee provided Plan Of Operations and will appeal citation issued.

Allegation investigated: Facility staff are interfering with residents receiving facility notifications in their mailboxes

On 05/08/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced subsequent complaint investigation to deliver findings. LPA explained the purpose of visit to sales director Jonathan Monroe. During the course of the investigation, LPA conducted a facility conducted a facility tour, interviewed residents, and reviewed records. The Department has investigated the allegation: Facility staff are interfering with resident receiving facility notification in their mailboxes. Through interviews conducted with residents, it was discovered that facility staff interfered by removing mail correspondence, from resident mailboxes. The removed correspondence included a notice regarding an activity that was scheduled to take place on 05/19/2025. Based on interviews and records review, the preponderance of evidence standard has been met therefore the allegation: Facility staff are interfering with resident receiving facility notification in their mailboxes is SUBSTANTIATED. Report continues onLIC9099-C Substantiated A deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted. Report signed on-site. A copy of this report and appeal rights were discussed and provided to the facility representative.the state’s words, verbatim · CDSS document, May 28, 2025 · control 24-AS-20250523105346

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(3) · Plan of correction due date: May 30, 2025

87468.2 (a)(3) Personal rights (3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section 887468.2 (a)(3) when facility failed to provide residents free from discrimination their personal rights, which is a potential health and safety risk to person’s in care.the state’s words, verbatim · CDSS document, May 28, 2025

Plan of correction: Licensee will appeal this complaint allegations.

Allegation investigated: garbage not being picked up inadequate emergency lighting in the hallways plumbing issues throughout the facility residents reported that the construction has lasted over a year, with workers allegedly starting work before 7 AM, playing loud music and smoking marijuana facility is not conducting quarterly fire/emergency drills as required

On 04/10/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced subsequent complaint investigation to deliver findings. LPA explained the purpose of visit to Sale Director Jonathan Monroe. Administrator, Jessica Sanchez was notified of visit via phone. Allegation: Garbage not being picked up. The Department received and viewed photos of waste on the premises. During this inspection, LPA toured the facility and conducted interviews. During an interview with the Administrator, the Administrator stated that the facility garbage was not picked up by waste services on 1/27/25 due to nonpayment. On 1/29/25, the Administrator acquired a U-Haul truck, and facility staff loaded the garbage onto the U-Haul to remove the garbage from the facility. Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D. Repot continues on attached LIC9099-D Substantiated Allegation: Inadequate emergency lighting in the hallway. During the complaint investigation, LPA conducted a facility tour with the maintenance director. During the tour, LPA discovered that the facility’s portable emergency lights were not functioning properly. When the emergency lighting was tested, the emergency lighting was non-operational and did not turn on. Based on observation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D. Allegation: Plumbing issues throughout the facility. During this investigation, LPA toured the facility, and interviewed residents and staff. During the tour, LPA observed water damage on the walls and ceiling of the facility. Interviews revealed that the facility is having plumbing issues, and that the plumbing system is in need of repair. Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D. Allegation: Facility is not conducting quarterly fire/emergency drills as required. LPA conducted interviews and reviewed records. It was discovered that the facility’s last documented fire drill was conducted on 02/24/2025. Prior to this, the last fire drill was conducted on 04/20/2024. California Health and Safety code requires a fire drill to be conducted at least quarterly for each shift. Based on interviews and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D. Allegation: Residents reported that the construction has lasted over a year, with workers allegedly starting work before 7AM, playing loud music and smoking marijuana. During this investigation, LPA conducted interviews with residents. Consistent statements from residents revealed that the construction crew plays music, while repairing the facility, prior to 7:00 AM. Based on interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D. Exit interview conducted. A copy of this report and appeal rights were discussed and provided to the facility representative. Report signed on-site. Allegation: Delayed response to repairs in the building due to insufficient staffing. During this investigation, LPA toured the facility and interviewed residents and staff. Based on records provided, there is no evidence of insufficient staffing. Consistent statements during interviews revealed that residents were informed that the “building is very old, and it takes time to address any kind of repair”. Based on records review and interviews, this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Allegation: Improper rate increase. During this investigation, LPA reviewed records and conducted interviews. LPA discovered through records review and interviews, that all residents receive a rate increase on their anniversary date of being admitted to the facility. Based on interviews and records review, this allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies issued during this inspection. Exit interview conducted. A copy of this report was discussed and provided to the facility representative. Report signed on-site.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 24-AS-20250220095235

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87468.1(a)(2) · Plan of correction due date: Apr 11, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations; this requirement was not met as evidenced by: Based on interviews conducted, the licensee did not comply with section 87468.1(a)(2) when constructions crew began working prior to 7:00AM and played loud music, which is an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 10, 2025

Plan of correction: The facility stated they will appeal this complaint finding. No POC provided The facility plan to follow city ordinance regarding work schedule. POC to be provided to Licensing Office by email or fax by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303 · Plan of correction due date: Apr 15, 2025

87303 Maintenance and Operation(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 was not met as evidenced by:the state’s words, verbatim · CDSS document, Apr 10, 2025

Plan of correction: The facility will ensure each concern regarding plumbing or other issues addressed immediatly. the facility employs maintenance staff on shift that will and have been responding to residents needs as requested. POC statement will be provided by fax to Licensing office by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695 · Plan of correction due date: Apr 15, 2025

§1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift… this requirement was not met as evidenced by: Based on record review and interviews, the Licensee did not comply with section 1569.695(c) when that the facility’s last documented fire drill was conducted on 02/24/2025 and prior to this, the last year fire drill was conducted on 04/30/2024, which is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 10, 2025

Plan of correction: The facility will make sure to conduct quarterly fire drills, record each fire drill with staff on each schedule. Provide an update to licensing office by fax or email on next fire drill by POC due date.

Allegation investigated: Staff did not ensure the automatic front door was functioning properly

On 04/09/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced subsequent complaint investigation to deliver findings on the above allegation. LPA met with Administrator Jessica Sanchez. The Department investigated the allegation: Staff did not ensure the automatic front door was functioning properly. It was found that on 01/29/2025, the main door stopped operating and needed repair. Interviews revealed that a call for service was made, and a service company responded to repair the door. The service company shipped the door out of state to be repaired, due to the service company not having the parts to repair the door. On 03/03/2025, the door was replaced and is now operational. 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. Report continues on attached LIC9099-A Unsubstantiated Exit interview conducted, report signed and copy of this report with appealk righrs provided to administrator for facility records.the state’s words, verbatim · CDSS document, Apr 9, 2025 · control 24-AS-20250211124158

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87303(b)(1) · Plan of correction due date: Apr 14, 2025

87303 Maintenance and Operation. (b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not observed as evidenced by: Based on observations facility measured temperature during the visit recorded at 65.9 degrees, staff failed to maintain comfortable temperature for residents at the facility, which poses potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The facility submitted proposal, Fire marshal approved to utilize portable heaters. Plan is ready. no date. provide a copy by POC due date

Allegation investigated: ELEVATOR NOT WORKING PROPERLY ELEVATOR NOT SERVICED SINCE 2022 FACILITY DOES NOT HAVE SUFFICIENT STAFF TO RESPOND TO RESIDENT’S CALLS FOR ASSISTANCE

On 04/09/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced subsequent complaint investigation to deliver findings on the above allegations. LPA explained the purpose Administrator Jessica Sanchez and toured the facility conducting safety checks. During the course of the investigation, LPA conducted a facility tour, reviewed records, and conducted interviews. The Department investigated the allegation: Elevator not working properly. It was found that on 02/16/2025, the facility elevator “broke down” with a resident inside, and became stuck between floor levels preventing residents from leaving. Based on record review and interviews, the preponderance of evidence standard has been met, therefore the allegation: Elevator not working properly is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22, on the attached 9099-D. Report continues on attached LIC9099-C Substantiated The Department investigated the allegation: Elevator not serviced since 2022. Record review revealed that the facility elevator was last serviced on 01/19/2021. LPA observed that the elevator permit expired on 01/19/2022. Per the Department of Industrial Relations, no elevator shall be operated without a valid, current permit. Based on observation, interviews, and records reviews, elevator next service date have not been established or recorded; the preponderance of evidence standard has been met, therefore the allegation: Elevator not serviced since 2022, is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22, on the attached 9099-D. The Department investigated the allegation: Facility does not have sufficient staff to respond to resident’s calls for assistance. It was found that on 02/16/2025, the facility elevator “broke down” with a resident inside. Record review and interviews revealed that facility staff did not respond to the elevator emergency assistant call light for approximately 30 minutes. The preponderance of evidence standard has been met, therefore the allegation: Facility does not have sufficient staff to respond to resident’s calls for assistance, is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22, on the attached 9099-D. Exit interview conducted. This report was signed on-site. A copy of this report and appeal rights were provided to Administrator.the state’s words, verbatim · CDSS document, Apr 9, 2025 · control 24-AS-20250220144909

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303 · Plan of correction due date: Apr 14, 2025

87303 Maintenance and Operation. (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 was met as evidenced by: on 02/16/2025 at approximately 4:45PM a resident was trapped in the elevator when it malfunctioned for approximately 30 minutes. Based on records review elevator was not serviced since 2021, which poses potential health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The facility will continue providing services through OTIS and continues follow up on permit renewal. Once received, provide POC to Licensing office by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Apr 14, 2025

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by; when on 2/16/24, at approximately 4:45PM resident trapped in the elevator when it malfunctioned. Residents calls for assistance went unanswered for approximately 30 min, this poses potential health and safety risk ti persons in care.the state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The Facility will appeal the citation. The retrain staff on procedures on elevator calls. Provide POC to Licensing office by POC due date

Type of visit: Case Management - Health Checks

On 03/21/2025 LPA Gorban visited the facility to conduct health and safety checks of clients in care. LPA introduced self, stated the purpose of the visit and was allowed entry. Administrator was notified of Licensing visit and was able to attend it. During this visit LPA toured inside and outside of the facility, interviewed facility staff and administrator Jessica Sanchez. During this visit LPA toured the facility conducting health and safety checks. Based on observations and interviews the assisted living section of the facility that equipped with call light system does not operate as required. Citation will be issued follow ing title 22 regulations with deficiency on following LIC809-D page. Exit interview conducted report signed and copy of this report with appeal rights provided for facility recordsthe state’s words, verbatim · CDSS document, Apr 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(i)(1) · Plan of correction due date: Apr 14, 2025

87303 Maintenance and Operation. (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: This requirement was not observed as evidenced by; the facility call light system does not work as required. Four out of nine residents unable to utilize call system services, which poses potential health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The facility use bells, RCL vendor to order new transmitter. Anticipated repair date on 4/18/25. The facility staff to Provide proof of repair by POC due date.

Type of visit: Case Management - Other

On 12/11/2024 Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct health and safety checks and provide amended report. LPA met with Maintenance Director (MD) Ramon Zepeda. Administrator (AD) Jessica Sanchez who was notified but was not at the facility to attend the visit. LPA explained the reason for the visit to MD and provided amended report. During this visit LPA conducted facility tour, reviewed facility emergency lighting with MD Zepeda and observed residents in care. No deficiencies were cited during this visit. Exit interview conducted, report signed and copy of this report provided for facility records.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Case Management - Other

On 2/25/2025, Licensing Program Analyst (LPA) M. Medina arrived to conduct an unannounced Case Management visit. LPA arrived, introduced self, stated purpose of visit, and allowed entrance into facility. Executive Director, Jessica Sanchez was unavailable during today's visit. LPA met with Melissa Arango, Business Office Manager to conduct visit and facility tour. LPA conducted visit to follow up on two (2) self reported incidents that both occurred on 2/16/25, the incidents involved Resident 1 (R1) and Resident 2 (R2). Both incidents were reviewed by this Department on 2/24/25. LPA also toured facility to verify that contractors who were observed to be living on site during a visit conducted on 2/21/25 by LPA Gorban were no longer on the premises. For incident involving R1, LPA gathered information and obtained copies of R1's physician report and Identification and Emergency Information sheet (LIC 601). For incident involving R2, LPA toured facility, used elevators to tour facility, tested emergency call button in elevator, and gathered documents available for elevator repair. Per telephone conversation with Executive Director (ED) there is currently no other documentation available regarding repair. If additional information is needed by Department, ED will request from OTIS Elevator Company which serviced elevator. LPA toured Independent Living West Wing and observed room where contractors were residing to be vacant, LPA observed items that were present which indicated the unit was at one time occupied. No personal belongings were observed in the unit. No deficiencies cited during this Case Management visit, deficiencies if observed may be cited at a later date. Exit interview conducted. A copy of this report provided to facility for their recordsthe state’s words, verbatim · CDSS document, Feb 25, 2025

Allegation investigated: The elevator was reportedly not working for an extended period, leaving residents trapped on the upper floor Some parts of the facility do not have heat, and the facility is utilizing space heaters. Emergency disaster plan is not sufficient

On 01/21/2025, Manager Brenda White, Licensing Program Manager (LPM) See Moua, and Licensing Program Analyst (LPA) V. Gorban conducted an unannounced complaint commencement visit. Licensing Program personnel explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegation: The elevator was reportedly not working for an extended period, leaving residents trapped on the upper floor. During complaint investigation department staff interviewed administrator in regards to not working elevator. Based on information provided the facility elevator was not operational no 11/20/24 and became operational 12/13/24, during that incident no residents were stuck in elevator. Based on LPAs observations and interviews which were conducted and record review the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations number being cited on the attached LIC 9099D. Report continues on attached LIC9099-C Exit interview conducted, report signed and copy of this report provided to Administrator for facility records Substantiated Allegation: Some parts of the facility do not have heat, and the facility is utilizing space heaters. During this allegation investigation Licensing personnel interviewed facility administrator and residents. Based on observations during the visit on 1/21/25 space heaters were observed in dinning room and per regulation requirements indoor temperature has to be in required temperature parameters. The dinning room never had heating unit and the facility has always utilized space heater for heating this area. The temperature observed at 65.6 degrees F. Based on LPA observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations number being cited on the attached LIC 9099D. Allegation: Emergency disaster plan is not sufficient. Based on administrator's interview and facility records review provided the emergency disaster plan is incomplete. The plan was not addressed transportation, staff and residents for emergency and fire drill. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations being cited on the attached LIC 9099D. Exit interview conducted, report signed and copy of this report with appeal rights provided to Administrator for facility records.the state’s words, verbatim · CDSS document, Jan 21, 2025 · control 24-AS-20250117115034

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 24, 2025

87303 Maintenance and Operation. (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 was not observed as evodenced by: Based on the interviews conducted and records reviewed, the elevator wasn't working properly on 11/20/24. Staff had to manually use the elevator by key for residents.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: Administrator agrees to submit proof of the elevator repairs to the Department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b)(1) · Plan of correction due date: Jan 24, 2025

87303 Maintenance and Operation. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not observed as evidenced by: Based on observation, space heaters were used to heat the dining room.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: The Administrator agrees to submit a statement from the Fire Department regarding safety of space heaters and will submit a plan to ensure the dining room is heated and maintained at the required temperature.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87212(b)(2) · Plan of correction due date: Jan 24, 2025

87212 (b) The plan shall be subject to review by the Department and shall include: (2) Plan for evacuation including... This requirement was not observed as evidenced by: the Emergency Disaster Plan was missing information regarding transportation of residents in an emergency and staff and resident's emergency drills.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: The Administrator agrees to update the Emergency Disaster Plan with the missing information and submit the plan to the Department by the POC date.

Allegation investigated: Staff did not prevent resident from creating a hostile environment for other residents in care

On 12/30/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegations: Staff did not prevent resident from creating a hostile environment for other residents in care During complaint investigation department reviewed facility files and interview administrator. Based on information provided the resident (R1) is not under Licensing supervision and jurisdiction. Based on these finding, the department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted, report signed and copy of this report provided to Administrator for facility records. Unfoundedthe state’s words, verbatim · CDSS document, Dec 30, 2024 · control 24-AS-20241226081531

Type of visit: Case Management - Other

On 12/11/2024 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to collect original report and provide amended report. LPA met with Administrator (AD) Jessica Sanchez who was at the facility. LPA explained the reason for the visit was to amend the original report, collect the original report, and provide a copy of the amended report. No tour of the facility was completed due to the sole purpose of the visit was to provide amended report. Exit interview conducted, original report was collected, and a copy of the amended report was emailed to Administrator.the state’s words, verbatim · CDSS document, Dec 11, 2024

Allegation investigated: Staff do not ensure facility is free from pests

On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegation: Staff do not ensure facility is free from pests. Based on records review and interviews conducted, it was determined that the facility had a problem with vermin however through review of records facility is maintaining and increased records to twice a week pest control service to resolve issue. Based on interviews and records review, this agency has investigated the complaint alleging staff did not ensure the facility was free from pests. 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, report signed and copy of thisrpeort provide for facility records. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 4, 2024 · control 24-AS-20240924084135

Allegation investigated: Facility retaliates against residents for complaints made Facility serves food that is not of good quality

On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegations: Facility retaliates against residents for complaints made. During this investigation department toured the facility and interviewed residens with diverse admission agreement arrangements. Based on observations and interviews on 10/22/24 no concerns from residents reported. Allegation: Facility serves food that is not of good quality. Based on observations, administrator and staff interviews, food arrives at the facility twice a week, no expired food observed during the facility tour. Food kept refrigerated till prepared and serviced to residents according to its instructions. Report continues on attached LIC9099-C Unsubstantiated Although the above 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, report signed and copy of this report provide for facility records.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 24-AS-20241016164531

Allegation investigated: Facility did not adhere to resident's Admission Agreement. Licensee is not ensuring that facility is free from mold. Facility is in disrepair. Staff did not accord dignity to resident in care.

On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegations: Facility did not adhere to resident's Admission Agreement. Licensee is not ensuring that facility is free from mold. Facility is in disrepair. Staff did not accord dignity to resident in care. During complaint investigation department reviewed facility files and interview administrator. Based on information provided the resident (R1) is not under Licensing supervision and jurisdiction. Based on these findings, the department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted, report signed and copy of this report provided to Administrator for facility records. Unfoundedthe state’s words, verbatim · CDSS document, Dec 4, 2024 · control 24-AS-20241126141511

Allegation investigated: Staff are not providing a comfortable environment for residents

On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegations: Staff are not providing comfortable environment for residents. During complaint investigation department reviewed facility files and interview administrator. Based on information provided the resident (R1) is not under Licensing supervision and jurisdiction. Based on these findings, the department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted, report signed and copy of this report provided to Administrator for facility records. Unfoundedthe state’s words, verbatim · CDSS document, Dec 4, 2024 · control 24-AS-20241126150237

Allegation investigated: Facility heater is in disrepair. Facility elevator is in disrepair. Staff not available to assist residents.

On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records. Allegations: Facility heater is in disrepair. Facility elevator is in disrepair. Staff not available to assist residents. During complaint investigation department reviewed facility files and interview administrator. Based on information provided the resident (R1) is not under Licensing supervision and jurisdiction. Based on these findings, the department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted, report signed and copy of this report provided to Administrator for facility records. Unfoundedthe state’s words, verbatim · CDSS document, Dec 4, 2024 · control 24-AS-20241202121000

Type of visit: Required - 1 Year

On 11/12/2024, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct Required Annual Inspection. LPA met with Administrator (AD) Jessica Sanchez, certification number 6072416740 and expiration date 10/01/2026. LPA conducted tour inside and out of facility with AD. Residents observed at the facility during lunch time. The facility was observed to be at a comfortable temperature of 77 degrees, clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 05/13/2024 Dining this visit Kitchen and dinning room were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in freezer, refrigerator, and pantry. Food is delivered twice a week on Tuesdays and Thursdays. Refrigerator temperature was maintained at 42.0-degree F. and freezer was maintained at -5-degree F. LPA toured resident bedrooms. Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. Hot water temperature tested at 110.6 degrees F. LPA observed securely fastened grab bar and non-skid mat in shower area. Medications were stored in a locked medication room in a medication cart. Medication records tracked by QuickMar. Medications records were reviewed. First Aid Kit was stored in medication room and observed with all required items. Adequate PPE supplies was observed. LPA toured laundry room and observed chemicals were stored and locked for staff use only. Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents. A sample of residents’ file was reviewed to have updated emergency contact, Admission agreement, Needs and Services Plan and Pre-Appraisal Plan. A sample of staff files were reviewed. Staff files were observed to have current First Aid/CPR, Health screening, and Personnel record. Staff are fingerprinted clear and associated to the facility. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · LIC 309 Administrative Organization Plan of Operations · LIC 500 Personnel Report Liability Insurance · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents Please submit the above forms/information to Fresno CCL by: 11/15/2024 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed. An exit interview was conducted with the ED. Deficiency attached on LIC809-D A copy of this report was given to the ED, whose signature on this form confirm receipt of these reports.the state’s words, verbatim · CDSS document, Nov 12, 2024

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: Case Management - Health Checks

On 10/28/2024, Licensing Program Analyst (LPA) V Gorban visited the facility to follow up on Plan Of Correction, additional information and to observe facility water temperature regulations status. During this visit LPA toured the facility performing safety checks, checked facility temperature status and interview resident. LPA requested facility files and interviewed facility staff. No deficiency were cited during this visit. Exit interview conducted, report signed and copy provided to Business Office Director for facility records.the state’s words, verbatim · CDSS document, Oct 28, 2024

Allegation investigated: Staff made significant changes to the facility's plan of operation without proper approval

On 10/24/2024 at 3:25 PM, Licensing Program Analyst (LPA) B. Miranda conducted a subsequent visit and met with Executive Director/ Administrator, Jessica Sanchez to deliver findings of above allegation. LPA explained the purpose of the visit with Administrator. Allegation: Staff made significant changes to the facility's plan of operation without proper approval. Finding: Substantiated LIC9099-C Continued... Substantiated On 10/23/24 the facility file was reviewed and there was no request to change the Plan of Operation. On 10/23/24, LPA found that the facility’s website is advertising as a “55+ independent living” component. On 10/24/24 LPA met with S1 and asked for a copy of Plan of Operation and a copy of admission agreement. Copy of admission agreement was provided, on page 5 it states "We own Pacifica Senior Living (the "Community"), a licensed residential care facility for the elderly located at _________, which provides residence, care and services to persons 60 years of age and older." There is an Appendix P- Addendum Declining Residence & Care Services. S1 stated they have been employed since 1/2024 and the facility has serviced the 55+ population. LPA interviewed S2 who stated the prior owners had residence age 60+ and now there are residence age 55+. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, and the Department has determined that a significant change to the plan of operation affecting the services of residents has been enacted without the approval of the Agency. Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Failure to correct deficiencies by POC due date may result in additional Civil Penalties. Exit interview was conducted and a copy of this report LIC9099, LIC9099D, and Appeal Rights were provided to Administrator Jessica Sanchez.the state’s words, verbatim · CDSS document, Oct 24, 2024 · control 24-AS-20240520161700

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Oct 31, 2024

87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: Administrator will follow-up with upper management to have request submitted.

Allegation investigated: Facility has no hot water or heat for the residents

On 10/18/2024, Licensing Program Manager (LPM) Brenda Chan and Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct a subsequent visit and met with Business Office Manager (BOM) Melissa Arango to deliver findings of above allegation. LPA explained the purpose of the visit. Allegation: Facility has no hot water or heat for the residents. Based on observations, interviews, and records reviews residents did not have access to hot water on 10/14 (98 degrees F), 10/15 (98 degrees F) and 10/17 (97 degrees F) in South Wing Building due to boiler stops hearting water and has to be reset mannualy by staff. The facility's broiler igniter is not working properly, and the facility has been intermittently without hot water in the South Wing Building. Based on interviews conducted, observation, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations being cited on the attached LIC 9099-D Exit interview conducted, copy of this report provide to facility with Appeal Rights Substantiatedthe state’s words, verbatim · CDSS document, Oct 18, 2024 · control 24-AS-20241015104513

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Oct 19, 2024

87303 Maintenance and Operation (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 was not observed as evidenced by: The facility failed to maintained water temperature within regulatory requirement of Titlte 22 regulation (105 degree F (41 degree C) and not more than 120 degrees F) .At a minimum, there were three days, from 10/14, to 10/17 hot water was not accesible to residents. This is poses immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: The hot water is ongoing issue. The Licensee agrees to submitt plan of correction by tomorrow. In the plan the facility administrator will provide resolution including timeline to have this completed by and documentation of the complanies who were contacted, when they came out, the issues that were found, and the repairs that are needed, and when they are made.

Allegation investigated: Staff unlawfully evicted a resident Staff is not abiding to admission agreement

Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct a subsequent visit and met with Administrator Jessica Sanchez to deliver findings of above allegation. LPA explained the purpose of the visit with administrstor. During the course of the investigation, the Department conducted interviews and reviewed records. With regards to the allegation, Staff unlawfully evicted a resident. The Provider issued a three-day eviction notice to the resident on August 16,2024. The department has obtained a copy of the notice. Based on the interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099-D. Report continues on attached LIC9099-C Substantiated With regards to the allegation, Staff is not abiding to admission agreement. The Provider did provide a Three-Day Notice to Pay or Quit to the resident on August 16, 2024. The Care and Residence Agreement and the Continuing Care Contract Statutes both provide for termination of an agreement upon ninety (90) day’s written notice to resident with good and sufficient cause as required by Health and Safety Code section 1788(a)(31). Based on the interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Exit interview conducted, administrator refused to sign a report. Appeal rights provided to Administrator for facility records.the state’s words, verbatim · CDSS document, Oct 15, 2024 · control 24-AS-20240822133921

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(1) · Plan of correction due date: Oct 17, 2024

87224 (a)(1) Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). (1) Nonpayment of the rate for basic services within ten days of the due date. This requirement was not observed as evidenced by: Based on review of record , interviews and documentation obtained during the investigation, the facility administrator did not provide the resident with the required 30 day written notice of eviction. The facility failed to follow title 22 regulation in regards to Eviction procedures which poses potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Refused to offer plan of correction.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1788(a)(31) · Plan of correction due date: Oct 18, 2024

H&S §1788 (a)(31) The Care and Residence Agreement and the Continuing Care Contract Statutes both provide for termination of an agreement upon ninety (90) day’s written notice to resident with good and sufficient cause as required by Health and Safety Code section 1788(a)(31). This requirement was observed as evidenced by: Based on review of records, interviews and documents obtained during the investigation, the provider issued the resident a three-Day Notice to Pay or Quit to the resident on August 16, 2024, which poses potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Refused to offer plan of correction.

Allegation investigated: Facility is without hot water Facility is without heat

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a complaint on the allegations listed above. LPA met with Facility Executive Director, Jessica Sanchez, and explained the purpose of today's visit. Regarding the allegation, Facility is without hot water. The facilities broiler igniter is not working properly, and the facility has been intermittently without heating, and hot water in facility south wing since 05/25/24. The facility is in the process of repairing the boiler igniter, and putting a plan in place for residents to have warm water in a vacant room inside the facility. Resident 1 stated they did have to take a cold shower recently, and was not aware there was a separate room made available for residents to have a warm shower. LPA measured the water temperature in several rooms in south wing of the facility and it measured to be 92 degrees. Based on LPA interviews conducted, observation, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED Substantiated Regarding the allegation facility is without heat. The facilities broiler igniter is not working properly, and the facility has been intermittently without heating, and hot water since 05/25/24. The boiler igniter is having to be tested and re lit hourly, and when it is not re lit timely the facilities south wing hot water, and heat does not work. The facilities boiler is not currently working at time of visit, and the water temperature measures at 95, and heating in south wing is not working. Based on LPA interviews conducted, observation, and records reviewed which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED The following Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Executive Director, Jessica Sanchez, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 10, 2024 · control 24-AS-20240529114424

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(2) · Plan of correction due date: Jun 24, 2024

87303 Maintenance and Operation (a)(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). The following requirement has not been met as evidenced by: LPA Hurt observed the facility water temperature inside residents south wing bedrooms to measure at 92 degrees, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2024

Plan of correction: Executive director will send proof facility warm water is measuring between 105 and 120 by POC date of 06/24//2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 24, 2024

87303 Maintenance and Operation (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. The following requirement has not been met as evidenced by: The facilities hot water, and heat has been in disrepair and not working intermittently since 05/25/24, which poses a potential, health, safety, or personal rights risk to residnets in care.the state’s words, verbatim · CDSS document, Jun 10, 2024

Plan of correction: Executive director will send proof facility heating in south wing is working continuosuly by POC date of 06/24//2024.

Allegation investigated: Resident's ceiling is leaking water.

On 4/11/2024, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPA met with Executive Director Jessica Sanchez and announced the purpose of the inspection. 1) Resident's ceiling is leaking water: During the visit, LPA conducted interviews and inspected the facility. LPA toured the bedroom and bathroom of Resident 1 (R1). R1 stated that there had been a leak in their bathroom ceiling, but it was repaired by facility staff. According to facility staff, the leak was repaired on 3/31/2024, and had been leaking for a few days. LPA observed two patches in the ceiling that appeared to be repaired and painted. There were no active leaks in residents' bedrooms at the time of inspection. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited. A copy of the report was provided to the licensee vial email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 11, 2024 · control 24-AS-20240404163037

Allegation investigated: Staff did not assist resident with obtaining prescription for OTC medications. Staff are not assisting resident with mobility issues. Staff are not following resident’s modified diet plan.

On 3/14/2024, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Jessica Sanchez and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Unsubstantiated. 1. Staff did not assist resident with obtaining prescription for OTC medications. In September of 2023, Resident 1 (R1) returned to the facility from a skilled nursing facility. R1 returned with a new physician's report which indicated she was unable to manage her own medications. Facility staff informed R1 they must keep her medications centrally stored. R1 has since been given doctor's orders to keep some of her own medications, and has been assisted by facility staff in obtaining her prescriptions. Unsubstantiated 2. Staff are not assisting resident with mobility issues: During interview, R1 has stated that staff provide her with the assistance she needs. R1 stated that during her stay at a skilled nursing facility, the staff there did not provide her with enough assistance retrieving her personal items from her old room at the facility. These staff are not employed by Pacific Grove Senior Living. 3. Staff are not following resident’s modified diet plan: Based off of record review and interview, there was no documentation to show that R1 was given a modified diet plan by her physician. Facility staff do track residents' modified diet plans on a roster, and these diet plans are adhered to by staff. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited. A copy of the report was provided to the licensee vial email.the state’s words, verbatim · CDSS document, Mar 14, 2024 · control 24-AS-20230907161406

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility on 02/21/2024 to conduct a Case Management visit. LPA Hurt met with Executive Director, Jessica Sanchez and explained the purpose of todays visit. LPA Hurt is following up on an incident involving Staff 1, and Resident 1. LPA Hurt collected receipts, and a police report related to the incident involving Staff 1, and Resident 1. LPA Hurt collected "Roommate and Caretaker Agreement." LPA Hurt spoke with Executive Director, Jessica Sanchez, and obtained more details related to the incident. LPA Hurt collected photos of text communication between Staff, and Resposnible party for Resident 1. LPA Hurt collected Power of Attorney documents for Resident 1 provided by Responsible Party. No deficiencies cited today Per Title 22 Regulation. Exit interview conducted with Executive Director, Jessica Sanchez, and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 21, 2024

Allegation investigated: Facility staff are not providing services agreed to in the Admissions Agreement. Facility staff are not adhering to food service requirements.

On 2/15/2024, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Jessica Sanchez and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Unsubstantiated. 1. Facility staff are not providing services agreed to in the Admissions Agreement. Based on records review and interviews, facility staff have been providing the services which have been agreed upon in the admissions agreement. "24 hours emergency response with Nurse oversight" was provided to the residents in the assisted living section of the facility, per the agreement. Unsubstantiated 2. Facility staff are not adhering to food service requirements- during multiple facility inspections, facility food service was found to meet the requirements set forth by California Code of Regulations and Health and Safety Code. The food was sufficient in both quantity and quality, and was stored properly. Snacks are provided to residents between meals, and residents stated that the food is adequate. 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. A copy of the report was provided to the licensee vial email.the state’s words, verbatim · CDSS document, Feb 15, 2024 · control 24-AS-20230824132408

Allegation investigated: Facility is without running water.

On 2/15/2024, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Jessica Sanchez and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Unsubstantiated. 1. Facility is without running water - Although the facility was without running water in the independent "cottages" for approximately 10 hours, 12/5/2023-12/6/1023, facility staff responded to the issue and had the plumbing fixed. Residents and staff in the assisted living section did not experience the lack of running water. 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. A copy of the report was provided to the licensee vial email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 15, 2024 · control 24-AS-20231206114146

Type of visit: Case Management - Health Checks

On 1/18/24, Licensing Program Analyst (LPA) V Gorban arrived unannounced to conduct a case management inspection. LPA explained the reason for inspection and met with (ED) Jessica Sanchez. LPA toured the facility inside and out to conduct safety checks. CCL received an incident report on 01/11/24 facility heaters stopped working on 1/5/24. Per incident report Maintenance Director made a contact on the same day with a heating company, Enviro-Tempt to diagnose the problem. At the same, time the facility provided portable heaters to residents. ED stated that five (5) resident rooms effected. Facility also offered residents alternative furnished guests rooms to use meantime till central heater problem resolved. During this visit LPA toured the facility effected section of the facility, observed residents and their rooms. NO deficiencies were observed and cited during this visit. Exit interview conducted, report signed and copy of this report provided for facility records.the state’s words, verbatim · CDSS document, Jan 18, 2024

Allegation investigated: Facility in disrepair.

On 12/21/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Billy Mitchell and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Substantiated: Facility in Disrepair - During an inspection on 5/31/2023, LPA observed an active leak from water pipes which were running along the ceiling of the underground resident parking garage. LPA observed a puddle which had formed as a reulat of the leak, approximately 20 feet by 10 feet in size, and over an inch deep at its deepest point. At the time of inspection, the body of water had not been marked or blocked off by facility staff. Substantiated Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiency was observed and cited on the attached LIC 9099-D. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted, and a copy of this report provided to the licensee via email. Appeal Rights (LIC 9058) were provided to the licensee, who signed the original copy of this report.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 24-AS-20230525162743

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 22, 2023

87303 Maintenance and Operation: (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 was not met as evidenced by: Based on obervation and interview, the licensee failed to ensure that the facility was in good repair and free from hazard around the time of 5/25/2023-5/31/2023, which presented a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Dec 21, 2023

Plan of correction: A work order had been placed to repair the leak on 5/31/2023. LPA verified that the leak was repaired and the area was free from hazards on 7/13/2023. Deficiency cleared.

Allegation investigated: Resident developed pressure sores due to staff negligence. Resident sustained skin lacerations due to staff negligence. Staff handled resident in a rough manner causing bruising. Staff spoke inappropriately to resident.

On 12/21/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Billy Mitchell and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Unsubstantiated. 1. Resident developed pressure sores due to staff negligence. Resident 1 (R1) began receiving hospice care on 6/13/2023. On 4/18/2023, R1 was prescribed with orders from the hospice physician for wound care, which was to be completed 3 times per week, for a wound developing on R1’s right ankle. R1 was seen in the emergency room on 7/7/2023, where it was identified by the attending physician that R1 was developing a pressure sore on his right foot. On 7/14/2023, facility staff updated the needs and service plan to reflect the need for wound care. This care was to be provided by hospice staff. Unsubstantiated 2. Resident sustained skin lacerations due to staff negligence. On 7/7/2023, while in the activity room, R1 received lacerations to his left hand and fingers. According to facility staff, R1 was left unattended for approximately five minutes. R1 was seen in the emergency room, where the attending physician determined that the lacerations were consistent with injuries that would be sustained from R1’s wheelchair. 3. Staff handled resident in a rough manner causing bruising. R1 complained to their responsible party and to facility staff of being handled roughly. R1 requested that certain staff at the facility no longer provide direct care to him due to what they claim was rough handling. Although R1 did receive bruising to their arms, it is unclear as to whether this was as a result of handling by facility staff. During interviews, facility staff deny handling R1 in a rough manner, and also deny witnessing any staff handle R1 roughly, or in a way which is considered inappropriate. 4. Staff spoke inappropriately to resident. During interviews, facility staff denied speaking inappropriately to R1, or any other residents. Other facility residents stated that staff provided adequate care for them and felt that they were treated well by staff. Although these 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. A copy of the report was provided to the licensee vial email and exit interview conducted.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 24-AS-20230721114455

Type of visit: Required - 1 Year

On 12/21/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with Interim Executive Director Billy Mitchell and announced the purpose of the visit. LPA toured the assisted living section located on the 2nd floor. Resident bedrooms and bathrooms were clean and odor free. Bedrooms had required minimum furnishings. Bathrooms had required secure grab bars and non-skid mats. Resident dining area was clean and free from hazards. Sharp items, chemicals, and detergents were secured in a locked cabinet within the kitchen area. LPA reviewed a sample of resident files, which contained required documents and records. There were two caregivers and a Resident Services Director is the assisted living section providing care and supervision to residents. LPA toured the facility main kitchen and dining area. The kitchen was clean, and all food items were observed to be stored and labeled properly. The facility had an adequate supply of perishable and nonperishable foodstuffs. LPA observed a supply of emergency food and potable water which was stored adjacent to the down stairs parking garage. LPA reviewed a sample of staff files and the facility emergency disaster plan. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted with Administrator. Executive Director agreed to send CCLD the following documents by 12/29/2023: LIC610E, LIC500, LIC9020, and a sample admission agreement.the state’s words, verbatim · CDSS document, Dec 21, 2023