Via Tercero Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by Administrator. LPA met with Alexander Gabat, Administrator and explained the nature of the visit. LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. There are four residents in care and there are no active covid-19 cases in the facility. LPA upon entry observed three residents in the living room watching TV and remainder of resident in their bedrooms. All residents appeared to be clean and well taken care of. LPA observed a check in station in the main entry of the facility. LPA observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have a supply of soap and appeared to be clean. LPA inspected residents’ bedrooms and appeared to be clean. All bedrooms observed to have all required components. Residents bedrooms are all private with one resident per. LPA observed the emergency disaster and evacuation plan. Facility has a supply of back-up emergency food and water supply in attached garage. LPA observed facility to have PPE supplies in storage and throughout the facility in all bedrooms as well as common spaces. LPA toured the outside of the facility and observed several shaded seating areas for resident’s enjoyment. LPA observed a staircase in the outside of the house that leads to the upstairs of the facility. There are no residents residing in the second floor of the facility, second floor is inaccessible to residents in care. The facility has completed the LIC808 Mitigation Plan. The plan was reviewed and approved by the Department on December 20, 2021. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 22, 2022

Allegation investigated: Facility staff is not providing resident with meals or food. Facility staff is coughing on food and not wearing a mask. Facility failed to follow reporting requirements. Facility staff are violating resident rights

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to deliver the findings for the investigation completed on the complaint filed on January 6, 2022 against this facility. LPA met with Administrator (AD) Alexander Gabat; and stated the purpose of the visit. On the allegation that facility staff is not providing resident with meals or food, the following are the findings. On January 7, 2022, LPA Marin conducted an unannounced physical visit in the facility. LPA observed that Resident 1 was agitated and heard R1’s voice from the main entrance with doors shut. R1 spoke of having a meal. Staff 1 brought in three stacks of pancake with syrup but R1 refused; and continued pacing inside room. After LPA spoke to R1, and R1 requested oatmeal with almond milk, and slice of cantaloupe and blueberries, which Staff 1 immediate provided. LPA further observed that the facility kitchen countertops were lined up with cereals and other food products often requested by R1. The facility refrigerator and freezer weere fully stocked with perishable goods. LPA observed that the two other residents in care were served with good portions of carbohydrates, protein, and vegetables for lunch service. Based on file review on site, AD Gabat recorded meals served to R1. Thus, the allegation that staff is not providing meals or food is UNFOUNDED. (Page 1/2) Unfounded On allegation that facility staff is coughing on food and not wearing a mask, the following are the findings. On January 7, 2022, LPA Marin conducted an unannounced physical visit in the facility. During the initial encounter with the Administrator and staff member, LPA observed that both were wearing surgical masks at all times. During the entire visit, LPA did not observe either AD and staff to be coughing. On January 13, 2022, the facility conducted Coronavirus 2019 (COVID 19) testing; and all came back negative including R1. Thus, the allegation that staff is coughing on food and not wearing mask is unfounded. On allegation that facility failed to follow reporting requirements, the following are the findings. AD stated and supported by written documents that on January 5, 2022, AD Gabat called Community Care Licensing Division (CCLD) to report on a COVID 19 positive case. AD received an email from CCLD requesting for information on the positive case. During the January 7, 2022 unannounced visit, LPA observed AD Gabat on the phone with Orange County Public Health and received directions for mass testing. Thus, the allegation that facility failed to follow reporting requirement is unfounded. On allegation that facility staff are violating resident’s rights, the following are the findings. During the January 7, 2022 unannounced visit, Resident was agitated and spoke to staff members in a loud manner. R1 stated Staff 1 was deaf. When LPA interviewed S1 regarding the hearing deficits, Staff denied and responded to questions asked by the LPA promptly and without any difficulty even with low modulated voice. AD attended to the queries of R1 with calm voice even R1 was highly agitated. Thus the allegation that facility staff are violating resident’s rights is unfounded. This agency has investigated the complaint. We have found that the above allegations were unfounded, meaning that the allegations were false, could not have happened and/or are without reasonable bases. We have therefore dismissed the complaint. LPA Marin conducted an exit interview with AD Gabat and copy of this report was left in the facility. Page 2/2the state’s words, verbatim · CDSS document, Feb 2, 2022 · control 22-AS-20220106183033

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to conduct a case management. LPA met with Administrator (AD) Alexander Gabat and stated the purpose of the visit. On December 20, 2021, The Community Care Licensing Division (CCLD) Orange Office received an information from AD Gabat that he is planning to suspend the operation of the facility. AD discussed the reasons with the LPA assigned to the facility. The LPA did a consultation with AD on issuance of 30 day notice to all residents, and requested copies of the notice to be provided to CCLD. On January 24, 2022, LPA Marin received information from AD on the placement status of the residents. All residents were relocated to another licensed facility by January 28, 2022. On February 2, 2022, LPA Marin confirmed the placement of residents in other licensed facilities. For this visit, LPA Marin toured the interior and exterior portions of the facility and did not observe any residents in care. LPA discussed that although the facility is suspending its operation, the facility is expected to pay the annual dues on time, and to comply with ongoing and all regulatory requirements. AD agreed to notify CCLD of plans when to resume the operation and before admitting new residents in the facility. LPA Marin conducted an exit interview with AD Gabat; and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Feb 2, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ruth Martinez conducted this case management visit to follow up on a 30-day notice received on September 27, 2021. LPA arrived to the facility was greeted and granted entry by Administrator. LPA met with Alexander Gabat, Administrator and explained the nature of the visit. During the visit LPA Martinez reviewed R1’s file. LPA noted that 30-day notice was served to R1 on September 19, 2021. LPA reviews all documents for accuracy of notice given to R1. Based on the information observed 30- day notice contains the required information to support the notice. R1 since the notice has complied with monthly dues, however other reasons still fall within required guidelines for section 87224 Eviction procedures. LPA advised Administrator to continue communicating the status surrounding the issue with R1. Administrator agrees to keep LPA informed and updated. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator and a copy of the LIC809 and LIC811 was provided and left at the facility.the state’s words, verbatim · CDSS document, Oct 8, 2021