Pacifica Senior Living South Coast

Allegation investigated: Neglect/Lack of Care and Supervision resulted in resident sustaining unspecified injuries. Staff did not meet a resident bathing and incontinence needs.

On July 10, 2026, Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegations. LPA met with the Resident Service Coordinator, Carmen Velasco and explained the purpose of the visit. An initial complaint investigation visit took place on May 19, 2026. During the visit, LPA accompanied by Executive Director conducted a tour of the facility's physical plant. LPA requested and obtained the resident and staff roster, face sheet, medical assessment, POLST, admission agreement, shower log, preplacement appraisal, physician’s orders, and shower body check form. Five staff and seven resident interviews were conducted during the visit. The investigation revealed the following: Regarding the allegation that neglect/lack of care and supervision resulted in resident sustaining unspecified injuries, it was reported that skin tears were not reported and hospice was not followed up on for Resident 1 (R1). Continued on LIC-9099C. Unsubstantiated Per R1’s LIC602, there was no mention of hospice being recommended. Five out of five staff stated R1 was not on hospice. LPA reviewed R1’s head-to-toe assessment dated April 3, 2026, and photos of bruises on R1’s legs and arm. Per shower body check forms dated April 7, April 10, April 17, April 21, April 24, April 28, May 1, and May 5, 2026, no abnormalities on the skin were noted by caregiver. Photographic evidence shows bruise on left calf and bruise on right arm when they moved in. LPA also reviewed photographic evidence of swollen feet, cracked nails, and a scab. Three out of five staff interviewed, corroborated that R1 had swollen feet and reported the incident. Per physician’s orders dated May 15, 2026, Amoxicillin 125mg oral tablets were prescribed for R1. Five out of seven residents, including R1 stated they had never sustained injuries due to lack of care. None of the evidence gathered supports the allegation. Regarding the allegations that staff did not meet a resident’s bathing and incontinence needs, it was reported that showers are not being provided as agreed upon and resident was found in feces and soiled diapers. R1 requires assistance with bathing and toileting. Per records review, R1 showered at least once a week. Five out of seven residents interviewed, including R1, denied the allegation. Two residents interviewed could not provide any details regarding the allegation and responded with unrelated information. Four out of five staff interviewed denied the allegation. One out of five staff interviewed confirmed the allegation. Based on the evidence gathered during the investigation, the allegations are found to be Unsubstantiated, meaning that 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. An exit interview was conducted, and a copy of the report was provided to a facility representative.the state’s words, verbatim · CDSS document, Jul 10, 2026 · control 22-AS-20260512163418

Allegation investigated: Staff did not ensure medication was stored locked and inaccessible to residents Staff did not dispense medications to residents as prescribed Unqualified staff administer injections to residents

On May 26, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Executive Director Yaylene Mazariegos was present and also assisted on today's visit. During the course of the investigation, LPA interviewed resident and interviewed staff. LPA also reviewed and obtained pertinent documents to this complaint such as resident records, including medication administration records. Regarding the allegation, staff did not ensure medication was stored locked and inaccessible to residents, the following has been concluded: During the course of the investigation, LPA inspected the facility's medication room and ten resident bedrooms. During a tour of Resident #1 (R1's) bedroom, R1 disclosed that she stores her insulin injection in her refrigerator. LPA then observed an insulin injection pen to be stored in R1's refrigerator which is kept unlocked and accessible to R1. LPA also observed that the door leading to R1's bedroom is also kept unlocked. CONTINUED ON LIC9099-C Substantiated LPA reviewed the Physician's Report for R1 dated June 2, 2025, which states that R1 is unable to manage her own prescription medications and is unable to store her own medications. Therefore, R1's insulin injection pen should be kept locked an inaccessible to R1. LPA conducted seven staff interviews. Four out of the seven staff interviewed corroborated the allegation and confirmed that R1's insulin injection pen is kept in R1's refrigerator. The four staff also confirmed that R1's refrigerator is not kept locked and is accessible to R1 at any time. Regarding the allegation, staff did not dispense medications to residents as prescribed, the following has been concluded: LPA conducted ten resident interviews. Eight out of the ten residents interviewed denied the allegation and reported no issues with their medications. The other two residents were unable to provide any useful information for this allegation. The Department conducted seven staff interviews. Six out of the seven staff interviewed denied the allegation. However, one staff interviewed corroborated the allegation. During the course of the investigation, LPA reviewed the medication and medication administration records nine residents of the facility. LPA observed the facility did not the following as needed medications for Resident #2 (R2): Acetaminophen 325 MG tablet, Benzonate 100 MG capsule, Geri-Lanta Liquid, and Milk of Magnesia suspension. All the medications listed were not present at the facility if R2 required it, despite it being listed under R2's active medication orders. LPA observed the facility did not have the following as needed medications for Resident #3 (R3): Geri-Lante Liquid, Loperamide 2 MG capsule, and Milk of Magnesium. All the medications listed were not present at the facility if R3 required it, despite it being listed under R3's active medication orders. LPA observed the facility did not have the following as needed medication for Resident #5 (R5): Cetirizine 10 MG tablet. The medication listed was not present at the facility if R5 required it, despite it being listed under R5's active medication orders. LPA observed the facility did not have the following as needed medication for Resident #6 (R6): Robafen liquid. The medication listed was not present at the facility if R6 required it, despite it being listed under R6's active medication orders. LPA observed the facility also did not have the following as needed medication for Resident #9 (R9): Milk of Magnesia Suspension. The medication listed was not present at the facility if R9 required it, despite it being listed under R9's active medication orders. LPA conducted ten resident interviews. Regarding the allegation, unqualified staff administer injections to residents, the following has been concluded: It was alleged that unqualified staff administer injections to R1. LPA reviewed the Physician's Report for R1 dated June 2, 2025, which states that R1 is Type 2 Diabetic. CONTINUED ON LIC9099-C It also states that R1 is unable to manage her own medication and is unable to administer her own prescription medications. LPA reviewed the medication orders for R1 which states that R1 requires a Lantus Solostar 100 unit milliliter injection daily. LPA conducted an interview with R1. R1 stated that she is not able to do her own injections, and R1 identified three staff who have done the injections for her previously. During the investigation, the Department obtained admission from three separate staff who stated that they have given injections to R1, and have observed other staff give injections to R1. Based on the evidence gathered during this investigation, the Department obtained sufficient evidence to substantiate the three allegations listed above. The preponderance of evidence standards has been met; therefore, the above allegation are SUBSTANTIATED. Deficiencies are being cited on the attached LIC9099-D pages. An exit interview was conducted with Executive Director Yaylene Mazariegos. A copy of the report and appeal rights were provided at time of visit. Regarding the allegation, staff did not assist residents in a timely manner, the following has been concluded: During the investigation, LPA observed that the facility's call button and call cord system does not document the time that it takes for staff to respond to resident's calls. LPA conducted ten resident interviews. Three out of the ten residents interviewed corroborated the allegation and reported that they have had issues with staffing not responding to them timely due to staffing issues. However, seven residents interviewed either denied the allegation or were unable to provide any useful information. LPA conducted seven staff interviews. One out of the seven staff interviewed corroborated the allegation. However, six out of the seven staff interviewed denied the allegation. Regarding the allegation, staff did not meet residents’ incontinence needs, the following has been concluded: LPA conducted ten resident interviews. Only four out of the ten residents interviewed stated that they require assistance with incontinence care. Two residents corroborated the allegation and reported issues with receiving incontinence care. However, two residents also denied the allegation and reported no issues with their incontinence care. LPA conducted seven staff interviews. One out of the seven staff interviewed corroborated the allegation. However, six out of the seven staff interviewed denied the allegation. Regarding the allegation, facility's air conditioner is not operational, the following has been concluded: During LPA's visits to the facility on March 20, and May 12, 2026, LPA observed the facility air conditioner to be operational. LPA conducted ten resident interviews. Four out of the ten resident's interviewed corroborated the allegation and reported previous issues with the facility's air conditioner. However, six residents either denied the allegation or were unable to provide any useful information. LPA conducted seven staff interviews. Two out of the seven staff interviewed corroborated the allegation. However, five staff interviewed denied the allegation and reported no issues with the facility's air conditioner. Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the four allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Yaylene Mazariegos. A copy of the report was provided to the facility at time of visit.the state’s words, verbatim · CDSS document, May 26, 2026 · control 22-AS-20260316142102

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: May 27, 2026

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not evidenced by: Based on interviews and records reviewed, the Licensee did not ensure that R1's medications were stored in a safe and locked place, due to R1 not being able to store her own medication per her Physician's Report. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: The Executive Director stated that she will centrally store R1's medication. The Executive Director stated that she will also conduct an in service training with staff regarding the storage of medication. The Executive Director agreed to provide LPA proof of training via email or fax by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: May 27, 2026

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed...(5) Facility staff, except those authorized by law, shall not administer injections.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not ensure that a medical profession administered injections to R1. LPA received an admission from R1 and three staff who corroborated the allegation. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: The Executive Director stated that she create a plan to ensure that injections are only administered to R1 by a medical professional. The Executive Director stated that she will also conduct an in service training with staff regarding injections. The Executive Director agreed to provide LPA the plan and the in service training via email or fax by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5) · Plan of correction due date: Jun 8, 2026

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not evidenced by: Based on records reviewed, the Licensee did not ensure that each resident's as needed medications were present at the facility if needed by the resident. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: The Executive Director stated that she will either discontinue the as needed medications, or order refills for them to be present at the facility. The Executive Director also stated that she will conduct an in service training with staff regarding medication management. The Executive Director agreed to provide LPA proof of the in service training via email or fax by POC due date.

Allegation investigated: Facility did not bring the change in cognitive functions to the resident’s physician.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged facility did not bring the change in cognitive functions to the resident’s physician. During the investigation, LPA conducted interviews with staff and resident in care. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility did not bring the change in cognitive functions to the resident’s physician, it was reported the facility did not seek an updated physician’s report for Resident (R1) with a current diagnosis. Interview with R1 stated they have seen their primary care physician (PCP) a couple of times since their readmission to the facility on February 27, 2026. Unfounded Interview with Administrator (AD) Yaylene Mazariegos stated upon R1’s readmission from the skilled nursing facility (SNF), R1’s PCP was present at the facility and administered a new exam for R1. AD added R1 arrived at the facility with a physician’s report provided by the SNF. LPA reviewed R1’s file and confirmed there was an updated physician's report signed by the PCP on March 6, 2026 with an examination date of February 27, 2026. The physician’s report did not indicate a diagnosis of dementia. LPA reviewed a prior physician's report dated also on February 27, 2026 with a diagnosis of dementia for R1. However, the physician’s report was not signed by a licensed medical professional and therefore not valid. Based on interviews and record review, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report was left with the facility representative. W1 stated they have been assisted by other staff with billing questions when AD is not available. Interview with AD stated she has not received calls from W1 recently. AD provided LPA with copies of her call log indicating last phone contact with W1 on June 30, 2025 via voicemail. AD added she has spoken with W1 in person on several occasions when they come to the facility to visit R1. Regarding the allegation the resident's call button is in disrepair, it was reported the call button in R1’s room is not working. Interview with R1 stated they are able to call for assistance by pulling on cord with call buttons located by the bed or in the bathroom. Two out of three other residents interviewed stated they have used the pull cord in the past and have had staff respond. The remaining resident stated they have never used the pull cord in their room. LPA pulled the cord in R1’s room and a staff member responded within 14 minutes. Regarding the allegation vehicle is in disrepair, it was reported the facility vehicle is not operational to assist residents with transportation. Interviews with one out of four residents stated the facility vehicle has been operational since November 2025 but was not in use February 2026 due to maintenance and repairs. The remaining three residents stated they have not had to use the facility vehicle for their transportation needs. Interviews with one out of six staff stated the vehicle was not available for three weeks in February 2026 as it needed have the wheelchair ramp repaired but has been operational since. The remaining five staff did not add anything relevant to the allegation. Interview with AD stated the facility vehicle was going through maintenance and repairs recently. AD added the facility was providing transportation for residents using Uber while the vehicle was being serviced. Record review revealed the facility vehicle had gone through recent maintenance and service including the repair of the wheelchair ramp February 2026. AD provided the transportation log for March 2026 including scheduled doctor appointments for residents. LPA along with staff observed the facility vehicle in operation. LPA did not observe the vehicle in disrepair. Regarding the allegation there is insufficient staff to support the needs of the resident, it was reported there are no drivers available to transport residents to their appointments. One out of five residents stated the facility has assisted with arranging for transportation using Uber. The resident added the facility covered the cost. Three out of the remaining four residents stated they have never needed to arrange transportation with the facility. The remaining resident did not add anything relevant to the allegation. LPA interview with one out of six staff stated they are a driver for the facility vehicle. The staff member showed LPA their driver’s license which is valid. The facility vehicle is a 12 passenger vehicle. A “P” (passenger) endorsement is required by the Department of Motor Vehicles to operate the vehicle. The staff member’s driver’s license does not indicate a P endorsement has been obtained. The remaining staff did not add anything relevant to the allegation. Interview with AD stated there are two facility drivers but neither has a P endorsement on their driver’s license. There are no staff qualified to drive the facility vehicle. AD added arrangements have also been made for transportation using Uber and medical transport companies Blue Riven and Garden Grove Bus for non-ambulatory residents. The cost of transport is covered by the facility. Record review revealed resident admission agreements include a transportation policy that states “We will make available to residents, or otherwise assure the provision of, scheduled transportation to the nearest appropriate health facilities for medical and dental appointments, social services agencies, shopping and recreational facilities within a ten (10) mile radius of the community.” The facility plan of operations states “Plan, arrange and/or provide for transportation to medical and dental appointments. Facility will assist with making arrangements for transportation to and from medical and dental services” as part of their basic services offered. Based on interviews, record review, and observations, the allegations of facility staff did not answer calls promptly from resident's representative, the resident's call button is in disrepair, the facility vehicle is in disrepair and there is insufficient staff to support the needs of the resident are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, May 15, 2026 · control 22-AS-20260320094728

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 98 non-ambulatory residents of which 20 may be bedridden. Facility has an approved hospice waiver for 20 residents. Executive Director (ED) Yaylene Mazariegos was present to conduct facility tour. ED has a valid certificate that expires on 08/16/2026. ED provided proof of liability insurance which expires on 10/18/2026. LPA along with ED toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, and facility documentation. The facility is a 2 story building with a secured memory care unit on the first floor. Seven resident bedrooms checked had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Seven resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 107.7 degrees F and 113.7 degrees F in all bathrooms checked. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA observed memory care delayed egress exits are operational. LPA and the ED toured the kitchen and dining room. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the refrigerator and freezer were operational. LPA checked refrigerator logs and observed meal preparation for lunch. Fire extinguishers observed were fully charged. LPA observed the call system is operational. LPA observed the call response time is less than eight minutes. LPA observed emergency evacuation chairs at each stairwell. LPA observed there is outdoor shaded seating areas for memory care and assisted living. There are no bodies of water in the outdoor areas of the facility. LPA reviewed the fire alarm system paperwork showing the system passed its annual inspection on 3/20/2026. LPA observed residents spending time in their rooms and walking along the halls. LPA observed several residents in the memory care area watching television in the community room. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts monthly emergency drills with the last drill conducted on 04/14/2026. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, music therapy, games, and outings. LPA observed the emergency food and water supply. LPA reviewed seven resident files and five staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in carts in the medication room. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, May 1, 2026

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

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced case management visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by staff and explained the purpose of the visit. On June 6, 2025, the Orange County Regional Office received an incident report regarding unwitnessed falls involving Resident 1 (R1) resulting in a closed fracture. The investigation determined the following: R1 was admitted to the facility on April 30, 2025, and was identified as a high fall risk based on the Preplacement Appraisal and Morse Fall Scale completed on April 28, 2025, by the facility staff. R1 sustained an initial unwitnessed fall on May 26,2025 and a secondary fall on May 30, 2025 per incident reports submitted to the Department. On May 26, 2025, at approximately 1:10 p.m., R1 sustained an unwitnessed fall in the common television room area of the memory care unit. R1 was found on the floor complaining of left ankle pain and was transported to the hospital for evaluation. R1 was diagnosed with a contusion of the lower leg and discharged back to the facility the same day. Hospital discharge instructions on May 26, 2025, directed the facility to ensure R1 was seen by their primary care physician (PCP) within three days. Interview with R1’s PCP confirmed the facility did not contact R1’s PCP following this incident, and no documented physician follow-up occurred until June 3, 2025. Continued on LIC809-C dated 01/23/2026 On May 30, 2025, R1’s service plan was updated to reflect increased needs, including requiring assistance with transferring and mobility. At the time the service plan was updated, R1’s physician had still not been consulted regarding R1’s initial fall. At approximately 8:40 p.m. the same day, R1 sustained a second unwitnessed fall in their bedroom and was found on the floor next to their bed. R1 was transported again to the hospital, where diagnostic imaging revealed fractures of the right inferior pubic ramus and right superior pubic ramus. Interviews conducted with three out of three facility staff members identified as being involved in R1’s care during the relevant time periods revealed that none were able to recall the last time they had seen R1 prior to the May 30, 2025, fall. One staff member reported that routine resident checks in the memory care unit are typically conducted every 20 to 30 minutes; However, no staff member was able to provide a specific timeframe or documentation verifying when R1 was last observed before being found on the floor. The investigation further determined that residents in the memory care unit do not utilize personal call pendants, although the building does have a pull cord system. However, Residents who are unable to cognitively know how to utilize the system and require assistance must verbally call out for help, requiring staff to be within hearing distance. Given R1’s documented fall risk, impaired mobility, and need for assistance with transfers, the facility did not implement adequate monitoring or supervision measures to ensure R1’s safety. Based on the totality of evidence obtained, the Department has concluded that the facility failed to provide adequate care and supervision to a known fall-risk resident by not implementing reasonable safety measures or monitoring practices resulting in R1 sustaining an unwitnessed fall and injury. The following is being cited per California Code of Regulations, Title 22. A Civil Penalty is pending determination by Community Care Licensing Division as per H&S Code 1569.49(f). An exit interview was conducted with Executive Director Yaylene Mazariegos, and a copy of this report, the LIC 809-D, the LIC 421IM and Appeal Rights were provided to the facility. A copy will be mailed to the licensee to the address on file.the state’s words, verbatim · CDSS document, Jan 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jan 24, 2026

Basic Services 87464(f)(1) Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: The Licensee failed to identify fall preventative measures needed to meet R1’s needs resulting in R1 sustaining a second fall with closed fracture diagnosis. This poses an immediate risk to resident’s health and safety.the state’s words, verbatim · CDSS document, Jan 23, 2026

Plan of correction: AD stated logs have been implemented to record safety check per resident in memory care. Furthermore, iPad will be issued to staff to ensure residents are being check on an hourly basis in the future. AD will provide copies of logs and in-service training by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(1) · Plan of correction due date: Jan 24, 2026

Incidental Medical and Dental Care 87465(a)(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by: The Licensee did not follow up with R1’s primary care physician as instructed per hospital discharge paperwork following R1’s fall on 5/26/25. This poses an immediate risk to resident’s health and safety.the state’s words, verbatim · CDSS document, Jan 23, 2026

Plan of correction: AD stated in-service training will be performed with staff specifically on reviewed discharge documents and instructions. AD to provide proof of training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c)(3) · Plan of correction due date: Jan 30, 2026

Reappraisals 87463(c)(3) … the licensee shall document all of the following in the resident’s reappraisal: Interventions to be implemented to minimize the risks to the health and safety of the resident or others associated with the resident's behavioral expression… This requirement is not met as evidence by: The Licensee failed to document interventions to be implemented to minimize falls after identifying R1 as a fall risk. This poses a potential risk to resident’s health and safety.the state’s words, verbatim · CDSS document, Jan 23, 2026

Plan of correction: AD stated R1 is on home health for physical therapy once per week. In addition, R1 has been placed on hour checks which are documented in a log. AD to provide proof of physical therapy and logs by POC due date.

Allegation investigated: Staff are not abiding to the admission agreement

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged staff are not abiding to the admission agreement. During the investigation, LPA conducted interviews with staff and resident in care. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation staff are not abiding to the admission agreement, it was reported resident 1 (R1) was informed rent is going to increase on January 1, 2026. LPA interview with Admininstrator (AD) Yaylene Mazariegos stated a rate increase letter was issued and provided to R1 on October 22, 2025. LPA interview with R1 stated they received a copy of the rate increase letter. LPA record review revealed R1's admission agreement states on page 11 "We shall give ninety (90) days' prior written notice to you of any change in the Base Monthly Fee..." Continued on LIC9099-C dated 11/13/25 Substantiated R1 is currently not receiving Supplemental Security Income (SSI) based on a letter sent to R1 on June 17, 2025 by the Social Security Administration. The date of the rate increase letter of October 22, 2025 informing R1 of the rate increase starting January 1, 2026 is less than ninety days. Based on LPA interviews and record review, 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), is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights. R1 stated their rib cage does not hurt and does not know how it could happen. R1 stated there was no fall that would have caused an injury to their rib. R1 added they told one staff member about it but did not want to go to the hospital because "it's too much of a hassle and they make you wait a long time." LPA interviews with three out of three additional residents stated their needs are being met at this time and are receiving medical care as needed. LPA observed R1 readjust from laying on their bed to sitting up on their bed without difficulty. LPA record review revealed R1 has seen outside medical personnel at the facility from July 4, 2025 through November 7, 2025 17 times either by a nurse or physician's assistant. No observations of fractures were noted. Regarding the allegation staff forced a resident to sign an unknown document, it was reported R1 was forced to sign a document under pressure. LPA interview with Administrator (AD) Yaylene Mazariegos stated AD had R1 sign a copy of the rate increase letter given to R1 on October 22, 2025 to acknowledge a copy was provided. AD provided a copy of the rate increase letter to LPA with R1's signature. LPA interview with R1 stated they vaguely remember signing a copy of the rate increase letter given by AD but not completely sure. R1 stated they received a copy of the rate increase letter. Regarding the allegation staff inappropriately took pictures of a resident, it was reported on an unspecified date, staff took pictures of client while client was unaware. LPA interviews with three out of three staff stated they are unaware of any staff taking inappropriate pictures of residents. LPA interview with R1 stated they have photos on their phone showing three pictures of R1 from the waist up at an angle coming from the floor as they are walking. R1 stated they are unaware of how those photos came about. LPA observation of the photos appear to be accidental selfies as the photos' angle appear to be coming from R1's left hand at arms length pointing up. Regarding the allegation staff are not safeguarding a resident's personal phone, it was reported some of R1's pictures have been deleted from their phone. LPA interviews with three out of three staff stated they have never witness anyone deleting pictures from a resident's phone. LPA interview with R1 stated they keep a passcode on the phone and sleep with the phone under their pillow. LPA observed phone securely held in R1's carrying bag with a strap around R1's body. Continued on LIC9099-C dated 11/13/2025 Based on interviews, record review, and observations, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 22-AS-20251104160452

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Nov 20, 2025

87507(f) Admission Agreements The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. The requirement is not met as evidenced by: The facility did not adhere to a 90 day rate increase notice as indicated in R1's admission agreement which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: AD stated a new rate increase letter will be issued to R1 to reflect a 90 notice. AD to send proof to LPA by POC due date.

Type of visit: Case Management - Health Checks

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Fred Arias for the purpose of a health and safety check. LPA met with Administrator (AD) Yaylene Mazariegos and explained the purpose of the inspection. During the inspection, LPA and AD toured the facility. LPA conducted health and safety checks on the residents and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA requested and reviewed copies of Resident 1 (R1) files. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jul 18, 2025

Type of visit: Case Management - Health Checks

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Fred Arias for the purpose of a health and safety check. LPA met with Administrator (AD) Yaylene Mazariegos and explained the purpose of the inspection. During the inspection, LPA and AD toured the facility. LPA conducted health and safety checks on the residents and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed the electricity and water were running and the medications were properly stored. LPA requested and reviewed copies of the resident roster, staff roster, and resident files. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jun 17, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 98 non-ambulatory residents of which 20 may be bedridden. Facility has an approved hospice waiver for 20 residents. Executive Director (ED) Yaylene Mazariegos arrived shortly to conduct facility tour. ED has a valid certificate that expires on 08/16/2026. ED provided updated liability insurance that expires on 01/01/2026. LPA along with ED toured the facility at 9:40 AM. LPA toured the physical plant, checked food service, and facility documentation. The facility is a 2 story building with a secured memory care unit on the first floor. Five resident bedrooms checked had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Five resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 105.4 degrees F and 115.8 degrees F in all bathrooms checked. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA observed memory care delayed egress exits are operational. LPA and the ED toured the kitchen and dining room. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the refrigerator and freezer were operational. Fire extinguishers observed were fully charged. LPA observed cleaning supplies are kept locked in a storage closet. LPA observed the call system is operational. LPA observed the call response time is less than 5 minutes. LPA observed emergency evacuation chairs at each stairwell. LPA observed there is outdoor shaded seating areas for memory care and assisted living. No bodies of water in the outdoor areas of the facility. LPA reviewed the fire alarm system paperwork showing the system passed its annual inspection on 3/5/2025. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts monthly emergency drills with the last drill conducted on 3/10/2025. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, music therapy, games, and outings. LPA observed the emergency food and water supply. LPA reviewed five resident files and five staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in cabinets in the medication room. Medications are being administered per physician order. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Apr 25, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

On this day at 11am, a meeting was conducted by Assistant Program Administrator (APA) Stacy Barlow to verify Chapter 7 Bankruptcy Report filed by the Pacifica Senior Living as reported by the media. Present during the meeting are: Shelly Gracce - Assistant Branch Chief, CCLD Craig Lundgren - Legal Counsel, CCLD Carl Knepler - Chief Executive Officer, Marlene Nelson - Director, Quality Assurance and Risk Management APA Barlow verified with Knepler information received by CCL from the media as follows: $25M lawsuit against the community located in Bakersfield Phtography lawsuit against one of the properties lawsuit against a Killed Nursing Facility (SNF) in the Healdsburg location Knepler states that despite the lawsuits, there is no financial impact to any of the properties, residents or staff of the company. Knepler added there are no vendor issues as well. continuation on Lic 809C ***Original signature on file with the Pacifica Senior Living Union City facility.*** Knepler also states that management communicates with the staff and residents to make them aware of the changes. Signages have been changed. Knepler added that the bankruptcy did not affect any of the communities because Pacifica Senior Living Management was no longer the management company for any of the Pacifica Communities, that the communities had given notice to the department and residents back in October or November of last year of the changes in management companies. He said that the judgment in Bakersfield did not involve the operating entity, only the management company. He said there were no other suits pending against any of the Pacifica entities. APA requested the following documents be provided to CCL by today: Spread sheet of all facilities whose management company was/is Pacifica Senior Living Management Company management companies for each location letter provided to the residents notifying them of the changes At the conclusion of the meeting, APA emphasized to Knepler the importance of communicating with CCL any lawsuits that the company may have in the future. Knepler agreed with APA. A copy of this report was provided to Knepler. *** Original signature on file with the Pacifica Senior Living Union City facility.***the state’s words, verbatim · CDSS document, Apr 4, 2025

Allegation investigated: Facility does not have adequate staffing. Facility does not provide adequate hygiene supplies.

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an uannnouced visit to conduct a complaint investigation. LPA was greeted and granted entry into the faciliy by Executive Director Yaylene Mazariegos and explained the reason for the visit. The Department received the complaint on 03/13/2025 and LPA Mendivil conducted the initial 10 day visit on 03/21/2025. LPA Mendivil toured facility and interviewed residents and staff. LPA obtained copies of staff schedule and resident roster. Regarding the allegations facility does not have adequate staffing and facility does not provide adequate hygiene supplies the investigation revealed the following: The facility is licensed for 98 residents and currently has a census of 18 residents in assisted living and 16 residents in memory care. Unsubstantiated Per interview with Executive Director Yaylene Mazariegos there is 1 LVN available Monday - Friday, 1 med-tech on every shift, 1 caregiver for assisted living and 2 caregivers for memory care for AM and PM shifts. Overnight staff is 1 med-tech and 1 caregiver. ED also stated all staff are trained to provide care to residents. Interviews with 2 out of 2 staff stated they are able to assist residents with activities of daily living with the current staffing ratios. Per interviews with 2 out of 2 residents they indicated staff is responsive and assists them as needed. ED stated there is a resident in Memory Care that will wander into other residents rooms and staff will redirect. ED stated most Assisted Living residents are ambulatory and can ask for assistance. LPA Mendivil observed staff responding to pendant calls during the visit. Interviews with 2 out of 2 residents stated they have not had any issues with hygiene supplies not being available. Residents stated they can ask for hygiene items and the facility will provide them. Per interview with ED, ED stated all except 3 residents in memory care under incontinent care. ED stated the facility provides wipes, briefs and incontinent pads if a resident is under the incontinent care program. ED stated if a resident is not under the incontinent care plan then the resident or resident's family is to provide briefs and wipes. ED stated if a resident that is not under incontinent care plan and runs out of supplies the facility will provide supplies as needed. LPA Mendivil observed a closet with extra supplies ready and available to all staff. Therefore based on the preponderance of evidence through interviews and observations the allegations that Facility does not have adequate staffing and Facility does not provide adequate hygiene supplies are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint. No deficiencies cited. An exit interview was conducted and a copy of this report this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 21, 2025 · control 22-AS-20250313151337

Allegation investigated: Staff prevented resident's medical professional from caring for resident. Facility did not provide resident's authorized representative with written refund policy in a timely manner.

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above. LPA met Executive Director (ED) Yaylene Mazariegos. It is alleged staff prevented Resident 1’s (R1’s) medical professional from caring for R1. Inteviews were conducted with four facility residents, one witness, and R1’s Responsible Party (RP). R1 could not be interviewed as they have since passed away. During their interview, R1’s medical professional, Witness 1 (W1) stated they were never denied visitation or access to R1 by the facility or its' staff, and stated the facility staff was very receptive during the time they cared for R1. During their inteview, R1's RP denied having any knowledge of staff preventing R1's medical professional from caring for R1. During today’s visit, four additional facility residents were interviewed; four of four residents denied staff preventing medical professionals from caring for them, (Cont. LIC9099-C) Unfounded It is alleged facility did not provide R1's authorized representative with written refund policy in a timely manner. During their interview, R1’s RP denied the facility not providing them with written refund policy in a timely manner. LPA also obtained and reviewed a copy of R1's facility refund agreement signed and dated December 16, 2019. The Department has investigated the complaint alleging staff prevented resident's medical professional from caring for resident and facility did not provide resident's authorized representative with written refund policy in a timely manner. After interviews conducted with facility residents, witness, and R1's RP, We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided at the end of the inspection. Four of four residents interviewed were unable to corroborate allegation and stated they receive medical attention as needed and in a timely manner. Three of three staff interviewed denied medical attention being delayed or denied to any resident and stated medical attention is sought in a timely manner for all residents. It is alleged staff did not safeguard R1’s personal belongings. Interviews were conducted with R1’s RP, three facility staff, and four residents. During their interview, RP stated that R1's Ipad was stolen at the facility and was never recovered. Three staff of three staff interviewed denied having any knowledge of R1’s Ipad being stolen and stated missing property or valuables have not been reported by any other resident or their responsible party. Four of four residents interviewed could not corroborate the allegation and denied having any missing property or valuables. It is alleged facility did not answer communications from R1’s authorized representative promptly. Interviews were conducted with R1’s RP, three facility staff, and four residents. During their interview, RP stated that due to the pandemic, they were unable to visit R1 and there were days when they were unable to get a hold of R1 by phone. RP stated R1 had a phone and knew how to use it, however R1 was also hard of hearing and would often go without answering their phone because they could not hear it. Per RP, the facility for their part was responsive and they did not have any concerns. Three staff of three staff interviewed denied allegation and stated there is ongoing communication between the facility and residents’ authorized representatives, if any. Four of four residents interviewed also denied the allegation and stated the facility and facility staff have ongoing communication with their authorized representatives. Due to conflicting information received during interviews conducted, LPA is unable to determine if staff did not seek medical attention for resident in a timely manner, if staff did not safeguard resident's personal belongings, or if the facility did not answer communications from authorized representative promptly. 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 at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Mar 12, 2025 · control 22-AS-20210125155304

Allegation investigated: Facility did not safeguard resident's cellphone which led to its theft. Facility did not follow their theft and loss policy regarding the theft of resident's cellphone

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Administrator (AD) Yaylene Mazariegos, discussed the purpose of the inspection, and explained the allegations. The investigation into the allegations that facility did not safeguard resident's cellphone which led to its theft and the facility did not follow their theft and loss policy regarding the theft of resident's cellphone revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, staff, and residents, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Admission Agreement. CONTINUED Unsubstantiated Regarding the allegation that facility did not safeguard resident's cellphone which led to its theft: it was alleged that R1’s cell phone went missing from their room, staff searched for the phone and could not find it, the phone reappeared in R1’s room a few days after it went missing without explanation, and one of R1’s hearing aids also went missing. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA interviewed AD who stated that R1 is no longer a resident of the facility, there are no major issues regarding theft and loss at the facility, the facility does not handle or store resident property, and residents are responsible for safeguarding the property they bring into the facility. LPA interviewed Staff #1 (S1), the staff who oversaw the investigation into R1’s missing property, who denied the allegation. S1 denied there are major issues regarding theft or loss at the facility, stating that most lost items were later found. S1 stated they investigated the loss of R1’s cell phone and hearing aid and did not obtain information that they were stolen. LPA interviewed six residents and obtained information that there was at least one other alleged theft approximately two years ago that was investigated by the police, but the police could not identify the suspect and LPA did not obtain information that there are systemic issues of theft at the facility. LPA interviewed two out of two care staff present and did not obtain information corroborating the allegation. The information obtained did not corroborate that R1’s missing items were stolen, that there is a systemic issue of theft at the facility, or that the facility’s theft and loss policies are inadequate. The information obtained did not corroborate the allegation. Regarding the allegation that the facility did not follow their theft and loss policy regarding the theft of resident's cellphone: it was alleged that R1’s cell phone and hearing aid went missing, the facility was aware of another resident who sometimes takes other residents’ property but did not search this resident’s room for the missing items, and the facility did not investigate the thefts, review camera footage, or call the police. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA reviewed R1’s Admission Agreement which indicates that the facility’s theft and loss policy states that the facility will create an inventory of each resident’s personal items brought into the facility and the facility will not be responsible for items not on that inventory. Per R1’s Admission Agreement, R1’s personal property inventory, which R1 signed, did not include R1’s cell phone or hearing aid. LPA interviewed AD who stated that there are no major issues regarding theft and loss at the facility, the facility does not handle or store resident property, and residents are responsible for safeguarding the property they bring into the facility. LPA interviewed S1, the staff who oversaw the investigation into R1’s missing property, who denied the allegation. Per S1, the facility’s theft and loss policy is that the facility is not responsible for missing items unless the loss was caused by the facility, but that the facility will investigate lost property, determine what happened, and punish those responsible and that the facility followed this policy with regards to R1’s missing items. S1 stated that when R1’s phone went missing, R1’s room was searched, multiple staff were interviewed, R1’s family was contacted, the transport company that R1 used was also contacted, and staff found the phone a few days after it was missing and returned it to R1. Regarding the missing hearing aid, S1 stated they interviewed staff and could not locate the hearing aid. Regarding the other resident who sometimes takes other residents’ property, S1 confirmed that this resident has a history of taking other residents’ property, but stated that this resident’s room was searched for both the cell phone and hearing aid and neither item was found in their room. S1 also stated they reviewed camera footage which did not reveal information helpful to the investigation. While the facility’s theft and loss policy states stolen items must be reported to law enforcement, the facility’s investigation did not determine that R1’s hearing aid was stolen. The information obtained did not corroborate that the facility did not properly investigate R1’s missing items or otherwise not follow its theft and loss policy. The information obtained did not corroborate the allegation. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Feb 19, 2025 · control 22-AS-20220308092622

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety case management visit in conjunction with an SOC 341 received by the department on 06/24/2024. LPA was greeted and granted entry by Administrator Stacie Anderson and explained the reason for the visit. During the visit, LPA toured the facility and observed the following: Facility is clean and sanitary and consists of two floors housing assisted living and memory care units. There are 35 residents present during today's visit. Facility has ample food in supply and LPA observed residents dining. LPA toured the memory care unit and observed residents relaxing in the dining room. LPA spoke with residents who expressed satisfaction with facility and verbalized being safe in the facility. LPA reviewed and obtained records for Resident 1 including physician report, pre-appraisal and medication orders. LPA observed no health or safety concerns during today's visit. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 3, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with the Executive Director (Administrator) Stacie Anderson and explained the reason for the visit. The Administrator's certificate expires on October 15, 2025. LPA and the Executive Director toured the facility. LPA observed the see something say something poster posted in the lobby of the facility. The facility is a 2 story building with a secured memory care unit on the first floor. LPA observed all the memory care delayed egress exits are operational. LPA and the Executive Director toured the kitchen and dining room. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the refrigerator and freezer were operational. LPA measured the hot water in 5 resident rooms, hot water measured between 110.0 degrees Fahrenheit to 115.0 degrees Fahrenheit. LPA observed all resident rooms inspected had the required furnishings and bedding. LPA observed all resident bathrooms checked were clean and operational. LPA observed cleaning supplies are kept locked in a storage closet. LPA and the Executive Director toured the second floor. LPA observed the call system is operational. LPA observed the call response time is less than 5 minutes. LPA observed emergency evacuation chairs at each stairwell. LPA observed there is outdoor shaded seating areas for memory care and assisted living. No bodies of water in the outdoor areas of the facility. LPA reviewed the fire alarm system paperwork showing the system passed its annual inspection on February 8, 2024. LPA reviewed 5 resident files, no discrepancies observed. LPA reviewed 5 resident's medications, no discrepancies observed. LPA observed the medication is kept locked in the Med Room. LPA observed the first aid kit did not have a current edition manual. LPA interviewed staff and residents. LPA reviewed 5 staff files. 2 of the staff files were for caregivers. LPA observed that 3 out of 5 staff files had no health screening. LPA observed that 2 out of 2 of the caregiver files did not have current training. The staff interviewed reported having in service training and online training. The Executive Director reported that staff are trained, but at this time there is no way to verify the training. No other discrepancies observed. Violations are being per Title 22 division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Jun 12, 2024

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

Allegation investigated: Facility is not following infection control protocols. Facility staff are not properly trained. Facility does not provide activities to residents. Lack of care and supervision. Facility is understaffed.

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings for the complaint received on 9/27/2023. LPA De Perio explained the purpose of today's visit, was greeted by Community Relations Director (CRD) Kimberly Melendez and Business Office Manager (BOM) Yesenia Castro. Facility administrator was unable to be present during today’s visit. It was alleged that facility is not following infection control protocols. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation by stating that the facility does follow infection control protocols. During the tour of the physical plant of the facility, LPA De Perio observed that the facility has an adequate supply of PPE such as disinfectants, gowns, masks and gloves. Per documentation review, the facility has an Infection Control Plan that is implemented and utilized if a resident has tested positive for COVID. Unsubstantiated It was alleged that the facility staff are not properly trained. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. All 6 resident interviews also confirmed that there were no health or safety concerns regarding staff and their training. Per documentation review, each staff member undergoes training that consists of hands-on orientation and shadowing, video tutorials, completion of tests and certifications. It was alleged that the facility does not provide activities to residents. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. During the tour of the physical plant of the facility, LPA De Perio observed that there is an activity calendar posted in the hallway of the facility and at the front desk for the entirety of the month. Per activity calendar, there are ongoing daily activities both in the assisted living and memory care portion of the facility, and is led by the facility activities director. Per documentation review, LPA De Perio observed photos of residents engaging in activities at the facility such as participating in games, pet therapy, arts and crafts, music, and outdoor activities. It was alleged that there is lack of care and supervision. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. 4 of the resident interviews specified about how “great” the staff was and disclosed their satisfaction with the facility. Per documentation review, it was observed that if a resident needs medical care or an evaluation, the facility contacts the resident’s medical team in a timely manner. 1 interview conducted with staff also specified that regardless of the staff’s position, each staff is trained on caring for a resident, reporting requirements and trained on obtaining medical assistance. It was alleged that facility is understaffed. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. All 3 staff interviews and 2 resident interviews specified that if there is a call-out for a care staff, the facility administrator, Health and Wellness director, or additional personnel with the qualifications, will obtain the shift to ensure coverage is met in the area needed. Per documentation review of the staff schedule, and monthly schedule from August 2023 to October 2023, LPA observed that there was a minimum of 2 caregivers, 2 med-techs, and 1 nurse, per shift. For night supervision, it was also observed that there is a designated staff member on-call to attend to the facility if needed. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with CRD Melendez and BOM Castro. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 22-AS-20230927162232