Ivy Park at Mission Viejo

Allegation investigated: Facility staff failed to provide adequate treatment after a resident sustained a burn on the premises. Facility staff did not provide adequate measures to ensure resident did not sustain a burn while in care.

** This report was amended due to typographical error"" On May 20, 2026, at 9:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Administrator (ADMIN) Foudhil Manadi and explained the purpose of the visit. The investigation consisted of the following. LPA Kim toured the facility with ADMIN Manadi. LPA requested and obtained copies of the resident roster and staff roster. LPA Kim reviewed and obtained copies of R1-R6s records, which include Admission Agreement, Identification and Emergency Information, home health notes, physician's reports, pre-appraisals, reappraisals, progress notes, and other pertinent documents. The investigation revealed the following: Continued on LIC9099C Unsubstantiated ** This report was amended due to typographical error"" Allegation: Facility staff failed to provide adequate treatment after a resident sustained a burn on the premises. It is alleged that Resident #1 (R1) was brought into the hospital on May 10, 2025, and upon review R1 was found to have a circumferential partial thickness burn with blistering on their left lower leg. It was alleged that there was no care or treatment provided for the burn and they were left untreated for several days. Based on record review, R1’s Physician Report dated March 10, 2025, diagnoses R1 with Dementia. Charting Notes dated May 9, 2025, at 9:42PM, stated R1 had a round blister. Follow-up encounter notes dated May 9, 2025, stated R1 was seen for follow-up for their blister. It was stated R1 had a blister on their lower left leg and a home health order will be done for monitoring. Wound care is not necessary at this time as there is no break in the skin. Ongoing monitoring and routine care will be continued. Charting Notes May 10, 2025, at 12:17PM, stated R1 still had the blister and there was no complaint about the blister on their leg. On May 10, 2025, at 1:42 PM stated R1 was sent to the hospital. At 10:05 PM, resident returned to the facility from the hospital. Home health Agency Care Note dated on May 5, 2025, Palliative Care came for heel care wounds, and there are no notes on lower left wound or burns. Home health Agency Care Note dated May 6, 2025, came in for vitals and follow up mentioning no falls were reported and the scab was intact on the heel. There are no notes or concerns of a burn or a wound on the lower left leg. Home health Agency Notes dated May 13, 2025, examined and wrote the injury as a wound and not a burn wound. It stated that they asked R1 if they knew what happened, but R1 stated they did not know how that wound appeared on the lower left leg. Home Health Agency dated May 16, 2025, May 20, 2025, May 23, 2025, May 27, 2025, June 3, 2025, June 17, 2025, and June 24, 2025, that the wound is healing and finally resolved. There are no indications that the wound was a burn wound. Based on interviews, three out of three staff and two out of four witnesses denied the allegation. One resident and Two out of four witnesses could not confirm or deny the allegation. R1 stated they could not recall when or how they had the wound on their left leg. R1 did not know if it was from a burn. R1 stated the facility treats them well and if they did receive a wound or burn, the facility would provide the best care for them. All three staff stated R1 had a wound. S1 stated they did not suspect a burn when they noticed it Continued on LIC9099C ** This report was amended due to typographical error"" when R1 was leaving the facility to the hospital. S3 stated they noticed the wound after R1 returned. Although the charting notes stated 911 was called and family could not pick up the family, S1 stated R1 went to the hospital with their family. W1 and W2 could not confirm when the family took R1 to the hospital but recall it was around early May the family brought R1 to the hospital. W1 and W2 stated when they saw the redness and blister, they did not believe it was from a burn. They believed it was due to a fall. All staff, W1, and W2 stated if it was a burn, the facility would have provided adequate treatment. All staff, W1, and W2 stated R1’s wound was provided adequate treatment prior to hospitalization. Based on the information gathered, there is no sufficient evidence gathered to confirm the above allegation. Allegation: Facility staff did not provide adequate measures to ensure resident did not sustain a burn while in care It is alleged that the facility did not provide adequate measure to ensure resident did not sustain a burn while in care. Based on Interviews conducted, three out three staff and two out four witnesses denied the allegation. One resident and two out of four witnesses could not confirm or deny the allegation. R1 does not recall how or when the wound happened on their lower left leg. R1 could not verify if the wound was due to being burned. R1 stated the facility does a good job in preventing situations for themselves and residents from being burned. All staff and all witnesses do not know how R1 received the wound. All three staff and two witness stated that R1’s room and common areas do not have anything that could lead to any residents sustaining a burn while receiving care or staying at the facility. W1 and W2 stated that the facility is safe in all areas and in R1’s room that can be ensured that R1 could not sustain a burn while in care or supervision. All three staff stated, R1’s room and the facility is in safe regards to the facility. Based on observations on May 28, 2025, January 9, 2026, and May 20, 2026, LPA observed the facility ensure residents were in safe accommodations. Staff were taking care of residents for their needs and did not observe a situation where any residents sustained a burn or any injury while in care. Continued on LIC9099C ** This report was amended due to typographical error"" Based on record review, there is no information on how R1 received their wound. Charting Notes dated May 9, 2025, at 9:42PM, stated R1 had a round blister. Prior to that Home health Agency Care Note dated on May 5, 2025, Palliative Care came and did not note any lower left wound or burns for R1. Home Health Agency Care Notes dated on May 6, 2026, Home Health noted no falls were reported and the scab was intact on the heel with no notes or concerns of a burn or a wound on the lower left leg. There is nothing on R1’s charting notes that show resident had burnt injuries that were not being tended to. Based on the information gathered, there is no sufficient evidence gathered to confirm the above allegation. Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegations Facility staff failed to provide adequate treatment after a resident sustained a burn on the premises and Facility staff did not provide adequate measures to ensure resident did not sustain a burn while in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Exit interview was conducted and a copy of the report was provided to Administrator Foudhil Manadi.the state’s words, verbatim · CDSS document, May 20, 2026 · control 22-AS-20250519154715

Allegation investigated: Staff does not treat residents with dignity and respect. Staff does not assist residents with toileting. Residents' hygiene needs are not being met. Facility does not have adequate staffing to meet residents' needs.

On April 6, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation into the above allegations. LPA met with Business Officer Director (BOD) Joan Shattler and stated the reason for the visit. On January 12, 2024, the Department received the complaint. The complaint investigation was initiated on January 18, 2024. During the course of the investigation, LPA conducted a walk through of the memory care unit and successfully interviewed six of seven residents since one resident was preoccupied at the time of the interview. LPA also interviewed three staff and obtained the following resident documentation for review: Resident Rosters, Personnel Reports, Face Sheets with photos, Medical Assessments (LIC 602s), and Individualized Service Plans (ISPs). The following was determined: Regarding the allegation, Staff does not treat residents with dignity and respect, it is alleged that the caregivers laughed instead of helping a memory care resident who was witnessed walking on all fours across the dirty floor. It was reported that there were a number of instances where the caregivers were seen laughing. Unsubstantiated Based on the rosters dated January 18, 2024 and April 6, 2026, five of six residents were residing at the facility at the time when the complaint was reported. All five residents denied witnessing named incident. Six of six residents indicated that staff treat them with respect and dignity while one out of the six residents stated that a few caregivers are mean, moody, and less engaged. Three of three staff denied the allegation indicating that the residents are treated like family. Based on LPA's observation on January 18, 2024 and on today's date, staff were observed treating residents respectfully and with a smile. Regarding the allegation, Staff does not assist residents with toileting, it is alleged that the residents are not assisted with wiping after toileting. Based on the six memory care resident interviews, five of six residents stated that they are independent. Based on the review of the ISPs, two of the six residents require full toileting assistance; however, both residents were unable to provide clear answers to the questions asked due to their medical condition. LPA was unable to further determine if residents are being assisted with wiping after toileting. Interviews with staff revealed three of three staff denied the allegation indicating that residents needed to be wiped after toileting if toileting assistance is part of their plan of care. Regarding the allegation, Residents' hygiene needs are not being met, it is alleged that caregivers are lax in making sure that residents wash their hands after going to the bathroom resulting in a couple residents contracting a urinary tract infection. Based on the six memory care resident interviews, one of six residents indicated requiring assistance with grooming and bathing/showering while the remaining residents indicated being independent. LPA was unable to obtain further details of their hygiene care for one resident due to their medical condition. Based on the review of the ISPs, four of six residents either require a full or stand-by assist. Because five of six residents reported being independent, LPA was unable to conclude that their hygiene needs were not being met. Three of three staff interviewed denied the allegation. Regarding the allegation, Facility does not have adequate staffing to meet residents' needs, it is alleged that ratio of caregivers to residents is too low resulting in the lack of providing proper supervision to residents. LPA conducted a walk through of the memory care building on January 18, 2024. LPA observed staff in the common area supervising residents on January 18th and on today's date. The census in the memory care unit is 45 per the roster dated April 6, 2026 and 39 per the roster dated January 18, 2024. LPA observed six staff on duty on both dates. Based on the interviews, six of six residents and three of three staff denied the allegation. Two of three staff reported that when the facility experiences inadequate staffing for the day, the activity aide, medication technician, and/or memory care director would assist as back up. Three of three staff reported that the residents care are/have not been affected. Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, 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 following allegations: Staff does not treat residents with dignity and respect, Staff does not assist residents with toileting, Residents' hygiene needs are not being met, and Facility does not have adequate staffing to meet residents' needs are deemed UNSUBSTANTIATED. An exit interview was conducted with Business Office Director Joan Shattler, and a copy of this report was provided at exitthe state’s words, verbatim · CDSS document, Apr 6, 2026 · control 22-AS-20240112171918

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit to Ivy Park at Mission Viejo. The purpose of today’s visit was to conduct the annual required visit. Facility is licensed for 150 non-ambulatory residents of which 8 may be bedridden in designated rooms. Facility has an approved hospice waiver for 50 residents and the facility has 72 residents in assisted living and 43 in memory care. There are 8 residents on hospice. Administrator Foudil Manadi has an administrator certificate expiring on 01/28/2027 LPAs Lyman and Mendivil along with Administrator Manadi toured the facility at 9:28 AM. LPAs toured the physical plant, checked food service, facility records and the first aid kit. The facility consists of two stories in the main building including a library, bistro, cinema room, game room and hair salon. Memory care is a single story detached building. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 108 degrees F and 117.8 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Emergency pull cord response times were immediate. Common areas were clean and clear of hazards, doorways were free of obstructions. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility had posted appliance temperatures and all were in range. Dining room has varied menu choices for residents. Smoke detectors and fire/ sprinkler inspections are conducted by a third party, Quick Response Fire Protection with the last inspection on 04/16/2025. Fire extinguishers were fully charged. LPAs reviewed the emergency disaster plan and plan is thorough and complete. Facility conducts emergency drills with the last drill conducted on 03/04/2026. CONTINUED ON LIC 809C DATED 03/26/2026 LPAs observed ample emergency food and water. Outside grounds were toured. LPAs observed outside patio areas for both assisted living and memory care. There is ample outdoor shaded seating for residents. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. LPAs observed residents participating in activities and facility offers an array of activities including outings in the community. First aid kit contained all required items including tweezers, scissors and thermometer. LPAs reviewed ten resident files and six 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, criminal record clearance and proof of CPR training. LPAs reviewed medication administration and storage. Medications are stored in locked medication carts and facility utilizes an electronic medication administration record. Medications appear to be administered per physician order. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 26, 2026

Allegation investigated: Staff is providing an unknown medication causing residents to choke. Staff harasses resident. Staff did not inform responsible party of incident.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above as well as to deliver findings. LPA was greeted and granted entry by Executive Director Foudil Manadi after stating the purpose of the visit. The initial investigation visit took place on May 1, 2025. During the visit, LPA requested and obtained the facility's current resident census, the employee roster as well as resident records for a total of five currently admitted residents, including their physician reports and charting notes. A tour of the assisted living medication room was conducted along with a review of the centrally stored medication and medication administration records. Two staff interviews and one resident interview also took place. Four additional staff interviews were conducted during the follow-up visit. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff is providing an unknown medication causing residents to choke, the following has been concluded: Based on a review of resident records for a random selection of five residents along with a review of medication on hand in the medication central storage, it was verified that all medication administered to residents under medication management by staff had been adequately prescribed and were adequately labelled. No evidence of additional medication not under physician orders was found during the investigation. Regarding the allegation that Staff harasses resident, the following has been concluded: A resident interview conducted with the alleged victim of staff harassment conducted in a confidential manner did not evidence any actual instance of harassment. Resident interviewed made statements to the contrary and told LPA that staff was treating them well. Witness interviews were attempted and did not bring forward any evidence of harassment either. Regarding the allegation that Staff did not inform responsible party of incident, the following has been concluded: Charting notes reviewed for five random residents failed to provide evidence of incidents that had failed to be reported to the appropriate responsible parties. Fall incidents for resident R1 were adequately documented as well as reported to the Department and the resident's responsible party as required. All other instances observed in the charting notes were also reported adequately as confirmed by fax receipts present on file. Based on the evidence gathered during the present investigation, all three 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 or refute the alleged violations occurred. An exit interview was conducted with the facility and a copy of the report was provided to a facility representative.the state’s words, verbatim · CDSS document, Jun 16, 2025 · control 22-AS-20250425081047

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Ivy Park at Mission Viejo. The purpose of today’s visit was to conduct the annual required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 150 non-ambulatory residents. Facility has an approved hospice waiver for 50 residents and the facility has 80 residents in assisted living and 36 in memory care. There are 8 residents on hospice. Administrator Foudil Manadi has an administrator certificate expiring on 01/28/2027 LPA Lyman along with Administrator Manadi toured the facility at 11:02 AM. LPA toured the physical plant, checked food service, facility records and the first aid kit. The facility consists of two stories in the main building including a library, bistro, cinema room, game room and hair salon. Memory care is a single story detached building. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.1 degrees F and 114.8 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Emergency pull cord response times were under five minutes. Common areas were clean and clear of hazards, doorways were free of obstructions. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility had posted appliance temperatures and all were in range. Dining room has varied menu choices for residents. Smoke detectors and fire/ sprinkler inspections are conducted by a third party, Quick Response Fire Protection with the last inspection on 01/01/2025. Fire extinguishers were fully charged. LPA reviewed the emergency disaster plan and plan is thorough and complete. Facility conducts emergency drills with the last drill conducted on 03/04/2025. LPA observed ample emergency food and water. Outside grounds were toured. LPA observed outside patio areas for both assisted living and memory care. There is ample outdoor shaded seating for residents. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. LPA observed residents participating in exercise and movies and facility offers an array of activities including outings in the community. CONTINUED ON LIC 809C DATED 03/19/2025 First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed ten resident files and six staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained required documentation including required annual training, medical assessment, criminal record clearance and proof of CPR training. At 3:00 PM, LPA reviewed medication administration and storage. Medications are stored in locked medication carts and facility utilizes an electronic medication administration record. Medications are being administered per physician order. Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 19, 2025

Allegation investigated: Facility did not provide records to authorized representative

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed Administrator as well as reviewed email string. Regarding the allegation that facility did not provide records to authorized representative, the investigation revealed the following: Facility received request for records for Resident 1 (R1) on Friday, July 5, 2024. Records were sent to authorized representative in the afternoon on Monday, July 8, 2024. Law firm confirms receipt of records on July 8, 2024. Health and Safety Code requires records to be "provided promptly and not to exceed 2 business days". Facility adhered to the regulatory turn around time. Therefore the allegation is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. Exit interview conducted with Administrator and a copy of this report was left at the facility. Unfoundedthe state’s words, verbatim · CDSS document, Aug 1, 2024 · control 22-AS-20240729154235

Allegation investigated: Lack of staff.

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to conduct the required 10 day visit to begin the investigation into the allegation listed above. LPA met with Foudhil Manadi, Executive Director, and explained the reason for the visit. Based on the information obtained during this investigation the department has concluded the investigation into the above mentioned allegation. Findings are based upon this investigation which included interviews conducted, tour of the memory care unit and copies of pertinent documents obtained. It is alleged that the facility has a lack of staff in the memory care unit. Records review revealed that at the time of visit the facility census is 105 of that census the memory care units census is 34. The facility roster reflects that the facility has a total of 48 caregivers on board. 24 caregivers are assigned to the memory care unit and an additional 2 Continued on LIC9099-C Unsubstantiated new hires will come on board within this week. The facility staff schedule reflects that there is three shifts per day. Schedule from December 31, 2023 to June 08, 2024 reflect the following on each shift: AM shift has anywhere from 4-7 caregivers, 1 medtech, 1 activity coordinator, and 1 memory care director. PM shift has anywhere from 4-7 caregivers, 1 medtech, and 1 memory care director. NOC shift has anywhere from 2-3 caregivers, and a medtech. All shifts have a nurse on board as well. Interview with Executive Director indicated that all shifts have caregivers, a nurse and a medtech scheduled per shift. Title 22 regulation 87411(a) Personnel Requirements-General states: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment, and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. LPA toured the memory care unit and observed residents in the living room and dinning room. LPA observed 5-6 staff assisting resident with their needs and observed 1 caregiver assisting a resident in their bedroom with hygiene needs. Interview with 2 of 2 staff revealed that they like to staff the memory care unit with a minimum of 4 caregivers on each shift, however the shift has 5-7 caregivers at one time. There are always nurses on board in assisted living and memory care unit that helps as needed when needed. The facility staff are cross trained and everyone at the facility is very hands on and fills in as needed when it is required to do so. The schedule for the memory care unit is always staffed to make sure that each shift is fully staffed. Based on the information gathered during the investigation, the Department is unable to ascertain if the allegation 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, this allegation is deemed Unsubstantiated. This report was reviewed with Executive Director and a copy was furnished to the facility.the state’s words, verbatim · CDSS document, Jun 4, 2024 · control 22-AS-20240529163033

Allegation investigated: Facility staff did not seek timely medical attention for resident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff as well as reviewed and obtained pertinent documentation such as hospital discharge paperwork. Regarding the allegation that facility staff did not seek timely medical attention for resident, the investigation revealed the following: Facility notes dated 03/22/2024 indicate Resident 1 (R1) was being seen by Nurse Practitioner and started antibiotics and prednisone for coughing/ congestion. Resident was receiving breathing treatments along with medication management as indicated on facility documents. Facility documents indicate R1 was non-compliant with treatments as well. On 03/29/2024, 911 was called due to resident wheezing and difficulty breathing. Resident was admitted to Providence Mission Hospital on 03/29/2024 for Acute Respiratory Failure with Hypoxemia. Resident discharged back to the facility on 04/12/2024 with a Hospice admission diagnosis of Heart Disease. Resident passed on 04/16/2024. CONTINUED ON LIC 9099C DATED 05/06/2024 Unfounded Based on record review and interviews conducted, the department has determined the facility did seek timely medical treatment for the resident. Therefore the allegation is deemed unfounded meaning the allegation is false could not have happened and/or is without a reasonable basis. Exit interview conducted with Administrator and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 6, 2024 · control 22-AS-20240502140416

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on incident reports dated 04/24/2024 and 04/28/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. Incident report dated 04/24/2024 indicated Staff 1 (S1) witnessed S2 driving the staff's fist into Resident 1's (R1) stomach. Incident report dated 04/28/2024 indicated R1 had reported to family that S2 had punched the resident three times in the stomach. Resident was assessed to have no injuries. OC Sheriff was called and responded with case numbers #24-014481 and 24-014879. Staff 2 was immediately put on suspension pending investigation. During the visit, LPA interviewed three staff and one out of three confirm the incident. Per physician report dated 08/25/2023, Resident is diagnosed with Dementia. The investigation remains ongoing. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 6, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Michael Tea made an unannounced visit to conduct the required annual inspection. LPAs met with Executive Director (ED) Foudil Manadi and explained the reason for the visit. Facility consists of two buildings in which one is for Assisted Living (AL) and the other for Memory Care (MC). The capacity is 150 non-ambulatory and a hospice waiver for eight. There are currently a total of 103 residents, thirty three of them are in memory care. Foudil Manadi Administrator's Certificate expires on January 28, 2025. LPAs observed the PUB 475 poster (See Something, Say Something Poster) posted in the front entry way and another one posted by the resident mail box. The PUB 475 poster posted is 20" X 26." Around 9:46 AM, LPAs and ED Manadi toured the facility. LPAs observed the kitchen is clean and organized. There is a two day supply of perishable food and a seven day supply of non-perishable food on-hand in the kitchen. LPAs and ED toured resident rooms on the first and second floors in AL. LPAs and ED toured the resident rooms in the MC building. LPAs inspected ten resident rooms. All resident rooms had the required furnishings. All resident bathrooms were clean and operational. LPAs tested the emergency pendants and observed the staff came promptly when alerted. The hot water in the ten resident rooms inspected measured 102 degrees Fahrenheit to 119 degrees Fahrenheit. LPAs observed residents participating in dancing exercises and memory games. There is fitness room and activities room for all residents. There is an outdoor courtyard in both buildings for residents to sit outside. Memory Care outdoor area had vegetable and fruit garden. There are fire extinguishers on every floor and all fire extinguishers are fully charged. LPAs observed emergency evacuation chairs in each stairwell. The last emergency fire drill was conducted on April 13, 2024. The delayed egress tested operational in the MC Building. The fire safety system is inspected annual every year, the last inspection was 4/19/23. The fire safety system is monitored electronically throughout the year. Around 11:00 AM after the facility tour, LPAs reviewed ten resident files with no discrepancies. All resident files had the required documents. Afterwards LPAs reviewed ten staff files with no discrepancies observed. All staff files reviewed had current CPR/First Aid training. Annual Report cont on LIC-809C All direct care staff files reviewed met training requirements. At around 1:30 PM, LPAs inspected medication and medication administration records (MAR) for ten residents. No discrepancies observed. LPAs observed medications are kept secured in a medication cart that is locked in a medication room. LPAs observed the first aid kits to have all the required components and a first aid book at hand. LPAs interviewed staff and residents. No obstacles or hazards were noted inside or outside of the facility. Based on the observations made during today's visit, no deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Apr 25, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff did not issue a proper eviction notice to resident in care

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as eviction notice and facility notes. Regarding the allegation that staff did not issue a proper eviction notice to resident in care, the investigation revealed the following: On 06/08/2023, Resident 1 (R1) was provided a "Letter of Concern" by facility administrator. The letter was to address an incident of a narcotic being stored in the resident's room as well as inappropriate touching of staff members. The letter provided the verbiage from house rules that were being violated. On 02/05/2024, R1 was provided a 30 day eviction notice outlining multiple instances of inappropriate behavior towards staff. Per admission agreement, R1 signed the acknowledgement of house rules on 05/30/2023. LPA interviewed Administrator, five staff members as well as R1 during the investigation. All staff interviewed confirm inappropriate behaviors as outlined in the eviction notice and R1 CONTINUED ON LIC 9099C DATED 02/27/2024 Unfounded admits to behavior that may have been misconstrued. Based on record review and interviews conducted, the department has determined the eviction notice was properly given. Therefore the allegation is deemed unfounded meaning the allegation is false could not have happened and/or is without a reasonable basis. Exit interview conducted with Administrator and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 27, 2024 · control 22-AS-20240222131129