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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to deliver complaint findings regarding the allegations listed above. LPA was greeted and granted entry into the facility by Caregiver 1 (CG1) LPA Quiroz called and spoke to Licensee/Administrator (L/AD) Brevet Dao and discussed purpose of the visit. The department received a complaint on 12/29/2020. LPA Shobhana Frank conducted the initial 10 day visit on 01/06/2021 and follow up visit on 9/9/2021. During the course of the investigation LPA Quiroz conducted a complaint follow up visit and interviewed staff and residents. LPA Quiroz obtained copies of resident records but not limited to physician reports, needs and services and identification forms. Regarding the allegations that "Resident's hygiene needs are not being met," "Resident left in soiled diaper/linens for an extended period of time" and "Staff does not meet resident's needs," the investigation revealed the following: During the courRead the full finding— CDSS inspection report, May 15, 2024 · control 22-AS-20201229142426

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by XX and explained the reason for the visit. The Department received a complaint on 06/12/2023 and LPA Mendivil conducted the initial 10 day visit on 06/15/2023. LPA Mendivil interviewed staff and residents and obtained copies of pertinent documents such as physician report, admission agreement and hospice documentation. Regarding the allegation facility tried to prevent resident from being taken to the hospital by family, facility staff decided resident should be on hospice and facility did not keep accurate resident records, the investigation revealed the following: Resident 1 (R1) arrived at the facility on 03/09/2023 and their admission agreement was signed on 03/16/2023 by a responsible party. SubstantiatedRead the full finding— CDSS inspection report, April 15, 2024 · control 22-AS-20230613154512

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Adminstrator/Licensee Brevet Dao and explained the reason for the visit. The Department received a complaint on 09/02/2022 and the Department conducted the initial 10 day visit on 09/08/2022. Regarding the allegations licensee does not ensure that a comfortable temperature is maintained in rooms that residents occupy, and facility does not meet resident’s dietary needs, the investigation revealed the following: During the visit on 10/31/2022 LPA Mendivil interviewed residents present at that time indicated the facility will provide fans if the weather outside is warm. LPA Mendivil visited the facility on 05/19/2023, 5/25/2023,06/15/2023 , 07/11/2023 and 8/15/2023 and the facility was within regulatory temperatures and LPA Mendivil observed the air conditioning to be operational and on, on multiple occasions. UnsubstaRead the full finding— CDSS inspection report, April 15, 2024 · control 22-AS-20220902153422

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced to deliver findings. LPA was greeted and granted entry into facility by Gemma Wanawan, Caregiver and explained the reason for the visit. Administrator Brevet Dao was available by phone. The Department received a complaint on 07/07/2023 and LPA Mendivil conducted the initial 10 day visit on 07/11/2023. During the visit LPA obtained copies of sample menus and interviewed residents and staff. Regarding the allegation Staff did not follow doctor's dietary orders for resident in care, the investigation revealed the following: Based on interviews with 1 out of 2 staff indicated they were unaware that any of the residents had a prescribed modified diet. Interviews with 2 out of 4 residents indicated they do not have a specific diet, the 2 other residents would not answer LPA Mendivil's questions. SubstantiatedRead the full finding— CDSS inspection report, March 27, 2024 · control 22-AS-20230707154552

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Caregiver Jean Vera Cruz and explained the reason for the visit. Administrator Brevet Dao arrived shortly after. The Department received a complaint on 06/11/2023 and the initial 10 day visit was conducted by LPA Cho on 06/20/2023. During the visit LPA Cho interviewed residents and staff. LPA Mendivil conducted a follow up visit on 08/15/2023 during another complaint visit for 22-AS-20230808134542. LPA Mendivil observed kitchen pantry and refrigerator. Regarding the allegation facility failed to provide afternoon snacks to residents, the investigation revealed the following: Based on interviews with staff 2 out of 2 staff stated they have snacks available for residents. Based on interviews with 2 out of 4 residents indicate there is food and snacks available in the home. CONT on LIC 9099-C dated 12/14/2023. UnsubstanRead the full finding— CDSS inspection report, December 14, 2023 · control 22-AS-20230612075559

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the allegation listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Brevet Dao was notified of the visit and arrived later to assist. The allegations investigated were presented to the administrator. An initial complaint investigation visit was conducted by LPA Saborit-Guasch on March 20, 2023. The complaint was investigated by the Department and consisted of a review of staff and resident’s records, a physical plant inspection and interviews of staff, witnesses and residents. Emergency Medical Transport records were obtained in addition to hospital records from Orange County Global and Kaiser Hospital. CONTINUED ON FORM LIC9099-C UnsubstantiatedRead the full finding— CDSS inspection report, December 5, 2023 · control 22-AS-20230317113524

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Jean Vera Cruz, caregiver and explained the reason for the visit. Licensee/Administrator Brevet Dao arrived at 10:40 am. The department received a complaint on 07/21/2023 and LPA Cho conducted the initial 10 day visit on 07/28/2023. During the course of the investigation LPA Cho interviewed staff and residents. LPA Mendivil obtained copies of apprasials/needs and services plans. Regarding the allegations that Staff is not meeting resident's needs and facility is malodorous, the investigation revealed the following: LPA Mendivil reviewed 4 out of 4 residents files. Per review 4 out of 4 Appraisal/Needs and Services Plan did not provide actionable objectives/plans. Review of Resident 1 (R1) Appraisal/Needs and Services Plan dated 12/01/2022 indicating R1’s diagnosed with Parkinson’s Disease, atrial fibrillation, hypertRead the full finding— CDSS inspection report, October 17, 2023 · control 22-AS-20230721153400

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into facility by caregiver Jean Vera Cruz and explained the reason for the visit. Administrator Brevet Dao was notified of LPA’s arrival and joined approximately at 10:40am. The Department received a complaint on 05/11/2023 and conducted the initial visit on 05/19/2023. LPA Mendivil obtained copies of pertinent documents including but not limited to: physician orders. In regards to the allegations Facility does not maintain a healthful and comfortable accommodations for residents and Facility water temperature is not within regulatory temperature range the investigation revealed the following: Regarding the allegation facility does not maintain a healthful and comfortable accommodations for residents, it was alleged Resident 1 (R1) was left in soiled clothing. Per physician report dated 12/14/2021 R1 is able to dress and groom self and iRead the full finding— CDSS inspection report, October 17, 2023 · control 22-AS-20230511091058

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Caregiver Ben Briones and explained the reason for the visit. The department received a complaint on 09/20/2023 and LPA Mendivil conducted the initial 10 day visit on 09/21/2023. During the course of the visit LPA Mendivil interviewed staff, residents and a witness. Regarding the allegation administrator is evicting residents without a written notice, the investigation revealed the following: Based on interivews with residents 2 out of 3 residents stated they were told on the morning of 09/20/2023 that they were going to be evicted and needed to relocate due to renovations. Interviews with 2 out 3 residents indicated they were offered a room at another licensed facility and were given 1 day to decide if they wanted to move to the other licensed facility. CONT on LIC 9099-C dated 09/21/2023 SubstantiatedRead the full finding— CDSS inspection report, September 21, 2023 · control 22-AS-20230920162715

On this day Licensing Program Analysts (LPAs) Andrea Mendivil and Rosie Quiroz made an unannounced visit to conduct a complaint investigation. LPA Mendivil and LPA Quiroz were greeted granted entry into the facility by caregiver Ben Briones and explained the reason for the visit. Administrator Brevet Dao was available by phone. The department received a complaint on 08/08/2023. During the course of the investigation LPA Mendivil inteviewed staff and obtained copies of documents such as admission agreement. Regarding the allegation faciltiy denied visitors, the investigation revealed the following: Based on review of facility's admission agreement visitation hours are from 9am-7pm and admission agreement states "should other visiting times be needed, please contact the facility in advance to make arrangements". CONT on LIC 9099-C dated 08/15/2023. UnsubstantiatedRead the full finding— CDSS inspection report, August 15, 2023 · control 22-AS-20230808134542

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings, LPA was greeted and granted entry into the facility by Caregiver Ben Briones and explained the reason for the visit. The deparmtnet received a complaint on 04/14/2023 and the department conducted the initial 10 day visit on 04/20/2023. During the course of the investigation LPA Mendivil interviewed staff and resident and obtained copies of pertinent documents such as physician reports. Regarding the allegation staff did not seek medical care for resident in care. Based on witnesses accounts Resident 1 (R1) fell sometime in the PM hours and R1 was on the floor. It was reported that staff was called into R1's room and picked up R1 and placed R1 back into bed. Per review of R1's physicians report dated 01/22/2022 does not indicate R1 is a fall risk. UnsubstantiatedRead the full finding— CDSS inspection report, June 20, 2023 · control 22-AS-20230414130816

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Caregiver Ben Briones and explained reason for the visit. Administrator/Licensee Brevet Dao arrived at 3:10pm. The department received a complaint on 05/24/2023 and the initial 10 day visit was conducted on 05/25/2023. During the visit LPA toured the facility and interviewed residents and staff. Regarding the allegation Staff failed to keep facility free of vermin, the investigation revealed the following: During the tour of the facility LPA Mendivil observed rodent droppings present in the living room, hallway cupboard and in resident's closets. Based on interviews with residents 1 out of 5 confirm they have seen rodents present in the facility. 4 out of 5 indicate they have not seen or heard any rodents, and the final resident was not available to interview due to not being oriented to space and time. CONT oRead the full finding— CDSS inspection report, May 25, 2023 · control 22-AS-20230524125330

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into facility by caregiver Bonifacio Briones and explained the reason for the visit. Administrator Brevet was available by phone. The Department received a complaint on 03/06/2023 and conducted the initial visit on 03/14/2023. LPA Andrea Mendivil obtained copies of pertinent documents including but not limited to: admission agreements and resident files, and rent increase letter. In regards to the allegations Facility unlawfully raised resident's rent and Facility unlawfully evicted resident the investigation revealed the following: Regarding the allegation facility unlawfully raised resident’s rent, LPA verified that 3 of 6 residents in care received a written notice of rate increase from Administrator Dao via text message. Text messages received included a photograph of a written 60 day notice dated February 25, 2023 notifying individuRead the full finding— CDSS inspection report, April 25, 2023 · control 22-AS-20230306140958

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Caregiver Bonifacio Briones. Administrator Brevet Dao was available by phone. The department received a complaint on 04/03/2023 and the initial visit was conducted on 04/07/2023. During the visit LPA Mendivil obtained copies of physician reports , physician’s dietary recommendations, and sample menu. Regarding the allegation facility is not following resident’s physician dietary orders, the investigation revealed the following: Per documentation Resident 1 (R1) was admitted to the facility on 02/02/2022. Based on review of LIC 602 Physicians Report dated 01/20/22 R1 does not require a special diet. LPA Mendivil obtained a copy of a letter, dated 11/03/2022, from R1’s physician with recommendation for dietary guidance. UnsubstantiatedRead the full finding— CDSS inspection report, April 25, 2023 · control 22-AS-20230403084619

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into facility by caregiver Bonifacio Briones and explained the reason for the visit. Administrator Brevet Dao was available by phone. The Department received a complaint on 03/06/2023 and conducted the initial visit on 03/14/2023. LPA Andrea Mendivil obtained copies of pertinent documents including but not limited to: resident roster and LIC 500 (Personnel Report). In regards to the allegations Facility staff yells at residents; Facility staff threw resident's wheelchair; Facility staff does not ensure that the facility is maintained at a comfortable temperature for the residents; Facility staff does not properly store bed linens the investigation revealed the following: Regarding the allegation Facility staff yells at residents, interviews conducted with Staff 1 (S1) and Administrator Dao deny allegations of yelling. S1 confirmed they dRead the full finding— CDSS inspection report, April 25, 2023 · control 22-AS-20230329103817

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit in order to conduct a complaint visit. LPA was greeted and granted entry into the facility by Leo Garias and explained the reason for the visit. Brevet Dao was not present. The Department received a complaint on 10/31/2022 and conducted the initial visit on 10/31/2022. LPA Mendivil obtained copies of pertinent documents including but not limited to: staffing documents, medication records and facility roster. In regards to the allegations facility staff lack emergency disaster training, facility does not have emergency oxygen, and An uncleared individual is living in facility, the investigation revealed the following: UnfoundedRead the full finding— CDSS inspection report, April 20, 2023 · control 22-AS-20221031081441

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into facility by caregiver Leo Garias and explained the reason for the visit. Administrator Brevet Dao was notified of LPA’s arrival and joined via telephone. The Department received a complaint on 03/01/2023 and conducted the initial visit on 03/02/2023. LPA Alvaro Ramirez obtained copies of pertinent documents including but not limited to: medication records and admission agreements. In regards to the allegations Facility is malodorous; Ombudsman poster is not posted in facility; Residents are not provided adequate bedding; Facility did not administer medications to resident; and Resident was not given an admission agreement, the investigation revealed the following: Regarding the allegation Facility is malodorous, LPA experienced a strong urine like odor coming from the bedroom of Resident 1 (R1) and Resident 2 (R2) during multiple viRead the full finding— CDSS inspection report, April 20, 2023 · control 22-AS-20230301162939

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Caregiver Leo Garias and explained the reason for the visit. The department received a complaint on 02/23/2023 and the initial visit was conducted on 03/02/2023 by LPA Alvaro Ramirez Jr. During the course of the investigation, the Department interviewed staff, residents and witnesses. In addition the department obtained copies of facility menu. Regarding the allegation staff are not providing food in the quantity and quality necessary to meet the needs of the residents, the investigation revealed the following: It was reported by witnesses that facility is providing residents with peanut butter and jelly sandwiches with spam for dinner and other meals include chicken and white rice. Based on observations by both LPAs Ramirez and Mendivil observed the refrigerator was stocked with eggs, bread, ham, and chicken.Read the full finding— CDSS inspection report, March 14, 2023 · control 22-AS-20230223151647

Licensing Program Analyst Michelle Reed arrived at the facility to deliver the findings of this complaint investigation. Upon arrival, LPA met with Staff Leo Garrais. Administer Brevet Dao spoke with LPA about the findings via telephone and stated she could not come to the facility. The complaint was investigated and consisted of interviews with the facility staff, Administrator and witnesses. The following was determined: Resident #1 (R1) was admitted into the facility on 12/27/22. R1 had Renal Failure and needed to attend Dialysis three times a week. R1 was confused and disoriented. and needed assistance with all his ADL's. He used a wheelchair to ambulate and needed assistance to get into the wheelchair. He could not leave the facility unassisted. Upon admission, no admission agreement was signed and according to staff and witnesses the POA was informed that the facility staff would take care of the transportation to medical appointments since R1 needed assistance. On 1/4/23, R1 wasRead the full finding— CDSS inspection report, March 3, 2023 · control 22-AS-20230127111023

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced complaint visit. LPA was greeted and granted entry into the facility by Caregiver Leo Garias and explained the reason for the visit. The department received a complaint on 01/17/2023. LPA Mendivil visited facility on 01/18/2023 . Regarding the allegation the facility has no heat,the investigation revealed the following: LPA Mendivil observed the thermostat at 66 degrees fahrenheit on 01/18/2023 during the initial 10 day visit. During the complaint delivering visit the thermostat read at 66 degrees fahrenheit. Interviews with residents indicate they were told the facility heat is not working. SubstantiatedRead the full finding— CDSS inspection report, January 20, 2023 · control 22-AS-20230117165840

On this day Licensing Program Analyst (LPA) Andrea Mendivil and Licensing Program Manager (LPM) Alisa Ortiz along with Rafael Perez Code Compliance Supervisor, Ines Guzman Code Compliance Officer and Orange County Fire Authority Representative R. D made an unannounced visit for the purposes of conducting an investigation into the above allegations. The investigation determined the following: At approx. 1:16PM LPM and LPA observed a rodent trap in facility kitchen along with rodent droppings. At 1:21PM rodent trap was observed under TV stand in living room. LPA and LPM also observed in resident bedroom #2 at 1:25pm. At 1:17PM 1:24pm ,1:25Pm and1:34PM LPA and LPM observed damaged and or missing screens throughout the home. At 1:17PM LPA and LPM observed a sticky brown substance on wall above the kitchen stove. At 1:18PM LPA and LPM observed damaged kitchen drawer. At 1:20 PM LPA and LPM observed fire alarm to be tapped over and nonoperational and a total of 3 smoke alarms were found to bRead the full finding— CDSS inspection report, October 31, 2022 · control 22-AS-20221031081441