The Meridian at Laguna Hills

Type of visit: Case Management - Licensee Initiated

Licensing Program Analyst (LPA) Ruth Martinez conducted a Case Management visit in response to the facility’s request to add a Memory Care Unit for up to 24 residents.The facility submitted a request to add the Memory Care Unit to its license on August 17, 2026. The facility is not requesting an increase in its licensed capacity. The request is limited to the addition of a Memory Care Unit located on the first floor of Building B, Rooms 120 through 135. The Memory Care Unit consists of 16 apartment-style resident bedrooms, including a combination of private and shared rooms. The unit also includes a medication room, resident common area, staff office, and dining room. Three delayed egress systems are installed within the unit, including two at entry/exit doors and one providing access to the secured outdoor courtyard. The fenced outdoor courtyard includes a walking path and a small patio area for residents in care. During today’s visit, LPA toured the Memory Care Unit and inspected the interior and exterior areas. The delayed egress doors were tested and found to be operational. LPA observed that the facility has dementia safety measures in place. LPA inspected the locked medication room designated for centrally stored medications. Medication carts will be utilized for medication storage and administration. LPA inspected resident bathrooms and measured the hot water temperature, which ranged from 105.6 to 111.5 degrees Fahrenheit. Resident bathrooms were equipped with required safety features, including nonskid mats and grab bars. CONTINUED ON LIC809-C Lighting throughout the Memory Care Unit was observed to be sufficient to ensure the safety and comfort of residents. Residents’ meals will be prepared in the facility’s central kitchen and delivered to the Memory Care Unit by staff. LPA inspected the resident bedrooms and observed sufficient lighting and appropriate accommodations for resident safety and comfort. Smoke detectors and carbon monoxide detectors were tested and found to be operational. LPA observed two fire extinguishers located in the hallway. The fire extinguishers were charged, properly mounted, and reflected a service date of June 30, 2026. A new fire clearance/inspection was requested in connection with the addition of the Memory Care Unit and installation of the delayed egress systems. The Fire Department conducted the fire clearance inspection, and approval was granted on September 1, 2026. Based on observations made during today’s visit, no deficiencies were noted in the areas inspected pursuant to Title 22, Division 6 of the California Code of Regulations. The Memory Care Unit was observed to be ready for occupancy. This report was reviewed with the Administrator, and a copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez Jr. made an unannounced visit for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by Executive Director (ED) Eric Jensen. LPA explained the reason for the visit. Facility is licensed for building A floors 1-5 with 200 non-ambulatory residents, of which 15 may be bedridden. Facility has an approved hospice waiver for 20 residents. During the inspection, LPA, ED, and Resident Services Director conducted a tour of the inside and outside of the facility, common areas, resident bedrooms, and observed the following: LPA observed a dining room on the first floor and second floors. During the tour LPA observed residents participating in activities such as exercises, reading, puzzles and/or going in an outing. LPA observed the monthly activities calendar posted throughout the facility. LPA inspected the centrally stored medication carts located in the medication room on the second floor. LPA reviewed random resident medications and no discrepancies were observed. First aid kit was observe in the medication room and mounted on the wall, the first aid kit has all the required components. LPA observed resident bedrooms to be clear of any hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. Resident beds had clean linens and blankets. Signal system/pendant was tested and observed to be operational. Bathrooms were observed to have functioning faucets and toilets, textured shower floors, and grab bars. Water temperature tested between 108.6-113.2 degrees Fahrenheit. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA observed the restrooms equipped with a call button in various resident rooms and common spaces. CONTINUED ON LIC809-C... LPA tour the dining room and observed that the menus were posted. LPA tour the kitchen and observed that the special diets are posted for review. Maintenance and cleaning records were observed in the main kitchen. LPA observed that the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. LPA observed the emergency food and water supply. LPA observed several courtyards with shaded seating areas for residents’ enjoyment. LPA observed a swimming pool with a fence around it. LPA observed the pool gate has a self-latching entry door which opens towards the pool. The fence has a key lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5 feet from base of the floor to the top of the fence and it was observed to enclose the entire pool area. Toxic chemicals, cleaning solutions and disinfectants are stored and locked in the housekeeping storage room located on Building B, first floor. Carbon monoxide detectors tested and noted to be operational. LPA reviewed the Fire Sprinkler System reports dated August 21, 2025. LPA observed that the inspection was passed and the Sprinkler System was observed to be operational. The facility is conducting quarterly emergency drills. LPA observed fire extinguishers mounted throughout the facility. The fire extinguishers were last service on June 30, 2026. Facility has evacuation chairs in each stairwell. LPA reviewed five resident files and five staff files, no discrepancies were observed. Staff files contained required documentation including health screenings, first aid, and fingerprint clearance. All employee files reviewed are associated to the facility. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 23, 2026

Allegation investigated: Staff left resident soiled for an extended period of time. Due to lack of supervision, resident fell and was on the ground for an extended period of time. Due to lack of supervision, resident was stuck between the wall and the mattress for an extended period of time resulting in hospitalization.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA met with Eric Jensen, Executive Director/Administrator and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records. It is alleged that staff left resident soiled for an extended period of time. Record review revealed that resident (R1) was independent with toileting and did not wear diapers. Needs and services plan indicates R1 needs redirection with correctly placing underpants and was placed on dressing assistance. Interview Continued on LIC9099-C Unfounded with staff stated that R1 does not wear diapers and there is no reason why resident would be left soiled when they are independent with toileting. Interview with witness stated that they never indicated that R1 was left soiled for 6 hours or for extended period of time. It is alleged that due to lack of supervision, resident fell and was on the ground for an extended period of time, specifically when R1 was showering. Interview with staff stated that R1 is on shower schedule and outside of that they do not shower on their own. If R1 had a fall staff would have known or been present due to being on shower assistance. Record review revealed that R1 is reflected on shower schedule. Resident assessment reflects that R1 requires standby assistance with showers 2x per week. Need and services plan reflects R1 is on shower standby assistance. Interview with witness stated that they did not indicate that R1 had been on the ground for an extended period of time or for 8 hours. It is alleged that due to lack of supervision, resident was stuck between the wall and the mattress for an extended period of time resulting in hospitalization. Record review did not reflect any unusual incident with R1 recently. The last incident reported to the department was on August 16, 2024. Interview with staff stated that the last incident R1 had was for an unwitnessed fall back about 18 months ago, but nothing recent. Due to that incident R1 was reassessed and needs and services plan were updated and was also reassessed for any changes in condition. Interview with witness stated that they did not indicate R1 was stuck between the wall and the mattress for extended period of time, but R1 had gotten their arm stuck between the recliner and the wall, but it was in an instant with no injuries. There was no fall and/or the bed and it wasn’t for an extended period. Therefore, the Department has determined the complaint to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Department has therefore dismissed the complaint. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20251205104055

Allegation investigated: Staff do not prevent a resident from engaging in self harming behaviors. Staff did not address the resident's change in condition.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to initiate and deliver findings into the above identified complaint allegations. LPA arrived at facility was greeted and granted entry by receptionist. LPA spoke with Eric Jensen, Executive Director and explained the purpose of the visit. Findings are based upon this investigation which included resident file review, tour of the physical plant of the facility, interviews conducted, and copies of pertinent documents obtained. It is alleged that staff do not prevent a resident from engaging in self-harming behavior, specifically to taking medication multiple doses at once. Record review revealed that resident (R1) is not on medication management at the facility. Physicians report indicates that R1 is able to manage and store own Cotinued on LIC9099-C Unsubstantiated medication, able to administer own medication. Need and services plan indicates that R1 is independent and does not require a level of care with services provided. Interview with staff stated that R1 is very independent and does not have a level of care due to it. Staff stated that R1 has only one medication and is not in the medication management to administer it. Interview with a witness stated that there are no concerns noted for R1 and that they are not concerned that R1 is taking double the dose of medication. It is alleged that staff did not address the resident’s (R1) change in condition. Interview with staff stated that they have not noticed there to be a change in condition for R1 and that R1 is very independent. R1 is very active in the community and is always observed by staff around the community throughout the day. Staff stated that care staff have not reported any concerns in R1’s condition that require attention. Interview with a witness stated that R1 has not had a change in condition and their primary diagnosis has not changed from what it was when they moved in. They had no changes in condition to report to staff or concerns. Records review revealed that upon admissions to the facility R1 primary diagnosis is MCI (mild cognitive impairment) and that has not changed. Preplacement appraisal reflects resident is ambulatory without assistive device, no sign of confusion, has a service dog, thyroid and no major illness. Admissions assessment scored at 0 and does not require any level of care. Needs and services plan reflects that resident is independent, and medication self-administered, no bathing assistance required. Based on the information mentioned above, 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 violations occurred; therefore, this allegations are deemed Unsubstantiated. An exit interview was conducted with Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Oct 27, 2025 · control 22-AS-20251022124832

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced site visit to the facility on this date for the purpose of delivering an amended report originally issued on October 1, 2025. LPA arrived at facility was greeted at the door by Executive Director and granted entry. LPA explained the nature of today's visit to facility to Eric Jensen, Executive Director. Exit interview was conducted with Executive Director and a copy of this LIC809 report was left with the facility representative, along with copies of amended reports.the state’s words, verbatim · CDSS document, Oct 14, 2025

Allegation investigated: Staff are not preventing a resident from harassing other residents while in care.

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 arrived at the facility was greeted by receptionist and granted entry. LPA met with Eric Jensen, Executive Director and explained the nature of today’s visit. Findings are based upon this investigation which included a tour of the physical plant of the facility, interviews, and copy of pertinent documents. It is alleged staff are not preventing a resident from harassing other residents while in care, specifically to a recent incident in the lobby, and comments made by a resident to other residents. Interview with 4 of 4 Continued on LIC9099-C Unsubstantiated staff stated that they were not aware of or had received any complaints about residents being harassed by other residents. Staff stated there were two residents that have a different political view and since had issues with each other not getting along. However, staff spoke to both residents about two weeks ago and resolved their indifference's. Interview with 2 of 2 staff mentioned in the complaint details about the incident in the lobby stated that they were not made aware of any incident that occurred in the lobby and no residents talked to them about an incident either. Interview with 6 of 6 residents stated that they have not been harassed by another resident or seen any other resident being harassed. Resident stated they feel safe in the community and have had no issues. Based on the information mentioned above, 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. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Oct 1, 2025 · control 22-AS-20250923120422

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Ruth Martinez conducted a Case Management visit to the facility to obtain information pertaining to a self reported incident for an unwitnessed fall involving resident 1 (R1). The facility submitted the Incident report on 8/20/25. The report indicated that the incident occurred on 08/15/2025. LPA observed various residents throughout the facility. Residents in care appeared to be safe; no imminent health/safety concerns were observed. LPA inspected the inside of facility, and living spaces. Facility appeared to be clean and organized. LPA inspected outside perimeter of facility, to ensure no health/safety hazards were present. The needs of the residents in care appeared to be met during LPA's inspection. Residents appeared to be groomed appropriately and no visible injuries noted. LPA obtained copies of pertinent documents. R1 after incident had a reappraisal and level of care of adjusted. LIC602 physician's report indicates R1 may leave independently with no escort, using public transportation or walking where desired. May drive own vehicle. R1's date of admission is 3/5/22 and this was the first fall R1 had since move in. R1 has had no other incidents since and was observed doing activities during the visit. Based on the information obtained during today’s visit, no citations are being issued during today’s visit. An exit interview was conducted, and a copy of this report was left at facility.the state’s words, verbatim · CDSS document, Sep 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by receptionist. LPA met with Eric Jensen, Executive Director, and LPA explained the nature of the visit. Facility is licensed for building A floors 1-5 with 200 non-ambulatory residents, of which 15 may be bedridden. Facility has an approved hospice waiver for 20 residents. The facility currently has 74 residents and 7 residents are on hospice during today's visit. LPA Martinez along with Executive Director toured the inside and outside of the physical plant of the facility. LPA observed a dining room on the first floor. LPA observed menus posted and the food offered is varied and healthy. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen. During the tour LPA observed residents involved in activities as well as a posted activity schedule including games, exercise, and outings at the facility. LPA inspected that medication is centrally stored in a safe locked location; facility has a medication room on the 2nd floor. LPA observed and inspected medication carts that are used to dispense meds to residents and observed medication was labeled and stored inaccessible to residents in care. First aid kit was observe in the medication room and mounted on the wall throughout the facility First aid manual kept and observed in the medication room. he facility has apartment style bedrooms for residents. LPA inspected apartments; all required components were observed in inspected apartments. Each apartment has their own bathroom, LPA inspected resident bathrooms. Toilets and water faucets worked properly, grab Continued on LIC809-C bars were secure, and shower was free of mold/mildew. Resident bathrooms were tested for hot water temperature in floors 1-5 and water temperature measured between 106.1 -109.2 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA observed the restrooms equipped with a call button in various resident rooms and common spaces. Call button when pulled calls to caregiver pager as well as the front desk for response accuracy. Residents also use a pendant. LPA observed caregiver receive a call button notification and response time was immediate. LPA observed several residents throughout the facility who appeared clean, and happy. LPA observed several courtyards with shaded seating areas for residents’ enjoyment. LPA observed a swimming pool with a fence around it. LPA observed the pool gate has a self-latching entry door which opens towards the pool. The fence has a key lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5ft from base of the floor to the top of the fence and it was observed to enclose the entire pool area. Toxic chemicals, cleaning solutions and disinfectants are stored locked in the housekeeping storage room in the basement floor. Carbon monoxide detectors tested and noted to be operational. LPA observed fire extinguishers throughout the facility that are fully charged and had a service date of July 19, 2025. Smoke detectors and sprinkler system are tested yearly by an outside agency, and LPA was provided with testing documentation, last testing was done July 29, 2025. Emergency drills are being conducted quarterly with a variation of shifts, LPA observed and reviewed Fire, drills and safety logs. Facility has evacuation chairs in the stairwells. LPA began file review. LPA reviewed seven resident files, all resident files contained required documentation including updated physician reports and care plans. LPA reviewed five staff files. Staff files contained required documentation including health screens, first aid, and fingerprint clearance. All employee files reviewed are associated to the facility. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Executive Director and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 9, 2025

Allegation investigated: Facility is in disrepair

Licensing Program Analyst (LPA) Ruth Martinez visited the facility visit to investigation the above identified complaint allegation. LPA arrive at facility was greeted and granted entry by receptionist. LPA spoke with Eric Jensen, Executive Director and explained the purpose of the visit. Findings are based upon this investigation which included facility file review, tour of the physical plant of the facility and interviews conducted. It is alleged facility is in disrepair, more specifically to pendent/pull cord are not working since April. LPA toured the facility and observed residents in common areas as well as in their bedrooms. LPA observed several residents to have a pendent around their neck and observed pull cords in bedrooms as well as in common areas of the facility. LPA with the assistance of staff tested the pendent system and observed Continued on LIC9099-C Unsubstantiated when pressed that a notification is sent to a computer located in the resident aid office where notification is sent to staff for resident checks. LPA observed care staff getting notification in their pager with room and resident to do answer to a pedant call. Record review revealed that facility has in addition to pendants a resident safety check for all assisted living residents. Interview with 3 of 3 staff stated that they are currently looking to upgrade the call system, but the current system has been working. Residents have called the front desk when they need assistance as well as them pressing their pendant. To further assist residents’ facility has place a safety check for all residents with half hour to an hour increment. Staff stated that in April to current pendants have been working, however in May facility decided to install a new system for pendants which has a locater as well. This will allow the staff to know the exact location or resident when pressing for assistance. The new system will be installed next week. Interview with 5 of 5 residents stated they have never had an issue with their pendants not working or getting the help that they need. Residents stated that they get more help than they need or ask for at times. Based on the information mentioned above, 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. An exit interview was conducted with Executive Director and a copy of this LIC9099 report was left at the facility.the state’s words, verbatim · CDSS document, Jun 4, 2025 · control 22-AS-20250527143553

Allegation investigated: Resident needs are not being met Facility is in disrepair Facility failed to address safety hazards resulting in resident falling

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Administrator (AD) Eric Jensen. LPA explained the purpose of the visit. This agency has investigated the complaint alleging that Resident needs are not being met. Regarding the allegations, the following was revealed: During the course of the interviews two of seven individuals interviewed confirm the allegations. During the course of the investigation LPA reviewed documents including the Physician Report (LIC602A) dated March 12, 2025, for Resident 1 (R1). Per Physician report R1 is able to shower self, able to groom/dress self, able to feed self, able to care for own toileting needs and is able to manage and store own medications. LPA also reviewed The Meridian at Laguna Hills Resident Assessment dated March 27, 2025, for R1. Per Resident assessment R1's level of care is Level 1 and only needs CONTINUED ON LIC9099-C... Unsubstantiated assistance with their laundry. During the course of the interviews with Residents, R1 reported that staff assist her with her laundry. Per R2 his needs are being met and stated that staff are always on-time and courteous. During the course of the interviews with staff, Staff 1 (S1) reported that all needs for R1 are being met. Regarding the allegation that facility is in disrepair, the following was revealed: During the initial visit on April 30, 2025, LPA tour the facility as well as bedrooms #108 and #530 and observed that the facility is in good repair. During the investigation LPA reviewed documents including The Meridian at Laguna Hills work orders dated March 29, 2025, through April 20, 2025. Per work orders the shower is clogged, the heater not working and/or A/C not working. Per work orders under technician notes it states fixed by vendor and/or done. During the course of the interviews with staff, S2 reported that before a resident moves in, maintenance will renovate the apartment. S2 reported that the heater and plumbing were not broken. Per R2 stuff breaks from time to time, it is common sense. R2 reported that maintenance usually gets work orders completed within 24 hours or less. Regarding the allegation that facility failed to address safety hazards resulting in resident falling, the following was revealed: During the initial visit LPA tour the bedroom on the first floor for R1 and observed the bedroom to be empty. During the initial visit LPA tour the current bedroom on the fifth floor for R1 and observed that the bedroom hallways are kept free of obstruction. During the course of the interviews with residents, R2 reported that there are never safety hazards resulting in residents falling. R2 reported that staff are always cleaning and picking up trash. Per R3 he has not seen safety hazards and reported that he can navigate his wheelchair fine. During the course of the interviews with staff, S1 reported that facility did not failed to address safety hazards. S1 reported that the bedrooms get cleaned weekly. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with AD Jensen, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 22-AS-20250422091003

Type of visit: Office

On this day at 11 am, 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: Shelley Grace - 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 • Photography lawsuit against one of the properties • lawsuit against a Skilled 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 Lie 809C 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.the state’s words, verbatim · CDSS document, Apr 4, 2025

Allegation investigated: Staff are mismanaging residents' medications. Staff are not ensuring that residents are administered their medications as prescribed.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the two allegations listed above. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Executive Director Eric Jensen was present and assisted with the visit. During the visit, LPA requested the current facility resident census, staff roster along with the list of residents under medication management by facility staff. LPA toured the physical plant and reviewed the medication administration process as well as reviewed the administration records for five randomly selected residents. Resident records for eight residents were also requested and reviewed. Three staff were interviewed along with eight conducted or attempted resident interviews. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegations that Staff are mismanaging residents' medications and that Staff are not ensuring that resident's are administered their medications as prescribed, the following has been concluded: Based on a tour of the facility's medication room as well as review of the medication administration records and resident records for a selection of randomly selected residents as well as staff and resident interviews conducted, there have been no discrepancies observed between the prescriptions on file and the medication dispensed. The five residents for whom the electronic medication administration records were reviewed showed consistently delivered medication for each of the prescribed doses. A majority of residents interviewed additionally reported no issues with their medications or concerns with their administration. Two residents however made statements indicating that on occasional instances they had advised facility staff that medication might be missing. There is however no additional evidence allowing the Department to indicate the dates of the stated incidents nor the medications involved. Doses were later found to have stuck to the bubble packs and were eventually dispensed correctly per the statements made. All resident records reviewed also found no inconsistencies between the assessed ability to managed medication and the reviewed residents' status on medication management. Additionally, medication was verified to be in its original packaging including a prescription label bearing the required information. There is therefore insufficient evidence to corroborate the allegations. The allegations are thus found to be Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Feb 25, 2025 · control 22-AS-20250220110817

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ruth Martinez made an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility was greeted by receptionist and granted entry. LPA met with Maria Rossi, Executive Director. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (200) capacity, (0) ambulatory, (185) non-ambulatory, and (15) bedridden residents was submitted to CCL on 03/05/2020. Structure: The facility is a two building facility, building A & B. The facility has independent living in building B and assisted living in building A floors 1-5 only. Facility has carports, garage and open assigned parking for residents’ vehicles. The facility has 122 apartment style bedrooms. A dining room in the 1st floor and 2nd floor of building A, 1 spa, 1 salon, 1 fitness center, I med room and 2 common space activities/movie rooms, and a restaurant style open kitchen. The resident’s apartment bedrooms are spacious and will easily accommodate the resident’s furnishings. There is shaded outdoor space in the front of the building, outside adjacent to first floor dining room, a putting green by building B and a gated pool by building B that assisted living residents can access. Signal system: Residents utilize pendant alert system for requesting assistance. Pendant alarm system triggers a signal to a pager system. Bedrooms Residents: Bedrooms are designed as an individual apartment for 0 ambulatory, 185 non-ambulatory and 15 bedridden residents. Bedrooms will accommodate 1 resident unless it is a couple with a private bathroom. Bedridden residents can be in floors Continued on LIC809-C 1-4 only of building A. Bedrooms Staff: No live in staff. Bathrooms: Resident have their own bathroom in their apartments. Facility has common bathrooms as well. All bathrooms have a working toilet, wash basin, bath-tub/shower. Linens & Hygiene Supplies: Adequate supply of linen stored in facility storage unit. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are to be stored in the kitchen with surplus goods stored in kitchen. Smoke Detectors: Facility has a fire panel in the reception area, smoke detectors, sprinklers and carbon monoxide alert systems are tested and maintained by an outside vendor and conduct yearly inspections. Fire panel last inspection was 3/13/24, sprinklers last tested on 4/24/24, smoke detectors last tested 6/24/24-6/28/24. Appliances: Residents apartments have small kitchen, with refrigerator, microwave and small sink. Facility main kitchen on the 1st floor is equipped with ovens/ranges/microwaves, prep counters, refrigeration, freezer, grill, steam tables, ice makers, washer, and dryer (on each floor) are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to resident are stored and locked in a storage unit. Water Temperature: Tested and recorded the water temperature measures 109.4 – 117.3 Fahrenheit degrees in all resident apartments and common bathrooms on floor 1-5 in building A. Medications, First-Aid Kit & Book: Medication, first aid and book are stored in med room inaccessible to residents. First aid kits are also mounted in a glass container locked in hallways, kitchen and common spaces throughout the facility. Resident & Staff Files: Records for staff and residents are in business office and resident medication files are stored in med room. Pool: Gated pool behind building B, assisted living resident have access to pool. Gate measures 5ft from base to the top of the fence. Fire Extinguisher: Mounted in wall throughout each floor dated 6/19/24. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents use, commensurate with the plan of operation. Fire clearance: Was approved on 5/30/24. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Aug 5, 2024

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Change of Ownership Capacity: 200 Census (if any clients in care): Unknown COMP II Participants: MARIA ROSSI Interview Method: Telephone interview On July 17, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jul 17, 2024