Meridian at Chino

Allegation investigated: Staff falsify residents records Staff do not follow residents care plan Staff determined resident was bedridden without required diagnosis from a qualified physician Unlawful Eviction

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Enriquez and explained the elements of the complaint. Allegation #1 - LPA Prieto obtained medical records for resident #1 (R1), and reveal these records originated from R1's Physician's office and have not been altered facility staff. Witness interviews reveal that medical records for R1 have not been altered for falsified by facility staff. Allegation #2 - LPA Prieto obtained R1's care plan, and records, as well as staff interviews, reveal that the care plan is being followed accordingly. The care plan obtained for this investigation. Unsubstantiated Allegation #3 - LPA Prieto obtained medical records for R1, and these records reveal that they have originated from R1's Physician's office. A diagnosis of bedridden was determined by R1's Primary Care Physician and the diagnosis was reconfirmed by the facility Executive Director. Documentation of this reconfirmation was obtained for this investigation. Allegation #4 - LPA Prieto interview with Executive Director revealed that R1 has not been evicted and has not been given an eviction notice. Interview with witness reveal that R1 has not been evicted and has not been given an eviction notice. Based on the information obtained there is not enough evidence that to substantiate the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Enriquez and a copy was left with the facility.the state’s words, verbatim · CDSS document, Sep 24, 2026 · control 56-AS-20260917121136

Allegation investigated: The facility did not ensure the resident's personal care needs were met The facility did not ensure the facility was kept free from bugs

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Enriquez and explained the elements of the complaint. Allegation #1 - LPA interviewed resident #1 (R1), in question, who does not have any concerns of the care that is being provided to her at the facility and expressed this to LPA at time of interview. R1 appeared to clean, groomed and well cared for. LPA obtained R1's resident assessment that indicates a one person total assist with grooming and dressing once daily, at the beginning of the day, and a one person total assist with bathing 3X per week, from an outside agency. Facility staff now assist with these duties, beginning July 1st. A meeting was had with R1's responsible parties as to the new care plan and when that plan would be initiated. LPA obtained records of that discussion for this investigation. This plan also included a change health insurance and pharmaceutical plan. Unsubstantiated Allegation #2 - LPA toured R1's room and found it to be clean and free from infestation. LPA toured Memory Ward Dining area and found it to be clean and free of infestation. LPA obtained the facility's Commercial General Pest Control Agreement. Agreement indicates that service is provided twice a month to the interior and exterior of the facility. Records will also show that Memory Ward's Kitchen and Dining areas are treated on every visit. Records also show that R1's room is treated on these visits. Based on the information obtained there is not enough evidence to support the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Enriquez and a copy was left with the facility.the state’s words, verbatim · CDSS document, Aug 3, 2026 · control 56-AS-20260731084458

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto conducted an unannounced annual required visit. LPA was greeted and granted entry to the facility by Executive Director Isabel Enriquez. LPA explained the nature of today's visit. LPA accompanied with MS Enriquez , conducted a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility was not operating over capacity or beyond any conditions and limitations on the license. Facility is being maintained at a comfortable temperature for residents. All outdoor and indoor passageways are kept free of obstruction. Hot water temperature was measured at resident bathrooms are within regulation. There are grab bars for each toilet, bathtub and shower used by residents. Smoke detectors and carbon monoxide devices were tested by the Fire Department and found to be in working order. Inspection document was obtained. Facility sprinkler and kitchen sprinkler / extinguisher systems were tested and found to be in working order. Food Service: There is a minimum of one week supply of nonperishable foods and 2 days of perishable foods. Kitchen is well staff and aware of resident's specific dietary needs. Kitchen area is clean and sanitary. Care and Supervision: The facility has ensured sufficient and competent staff to provide the services needed to meet resident needs. The facility is appropriately staff during night shift hours Record Review: LPA requested and reviewed (12) resident and (8) staff files. LPA reviewed staff files for current CPR/1st aide certificates, TB results, and required training's. LPA reviewed client files for admissions agreement, physician report, and needs and service. Administration: LPA did not observe any excluded individuals on the premises at time of visit. The Administrator appears to be on the premises a sufficient number of hours to manage and oversee the business operation. Medical Related Services: Prescriptions and non-prescription PRN medications contain a signed and dated written order from a physician. Medications are centrally locked in the staff office and inaccessible to residents in care. Medications are being administered as prescribed by physician's directions. No deficiencies cited. An exit interview was conducted where this report was provided and discussed with MS Enriquez.the state’s words, verbatim · CDSS document, May 19, 2026

Allegation investigated: Staff are storing inaccurate records for a resident in care.

Licensing Program Analyst (LPA) Javier Prieto arrive to the facility to conduct a complaint investigation regarding the above allegation. LPA Prieto met with Executive Director Enriquez and explained the elements of the complaint. Allegation #1 - LPA Prieto reviewed resident #1 (R1) medical records to see that the medical records in question are updated an accurate per the R1. Medical Tech (S1) confirmed that updated documents were received by R1 and their medical representative and filed accordingly. Executive Director confirmed the receipt of such documents and obtained these documents for this investigation. Based on the information obtained there is not enough evidence that staff are storing inaccurate records for a resident in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Enriquez and a copy was left with the facility. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 13, 2026 · control 56-AS-20260511153233

Allegation investigated: Licensee did not ensure that staff adequately supervised resident(s) in care. Staff did not respond to resident's requests for assistance in a timely manner. Staff did not ensure that resident's hygiene needs were met while in care Staff did not ensure that resident's toileting needs were met while in care Staff yell at resident in care. Staff threaten resident in care.

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Enriquez and explained the elements of the complaint. Allegation #1 - LPA Prieto interviewed Executive Director Enriquez (S1) who states memory care ward, where resident #1 (R1) resides, is adequately staffed during the day, evening and NOC shifts. Interview with R1 states that there is adequate staff at the facilty to meet resident's needs. Interview with R2, R3, R4 and R5 states the facility is sufficiently staff to meet their needs. Allegation #2 - LPA obtained the call logs for R1, where the call pendant was pressed and addressed multiple times, with an average response time of 2 minutes. LPA tested call response time during this investigation, with R1, and the response was approximately 2 minutes. LPA interviewed R2, R3, R4 and R5 state staff respond to their needs in a timely manner. Unsubstantiated Allegation #3 - Interview with R1, states that staff routinely meet her hygiene needs. Interview with R2 R3, R4 and R5 state their hygiene needs are being met. LPA obtained resident assessment for R1, indicating that assistance is required with grooming and bathing 2X per week and S1 states those needs are being met. Allegation #4 - Interview with R1, states that staff routinely meet her toileting needs. Interview with R2 R3, R4 and R5 state their hygiene needs are being met. LPA obtained resident assessment for R1, indicating that assistance is required with toileting, with a 2 person assist. S1 states those needs are being met. Allegation #5 - Interview with R1, R2, R3, R4 and R5 state that staff does not yell at them while in care. Allegation #6 - Interview with R1, R2, R3, R4 and R5 state that staff does not threaten them while in care. Based on the information obtained there is not enough evidence to support the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Enriquez and a copy of this report was left with the facility.the state’s words, verbatim · CDSS document, Apr 7, 2026 · control 56-AS-20260330171859

Allegation investigated: Facility is refusing to communicate with resident's authorized representative. Facility is not properly showering and grooming resident Facility did not provide residents representative with proper rent increase documentation

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Enriquez and explained the elements of the complaint. Allegation #1 - LPA Prieto interviewed Executive Director staff #1 (S1) and Resident Service Director S2, each stating that staff are in communication with resident #1, (R1) authorized representative. Copies of text communication, as well as email and phone communications from R1's responsible parties were also obtained during this complaint investigation. Allegation #2 - S1 provided LPA with R1 Resident Assessment documentation, indication the R1 is independent with grooming and minimal assistance with bathing. S1 and S2 indicate that R1's needs are being met relating to these services. R1 was not available for interview at time of investigation and has since moved from the facility. Unsubstantiated Allegation #3 - S1 provided LPA with documentation that R1 did not have an increase in rent. S1 did provide documentation of an increase of cost of care, after a reappraisal was conducted at the facility due to a change of condition. S1 provided R1's responsible party the new assessment and cost, via email. Documentation of this communication with R1's responsible party was obtained during this investigation. Based on the information obtained there is not enough evidence to support the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Enriquez and a copy was left with the facility.the state’s words, verbatim · CDSS document, Oct 14, 2025 · control 56-AS-20251008145558

Allegation investigated: Facility staff did not dispense medications as prescribed Facility staff did not answer communications from resident’s representative Facility staff did not provide quality meals to resident(s) Facility staff spoke inappropriately to residents Facility staff did not respond to resident calls for assistance

Licensing Program Analyst (LPA) Javier Prieto arrived to the facilty to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Enriquez and explained the elements of the complaint. Alleged,ation #1 - LPA Prieto interviewed resident #1 (R1), R2, R3, R4, R5, R6 R7 and R8, each stating that they are getting their medications as prescribed. Resident Services Director, Staff #1 (S1), Med Tech S2, and Executive Director S3, were interviewed, revealing that residents are getting their medications as rescribed. Allegation #2 - LPA Prieto interviewed resident #1 (R1), R2, R3, R4, R5, R6 R7 and R8, each stating that staff are addressing communications with themselves and other family members. S1 and S3 were interview stating that staff are communicating with family member of the residents in care. Unsubstantiated Allegation #3 - LPA Prieto interviewed resident #1 (R1), R2, R3, R4, R5, R6 R7 and R8, each stating that they are being served quality meals at their appropriate meals times. Interview with Culinary Director (S4) and S3, reveal that residents are being service quality meals at their appropriate meal times. Allegation #4 - LPA Prieto interviewed resident #1 (R1), R2, R3, R4, R5, R6 R7 and R8, each stating that staff are courteous, helpful and respectful when interacting with residents. Interviews with S1, S2, S3 and S4 concluded that resident's are treated with respect and courtesy. Allegation #5 - LPA Prieto interviewed resident #1 (R1), R2, R3, R4, R5, R6 R7 and R8, each stating that staff response to the call buttons/cord in a timely manner when help is requested. Interview with S1, S2 and S3 concluded that staff respond to call button/cords as needed and in a timely manner. Based on the information obtained there is not enough evidence to support the allegations in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Enriquez and a copy was left with the facility.the state’s words, verbatim · CDSS document, Sep 10, 2025 · control 56-AS-20250903102925

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto conducted an unannounced annual required visit. LPA was greeted and granted entry to the facility by Executive Director Isabel Enriquez. LPA explained the nature of today's visit. LPA accompanied with MS Enriquez , conducted a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility was not operating over capacity or beyond any conditions and limitations on the license. Facility is being maintained at a comfortable temperature for residents. All outdoor and indoor passageways are kept free of obstruction. Hot water temperature was measured at resident bathrooms are within regulation. There are grab bars for each toilet, bathtub and shower used by residents. Smoke detectors and carbon monoxide devices were tested by the Fire Department and found to be in working order. Inspection document was obtained. Facility sprinkler and kitchen sprinkler / extinguisher systems were tested and found to be in working order. Food Service: There is a minimum of one week supply of nonperishable foods and 2 days of perishable foods. Kitchen is well staff and aware of resident's specific dietary needs. Kitchen area is clean and sanitary. Care and Supervision: The facility has ensured sufficient and competent staff to provide the services needed to meet resident needs. The facility is appropriately staff during night shift hours Record Review: LPA requested and reviewed (12) resident and (8) staff files. LPA reviewed staff files for current CPR/1st aide certificates, TB results, and required training's. LPA reviewed client files for admissions agreement, physician report, and needs and service. Administration: LPA did not observe any excluded individuals on the premises at time of visit. The Administrator appears to be on the premises a sufficient number of hours to manage and oversee the business operation. Medical Related Services: Prescriptions and non-prescription PRN medications contain a signed and dated written order from a physician. Medications are centrally locked in the staff office and inaccessible to residents in care. Medications are being administered as prescribed by physician's directions. No deficiencies cited. An exit interview was conducted where this report was provided and discussed with MS Enriquez.the state’s words, verbatim · CDSS document, May 22, 2025

Allegation investigated: Resident's call button is in disrepair Facility is not following admission agreement

Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conduct a complaint investigation regarding the aforementioned allegation. LPA Prieto met with Executive Director Enriquez, who provided a comprehensive explanation of the complaint elements.Regarding the allegation that a resident's call button is in disrepair, Director Enriquez and LPA Prieto toured the memory ward of the facility and interviewed residents R1, R2, R3, and R4. All residents stated that they have not used their call buttons and that staff are always available to assist when needed. The call buttons in this complaint refer to the pull cords in each resident's room. LPA Prieto observed four additional resident rooms and found that none of the call pull cords were in disrepair. LPA Prieto also obtained an Activity Device Report, which monitors response times to all residents at the facility, with an average response time of four minutes. Regarding the allegation that the facility is not following the admission agreement, Director Enriquez provided the needs and care plan for resident R5, who was in question. The allegation stated that R5 was not Unsubstantiated assessed as a fall risk and that status checks were not conducted. However, the needs and services plan indicates that R5 was assessed as a fall risk and that status checks of four per shift were mandated. R5 was not available for an interview at the time of the initial complaint investigation. Based on the information obtained, there is not enough evidence to substantiate the claims that the resident's call button is in disrepair or that the facility is not following the admission agreement. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Director Enriquez, and a copy was left with the facility.the state’s words, verbatim · CDSS document, Feb 10, 2025 · control 18-AS-20211118151519

Allegation investigated: Staff neglect resulted in a resident sustaining multiple pressure injuries Staff mishandled a resident's medication while in care Staff allows a resident to be soiled while in care Staff left a resident unattended in the dark while in care

Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conduct a complaint investigation regarding the aforementioned allegation. LPA Prieto met with Executive Director Enriquez, who provided a comprehensive explanation of the complaint elements. Regarding the allegation that staff neglect resulted in a resident sustaining multiple pressure injuries, resident #1 (R1) in question was alleged to arrive to a medical facility with an injuries alleged to have originated from the facility. Interview with Memory Care Director (S1), states that R1 was cleaned and changed in the presence of R1's family member, with no noticeable injuries R1 upon discharge to a medical facility. Resident Service Director (S2), concurred that R1 did not have any pressure injuries upon discharge to the medical facility. LPA obtained R1's Physician Report that does not reveal any previous skin breakdown diagnosis. Unsubstantiated Regarding the allegation that staff mishandled, LPA Prieto obtained medication records for R1. The allegation stated that R1 was given antibiotics an those medications were given to facility but not dispensed. Medication records state that R1 was not prescribed this particular medication, which records appear to concur with statement. Interview with S1 and S2 both stated that antibiotics were brought to the facility with no doctor's order. Regarding the allegation that staff allows resident to be soiled while in care, Interview with Memory Care Director (S1), states that R1 was cleaned and changed prior to leaving to a medical facility and no noticeable injuries R1 upon discharge to a medical facility. R1 was available for interview during time of investigation and could not observe or corroborate that resident was left in soiled diapers. Regarding the allegation that staff left resident unattended in the dark while in care, due to R1 being available for interview during time of investigation, LPA could not observe or corroborate that resident was left unattended. No specific time periods were provided to investigate such allegation. Based on the information obtained there is not enough evidence that staff neglect resulted in a resident sustaining multiple pressure injuries, staff mishandled a resident's medication while in care, staff allows a resident to be soiled while in care and staff left a resident unattended in the dark while in care. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Enriquez and a copy was left with the facility.the state’s words, verbatim · CDSS document, Feb 10, 2025 · control 56-AS-20231030090247

Allegation investigated: Staff mismanaged resident's medication

Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conduct a complaint investigation regarding the aforementioned allegation. LPA Prieto met with Executive Director Enriquez, who provided a comprehensive explanation of the complaint elements. Concerning the allegation of staff mismanaging a resident's medication, Director Enriquez stated that during a task review, she inspected the medication administration records (MAR) and discovered that medication for resident #1 (R1) had been dispensed outside of the allowable time window. The medication was administered by staff #1 (S1) on 02/02/2025 at 12:31 PM, while it was scheduled for 8:00 AM, with an acceptable window of one hour before or after the prescribed time. Director Enriquez filed an incident report with Licensing and informed R1's family responsible party. R1 was unavailable for an interview at the time of the investigation. The medication records were obtained during today's investigation. Substantiated Based on LPA observations, interviews which were conducted and records review, the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22 are being cited on the attached LIC 9099D. This report was discussed with Executive Director Enriquez, as well as the appeal rights and a signed copy was left with the facility.the state’s words, verbatim · CDSS document, Feb 10, 2025 · control 56-AS-20250207120239

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 14, 2025

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self administered medications as needed This was not met as evidenced by: Executive Director Enriquez was made aware of the medication error and documented that the medication was not dispensed with the allowable time frame for this medication.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: Executive Director Enriquez to retrain all med tech staff by POC date and email LPA upon completion.

Allegation investigated: Staff mishandled a resident's personal belonging Staff did not provide comfortable accommodation for a resident Staff did not properly maintain a resident's bathroom Staff left a resident soiled for an extended period of time Staff did not meet a resident's incontinence needs

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Residence Service Director Isabel Eriquez and explained the elements of the complaint. Investigation is based on documentation, observations, staff and resident interviews. Regarding the allegation that staff mishandled a resident's personal belonging; The belonging in question is resident #1 (R1), in question, TV remote. Interview with staff revealed TV remote was misplaced by R1, but eventually found and returned to R1. R1 states that remote is in R1's procession. LPA observed TV remote in R1's room during time of investigation. Regarding the allegation that staff did not provide comfortable accommodation for a resident; LPA interviewed R1 in assigned room during time of investigation and found the room to be clean and in order with a comfortable temperature. Interview with R1 stated that room is clean and properly maintained by facility staff. ***Continued on LIC 9099C*** Unsubstantiated Regarding the allegation that staff did not properly maintain a resident's bathroom; Interview with staff #1 (S1) and S2 states that rooms cleaned according to facility cleaning maintenance procedures. Interview with R1 states bathroom and clean and maintained well. Observation by LPA Prieto, at time of visit, observed bathroom to be clean and free of odors. Regarding the allegation that staff left a resident soiled for an extended period of time; S1 produced R1's service plan to reveal that R1 a two (2) person assistance, with additional time for changes if necessary. Hospice records reveal that R1's is changed during every visit. Interview with R1 revealed that changes are being conducted and has complaints about being left soiled for long periods of time. Regarding the allegation that staff did not meet a resident's incontinence needs; Hospice records reveal that incontinence supplies are being provided by the Hospice Agency with Hospice staff documenting changes and continence needs being met during every visit. S1 confirmed incontinence supplies being provided by facility if necessary, but concluded that incontinence supplies are replenished but Hospice Agency after every visit. Based on the information obtained there is not enough evidence that staff mishandled a resident's personal belonging, staff did not provide comfortable accommodation for a resident, staff did not properly maintain a resident's bathroom, staff left a resident soiled for an extended period of time and staff did not meet a resident's incontinence needs . Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Residence Service Director Enriquez and a copy was left with the facility.the state’s words, verbatim · CDSS document, Jul 15, 2024 · control 56-AS-20240711100038

Allegation investigated: Facility staff did not notify responsible party of rent increase.

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Jennifer Heldoorn and explained the purpose of the visit. During the course of the investigation, records were reviewed, and interviews were conducted with facility staff members and residents. On October 12, 2020, Community Care Licensing received a complaint alleging that facility staff did not notify responsible party of rent increase. It was alleged that facility staff did not notify responsible party of rent increase. Interviews with facility staff and Resident’s responsible party revealed that Resident 1’s responsible party confirmed that the rent increase had not been automatically taken out of account and R1 was moved out of the facility before the rent increase was going into effect. LPA reviewed facility records dated July 25, 2020, where R1’s responsible party was mailed a letter with the effective date of the increase. This agency has investigated the complaint alleging "facility staff did not notify responsible party of rent increase". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to facility representative. Unfoundedthe state’s words, verbatim · CDSS document, May 16, 2024 · control 18-AS-20201012132303

Allegation investigated: Resident's room is not kept sanitary. Resident's room is malodorous. Resident has spoiled foods in their room. Resident's room has mold.

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Jennifer Heldoorn and explained the purpose of the visit. During the course of the investigation, records were reviewed, and interviews were conducted with facility staff members and residents. On October 12, 2020, Community Care Licensing received a complaint alleging that resident’s room is not kept sanitary, resident’s room is malodorous, resident has spoiled foods in their room, and resident’s room has mold. Regarding the allegation that “Resident’s room is not kept sanitary”, facility records revealed that facility had sufficient staff on shift to clean schedule rooms as assigned with house cleaning checklist. R1 was unable to be interviewed as R1 no longer lives at the facility and is unable to be interviewed. Interviews with staff denied that R1’s room was not kept sanitary by facility staff. Unsubstantiated (Continued from Page 1) Regarding allegation that “Resident’s room is malodorous”, facility records revealed that that facility had sufficient staff on shift to clean schedule rooms as assigned with house cleaning checklist. R1 was unable to be interviewed as R1 no longer lives at the facility and is unable to be interviewed. Interviews with staff denied that R1’s room was malodorous by facility staff. Regarding allegation “Resident has spoiled foods in their room”. Facility records revealed that the facility staff would be in/out of resident’s room to deliver food trays, clean room, and empty trash daily. R1 was unable to be interviewed as R1 no longer lives at the facility and is unable to be interviewed. Interviews with staff denied that R1’s room had spoiled food left in R1’s room. Regarding the allegation “Resident’s room has mold”. External records revealed that what appears to be mold was not mold. R1 was unable to be interviewed as R1 no longer lives at the facility and is unable to be interviewed. Interviews with staff denied that R1’s room had mold. Therefore, the allegations of resident’s room is not kept sanitary, resident’s room is malodorous, resident has spoiled foods in their room, and resident’s room has mold is Unsubstantiated. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Jennifer Heldoorn and a copy of this report along with LIC811- Confidential Names list was provided.the state’s words, verbatim · CDSS document, May 16, 2024 · control 18-AS-20201012132303

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto conducted an unannounced annual required visit. LPA was greeted and granted entry to the facility by Executive Director Jennifer Heldoorn. LPA explained the nature of today's visit. LPA accompanied with MS Heldoorn , conducted a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility was not operating over capacity or beyond any conditions and limitations on the license. Facility is being maintained at a comfortable temperature for residents. All outdoor and indoor passageways are kept free of obstruction. Hot water temperature was measured at resident bathrooms are within regulation. There are grab bars for each toilet, bathtub and shower used by residents. Smoke detectors and carbon monoxide devices were tested by the Fire Department and found to be in working order. Inspection document was obtained. Facility sprinkler and kitchen sprinkler / extinguisher systems were tested and found to be in working order. Food Service: There is a minimum of one week supply of nonperishable foods and 2 days of perishable foods. Kitchen is well staff and aware of resident's specific dietary needs. Kitchen area is clean and sanitary. Care and Supervision: The facility has ensured sufficient and competent staff to provide the services needed to meet resident needs. The facility is appropriately staff during night shift hours Record Review: LPA requested and reviewed (7) resident and (5) staff files. LPA reviewed staff files for current CPR/1st aide certificates, TB results, and required training's. LPA reviewed client files for admissions agreement, physician report, and needs and service. Administration: LPA did not observe any excluded individuals on the premises at time of visit. The Administrator appears to be on the premises a sufficient number of hours to manage and oversee the business operation. Medical Related Services: Prescriptions and non-prescription PRN medications contain a signed and dated written order from a physician. Medications are centrally locked in the staff office and inaccessible to residents in care. Medications are being administered as prescribed by physician's directions. No deficiencies cited. An exit interview was conducted where this report was provided and discussed with MS Heldoorn.the state’s words, verbatim · CDSS document, May 7, 2024

Allegation investigated: Staff did not administer resident’s medication

On 3/25/2024, Licensing Program Analyst (LPA), Janette Romero conducted an unannounced visit to the facility to deliver the findings of the investigation into the allegation noted above. LPA met with Resident Services Director, Isabel Enriquez who was informed of the purpose of the visit. It was alleged, “Staff did not administer resident’s medication”, LPA reviewed Resident #1’s (R1’s) Needs and Services Plan dated 2/22/2019, which noted R1 required total assistance by medication technicians for medication administration. The Plan also indicated staff were to provide total assistance by ensuring staff would: remain with the resident until the medications had been taken, medications were not left unattended, medications were documented, report to the physician any missed doses or resident refusal of medication, report any changes in condition to physician and following any orders. Unsubstantiated LPA reviewed R1’s July 2020 Medication Administration Record along with R1’s medication list which revealed no documented resident refusals of medications or missed doses. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was reviewed and provided along with Confidential Names List (LIC811). One (1) of six (6) interviews conducted reported that R1 had been found on 7/24/2020, around 12:00 p.m., with injuries to their head and was subsequently sent to the hospital. One (1) of six (6) interviews conducted reported R1 was found in their bed, soaked in urine, with a bruise to their eye, which was swollen to the size of a golf ball. Staff interviews revealed no falls had been reported prior to the discovery of the resident. Records reviewed failed to show a record of any fall prior the incident on 7/24/2020. Medical records were requested and obtained; an American Medical Response (AMR) report revealed emergency personnel arrived to the facility at 11:52 A.M., and observed R1 with a, "large hematoma over left eye with ecchymosis left eyelid". The Discharge/Transfer Documentation report revealed R1 was admitted to Pomona Valley Hospital on July 24, 2020, and diagnosed with Blunt Head Trauma and Traumatic Orbital Hematoma. Regarding the allegation of, “Staff did not provide adequate food service”, LPA reviewed R1’s Needs and Services Plan dated 2/22/2019, which noted R1 required meal reminders. One (1) of six (6) interviews conducted revealed R1 was able to eat on their own if facility staff provided R1 with a meal in R1’s bedroom. One (1) of six (6) interviews conducted revealed facility staff frequently required reminders to provide R1 with a meal and witnessing facility staff rushing to put meals together to provide for R1 because they had forgotten to distribute R1’s meals. Based on LPA’s interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations (Title 22, Division 12, Chapter 1), are cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided along with Confidential Names List (LIC811) and Appeal Rights.the state’s words, verbatim · CDSS document, Mar 25, 2024 · control 18-AS-20200804144941

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Apr 4, 2024

(f) Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: During investigation of a complaint, LPA found that R1 sustained injuries while in the facility's care. This poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Mar 25, 2024

Plan of correction: Licensee stated the facility will conduct an in-service training regarding resident care and supervision and provide LPA with a copy of the sign in sheet by close of business on POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(3) · Plan of correction due date: Apr 4, 2024

(f) Basic services shall at a minimum include: (3) Three nutritionally well-balanced meals and snacks made available daily... This requirement was not met as evidenced by: During investigation of a complaint, LPA found that facility staff had forgotten to distribute R1’s meals during several occasions. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 25, 2024

Plan of correction: Licensee stated the facility will conduct an in-service training regarding food service and provide LPA with a copy of the sign in sheet by close of business on POC due date.

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Javier Prieto conducted an unannounced visit to the facility for to initiate Case Management visit Health & Safety check. LPA Prieto identified himself and discussed the purpose of the visit with Jennifer Heldoorn, Executive Director. Clients in care were present during visit. No imminent health and/or safety concerns observed at the time of visit. LPA Prieto observed no health and/or safety hazards inside the facility. LPA Prieto inspected the outside perimeter of the facility and observed no health and/or safety hazards. It was observed to have sufficient staff present at the facility to provide care. LPA Prieto inspected the facility dining and kitchen area and found to be clean, sanitized and neat in order. The needs of the residents in care appear to be met during this inspection. An exit interview was conducted where this report (LIC809) was discussed and provided to Jennifer Heldoorn, Executive Directorthe state’s words, verbatim · CDSS document, Mar 20, 2024