Brookdale Oceanside

Allegation investigated: Licensee did not take measures to keep the faciliity free from pests

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to open an investigation and deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Business Office Manager Raquel Tarango. During today’s visit, LPA toured the facility, observed residents in care, reviewed and obtained copies of facility records, and interviewed residents and staff. The Department's investigation consisted of interviews with residents and staff, records review, and a tour of the facility. It was alleged that the Licensee did not take measures to keep the facility free from pests. Interviews with staff revealed that the facility contracted with an outside company to conduct monthly pest control visits at the facility and facility staff were prohibited from using any chemicals or pesticides by the pest control company. Continued on LIC9099-C page... Unsubstantiated Interviews with staff and residents revealed that some residents had complained about small flying insects in their rooms during their weekly housekeeping visits. Staff stated that they would report to the front desk or the maintenance director whenever a resident complained about insects or the staff observed insects. Interviews and records review revealed that the front desk staff were responsible for generating a work order and logging the issue in a binder at the front desk for the contracted pest control company to address during their monthly visit. Interviews revealed that the contracted pest control company would review the binder at the front desk and address each logged concern. Records review revealed that the pest control company was present at the facility once a month and left a receipt detailing the work conducted with the maintenance director. Interviews with staff revealed that staff would attempt to address any issues with insects during weekly housekeeping visits by using cleaning products in the areas where insects were observed. Interviews with staff revealed that insects were a concern around this time of year and denied any residents who had consistent issues with insects in their room. Interviews with residents were inconsistent regarding the presence of insects in the facility and resident rooms. During the visit on 10/6/2023, LPA Ruiz observed multiple resident rooms, hallways, and common areas of the facility. LPA observed a few small flying insects in Resident 1’s (R1) room located around drink bottles and cups. Interviews with R1 revealed that the insects were attracted to open food containers and drinks which R1 admitted to leaving food containers out in the past. R1 stated that they did not wash drink cups or bottles with soap after they contained sugary drinks and only rinsed them out. R1 stated that they often ate meals in their room and returned any remaining food to the dining room after they completed their meal. R1 stated that the issue with insects had improved. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Business Office Manager Raquel Tarango, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).the state’s words, verbatim · CDSS document, Oct 6, 2023 · control 08-AS-20231002135512

Allegation investigated: Lack of supervision resulted in resident being sexually abused

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Christopher Burk. The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that lack of supervision resulted in a resident being sexually abused. Interviews and review of physician’s report from December 2022, revealed that Resident 1 (R1) was diagnosed with dementia, was confused, disoriented, and had wandering behaviors, but did not have any history of inappropriate or sexual behaviors. Interviews with staff revealed that after admission to the facility in December 2022, R1 began attempting to touch staff inappropriately and would expose themselves to staff and other residents. Continued on LIC9099-C page... Unsubstantiated Review of physician’s report revealed that Resident 2 (R2) had a diagnosis of dementia, was confused, disoriented, and had wandering and Sundowning behaviors. Interviews with staff revealed that R2 had a history of wandering into other residents’ rooms but was redirectable. Interviews with staff revealed that on 1/17/2023, R1 was observed in a common area touching R2's genitals over R2’s clothing. Staff separated R1 and R2 and instructed R1 not to touch anyone. On 1/18/2023 at around 5:00 am, R1 and R2 were observed to be in R1’s room laying on the bed together while R1 was fully undressed and R2 was not wearing any clothing below the waist. R2 had their hand on R1’s genitals with R1’s hand covering R2’s hand. Staff called for assistance to separate both residents and called local law enforcement who responded to the facility. On 1/18/2023, facility management arranged and paid for R1 to have a private caregiver to provide 1 on 1 supervision in order to protect other residents, including R2. The private caregiver began supervising R1 on 1/19/2023. The private caregiver was tasked with ensuring residents did not enter R1’s room, accompanying R1 in common areas, redirecting R1 when they attempted to expose themselves or engage in inappropriate behaviors, and report all incidents to facility management. The private caregiver was also given a towel to cover R1 when they did expose themselves and escort R1 back to their room. Interviews with staff revealed that R1 had stated to staff on multiple occasions that they would stop touching and exposing themselves to staff and other residents, but R1 continued with their behavior. Interviews with R1 revealed that R1 understood that their behavior was inappropriate but continued to engage in those behaviors. On 1/19/2023, R2 reported to staff that they had genital pain and R2 was transferred to the hospital for evaluation. R2 returned to the facility the next day with no new medications or diagnosis. Interviews with R2 revealed that R2 could not recall any of the interactions with R1. Interviews with staff revealed that R2 could not understand that the interactions between R1 and R2 were inappropriate. On 1/20/2023, R1 was assessed by a medical professional and prescribed R1 a medication which calmed R1 but did not cause the behaviors to stop. Interviews with staff revealed that facility management reached out to R1’s responsible party who was not responsive to the facility’s steps to mitigate the behaviors. Continued on LIC9099-C page... Interviews with staff revealed that R1 refused to be re-evaluated and became aggressive with staff when the topic of medical evaluation was discussed. On 1/26/2023, R1 was given a 30-day eviction notice for failure to follow facility rules and was evicted from the facility on 2/20/2023. Interviews with staff revealed that R1 did not have any incidents with other residents in which R1 was able to touch other residents once the private caregiver started on 1/19/2023. R1 continued to expose themselves to staff and other residents until R1 was evicted from the facility on 2/20/2023. The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Executive Director Christopher Burk, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).the state’s words, verbatim · CDSS document, Jul 20, 2023 · control 08-AS-20230125122312

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Chris Burk. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 05/20/2023), involving Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1]. According to the LIC624: on 05/15/2023, R1 had an unwitnessed fall beside their bed, inside their bedroom. R1 denied having pain, and staff’s initial assessment did not undercover any sign of injury. The next day on 05/16/2023, R1 complained of right hip pain and had a hematoma on their forehead, so staff arranged for R1 to be transported to the hospital. As of today’s CCLD visit (06/16/2023), R1 had already moved out of the facility. However, LPA performed a brief facility tour and welfare check on remaining residents in care, seeing no immediate safety concerns. LPA also reviewed pertinent care records and interviewed relevant staff. According to R1’s LIC602 Physician’s Report (dated 04/03/2022): while R1 was diagnosed with Mild Cognitive Impairment, their doctor clarified that R1 was not “confused/disoriented.” The doctor also wrote that R1 was “able to follow instructions” and “able to communicate needs.” According to the Plan of Care which licensee authored on R1 (dated 05/04/2023), R1 was “oriented to person, place and time” and “can communicate needs and preferences.” [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] According to staff interviews and corroborated by the facility’s date and time stamped progress/care notes: R1 was found on the floor beside their bed during the afternoon of 05/15/2023. R1 told responding staff, med tech Staff #1 (S1) and nurse Staff #2 (S2), that they slipped out of their wheelchair while trying to transfer themselves from bed. S1 wrote that R1 denied hitting their head, denied pain, and had no visible sign of injury. R1’s vital signs, to include blood pressure and pulse, were measured and were unremarkable. Staff notified R1’s responsible person and physician of the incident, and continued to observe R1. Staff #3 (S3) documented that they checked on R1 through the night, and that R1 slept soundly without pain or discomfort. Then on 05/16/2023, Staff #4 (S4) checked on R1; R1 now exhibited right hip pain. S4 wrote that R1’s hand was also swollen/bruised, and they saw a bump on the left side of R1’s forehead. S4 arranged for R1 to be transported to the hospital and updated R1’s responsible person and physician. However, when medical transport arrived for R1, they refused to be taken to the hospital and signed a waiver for the medical transport staff. S4 continued to dialogue with R1’s responsible person. S4 arranged medical transport to come back to the facility later that same day, and this time R1 agreed to go to a local hospital. According to staff interviews and corroborated by hospital discharge paperwork: R1 was soon released back to the facility, with their only identified injury being a “contusion” on their head. There were no bone fractures or hip or hand injuries identified. Progress/care notes and a faxed note to R1's doctor showed: after R1 discharged back to the facility, staff continued to provide increased observation to R1, and continued to communicate with R1’s responsible person and physician. Interviews and care documents revealed that R1 wore a pendant call device/button (which is used to summon staff for help) during the slip/fall incident. LPA reviewed an electronic signals log corresponding to R1’s pendant device for 05/15/2023. The log evidenced that facility staff quickly responded to each of R1’s three (3) pendant calls, which were spread out over this date. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] There does not exist a preponderance of evidence showing that licensee’s staff did not provide needed care or observation to R1, or that licensee did not arrange for needed emergency medical care for R1 when it became warranted. No deficiency was cited for the above incident. Also, no deficiency was observed or cited during today’s licensing visit. However, LPA identified one Technical Violation regarding Reporting Requirements, and provided education, accordingly. An exit interview was conducted with Burk, to whom a copy of this report, the LIC9102-TV, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jun 16, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Chris Burk. Today's visit was in response to an LIC624 Incident Report and an SOC341 Report of Suspected Dependent Adult/Elder Abuse, which licensee self-submitted to the CCLD San Diego Regional Office on 04/15/2023. According to the LIC624 and SOC341: during the early evening of 04/14/2023, Resident #1 (R1) pinched caregiver Staff #1’s (S1) arm while S1 was reaching for a TV remote. [See LIC811 Confidential Names List for a description of select person identifiers used in this report]. S1 then used their own hand to remove R1’s hand from their arm. R1 alleged that a bruise formed on their arm from this incident. Staff #2 (S2) was witness to the incident. Licensee wrote they temporarily removed S1 from caregiving duties pending internal investigation. By 04/18/2023, S1 was reinstated in their caregiving duties, but was no longer assigned to care for R1. During today’s visit, LPA briefly toured the facility and interviewed R1, verifying that they felt safe, felt free of pain, and that no serious bodily injury was involved. By the date of LPA’s visit, there was no residual bruising present on R1’s arm. LPA also collected pertinent records and interviewed S1, other relevant staff, and multiple resident witnesses to the incident. According to R1’s latest LIC602 Physician’s Report, R1 did not exhibit any cognitive impairment. Their doctor determined R1 was not “confused/disoriented” and denied R1 having any “aggressive behavior,” “inappropriate behavior,” or “sundowning behavior.” Their doctor wrote that R1 was “able to follow instructions” and “able to communicate needs.” During interview, LPA observed that R1 was alert, oriented, and articulate about the incident. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] Per interview of R1: they were watching a movie in a common area room with other residents. S1 came to collect and escort R1 to the dining room for dinner, but R1 insisted on finishing their movie. S1 then grabbed R1’s arm to forcefully take away a TV remote which they were holding, leaving a bruise on R1’s arm. R1 denied grabbing S1’s arm or pinching them. Per interview of S1: S1 reached for a TV remote that was on a nearby table. R1 became upset, stood up, and grabbed S1’s left arm. S1 used their opened right hand to brush away R1’s grip on their arm. R1 then pinched S1 in their right shoulder area with their fingers. Per their seperate interview: S2 said S1 picked up a TV remote that was on a nearby table and used it to turn off the TV, upsetting R1. R1 tried to grab S1’s arm, and S1 used their open hand to brush away R1’s hand. S2 then instructed S1 to leave the area to de-escalate the situation. [LPA reviewed the written incident statements that S1 and S2 provided to licensee on 04/14/2023; S1 and S2’s verbal statements were consistent with their written statements.] Together, R1’s, S1’s, and S2’s interviews revealed that Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4) were seated with R1 during the incident. Due to their baseline memory loss and disorientation, LPA determined the R2 was unable to participate a reliable historian/interviewee. According to R3’s latest LIC602 Physician’s Report, they were diagnosed with Mild Cognitive Impairment. However, their doctor also determined that R3 was not “confused/disoriented,” and that they were “able to follow instructions” and “able to communicate needs.” During LPA’s interview, R3 was alert, oriented, and able to be qualified as a witness. Per interview of R3: due to the darkness in the room, they did not see if there was a physical altercation between R1 and S1, but said S1 approached the group with a rude and loud tone of voice to insist that they stop their movie. R3 said they wanted to keep watching the movie. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] According to R4’s latest LIC602 Physician’s Report, they were diagnosed with Mild Cognitive Impairment. However, their doctor also determined that they were “able to follow instructions” and “able to communicate needs.” During LPA’s interview, R4 was alert, oriented, and able to be qualified as a witness. Per interview of R4: they witnessed S1 grab R1’s arm to forcibly remove a TV remote from R1’s hand. R4 did not see R1 grab S1’s arm or pinch S1. R4 said they wanted to keep watching the movie. Per interview of facility management: R1 takes blood thinner medication. A mild bruise was present on R1’s lower right arm during their investigation, but the bruise was not caused during the incident. Rather, this same bruise was already present on R1’s arm prior to the incident, as observed by S2 during their 04/07/2023 shower assistance to R1 and documented in caregiver charting. Per date and time stamped electronic progress notes: licensee notified R1’s responsible party (RP) and physician about the incident the same day it occurred, and facility management provided follow up training to their direct care staff on Resident’s Personal Rights. Based on records and interviews, a preponderance of evidence does not exist to show that the incident between S1 and R1 constituted physical abuse or resulted in injury to R1. However, a preponderance of evidence does exists to show that S1’s did not respect resident freedom of choice, contributing to the incident occurring/escalating. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Burk, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 25, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(6) · Plan of correction due date: May 25, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a)…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (6) To make choices concerning their daily lives in the facility.” This requirement was not met, as evidenced by: Based on records and interviews, during the incident, licensee’s staff (S1) did not allow 3 of 81 residents (R1, R3, and R4) to make choices concerning their daily lives in the facility, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 25, 2023

Plan of correction: Per interviews and record review, following the incident, facility management retrained its direct staff staff, to include S1, on Resident’s Personal Rights. Licensee agreed to E-mail LPA a copy of the training sign-in sheet, by the POC due date, as evidence. This action would resolve the deficiency.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA was allowed entry by the receptionist. LPA met, identified herself to, and discussed the purpose of the visit with Administrator Valorie Adams. Executive Director Christopher Burk arrived during the visit. Today's visit is in response to the self-reported incident which occurred on 11/2/2022 regarding the fall of Resident 1 (R1). R1 was holding onto Resident 2's electric scooter when R1 fell (R2 - see LIC811 Confidential Names List for explanation of R1 and R2). Staff present did not witness the fall. R1 has been advised not to hold onto anyone's electric scooter. LPA conducted a wellness check at the facility, and no health or safety issues were identified. Residents observed appeared appropriate for the facility. No deficiencies were cited or observed on this date. An exit interview was conducted with the Executive Director Christopher Burk. A copy of this report and appeal rights (LIC9058 03/22), were provided via hardcopy.the state’s words, verbatim · CDSS document, Jan 4, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kayla Hilario, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by the receptionist. LPA identified herself to, and explained the purpose of the visit to Administrator Valorie Adams. Executive Director Christopher Burk arrived during the visit. LPA conducted a tour of the facility, both inside and outside and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. No deficiencies were cited or observed on this date. An exit interview was conducted with Executive Director Christopher Burk. A copy of this report and appeal rights (LIC9058 03/22), were provided via hardcopy at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 4, 2023

Allegation investigated: Licensee did not observe resident's change in condition Staff served expired food to residents Staff did not follow food sanitation practices

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Directors Mario Preston and Chris Burk. The Department’s investigation consisted of observations, interviews with staff, residents, and outside sources, review of records, and a tour of the facility. It was alleged that the Licensee did not observe resident’s change in condition specific to wound care. Interviews with facility staff revealed that there were three residents at the facility that received wound care from outside agencies. Interviews with the Health and Wellness Director (HWD) revealed that the residents received wound care one to three times a week and the care provided by those outside agencies included wound treatment and applying bandages to the wound. Continued on LIC9099-C page Unsubstantiated Facility staff were trained to call the outside agency if the wound smelled, looked infected, had any changes, or if the bandage slipped or fell off. Facility medication technicians and nurses had received training to replace the bandage on the wound if needed, but were still instructed to call the outside agency to notify them of the changes. Interviews with the outside agencies revealed that there are no concerns about facility staff reaching out to them regarding residents’ wound care. Interviews with Resident 1’s (R1) home health nurse stated that R1 was non-compliant with wound care and would not allow staff or outside agency staff to observe or care for the wound. R1’s nurse arranged a care conference with the facility’s HWD to discuss R1’s wound. Interviews with HWD stated that R1 would be non-compliant with home health nurses depending on how they approached R1 and would agree to care from some nurses and deny care from others. Review of home health care documents revealed that R1 occasionally denied services but was able to receive wound care services. HWD stated that R1’s wound had healed as of October 21, 2022 and R1 is no longer receiving wound care services. It was alleged that staff served expired food to residents and did not follow food sanitation practices. Interviews with the staff revealed that staff conduct inventory on the facility’s food supply and order food supplies once a week. Staff are directed to fill out a food label when preparing food which includes the name of the food, the date prepared, the expiration date of the food, the food’s shelf-life time period, the preparer’s initials, and the manager’s initials. During the initial visit on August 15, 2022, LPA Ruiz observed food in the facility’s walk-in refrigerator and freezer that had the date prepared but did not have the expiration date or a shelf-life time period. LPA Ruiz did not observe any food that was spoiled or rotten during the initial visit. Interviews with the Dining Services Director (DSD) revealed that there is a specific staff member that is having an ongoing problem with not putting the expiration date on food. Interviews with dining staff revealed that any food that is identified as spoiled or expired is thrown out. Interviews with residents revealed that residents like the food served at the facility and have not observed any spoiled or expired meals. Interviews with staff revealed that dining staff are responsible for cooking and preparing meals in the facility kitchen, placing the food into warming boxes that are used to transport food to the facility’s two dining rooms for assisted living and the two memory care areas. Continued on LIC9099-C page. Dining staff transfer the food into steam trays in kitchenettes located in each dining room and plate and serve food to residents. In memory care, dining staff transport the warming boxes to the memory care kitchenettes where memory care staff place the food into steam trays and plate and serve residents. Interviews with the DSD revealed that dining staff use gloves when preparing food. The Department has investigated the above-mentioned allegations and based on interviews, observations, and review of records, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Executive Directors Mario Preston and Chris Burk, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Dec 6, 2022 · control 08-AS-20220906173219

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rebecca Ruiz and County of San Diego Nurse Contractor Robert Montinallo with the HAI Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with Health and Wellness Director Valorie Adams. The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Health and Wellness Director and conducted a walk-though of the facility. A debriefing was conducted at the conclusion of the visit. No deficiencies were cited or observed on this date. An exit interview was conducted with Valorie Adams, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Nov 3, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management visit. LPA was greeted and allowed entry by the receptionist and met with Business Services Director Raquel Tarango to whom LPA identified herself and discussed the purpose of the visit. Today's visit is in response to the reported death of Resident #1 (R1 - See LIC811 Confidential Names List). The date of death is listed as 10/13/2022 and R1 passed away at the 10/13/2022. LPA obtained additional information on this date. All residents observed appeared appropriate for the facility. All staff the LPA interacted with had a current criminal record clearance. No immediate health or safety issues were identified. No deficiencies were cited or observed on this date. An exit interview was conducted with Business Services Director Raquel Tarango. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Business Services Director via hard copy at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 18, 2022

Allegation investigated: Neglect/Lack of Supervision to resident resulting in fall and injury

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. The LPA was greeted by Executive Director, Foudhil Mnadi, identified himself, and disclosed the purpose of the visit. The Department’s investigation consisted of review of records, and interviews with internal and external sources. It was alleged neglect, Lack of Supervision to a resident resulted in fall and injury.Resident #1 (R1) moved into the facility on 12/3/21, and was at the facility from approximately 12pm to 8pm. R1 sustained two falls within this timeframe. The second fall resulted in a laceration to the eyebrow, and R1 was transported to the hospital. An interview with an outside source corroborated this information to be true. Obtained records revealed R1 was a fall risk, used mobility aids, often attempted to walk and transfer without assistance, and had a history of recent falls. Unsubstantiated Interviews with internal sources revealed residents in the memory care unit were frequently observed and encouraged to participate in community activities. If a resident decided to spend time in the resident’s room, staff would conduct hourly to half hour checks. The time frame of the checks was dependent on the resident’s needs at that specific time. On 12/3/21, R1 was assisted to the dining room for dinner and assisted back to R1’s room after. A few minutes later, R1 was found on the ground with a laceration to the eyebrow and was transported to the hospital. Documents obtained at the facility revealed the facility does not provide one to one care and supervision, and residents were able to hire a third party to provided additional services, including assistance and companionship. An interview with an outside source who conducted regular visits to the facility did not disclose any concerns regarding neglect, nor lack of supervision at the facility. Based on the evidence gathered throughout the investigation, there is not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation is unsubstantiated. An exit interview was conducted with Executive Director, Foudhil Manadi, to whom a copy of this report, and Licensee's Rights (LIC 9058 01/16) were provided tothe state’s words, verbatim · CDSS document, Aug 30, 2022 · control 08-AS-20220120104809

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to follow up on an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit to Executive Director Foundil Manadi and Business Office Director Candi Laird. The Department received an incident report from the facility on 8/11/2022 stating the Resident 1 (R1) had eloped from the facility on 8/6/22. [Executive Director was provided with an LIC811 Confidential Names list to identify R1]. During today's visit, LPA toured the facility, interviewed staff, and reviewed and obtained copies of facility records. No deficiencies were cited or observed on this date. An exit interview was conducted with Executive Director Foundil Manadi, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Aug 11, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst, (LPA), Kristina Ryan, conducted an unannounced case management visit to follow up on a report of Suspected Elder Abuse (SOC 341) received on February 22, 2022. LPA Ryan introduced herself, stated the purpose of the visit, was allowed entry and met with Executive Director, Foudhil Manadi. Community Care Licensing (CCL) received a SOC 341 on February 22, 2022 which stated that two residents were involved in an incident. Licensee informed all of the relevant parties of the incident. During today's visit, LPA toured the facility, reviewed resident records, and interviewed staff. No deficiencies were cited. An exit interview was conducted with Mr. Manadi. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to the executive director at the conclusion of the visit, an electronic response confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Feb 23, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced case management visit to follow up on a SOC 341 received on December 20,2021. LPA Ryan introduced herself, stated the purpose of the visit, was allowed entry and met with Executive Director, Foudhil Manadi. Community Care Licensing (CCL) received a SOC 341 on December 20, 2021, which stated that a resident had an incident with a staff. Licensee informed all of the relevant parties of the incident. During today's visit, LPA reviewed resident and staff records, and interviewed staff and residents. Executive Director was informed that this investigation into this incident requires more time and future visits may be needed. No deficiencies were cited at this time. An exit interview was conducted with Mr. Manadi. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to the executive director at the conclusion of the visit, an electronic response confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Dec 23, 2021

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced case management visit to follow up on an incident report received on September 17, 2021 LPA Ryan introduced herself, stated the purpose of the visit, was allowed entry and met with Executive Director, Foudhil Manadi and Business Office Manager, Candi Laird. Community Care Licensing (CCL) received an incident report on September 17, 2021 which stated that two residents were involved in an altercation. Facility staff submitted the incident report along with a SOC 341. Licensee informed all of the relevant parties of the incident. During today's visit, LPA toured the facility, reviewed resident records, and interviewed staff and residents. No deficiencies were cited. An exit interview was conducted with Mr Manadi and Ms. Laird. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to the executive director at the conclusion of the visit, an electronic response confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Nov 5, 2021

Type of visit: Case Management - Incident

This is an amended report, dated 10/5/21. The original report was created on 5/22/19. Licensing Program Analyst (LPA), Jonathan Pineda made an unannounced visit to conduct a case management visit regarding an unusual incident report submitted to CCL on 5/7/19 by the licensee. LPA identified himself and was granted entry into the facility by Laura Eckert, Administrator It was reported that on May 8, 2019, resident (R1) was found lying on his back on the floor next to his bed. Resident was evaluated and sent to Tri City Medical Center by ambulance where R1 was diagnosed with a hip fracture. Based on observation, interviews, and record review, LPA did not observe any culpability. No deficiencies were cited during today’s visit. This report was discussed and a copy along with Licensee Rights (01/16) was provided to Laura Eckert.the state’s words, verbatim · CDSS document, May 22, 2019