The Meridian at Lake San Marcos

Type of visit: Required - 1 Year

On 3/27/26, Licensing Program Analyst (LPA) Kyle Wellington made an unannounced visit to the facility to conduct an annual inspection. LPA met with the Administrator (Admin), Shaun McGuirk, who was informed of the purpose of the visit. Admin informed LPA there are 121 residents and 132 staff members at the facility. The facility has a fire clearance to serve 170 non-ambulatory residents of which 10 may be bedridden on the first floor only. The facility has an approved hospice waiver for 10 residents with 7 residents currently receiving hospice services. LPA received a resident and staff roster from the Admin. LPA did an observation of the inside and outside of the facility with the Admin and conducted record reviews for the inspection. The facility contains two (2) three story buildings for memory care and assisted living residents and one (1) two story commons building that contains a kitchen, dining room, activities rooms and common areas available for resident use. There are multiple outdoor shaded areas with seating. Indoor and outdoor passageways along with entrances and exits were free of obstructions. There is a swimming pool and spa on the property that is surrounded by a fence with locked gates. There are fire alarm systems, carbon monoxide detectors, and charged fire extinguishers throughout the facility. The fire extinguisher service tags noted the fire extinguishers were last serviced on 9/30/25. LPA reviewed the fire safety certificate performed by the San Marcos Fire Dept conducted on 6/18/25 noting the facility passed its fire safety inspection. LPA reviewed the facility's Fire/Disaster Drill noting the facility's last fire drill was conducted on 8/28/25. LPA observed the laundry and supply rooms to be locked and inaccessible to residents, LPA toured the kitchen and observed food prepared and stored in a safe and clean manner. The facility has a two day supply of perishable foods and a seven day supply of non perishable foods. LPA observed a white board with on the kitchen wall noting residents' food allergies and dietary needs. LPA observed medications secured in medication carts, only accessible to authorized personnel such as nurses and medication technicians. LPA reviewed five staff and ten resident files. The files contained all the required documentation and paperwork. No deficiencies were cited during this visit. Exit interview was conducted with the Administrator and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Mar 27, 2026

Allegation investigated: Staff did not answer resident's call button in a timely manner

On 10/21/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering investigative findings into the allegation listed above. The investigation consisted of interviews and records review. Information received alleged facility staff did not answer Resident #2 (R2)’s call button in a timely manner. Information received from R2 alleged Resident #1 (R1) was observed choking in the dining room on 9/21/2025. R2 activated their pendant, and it took Staff #1 (S1) approximately 5 to 10 minutes to arrive for assistance. Interviews conducted with S1 and R1 reported that R1 was not choking and reported that R1 was coughing. Interviews conducted with R1 and S1 further reported that R1’s diagnosis may cause R1 to cough and R1 was not requiring assistance. (Continue to LIC9099C) Unsubstantiated (Continuation from LIC9099) Interview conducted with S1 confirmed they observed R1 was coughing and did not clear the R2’s pendant immediately as R2 advised S1 that R1 was the person requiring assistance. A records review conducted of the facility’s signal system recorded a 22-minute response time for an incident occurring on 09/25/2025. The signal system did not have an records of R2’s pendant being activated on 09/21/2025. LPA attempted to conduct an interview with R2 to obtain additional information but R2 declined. Therefore, the allegation is deemed unsubstantiated. A finding that is determined unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. There were no deficiencies cited during today's visit. Exit interview conducted and copy of report provided Executive Director, Shaun McGuirk.the state’s words, verbatim · CDSS document, Oct 21, 2025 · control 18-AS-20250923103316

Allegation investigated: Staff do not ensure adequate supervison is provided to residents in care

On 10/21/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering investigative findings into the allegation listed above. The investigation consisted of interviews. Information received alleged staff do not ensure adequate supervision is provided to residents in care as it was reported that Resident #1 (R1) observed an unknown male resident in R1’s room. A follow-up interview was conducted with the Reporting Party (RP) which divulged that RP is unsure if the allegation is true as R1 is confused at times often retelling incidents that have not occurred. Interviews conducted with Staff #1 (S1) and R1 reported that residents often wander in the common area’s of the facility but do not have knowledge of any residents wandering into R1’s rooms. (Continue to LIC9099C...) Unfounded (Continuation from LIC9099) Interview conducted with R1 further detailed encounters with Resident #2 (R2) where R2 wanders the common areas and has attempted to open R1’s unit door but has not gained access to the unit as it required a key to open. R1 reports having a key to access their unit. R1 reports that all staff and residents are aware of R2’s actions as R2 is highly confused. R1 further reports that R2 nor any other resident have ever entered into R1’s room. Therefore, the complaint allegation of staff do not ensure adequate supervision is provided to residents in care is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and copy of report provided Executive Director, Shaun McGuirk.the state’s words, verbatim · CDSS document, Oct 21, 2025 · control 18-AS-20250925082723

Allegation investigated: Facility staff is sleeping at work.

On 03/30/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro and LPA Wendy Gibbs conducted an unannounced subsequent complaint visit. LPA Leandro met with Memory Care Director, Melissa Sigala the purpose of the visit was explained, and LPA was granted entry to the facility. Unsubstantiated The investigation consisted of the following: On 9/13/2024, staff records were reviewed, interviews of staff and residents were conducted. On 3/29/2025, records were collected, and interviews were conducted. Interviews conducted consisted of 5 staff interviews [Staff 2 (S2) to Staff 6 (S6) were interviewed] and 8 resident interviews [Resident 1 (R1) to Resident 8 (R8) were interviewed]. On 3/30/2025, records and interviews were reviewed, and interviews were conducted. Records reviewed consisted of Staff 1 (S1) file, Employee Roster dated 3/29/2025, Resident Census dated 3/29/2025, and Resident Roster dated 3/29/2025. Interviews reviewed consisted of S2 to S6 interviews and R1 to R8 interviews. Interviews conducted consisted of 2 staff interviews [Staff 7 (S7) to Staff 8 (S8) were interviewed] and 3 resident interviews [Resident 9 (R9) to Resident 11 (R11) were interviewed]. The investigation revealed the following: Allegation: “Facility staff is sleeping at work”, it is being alleged that a staff member is sleeping at work. Interviews conducted with R1 to R11 revealed the following: 1 out of 11 residents saw a staff sleeping at work, and 10 out of 11 residents have not heard about staff sleeping at work nor seen staff sleeping at work. Interviews conducted with S2 to S8 revealed the following: 1 out of 8 staff saw S1 sleeping at work; 2 out of 8 staff heard that S1 sleeps at work; and 5 out of 8 staff have not heard about staff sleeping at work nor seen staff sleeping at work. Records reviewed of S1 file revealed the following: there is no mention of S1 sleeping at work. Observations revealed the following: On 3/29/2025 and 3/30/2025, the department did not observe staff sleeping in the facility. Based on interviews, records, and observations this allegation is unsubstantiated. Unsubstantiated: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left with the Memory Care Director, Melissa Sigala.the state’s words, verbatim · CDSS document, Mar 30, 2025 · control 18-AS-20230530163628

Allegation investigated: Staff does not keep an accurate medication log.

On 03/30/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent complaint visit to the facility listed above. LPA met with Memory Care Director, Melissa Sigala, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: On 10/26/2023, LPA Kathleen Banrasavong conducted an initial visit. The visit consisted of a facility tour, interiew with Administrator and review of facility record, and collected pertinent documents. During a subsequent visit conducted on 03/29/2025, LPA Gibbs toured the facility, interviewed Staff S4-S8, interviewed Residents R3-R7, and received copies of Staff S1 employee file. During today’s visit, LPA Gibbs interviewed Staff S9 and S10 and interviewed Resident R8-R12. The investigation revealed: Substantiated Allegation: Staff stealing resident medication. The allegation alleges that staff is stealing residents’ medication. During record review, LPA reviewed the Medication Administration Records (MAR) and Physician’s Orders for 10 residents. During the facility tour LPA inspected the medication room and reviewed the MAR and medications for 10 residents. LPA observed eight (8) out of ten (10) resident medications are consistent with properly documented records. LPA reviewed 15 residents Controlled Drug Administration Record and conducted a Narcotic Drug pill count. LPA observed fifteen (15) out of fifteen (15) Controlled Drug Administration Record and pill count are consistent with properly documented records. During interviews with Staff S3-S10, were asked if they suspect, seen, or heard of staff stealing medications, three (3) out of eight (8) stated they had heard a while ago that a staff might be stealing resident’s narcotics, but nothing recently. During interviews with Residents R3- R12, were asked if they had any concerns if staff were stealing their narcotics, ten (10) out of ten (10) stated they have no concerns of staff taking their narcotics. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Memory Care Director, Melissa Sigala, and a copy of this report was provided. Allegation: Staff does not keep an accurate medication log. The allegation alleges that staff changes the medication count on the medical log and they not accurate. During Staff File review, LPA reviewed a Separation Form for S1, indicating an Involuntary Termination for Violation of company Policy effective 09/13/2024. Additionally, LPA reviewed a Suspension Notice for S1 dated 09/10/2024, pending an investigation. LPA reviewed an Employee Counseling Report dated 01/09/2024 for an incident that occurred on 12/05/2023. On 12/05/2023 there was a report of a discrepancy in the Controlled Substance count. The count sheet noted 10 pills and the bubble pack had 9 pills. During record review, LPA reviewed the Medication Administration Records (MAR) and Physician’s Orders for 10 residents. During the facility tour LPA inspected the medication room and reviewed the MAR and medications for 10 residents. LPA observed eight (8) out of ten (10) resident medications are consistent with properly documented records. LPA reviewed 15 residents Controlled Drug Administration Record and conducted a Narcotic Drug pill count. LPA observed fifteen (15) out of fifteen (15) Controlled Drug Administration Record and pill count are consistent with properly documented records. During interviews with Staff S3-S10, were asked if they have observed any discrepancies on the Controlled Drug Administration Record , four (4) out of eight (8) stated they have observed discrepancies on the Controlled Drug Administration Record. During interview with Residents R3-R12, were asked if they believe staff keep accurate documentation of their medications taken, ten (10) out of ten (10) stated they believe staff keep accurate records of their medications taken. During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D. An exit interview was conducted with Memory Care Director, Melissa Sigala, and a copy of this report and the Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 30, 2025 · control 18-AS-20231020143409

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Apr 9, 2025

87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Based on observation, record review, and interviews S1 had Employee Counseling Report due to discrepancies in Controlled Drug Administration Record and during file review, LPA observed 2 out of 10 were not consist with properly documented records.the state’s words, verbatim · CDSS document, Mar 30, 2025

Plan of correction: Adminsitrator will conduct an In-Service for Med Tech and review proper documentation for Medication Administration. Logs for the in-service will be emailed to LPA Gibbs by the POC date.

Allegation investigated: Staff is providing resident care while intoxicated

On 03/30/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent complaint visit to the facility listed above. LPA met with Memory Care Director, Melissa Sigala, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: On 06/16/2023, LPA Chinwe Nwogene conducted an initial visit. The visit consisted of a facility tour, review of facility record, and collected pertinent documents. During a subsequent visit conducted on 03/29/2025, LPA Gibbs toured the facility, interviewed Staff S4-S8, interviewed Residents R3-R7, and received copies of Staff S1 employee file. During today’s visit, LPA Gibbs interviewed Staff S9 and S11 and interviewed Resident R8-R12. Unsubstantiated The investigation revealed the following: Allegation: Staff is providing resident care while intoxicated. The allegation alleges that staff is coming into work while intoxicated and providing resident care. During Staff File review, LPA observed a Drug and Alcohol-Free Workplace Policy Employee Acknowledgement signed by S1 on 06/07/2022. The document states drug and alcohol testing will be done. Additionally, LPA reviewed a Separation Form for an Involuntary Termination for Violation of Company Policy. During interviews with Staff S4-S10, were asked if they have observed Staff intoxicated or smelled alcohol on staff while working, one (1) out of eight (8) stated they have seen and smelled alcohol on staff while working. Additionally, Staff S4-S10 we8e asked if they have heard of staff coming to work intoxicated, three (3) out of eight (7) have stated they have heard of staff coming to work intoxicated. During interview with Resident R1-R10, were asked if they have observed staff intoxicated or smelling of alcohol while working, one (1) out of ten (10) stated they have observed staff intoxicated and smelled like alcohol. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Memory Care Director, Melissa Sigala, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 30, 2025 · control 18-AS-20230609171027

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that one- hundred and twenty-eight (128) residents live at this facility. The Executive Director, Amy Banaga was advised of the annual and conducted and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Ten (10) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Ten (10) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. The Exceuctive Director, Amy Banaga, Administrator’s certificate expiration date was 09/25/2026 Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the designated laundry room. There is a location for storing laundry soap, cleaning supplies and chemicals in the closet in the Housekeeper’s closet. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There is one (1) pool at the facility. It is secured with a gate surrounding the pool. LPA observed emergency supplies and several first aid kits throughout the facility. The last emergency fire drill was conducted on 02/26/2025. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed several smoke detectors and carbon monoxide detectors that are hard wired throughout the facility. The system is monitored by Simplified Technologies, INC. The most current fire inspection was conducted on 07/10/2024. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Executive Director, Amy Banaga.the state’s words, verbatim · CDSS document, Mar 17, 2025

Allegation investigated: Facility not providing adequate food service. Facility elevator disrepair. Facility not cleaned properly.

On 2/25/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to deliver findings regarding the above allegations. LPA met with Administrator, Amy Banaga who was informed of the purpose of the visit. It was alleged from approximately October 2022 to April 2023 all meals were served cold and often not cooked to temperature. LPA conducted an interview with Facility Cook (FC), David Padilla who reported being present during the alleged incident timeframe. FC reported all meals are prepared and cooked in the club house kitchen located near the Caprese Dining Room (CDR). FC reported hot foods are placed in food warmers and transported to the Assisted Living (AL) and Memory Care Units (MCUs) where they are then transferred onto industrial steamtables. FC added the steamtables keep the foods hot until facility servers plate and serve the food to the residents. FC reported most resident meals are cooked to order and at a specific safe minimum internal temperature unless otherwise requested by the residents, such as the desired doneness temperatures of steaks. Unsubstantiated FC reported the facility also serves cold food that is traditionally consumed raw/undercooked such as sandwiches, wraps, salads, or vegetables. FC reported some residents have expressed differences in opinions regarding doneness of steaks/vegetables, but kitchen staff will remake the food in question and accommodate food preferences. FC was unable to recall complaints of food served cold/undercooked during the specific alleged timeframe. FC reported they have completed food safety training and ensure hot foods are cooked to safe minimum internal temperatures using food thermometers. Four (4) of six (6) resident interviews conducted refuted the allegations. One (1) of six (6) resident interviews conducted reported the food was never served undercooked, however, sometimes it was served on a cold plate which would make the food cool down faster. One (1) of six (6) resident interviews conducted explained if their food was cold or not prepared as ordered they would send it back to the kitchen and receive a replacement in a timely manner. Two (2) staff interviews conducted confirmed hot food is transported in food warmers and placed onto steamtables before being served to the residents. Administrator, Amy Banaga reported due to the lapse in time, the facility was unable to locate the California Food Handlers Cards or food safety training records for the kitchen or dining room staff who worked during the alleged incident timeframe. It was further alleged from approximately April 2022 to April 2023, dining tables shared by residents residing in Independent Living (IL), AL, and MCU were often sticky and not cleaned. The CDR was identified as the only dining room shared and accessible by residents residing in IL, AL, and MCU. LPA conducted an interview with Dining Room Supervisor (DRS) Victoria Taverna who reported being present during most of the alleged incident timeframe. DRS reported facility servers were responsible for bussing tables, wiping them with sanitizing spray, and resetting silverware and napkins for new residents. DRS recalled during breakfast or rush hours some residents would choose to sit at dirty tables where plates from the previous resident(s) had not been cleared, and tables had not been wiped despite clean tables being available. DRS reported facility servers bussed and disinfected tables in a timely manner. DRS was unable to recall any reports of dining room tables being sticky and not cleaned during the alleged timeframe. Six (6) residents were interviewed and refuted the allegations. One (1) of six (6) resident interviews conducted explained the CDR tables have placemats with slight rubberized backing which caused the placemats to adhere to the dining tables after wiping. One (1) of six (6) resident interviews conducted reported the dining tables and placemats did not feel greasy or appeared dirty and the placemats did not stick to the tables once the table tops air dried. It was also alleged from approximately February 2023 to March 2023, the elevator shared by residents residing in IL, AL, and MCU made a loud banging noise. LPA conducted an interview with Maintenance Director (MD), Oliver Davila who identified the elevator in question as the club house elevator, also known as “car number 8”. MD was unable to recall the club house elevator being in disrepair specifically during the alleged incident timeframe. MD reported any issues with any of the elevators would have been addressed and repaired immediately. MD has not received complaints of the elevators making loud/unusual noises. MD reported the facility has an ongoing contract with Schindler Elevator Corporation (SEC) who has provided monthly preventative maintenance inspections and as needed repairs since 2012. LPA reviewed copies of SEC invoices confirming the preventative maintenance inspections during the alleged incident timeframe. MD reported the facility has always maintained a conveyance permit to operate all the elevators including the club house elevator. Administrator Banaga reported due to the lapse in time, the facility was unable to locate a copy of the club house elevator’s Conveyance Permit issued by the San Diego District Office for the alleged incident timeframe. Six (6) resident interviews conducted reported the club house elevator has never made unusual noises or been in disrepair for an extended period of time. One (1) of six (6) resident interviews reported the club house elevator may be the facility's most used elevator since it transports residents to the second floor to access the various activity rooms. One (1) of six (6) resident interviews conducted estimated the club house elevator to be in working order ninety percent of the time with maintenance working on it the remaining ten percent. During the investigation, LPA attempted to make contact with the reporting party to inquire about all the allegations but was unsuccessful. 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 and a copy of this report was reviewed and provided to Administrator Banaga.the state’s words, verbatim · CDSS document, Feb 25, 2025 · control 18-AS-20230403114528

Type of visit: Required - 1 Year

On March 08, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced annual required visit and met with Jessica Lane, Resident Services Director, who was informed of the purpose of the visit. The Facility File review was conducted in the Regional Office and additional forms were requested and reviewed on site. LPA Mixson toured the facility, along with the Resident Services Director, and inspected the inside and outside of the facility. The facility is comprised of five buildings two of which are licensed for memory care and assisted living. Each building is three stories with total capacity of 170 residents, 170 of which may be non-ambulatory, and ten of which may be bedridden on the first floor only. The residents served are elderly ages 60 and above. The Facility is located at 1177 San Marino Dr San Marcos, CA. 92078, and the facility phone number is (760) 510-7500, and is operable. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen. LPA Mixson observed gloves and cleaning supplies to do regular cleaning of the facility. The LPA reviewed the facility's infection control plan and found all required infection control measures. LPA Mixson observed PPE supplies at the facility. The LPA reviewed infection control training conducted with facility staff which met the department requirements. Physical Plant/Planned activities: LPA Mixson observed the resident living units. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. There is a pool that is locked with resident in assisted living having a key to access. The laundry room was observed to be locked. The hot water temperature was recorded and logged within regulations. Food Service: LPA Mixson observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. The LPA observed the facility met the required two day supply of perishable and seven day supply of non-perishable foods. Care & Supervision: adequate per facility type and within the regulations. Records Review: The LPA reviewed staff and resident files, conducted staff and residents interviews, and reviewed Previous Community Care Licensing forms. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was provided to Resident Service Director, Jessica Lane.the state’s words, verbatim · CDSS document, Mar 8, 2024

Allegation investigated: Facility staff financially abused resident

Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to deliver findings on a complaint investigation regarding the allegations listed above. LPA met with Administrator, Amy Banaga and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observations, interviews with staff members and residents, and record review. LPA was unable to interview S1 as LPA was unable to obtain contact. On 01/24/2024, Community Care Licensing (CCL) received a complaint that alleged staff financially abused resident. It was reported that a facility staff member stole $900 from a resident (R1). In regards to the allegation that facility staff financially abused resident, Resident 1 (R1) stated that they got a notification from their bank about a withdrawal of $900. R1 stated that they did not authorize that amount. R1 notified Administrator, Amy Banaga of the unauthorized withdrawal. R1 obtained a copy of the check and it revealed that the check was written out to an employee of the facility, Staff (S1). Substantiated The check was in the amount of $900 and “Happy Birthday” written in the memorandum area. Information obtained from Administrator Banaga stated that she contacted S1’s supervisor to advise of concerns and initiate an investigation. During the course of the investigation initiated by the facility, S1 initially stated that they received money as a gift from R1. S1 then admitted that they stole the check and wrote the check, signed it, and cashed it at a local check cashing location. LPA reviewed the written and signed statement submitted to HR and on file with the facility. LPA was also able to obtain termination paperwork for the employee. During an interview with R1, the information regarding the account was corroborated. Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the above allegation that the facility staff financially abused the resident is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8 87468.2 (a) (4)), are cited on the attached LIC 9099D. Pursuant to Title 22 of The California Code of Regulations Division 6, there are one (1) deficiency that will be cited. An exit interview was conducted. The report, along with the 9099D and appeal rights were reviewed and provided to the Administrator, Amy Banaga.the state’s words, verbatim · CDSS document, Feb 26, 2024 · control 18-AS-20240124163406

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87468.2(a)(4) · Plan of correction due date: Mar 15, 2024

87468.2 (a) In addition to the rights...residents...shall have all of the following personal rights:4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement was not met, as evidenced by: Based on the LPA's record review, interviews, the facility staff (S1) was not competent, by stealing $900 from R1.the state’s words, verbatim · CDSS document, Feb 26, 2024

Plan of correction: The Administrator, Amy Banaga stated that she will have all the staff review the regulation being cited and submit a signed affidavit, of the staffs' signature reading and understanding the regulation.

Allegation investigated: Facility failed to report financial abuse to Licensing

On 01/24/2024, Community Care Licensing (CCL) received a complaint that alleged the facility failed to report financial abuse to Licensing. During the course of the investigation, LPA interviewed the Administrator, Amy Banaga. Banaga stated that she submitted the Unusual Incident/ Injury Report to the Regional Office. Administrator indicated that the incident occurred on 01/17/2024 and it was reported on 01/17/2024. LPA reviewed the serious incident report that was submitted to the regional office. LPA reviewed the facility log of serious incident reports and the serious incident report was not logged. However, it is unreasonable to state that the facility did not report the incident. There are currently no concerns regarding the facility reporting incident to the regional office. Based on LPA’s observation, interview conducted, and record reviews, the preponderance of evidence shows that the allegations that facility failed to report financial abuse to Licensing. The Department has found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Unfoundedthe state’s words, verbatim · CDSS document, Feb 26, 2024 · control 18-AS-20240124163406