The Peninsula Regent

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Type of visit: Case Management - Annual Continuation

To complete annual inspection of 11/20/25, LPA Jeung reviewed resident records--which are accessible electronically--and Centrally Stored Medications Records. Required resident records are maintained, and clients' medications are recorded on Centrally Stored Medications REcords. No deficiencies of the California Code of Regulations, Title 22 are cited today. See Advisory Note for technical violation.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this Continuing Care Retirement Community, which is 11 stories tall and accommodates independent residents and assisted living residents in 20 units on the ground floor. There is an activity room with piano, an art room, and 4 guest bedrooms for visiting overnight guests of residents on the 11th floor. There is a covered swimming pool and jacuzzi tub, as well as a shallow pond on premises. Pool and jacuzzi can be accessed by a door fob issued to independent residents only. Common areas on the ground floor include beauty salon, game room, fitness room and library. There are no fire safety hazards observed. Hot water temperature is tested at 116 degrees in room 117. Food supply, signal system, and first-aid kit are inspected. Emergency food supply consists of dehydrated canned food, which must be reconstituted with water. Facility maintains supply of fresh water in addition to 2 large capacity boilers on the roof. Reports of quarterly consultations by registered dietician are maintained, Fire and emergency drills are documented and occur at least quarterly. "Stryker" evacuation chairs are maintained on the 6th floor stair landings; there is an evacuation chair for each of 4 stairwells. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as required staff records. Martin Herter is a certified RCFE administrator (x 12/25) that oversees facility operations. Resident records will be reviewed at a later date--including Centrally Stored Medications Records--due to time constraints. Three residents are receiving hospice services at this time. An updated Disaster and Mass Casualty Plan is readily available. The following forms are requested to be completed and returned to CCL by 12/4/25: • LIC 309 Administrative Organization for BASS Inc. and PRS Inc. • LIC 500 Personnel Report Deficiencies of the California Code of Regulations, Title 22 are observed and cited on following pages.the state’s words, verbatim · CDSS document, Nov 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(1) · Plan of correction due date: Nov 21, 2025

PERSONNEL REQUIREMENTS - GENL Prior to employment or initial presence in the facility, all employees... subject to a criminal record review shall obtain a CA clearance or a criminal record exemption as required by law or Dept. regulations. This requirement is not met, as dining server staff #1 does not have criminal record clearance and is 18 years old. Licensee failed to ensure that all employees with direct client contact maintain criminal record clearance, whish poses an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 20, 2025

Plan of correction: Staff #1 will obtain criminal record clearance and proof of correction will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Nov 20, 2025

INCIDENTAL MEDICAL CARE Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met, as OTC meds & supplements are stored in 2 assisted living apartments, which are occupied by clients who are unable to safely store & administer their medications. Licensee failed to ensure that medications are inaccessible to residents who are unable to store their medications, posing an immediate health and safety risk.the state’s words, verbatim · CDSS document, Nov 20, 2025

Plan of correction: Advil and Tylenol were removed from room 116 in LPA's presence and 3 bottles of Fiber Gummies were removed from room 101 during LPA's visit. Deficiency corrected and cleared

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this Continuing Care Retirement Community. Building consists of 11 stories, with 20 assisted living units on the ground floor. On the 11th floor, there is an activity room with piano, an art room, and 4 guest bedrooms for visiting overnight guests of residents. There is a covered swimming pool and jacuzzi tub, as well as a shallow pond on premises. Pool and jacuzzi can be accessed by a door fob issued to independent residents only. There are no fire safety hazards observed. Toxins and sharps are stored appropriately and inaccessible to clients, and lighting is sufficient for comfort and safety. Hot water temperature is tested at 118 degrees in room 117. Food supply, signal system, and first-aid kit are inspected. Emergency food supply consists of dehydrated canned food, which must be reconstituted with water. Facility maintains fresh water in 2 large capacity boilers on the roof. "Stryker" evacuation chairs are maintained on the 6th floor stair landing, and there is an evacuation chair for each of 4 stairwells, according to Mr. Herter. Some client and staff files are reviewed, and clients' medications are recorded on Centrally Stored Medications Records. An updated Disaster and Mass Casualty Plan is readily available. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Martin Herter is a certified RCFE administrator (x 12/25) that oversees facility operations. The following forms are requested to be completed and returned to CCL by 12/16/24: • LIC 309 Administrative Organization for BASS Inc. and PRS Inc. • LIC 500 Personnel Report Updated Emergency Disaster Plan (LIC610E) is provided to LPA today. PUB474, pertaining to resident councils (per AB1572) is posted, as are text of Health and Safety Code 1569.269 AND CCR Title 22 Section 87468 (Personal Rights form LIC613C) (per AB2171) and CCLD Hotline information (per SB895). Deficiencies of the CA Code of REgulations, Title 22 are cited on a following pagethe state’s words, verbatim · CDSS document, Dec 2, 2024

Allegation investigated: Staff do not ensure call button alerts are responded to in a timely manner Resident sustained an injury while in care Staff do not ensure residents are spoken to in an appropriate manner Staff handle residents in a rough manner

LPA Jeung met with executive director and health and wellness director to discuss allegations regarding client #1 and reviewed client file, including emergency call system log of responses to client #1 from 4/1/24 to 5/21/24. Care staff was interviewed. Based on information reported by staff and review of facility records, these allegations are substantiated. The preponderance of evidence standard has been met. As per review of facility's Alarm History Report of emergency calls from room 123--where client #1 resides--for period 4/1 - 5/21/24, it is noted that client activated the alarm frequently; alerts were recorded almost daily, and several times on each day. On at least 16 occasions over the period of 51 days, staff responded 15 minutes or more after the alert was activated. Continued Substantiated Continued from page ONE Incident of 5/4/24 was documented and reported to licensing agency after client's family observed discoloration on client's arms and a skin tear. Upon facility's investigation, a staff was found to be responsible for handling client roughly, resulting in bruises and skin tear on client's arms. In addition, this staff did not respect client's wishes to rest instead of getting up for breakfast; she was perceived as rude and impatient when interacting with client. Facility terminated this staff on 5/15/24.the state’s words, verbatim · CDSS document, Sep 27, 2024 · control 14-AS-20240514110539

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 4, 2024

PERSONAL RIGHTS Residents in all RCFEs shall have the personal right to be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met, as client #1 sustained an injury when a staff handled client in rough manner. Licensee failed to accord client the right to be treated with dignity and respect in relationship with staff, which posed a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: Staff LVN is no longer employed at facility as a result of interactions with this resident. Plan of correction to be submitted to CCLD BY DUE DATE, documenting how this situation was addressed, and what facility has done to avoid a recurrence

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

ADDITIONAL PERSONAL RIGHTS Residents in all RCFEs shall have the personal right 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 staff failed to respond to client's call alerts in a timely manner. Licensee failed to ensure that staff were sufficient in numbers and competency to respond to client's needs in timely manner. This posed a potential health, safety, or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: Plan of correction to be submitted to CCLD BY DUE DATE, describing how facility will ensure that residents calls for assistance will be monitored for timely responses