Peninsula Del Rey

Allegation investigated: - Staff did not prevent facility from being in disrepair.

LPA Jeung met with director of assisted living, maintenance director, maintenance staff, and client #2. Upon visiting client's apartment, an electric stainless steel rice cooker with lid was observed. Two GFI electrical outlets are present by the kitchen counter, and when tested, red lights appeared on the GFI tester, indicating that the outlets are working. The red indicator light on the rice cooker did not light up when plugged into the kitchen counter outlets, and lit up inconsistently when plugged into an electrical outlet under the thermostat in the apartment and in the hallway outside of the apartment. Based on this information, the allegation that facility is in disrepair has been investigated by the Community Care Licensing Division of the CA Department of Social Services, and determined to be unfounded. This means that the allegation could not have happened and/or is without a reasonable basis. Unfoundedthe state’s words, verbatim · CDSS document, Jun 2, 2026 · control 14-AS-20260601165228

Type of visit: Case Management - Incident

In response to Incident Report dated 5/12/26 regarding suspected financial abuse of client #1, LPA Jeung met with director of assisted living and reviewed file of client #1. LPA also met individually with client #1. Relevant documents are obtained for later perusal. At this time, no deficiencies are cited.the state’s words, verbatim · CDSS document, Jun 2, 2026

Type of visit: Case Management - Deficiencies

During case management visit and review of resident's file, it is noted that physician's report for client #2 is dated in 2022. Deficiency of the California Code of Regulations, Title 22 is cited on a following page.the state’s words, verbatim · CDSS document, Jun 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(h)(1) · Plan of correction due date: Jun 16, 2026

REAPPRAISALS The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every 12 months...Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. This requirement is not met, as MD report for client #2 is dated in 2022. Licensee failed to ensure that residents have annual documented MD assessments, which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2026

Plan of correction: Updated and completed MD report for client #2 will be sent to CCLD BY DUE DATE

Allegation investigated: Staff did not install resident's grab bar

On April 16, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced 10-day complaint visit. LPA met with Administrator, Katherine Tazawa and explained the purpose of the visit. Regarding the allegation, staff did not install resident's grab bar, according to the reporting party, on 4/1/26, maintenance director notified Resident 1's (R1’s) responsible party that a grab bar will be installed by R1’s entrance door by 4/2 for reasonable accommodations, however on 4/2 the maintenance director notified R1’s responsible party that he did not have the grab bar available and had to order one. As of 4/7/26, the grab bar has still not been installed in R1’s room. During the visit, LPA reviewed documents, interviewed the administrator, reviewed service order, and observed R1's room. Based on observations, LPA observed the grab bar installed in R1's room by the entrance door. According to the administrator and documents reviewed, on 3/31/26, R1's responsible party emailed Administrator and Director of Assisted Living requesting a grab bar/hand rail to be installed In R1's room on 4/3/26. (Continue to 9099C). Unsubstantiated According to the administrator, on the same day, she notified the Maintenance Director and Director of Assisted Living to survey the area for the grab bars and to ensure it does not interfere with opening and closing of the fire door. The administrator indicated, she emailed R1's responsible party on 4/3/26, notifying him/her that the Maintenance Director needed to assess the area and check to see if they had the grab bar on hand and notified R1's responsible party that the grab bar was ordered on 4/2/26. Based on the service order reviewed, the grab bar was ordered on 4/2/26. Maintenance Director and Administrator confirmed that the grab bar was installed in R1's room on 4/9/26. Based on interviews conducted, documents reviewed, and information collected, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Report is reviewed with administrator, Katherine Tazawa and a copy is provided.the state’s words, verbatim · CDSS document, Apr 16, 2026 · control 14-AS-20260409081451

Type of visit: Required - 1 Year

**This is an amended copy of the report On April 16, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced annual inspection. LPA met with Administrator, Katherine Tazawa and explained the purpose of the visit. LPA toured the facility inside and outside including a random sample of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. LPA observed a hot-tub but gates were observed to be all around and locked. There were no fire safety hazards observed. This is a four story facility; assisted living (AL) on 1st, 2nd, and a portion of the 3rd floor and independent living (IL) on the rest of 3rd floor and all of the 4th floor. Rooms observed were clean, odor-free with all required furniture. Each resident room has it's own bathroom. Water temperature throughout the facility measured between 110-118 degrees F. Dining room was observed free from tripping hazards. Residents were observed to be having lunch in the dining room. A comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed two day perishables and seven day non-perishables. Extra food supply was observed to be present. LPA observed med-carts on each floor. Medications, sharps, and chemicals were observed locked an inaccessible to residents in care. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of July 2025. Emergency drills are logged and done every month. LPA reviewed 5 resident records and 5 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during the visit. Report is reviewed with Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Apr 16, 2026

Allegation investigated: Staff did not ensure that resident was transported to religious services.

On October 8, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced 10-day complaint inspection. LPA met with Administrator, Katherine Tazawa and explained the purpose of the visit. Regarding the allegation, staff did not ensure that resident was transported to religious services, according to the reporting party, facility staff cancelled a schedule pick up for Resident 1 (R1) to attend religious services and the facility failed to notify R1 or R1's responsible party. In addition, the reporting party indicated that R1 had to spend $23 on Uber for transportation. During the investigation, LPA interviewed staff and reviewed documents. Based on documents reviewed and staff interviewed, the facility paid for R1's Uber with the facility's funds. Based on interviewed staff, the facility never cancelled transportation for R1. R1's responsible party got upset due to Quickshop being scheduled on Saturday, the same day R1 goes to his/her religious services. According to staff interviewed, the facility did not receive any notice from R1 or R1's responsible party to transport R1 to his/her religious services. (continue to 9099C). Unsubstantiated Staff interviewed indicated that they were willing to accommodate R1 and have him/her go to church with a friend, who picks R1 up and goes with R1, then have the facility driver pick R1 up from church and take him/her to Quickshop, however R1's responsible party stated no because R1 will be tired after church. LPA reviewed transportation log for the week, however there was no documentation stating that R1 or R1's responsible party scheduled an outting to church. The facility ended up accommodating R1 by taking R1 to Quickshop on Friday so that R1 can go to church on Saturday. Based on interviews conducted and information collected, the department has determined that although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Report is reviewed with administrator, Katherine Tazawa and a copy is provided.the state’s words, verbatim · CDSS document, Oct 8, 2025 · control 14-AS-20251006120240

Type of visit: Required - 1 Year

On April 15, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Administrator, Katherine Tazawa and explained the purpose of the visit. LPA toured the facility inside and outside including a random sample of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. LPA observed a hot-tub but the gates were observed to be locked. There were no fire safety hazards observed. This is a four story facility; assisted living (AL) on 1st, 2nd, and a portion of the 3rd floor and independent living (IL) on the rest of 3rd floor and all of the 4th floor. Rooms observed were clean, odor-free with all required furniture. Each resident room has it's own bathroom. Bathrooms observed were observed to be clean, equipped with liquid soap, toilet paper and paper-towels. Water temperature throughout the facility measured between 117-118 degrees F. Extra linen was observed to be present. First aid kit was observed to be complete. Dining room was observed free from tripping hazards. Residents were observed to be having lunch in the dining room. A comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed two day perishables and seven day non-perishables. Extra food supply was observed to be present. Medications, sharps, and chemicals were observed locked an inaccessible to residents in care. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of July 2024. Emergency drills are logged and done every month. LPA reviewed 5 resident records and 5 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during the visit. Report is reviewed with Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Apr 15, 2025

Allegation investigated: Facility staff refusing to assist resident with CPAP machine

On 8/15/2024 , Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director (ED), Katherine Tazawa and explained the purpose of today's visit. Regarding the allegation of facility staff refusing to assist resident with CPAP machine. Reporting party (RP) stated that the resident (R1) has a CPAP machine for sleep apnea that R1 has been struggling to use. RP is reporting that staff have attempted to educate and assist the resident with the CPAP machine twice, however the resident requires additional assistance from staff. Per RP, R1 asked for additional assistance from staff (S1) on 7/22/24 at 3pm, however per RP, S1 "doesn't want to help R1 anymore". Unsubstantiated During the course of the investigation, LPA interviewed 2 staff members. S2 mentioned that S1 did the assessment. During training with Med Aid and S1, R1 freaked out. The responsible party wants R1 to try again. No show on the scheduled time, rescheduled and nobody was there again. LPA also interviewed R1 and he/she stated that he/she doesn’t want to use the CPAP machine. A police officer (PO) also visited the facility and had the ED accompany them in R1s room, R1 also stated to them that “I don’t want to use the CPAP." S1 was also interviewed and mentioned that he/she did not use that language to R1. There has been several attempts for R1 to try and be trained with the machine. Several schedules have been made. As of this report, R1 has already agreed to use it and additional staff has been trained to assist R1 with the use of the machine. Based on records review, S1 visited R1s room on 7/22/24 with another staff member, S3. R1 was scheduled to have another training at 2pm. Staff knocked and no one was in the room. They waited for 10 minutes then advised responsible party that no one was in the room. Based on interviews & records review, the department has determined 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, therefore the allegation is UNSUBSTANTIATED. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Aug 15, 2024 · control 14-AS-20240723151606

Allegation investigated: Staff displayed inappropriate behavior while in front of residents in care Staff did not ensure resident received adequate food service Staff does not ensure residents are accorded dignity in their personal relationships with staff, residents, and other persons.

On 8/15/2024 , Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with Executive Director (ED), Katherine Tazawa and explained the purpose of today's visit. Regarding the allegations of staff displayed inappropriate behavior while in front of residents in care and Staff did not ensure resident received adequate food service, Reporting party (RP) stated that staff disposed of R1s lunch by aggressively slamming the food into the trash in front of R1 and did not replace the meal with another option resulting in the resident not being provided a meal in the facility. LPA interviewed R1 and it was mentioned that he/she wanted to exchange the meal that was ordered because earlier in the day he/she has already consumed some eggs, so the egg sandwich was too much. Unsubstantiated When R1 asked to exchange the meal, S1 asked why and when the reason was explained S1, threw the food in the trash. R1 was asking beforehand if it can just be served again because it was a waste of food. S1 then explained to R1 that they can’t serve food to another resident if it already left the kitchen due to food safety. R1 said that they offered cheeseburger as replacement and R1 agreed to this. LPA interviewed 2 staff members. S1 mentioned that the food was thrown out due to them not being able to serve it to a different resident per food safety protocols of the facility. S1 is aware the food is being returned and it just so happens that the trash bin is beside S1, by the kitchen door. S1 stated that they did not say anything demeaning to the R1 but instead asked if they would want to order another meal. Another staff, S2, was tasked to get the order of R1 and when the ticket was done it, the meal was immediately prepared. A third staff member, S3, was the one who served the meal while R1 was waiting on the table. RP was not in the vicinity when the alleged altercation happened. Based on records review, there is a ticket provided by the facility that says that an order was made for a different meal after R1 returned the other food. Regarding the allegation of staff does not ensure residents are accorded dignity in their personal relationships with staff, residents, and other persons, RP stated that R1 is treated unfairly by staff for being Chinese and not Filipino. LPA interviewed R1 and it was stated that he/she is happy at the facility and that there are no issues with the staff. LPA also interviewed five other residents with different nationalities, and all mentioned that there is no issue with regards to staff and they are happy here in the facility. R2 mentioned that the staff here have been wonderful, and the stay here has been good. Another resident, R3, mentioned that staff here are friendly and all are very competent, they are kind and not intrusive. Based on interviews & records review, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Aug 15, 2024 · control 14-AS-20240724102302

Type of visit: Post Licensing

On 04/12/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced post licensing. LPA met with executive director Katherine Tazawa. LPA toured the facility with the executive director. The facility is licensed for a capacity of 150 residents of which 20 bedridden on the first floor only and the 140 non-ambulatory on the first and second floors. Hospice for 20 approved. At this time there are 5 bedridden due to hospice. Infection Control Plan submitted to CCL. LPA observed oxygen signs posted on resident rooms where oxygen is in use. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 70F which is within the required range of 68-85F. The hot water temperature was measured at 111.6F which is within the required range. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed resident rooms at random and the rooms contained the required furniture outlined per regulations. Commercial laundry service was done in the facility laundry room and resident laundry machines as well in each resident room. LPA observed 3 staff and 3 resident files during this visit. Facility files, including staff files and resident files, are to be reviewed on a later date. Katherine informed LPA that her administrator indicated that her administrator certificate is expired as of January 09, 2023 but did submit the required renewal documents and credits to the appropriate department for renewal and is currently pending and is awaiting a new certificate to be sent. Report is reviewed with Katherine. No citations issued.the state’s words, verbatim · CDSS document, Apr 12, 2024

Type of visit: Required - 1 Year

On 04/12/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with executive director Katherine Tazawa. LPA toured the facility with the executive director. The facility is licensed for a capacity of 150 residents of which 20 bedridden on the first floor only and the 140 non-ambulatory on the first and second floors. Hospice for 20 approved. At this time there are 5 bedridden due to hospice. Infection Control Plan submitted to CCL. LPA observed oxygen signs posted on resident rooms where oxygen is in use. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 70F which is within the required range of 68-85F. The hot water temperature was measured at 111.6F which is within the required range. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed resident rooms at random and the rooms contained the required furniture outlined per regulations. Commercial laundry service was done in the facility laundry room and resident laundry machines as well in each resident room. LPA observed 3 staff and 3 resident files during this visit. Facility files, including staff files and resident files, are to be reviewed on a later date. Katherine informed LPA that her administrator indicated that her administrator certificate is expired as of January 09, 2023 but did submit the required renewal documents and credits to the appropriate department for renewal and is currently pending and is awaiting a new certificate to be sent. Report is reviewed with Katherine. No citations issued.the state’s words, verbatim · CDSS document, Apr 12, 2024