Harbor at Hillsdale Senior Living

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Type of visit: Case Management - Legal/Non-compliance

On 09/11/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - legal/non-compliance visit in response to and as per Stipulation/Waiver/Order dated 11/29/23. LPA met with administrator Jasmine Seiffert. LPA Vado observed the following per the Stipulation/Waiver/Order: 1. Secure storage of cleaning compounds, detergents and poisons in the MC (Memory Care) prep kitchen. Main kitchen and locked rolling carts in storage room are observed as secured. 2. Proper labeling of cleaning compounds, detergents and poisons in kitchen and MC prep kitchen. 3. Appropriate signs in main and MC kitchen and dining rooms that food and beverage containers can only be used for food and beverages. This is observed in both MC and the main dining room 4. Staffing in memory care unit of 4 caregivers for 32 MC residents and 1 housekeeper in this area. 6. LPA observed the posting of the Stipulation/Waiver/Order dated 11/29/23 in a framed box near courtyard door near the activity room This report is reviewed with Jasmine Seiffert and a copy is provided on this day. No deficiency cited.the state’s words, verbatim · CDSS document, Sep 11, 2026

Type of visit: Case Management - Other

On 07/06/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - other visit regarding an order to an individual of immediate exclusion received. LPA met with memory care director Barenadette Kang and administrator Jasmine Seiffert and explained the purpose of today's visit. During today's visit, LPA met with the memory care director and administrator to discuss the order regarding a staff member (S1). LPA Vado provided the letter in person regarding S1 and discussed the letter. The administrator confirmed that S1 never worked in the facility. She confirms that S1 was in the process of being hired but was never fully hired and has not been at the facility. She also provided evidence that S1 has been disassociated from the facility via the Guardian system. LPA also confirmed this information with the memory care director Bernadette Kang that S1 is not present and not working in memory care or in the assisted living portion of the facility per observations made and records reviewed. This report is reviewed and discussed with the memory care director and a copy is provided.the state’s words, verbatim · CDSS document, Jul 6, 2026

Type of visit: Case Management - Other

On 06/24/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - other visit. LPA met with administrator Jasmine Seiffert and explained the purpose of today's visit. During today's visit LPA Vado delivered an amended LIC9099D page associated with the visit conducted on 06/17/2026 to correct a typographical error. LPA delivered the corrected page to the administrator and showed where the correction was made. No citations issued. Report is reviewed with Jasmine and a copy is provided.the state’s words, verbatim · CDSS document, Jun 24, 2026

Allegation investigated: - Staff did not treat residents in care with dignity and respect

On 06/17/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an uannounced complaint inestigation visit in regards to the allegation received. LPA met with administrator Jasmine Seiffert and explained the purpose of today's visit. During the course of the investigation, LPA interviewed staff, reviewed pertinent documentation, video evidence, and attempted to interview residents. The facility self reported an incident on 06/03/2026 via incident report to the Department after discovering the video being sent to them from an outside source. The video evidence reviewed by the Department shows a staff person harassing residents in care. In response to this, the facility conducted training in personal rights, elderly abuse, and reporting requirements, and terminated the staff member as this posed an immediate health and safety risk to residents in care. Based on the evidence reviewed this allegation is substantiated. Based on LPA interviews and items letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D. Report is reviewed with the administrator and a copy is provided on this day. Appeal rights given. Substantiatedthe state’s words, verbatim · CDSS document, Jun 17, 2026 · control 14-AS-20260616081457

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 18, 2026

87468.1(a)(1) - Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This regulation has not been met as evidenced by: Based on video evidence reviewed, this regulation has not been met. The video evidence shows a staff person harrassing residents in care, which is not according them dignity or respect with their relationships but staff. This poses an immediate health and safety risk.the state’s words, verbatim · CDSS document, Jun 17, 2026

Plan of correction: The facility shall conduct an in-service training with staff regarding: Resident Rights, including abuse, and reporting requirements. Evidence of such training to be recieved by due date. POC has been received as the facility had conducted such training in response to the incident.

Type of visit: Case Management - Legal/Non-compliance

On 05/04/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - legal/non-compliance visit in response to and as per Stipulation/Waiver/Order dated 11/29/23. LPA met with Jasmine Seiffert and explained the purpose of today's visit. 1. Documentation that administrator received 25 hours of live virtual training and 15 hours of online self-study in January and February 202 from a local vendor approved by CDSS Administrator Certification Unit on: a. Proper handling of hazardous materials, including how to store, who can/should handle, how to identify, how to dispense, and how to catalogue hazardous materials. b. Emergency planning, including methods for ensuring that every substitute administrator is prepared to function as an administrator, methods to ensure that staff are aware of their roles in an emergency, what role Poison Control has in emergencies. c. Facility staffing levels/resource allocation, including creation of staffing schedules to have the appropriate level of staffing at all times. d. Communication with emergency services, including development of a system and incident command process in the event of an emergency and clear assignment of communication between staff and emergency responders, as well as the importance of disseminating correct and truthful information to emergency responders. Continued on next page. Page 2 2. Documentation of quarter 1 training and of 5 staff who were trained on how to respond when a resident ingests a cleaning product or other hazardous material. 3. Written acknowledgements of new and current residents that they have received copies of Stipulation and amended accusation are maintained. LPA observed 5 resident acknowledgements on this day. Administrator Jasmine Seiffert acknowledges conditions of Stipulation, including additional staff training and reporting requirements. LPA Vado received copies of training records on this day. LPA reviewed the hazardous communications training materials on this day. No deficiencies cited. Report is reviewed with administrator Jasmine Seiffert and a copy is provided on this day.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Prelicensing

On 12/12/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced prelicensing visit. LPA met with interim administrator John O'Neil and explained the purpose of today's visit. There are currently 74 residents in place within the facility. There are 28 residents in memory care and 46 residents in assisted living. The facility is being licensed for age range 60 and over. A fire clearance has been approved for 125 non-ambulatory residents and 50 bedridden residents according to the clearance reviewed. LPA Vado toured the facility and grounds with the interim administrator, consisting of approximately 135 studios and 1 bedroom units on 3 floors. Thirty rooms comprise the memory care unit on the ground floor, where there are 4 exits, each equipped with a delayed egress and alert system to inform staff if the doors are opened. This unit has a dining room, activity area and living room, as well as a prep kitchen and enclosed patio. There are 15 living units on the ground floor, 45 units on the 2nd floor, and 45 units on the 3rd floor for both independent and assisted living residents. Each floor has its own laundry rooms for resident use or staff use. All are observed to be clean and lint free behind dryers. All living units include a private bathroom, and refrigerators, mini microwave ovens, wet bars, and wall safes are present in all assisted living units. LPA observed rooms at random which included all required furniture and lighting per Title 22. A large dining room in on the ground floor, roof top open air terrace and multiple common use rooms are available to independent and assisted living residents, including a fitness room. No accessible bodies of water or fire safety hazards observed. The facility's main kitchen is observed to be clean, organized, and in order. Modified diets and food restrictions are observed to being tracked. Ansul system is tagged with an inspection/cleaning date of 10/27/2025. Continued on next page... Page 2 Two day perishable and 7 day non-perishable food supplies are observed as in place. Refrigerator and freezer temperature logs are observed. Kitchen grade fire extinguisher is in place with an inspection tag 07/16/2025. Additional regular graded fire extinguishers are observed through out the facility with the same inspection date. Facility is fully equipped with fire sprinklers. PPE supply is in place as well if needed. Medications, toxins and sharps are stored appropriately and inaccessible to clients. Medications are primarily stored in two medications rooms on the ground floor, one being for memory care, and the other is for assisted living. Medications are audited at random, and all are observed to be accurately logged and stored. Hot water temperature is tested at random on all floors. Water temp in memory care is tested as 108F, first floor as 107F, second floor as 107F, and third floor as 105F. Liquid soap is available in common bathrooms and private bathrooms of independent and assisted living bathrooms. Memory care bathrooms do not have liquid soap for the safety of those residents, but is used when staff is present. First-aid kit is inspected as complete. A Disaster and Mass Casualty Plan is accessible and viewed. Emergency exit routes are observed as clear of obstructions. Last emergency drill was conducted on 09/27/2025. The drill conducted is recorded as a fire drill. Resident records are reviewed and staff records are reviewed as current. Component III is conducted with interim administrator John O'Neil. LPA received copies of water temperature logs, resident roster, and staff roster during today's visit. No deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed. Facility is operating in substantial compliance. No citations issued. Report is reviewed with interim administrator John O'Nielthe state’s words, verbatim · CDSS document, Dec 12, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Dec 12, 2025