Westmont of Morgan Hill

Allegation investigated: Staff did not file resident's insurance paperwork for payment

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding for the above complaint allegation. LPA met with Executive Director, Jolie Higgins. On 07/20/2023, the Department received the complaint. On 07/28/2023, the initial complaint investigation was conducted. It was alleged the facility staff did not file resident (R1)'s insurance paperwork for reimbursement since January 2023. Documents were obtained for this investigation to include the resident roster, staff schedule for July 2023, staff roster, resident (R1) admission agreement, physician’s report, service plan, and insurance invoices from November 2022 – June 2023. SEE LIC9099-C. Unsubstantiated On 07/20/2023, 2 staff members were interviewed regarding the allegation. Based on interview, the facility was only notified of this issue in June 2023 and acted immediately after. Notifications regarding R1's insurance were being sent to R1's responsible party. S1 stated that the facility provided a courtesy service to assist resident (R1) in filing their insurance paperwork every month. S1 states based on their contract this task is not the facility’s responsibility, but is the responsibility of either the resident and/or family. It was stated that R1’s insurance paperwork was delayed for 6 months due to the need of an updated assessment from the insurance company. The Memory Care Director who would have been responsible for filing the insurance paperwork during these months does not currently work for the facility. The review of records does not state a written agreement regarding the facility’s responsibility to file insurance paperwork for resident(s). The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 20, 2023 · control 26-AS-20230720102657

Allegation investigated: Staff does not allow resident to have visitors.

Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to open the initial complaint investigation. LPA met with Executive Director (ED) Jolie Higgins. On 09/11/2023, the Department received a complaint alleging staff did not allow resident (R1) to have visitors. On 09/20/2023, the initial complaint investigation was conducted. The following documents were obtained for this investigation to include resident (R1)’s physician’s report, service plan, identification and emergency information, Power of Attorney (POA) information, progress notes, visitation list, and facility’s visitor log from 08/29/23 and 09/11/23. SEE LIC9099-C. Unsubstantiated On 09/20/2023, 1 staff member and 2 witnesses were interviewed. Based on staff interview, the facility was provided a visitation list signed by the resident (R1) and R1’s POA during admission. The list includes a list of residents who are allowed to visit and not visit R1. The list was maintained at the front desk. It was explained that if a visitor from the list were to arrive to the facility, the Executive Director (ED) would still ask R1 if he/she would like to see the visitor per the resident’s right. ED stated that R1 refused to see visitors. The review of records show that R1 signed a list of visitors who were allowed to visit and not allowed to visit R1. On 08/28/2023, the facility received communication to add another visitor to the “no visit” list. Based on interview with witness (W2), it was R1’s decision to put together a list of people who can visit and not visit R1. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 20, 2023 · control 26-AS-20230911135649

Allegation investigated: Staff are not responding to resident's call button in a timely manner. Resident's dietary requests are not being met. Facility failed to maintain resident's room in good repair

On 08/11/2023, Licensing Program Analysts (LPA's) Steve Chang, Manuel Monter and Simi Rai conducted an unannounced complaint investigation regarding the allegations above. LPAs met with Administrator (ADM) Jolie Higgins. On 08/20/2020, the Department received a complaint with the above allegations. On 9/04/2020, the Department conducted interview with former Administrator (ADM). Due to COVID19 preventative measures, CCLD has suspended on-site visit and this was a tele-visit. Resident's dietary requests are not being met LPAs interviewed ADM. ADM stated it is facility's policy to follow the pre-set menu for the week. ADM stated if a resident has a special dietary requirement, the facility will provide those options. Page 1 out of 3 Unsubstantiated Based on record review of R1's physicians report sign & dated 2/20/2019, R1 does not have a special diet. LPA requested 2020 facility menu, ADM stated facility menu for the year 2020 is not available. LPA interviewed Food Service Director (FSD). FSD stated he/she does not recall complaints or interactions from R1. FSD stated he/she only follows the pre-set menu and has never deviated from the menu. Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Staff are not responding to resident's call button in a timely manner. The incident occurred on 8/23/2020 and 8/25/2020 where R1's pendent was not answered for over an hour. On 8/10/2023, the Department interviewed ADM. ADM stated the staff need to respond to the resident's call pendent within 12 minutes. Per ADM, the facility changed the signal system to a new model. Per Stanley Healthcare Invoice the facility installed the new call system on 5/25/2022. Per ADM, the facility does not have records from the previous signal system which was used when the incident occurred. Based on interview of S1-S3 who worked at the facility in 2020, 3 of 3 staff members stated the resident's pendent would be cleared within 10 minutes and 2 of 3 staff stated the previous signal system would not clear the call pendent signal after the resident was assisted, which is why the facility replaced the signal systems. Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Page 2 out of 3 Facility failed to maintain resident's room in good repair It has been alleged that the facility does not respond to work orders. LPAs interviewed ADM. ADM stated the facility will assist if the residents notify maintenance via work order. ADM stated, as long as it is requested, the facility will address the issue. ADM stated how quickly they address the work order depends on the priority level. ADM stated if its high priority, like something that may endanger a resident, then it will be address immediately. ADM stated if its low priority, then that will take longer to address. ADM wanted to note that the facility will fix the things the facility is responsible but will not fix the residents personal property. ADM stated that the refrigerators does make a noise which is normal when the refrigerator is functioning properly. ADM stated if there was noise coming from the fridge would be considered a potential health and safety risk for the resident, then the facility would remove the fridge. ADM also stated if the residents fridge is not working, they will replace it the same day. ADM stated maintenance will do rounds one a month, which includes, but not limited to, changing filters and inspecting residents apartments. ADM stated if maintenance sees an issue during the monthly rounds, it will be addressed immediately. LPAs reviewed facility work orders made by R1. R1 work order request made on 08/09/2020 was completed on 8/19/2020. R1's work order on 8/26/2020 was completed on 8/27/2020. R1's work order on 8/27/2020 was completed on 8/27/2020. LPA did not interview maintenance director. The maintenance director who worked during the time period of the complaint no longer works at the facility. Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Page 3 out of 3the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 26-AS-20200825152249

Allegation investigated: Staff did not respond to call button in a timely manner.

Licensing Program Analysts (LPAs) Simi Rai, Steve Chang, and Manuel Monter conducted an unannounced complaint investigation regarding the above allegation. LPAs met with Executive Director (ED) Jolie Higgins and stated the purpose of the visit. On 10/7/2020, the Department received a complaint with the above allegation. On 7/13/2020, the Department conducted interview with former Executive Director. Due to COVID19 preventative measures, CCLD has suspended on-site visit and this was a tele-visit. Continuation on LIC 9099-C. Page 1 of 2. Unsubstantiated Page 2 of 2. During visit, LPAs interview ED. ED stated he/she began his/her employment in 2021 after this complaint was received by the Department. LPAs interviewed Staff S1-S3. During visit, LPAs requested a current roster of staff and residents. LPAs received Stanley Healthcare signal systems invoice 5/25/2023, R1's Narrative Charting from 9/10 - 9/14/2020, and R1's Hospice Visit Communication 9/12-9/14/2020. Staff did not respond to call button in a timely manner. On 8/11/2023, the Department interviewed ED. ED stated the staff need to respond to the resident's call pendent within 12 minutes. Per ED, the facility changed the signal system to a new model. Per Stanley Healthcare Invoice from 5/25/2022, the facility installed the new call system. Per ADM, the facility does not have records from the previous signal system which was used when the incident occurred. Based on interview of S1-S3 who worked at the facility in 2020, 3 of 3 staff members stated the resident's pendent would be cleared within 10 minutes and 1 of 3 staff stated the previous signal system would not clear the call pendent signal after assisting the resident, which is why the facility replaced the signal systems. During today's visit, LPAs pulled the emergency cord in one of the restrooms located on the first floor next to the dining room. LPAs observed facility staff respond to the emergency cord in less than a minute. Based on the interviews conducted with clients and staff, based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited and exit interview conducted with Executive Director, Jolie Higgins and a copy of the report was provided. Page 2 of 3. During visit, LPAs interview ED. EDstated he/she began his/her employment in 2021 after this complaint was received by the Department. LPAs interviewed R1's responsible party. LPAs requested a current roster of staff and residents. LPAs reviewed R1's Admission Agreement, Email Communication, R1's Move Out Notice, and R1's refund check. Facility did not issue a refund. Based on record review of R1’s signed admission agreement by R1's responsible party, on page 12 of 69, the document states “You may terminate this agreement at any time…by giving the executive director thirty (30) days’ prior written notice…You will continue to be responsible for your full monthly fee until the thirty (30) day period has expired." Per interview with ADM, the facility did not have another verbal or documented agreement in place, besides the admission agreement signed by responsible party. Based on record review of email communications between R1’s responsible party and the facility on 9/14/2020 and R1’s responsible party notified the facility he/she wanted to terminate the contract effective the same day and facility accepted the email notification as a 30-Day Notice. Based on record review of R1’s move out notice signed by the responsible party, the form states R1’s responsible party gave move out notice on 9/14/2020. The form also states “by signing and submitting this form you will be giving the required 30-day notice. The last day of your notice will be 10/14/2020.” Based on record review of facility’s copy of R1 refund check. The form states the refund was given on 10/30/2020 and was cashed out on 12/01/2020. On 8/11/2023, LPA interviewed R1’s responsible party. Responsible party confirmed the address on the check was his/her home but could not confirm if check was received. Continuation on Page 3 LIC-9099. Page 3 of 3. Staff did not seek medical attention in a timely manner. Based on record review of R1's Narrative Charting 9/12/2020 at 9pm, the Medication Technician (MT) during the shift reported R1's child was with resident when he/she stated R1 was "having a stroke". MT checked on the resident right away and called the Hospice agency. While MT was connecting with Hospice Nurse, R1's child spoke to Hospice Nurse and describe R1's symptoms. Per R1's Narrative Charting, Hospice Nurse advised R1's child to administer PRN medication after hearing R1's symptoms. Based on record review of R1's Hospice Visit Communication on 9/12/2020, Hospice LVN visited R1 the same to assess the resident at the facility. Per notes, R1's child stated R1 had anxiety attack and was asleep during visit. Based on record review, two subsequent visits were made by the Hospice Nurse on 9/13/2020 and 9/14/2020 wherein R1 was observed to be alert and did not have symptoms of stroke. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited and exit interview conducted with Executive Director, Jolie Higgins and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 26-AS-20201007102938

Allegation investigated: Resident sustained injuries while in care.

Licensing Program Analysts (LPAs) Steve Chang, Simi Rai and Manuel Monter conducted an unannounced investigation visit and met with Executive Director (ED) Jolie Higgins. On 5/6/2021, the Department received a complaint with the above allegation. On 5/7/2021, an initial investigation visit was conducted. During today's investigation, LPAs interviewed ED, Business Office Director (S1), and Med Tech (S2). LPAs requested resident R1's physician report and Appraisal Needs and Service Plan. LPAs reviewed the incident report sent to CCL office dated 05/03/2021. R1 obtained bruise on his/her left forearm. Continue on LIC9099-C, page 1 of 2. Unsubstantiated On 05/07/2021, the Department interviewed the prior Executive Director (PED). PED stated during a transfer, R1 became excited and anxious, threw himself/herself onto the chair, and obtained bruises on R1's forearm. PED also stated R1 has resisted care before, and usually moves around during transfer. On 8/11/2023, around 10:50AM, LPAs interviewed ED. ED stated ED knew R1 at another facility. ED stated R1 was easily get excited and moved around the two hands. ED stated R1 obtained bruise during transfer at another facility. On 8/11/2023, around 11:30 AM, LPAs interviewed S1. S1 stated R1 needed two care givers to move/transfer, S1 stated R1 resisted during the care or transfer. S1 stated R1 moved two arms while transfer. LPAs interviewed S2. S2 stated R1 needed two caregivers to move/transfer. S2 stated it was tough to take care of R1. S2 stated R1 resisted the care provided by caregivers, sometimes R1 combated with the caregivers when caregivers provided the care or transfer. LPAs interviewed 2 caregivers (S3, S4), and both of them stated R1 resisted care and got excited when caregivers to provide the care and to transfer. Based on the documents reviewed and interviews conducted, there is no evidence shows R1 obtained bruise due to staff's careless. Based on record review of R1's physician report signed and dated 2/20/2019, R1 requires toileting assistance every 3-4 hours. The physician report also states R1 is a fall risk. The Department has investigated the above allegation. Based on interviews, and record review, the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur. No citations were cited per California Code of Regulations, Title 22. This report was reviewed with ED. A copy of the report was provided to ED.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 26-AS-20210506115407

Allegation investigated: Staff are not assisting resident with incontinence needs.

Licensing Program Analysts (LPAs) Steve Chang, Simi Rai and Manuel Monter conducted an unannounced investigation visit and met with Executive Director (ED) Jolie Higgins. On 4/25/2022, the Department received a complaint with the above allegation. On 5/5/2022, an initial investigation visit was conducted. During today's investigation, LPAs interviewed ED and Resident Service Director Ria Hernandez (S1). LPAs reviewed R1's physician report, and R1's Care Plan. Continue on LIC9099-C, page 1 of 2. Unsubstantiated On 8/11/2023 around 1:00PM, LPAs interviewed ED. ED stated the facility staff checks incontinent residents every two hours to assess if the resident needs assistance. ED stated residents on incontinence service program can call for assistance as needed. ED stated R1 participated the incontinence service program. LPAs reviewed R1's care plan, R1 participated the facility incontinence service program. Around 1:20 PM, LPAs interviewed Resident Service Director (S1). S1 stated caregivers check incontinent residents every two hours including the bed time and as needed. S1 stated resident can call staff if assistance is needed. Based on record review, facility stated they were tracking R1's incontinence needs but the facility staff could only produce records for two weeks. The Department has investigated the above allegation. Based on interviews, and record review, the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur. No citations were cited per California Code of Regulations, Title 22. This report was provided to ED for review. A copy of the report was provided to ED.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 26-AS-20220425155409

Allegation investigated: Facility doesn't have a director Facility doesn't have an activities director Staff are not assisting resident with making phone calls

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation. LPA met with Executive Director (ED) Jolie Higgins and Resident Service Director (RSD) Ria Hernandez. On 07/20/2023, the Department received the complaint regarding the above allegations. During visit, LPA toured the memory care section. LPA interview 5 staff members. Documents were obtained to include the resident roster, staff schedule for July 2023, staff roster, resident (R1) admission agreement, physician’s report, service plan, and insurance invoices from November 2022 – June 2023. Based on interview and record review, the facility does have a director who oversees both Assisted Living and Memory Care. The facility also has an activities director for Assisted Living and Memory Care. SEE LIC9099-C. Unfounded Based on interview, 5 out of 5 staff state the facility has a cell phone that is provided for residents to make telephone calls. Staff (S5) states the cell phone is used to make calls to family along with receive calls from family. LPA observed the cell phone is capable of telephone calls and video calls. Staff (S4) states the staff assist the residents with telephone calls and/or video calls when needed. Telephone calls to family members are not scheduled and based on request of the family member. The residents are able to receive calls anytime throughout the day. The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded. An unfounded finding means the allegation is false, could not have happened and/or without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director (ED) Jolie Higgins and Resident Service Director (RSD) Ria Hernandez and a copy of the report was emailed to ED and RSD due to technical difficulties.the state’s words, verbatim · CDSS document, Jul 28, 2023 · control 26-AS-20230720102657

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management – incident visit. LPA met with Executive Director (ED) Jolie Higgins and Resident Service Director (RSD) Ria Hernandez. On 07/24/2023, the Department received an incident report for resident (R1) reporting R1 had eloped from the facility on 07/22/2023. On 07/22/2023 at 11:20am staff noticed resident was missing when residents were being called for lunch. R1 was last seen at 11:10am. Staff checked all rooms, did a head count, and immediately went out of the community to look for R1. Within 10 minutes, R1 was found in close proximity from the facility. R1 was brought back to the community and re-assessed. The Fire Department was contacted to evaluate resident and no change of condition was found. Family was notified. During the facility’s investigation, it was found that one of the egress doors did not reset after the facility was experiencing several power outages from 07/21/23 – 07/22/23. Based on interview with the ED, 4 out of 5 delayed egress doors were checked after the power outage on 07/21/23 - 07/22/23. 1 out of 5 doors was missed during the checks, which was the door R1 had exited from. Based on record review, R1 is not able to leave the facility unassisted. After the incident, the facility immediately updated R1’s care plan and placed R1 on alert charting. The facility completed an in-service training with staff on Egress doors and Elopement. Going forward the facility plans to designate a staff to ensure all egress doors are functioning properly after an outage. During visit, LPA toured the memory care section with ED, RSD, and Maintenance Director (MD). 5 out of 5 egress doors were tested in Memory Care. 4 out of 5 egress doors observed working. 1 out of 5 egress doors not observed working and would not open. This is the same door R1 had exited from. Based on interview, the doors were checked on 07/22/23 – 07/24/23 and observed in working condition. LPA observed the facility's egress door after a couple hours. LPA observed the door was able to open after inputting a code. The facility is currently in contact with the vendor to fix the sound system for the egress door. A deficiency was cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director (ED) Jolie Higgins and Resident Service Director (RSD) Ria Hernandez and a copy of the report was emailed to ED and RSD due to technical difficulties.the state’s words, verbatim · CDSS document, Jul 28, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(k)(6) · Plan of correction due date: Jul 29, 2023

(k) The following initial and continuing requirements must be met for the licensee to utilize delayed egres devices on exterior doors or perimeter fence gates: (6) Without violating Section 87468, Personal Rights, facility staff shall ensure the continued safety of residents if they wander away from the facility. This requirement is not met as evidenced by: Based on interview, record review and observation resident (R1) was able to elope from the facility through a delayed egress door that was not checked to be functioning properly after several power outages which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 28, 2023

Plan of correction: Licensee corrected the deficiency before visit. POC cleared.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection. LPA met with Executive Director (ED) Jolie Higgins. During visit, LPA toured the facility with ED to include the entrance, dining room, kitchen, memory care, assisted living, hallways, and office spaces. Facility temperature maintained between 71 - 72 degrees Fahrenheit. Fireplace observed adequately screened at the entrance. Facility's license is posted in the hallway. Posters such as the Ombudsman, if you see something say something, emergency disaster plan, and personal rights poster posted in the hallway. Facility kitchen observed clean and sanitary. Facility has an adequate amount of dishes and silverware. Sinks observed with hygiene products and hand washing signs. Special diet paperwork posted in a visible area. Facility observed with at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator maintained at 33 degrees Fahrenheit. LPA observed food items in the refrigerator were not properly covered to include a whole container of lettuce and deli turkey meat. The freezer's temperature states the temperature is maintained at 9 degrees Fahrenheit. ED states they have contacted the contractor for the freezer to adjust the thermometer. Fire extinguisher in the kitchen last serviced on 05/13/2022. The facility is scheduled to service their fire extinguishes on 05/31/2023. LPA entered Compass Rose (memory care) with the ED. LPA inspected room 138 and observed cleaning supplies and laundry detergent accessible to 2 out of 2 residents living inside the apartment. The cleaning supplies and laundry detergent were removed from the apartment. LPA inspected room 126, 129, and 121B; each room contained proper furniture, lighting, and linens. Sharp objects and chemicals observed secured. LPA observed residents attending an activity in the dining room. LPA did not observed a planned activities calendar was posted. The compass rose kitchen refrigerator contained an uncovered pitcher of an unknown liquid substance. ED stated the substance smelled like apple juice and was immediately thrown out. SEE LIC809-C. The compass rose exterior passageways was free and clear of obstruction. LPA inspected the exterior's 2 delayed egress doors with ED. LPA and ED observed 1 out of 2 delayed egress doors did not alarm and unable to open. During visit, the facilities maintenance director fixed the delayed egress door and LPA observed the door alarmed and properly open. LPA entered the compass rose medication room and inspected 3 residents (R1 - R3)'s files to include their physician's report, TB, appraisal needs and services plan, consent to treat, and centrally stored medication records. LPA observed the centrally stored medication records were not being maintained to include incomplete and/or inaccurate items such as start dates, refills, instructions, and prescription numbers. LPA observed at least 4 medications of R3's were not written in the centrally stored medication record. LPA entered the Assisted Living area with the ED. LPA observed an activities calendar posted in the common area. LPA entered rooms 225, 229, 235, 244, and 247. LPA interviewed 5 residents (R4 - R9). LPA entered the AL medication room and reviewed resident R4 - R9's files. R4 - R5 are not on medication management. 2 random residents (R10 - R11) centrally stored medication records were inspected to be maintained. Staff files observed to include training, CPR certification, medical assessments, fingerprint clearance, and employee rights forms. All staff observed are fingerprint cleared and associated to the facility. Emergency fire drill and elopement drills conducted every month with staff on every shift. Facility is equipped with a carbon monoxide and fire extinguishers throughout the facility. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with the Executive Director (ED), Jolie Higgins and Resident Service Director, Ria Hernandez and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, May 22, 2023

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Resident suffering from dehydration

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to deliver the finding of the above allegation. LPA met with Executive Director, Jolie Higgins. On 01/27/2021, the Department received a complaint that a resident suffered from dehydration. On 1/28/2021, an initial investigation was conducted. From 02/01/2021 – 02/03/2021, three hospice care staff were interviewed. Documents were obtained to include resident (R1)’s hospice records. On 12/08/2022, additional documents were obtained to include R1's physician's report, needs and services plan, and narrative charting. Based on record review and interview, R1 was under hospice care. See LIC9099-C. Unsubstantiated Three hospice care staff were interviewed. Based on the interviews, R1 was being visited by Hospice between three to five times a week. When asked a routine question on the status of the resident’s condition, facility staff stated R1 would eat almost 100% of all their meals. R1 had a behavior in opening their mouth constantly, regardless if food or drinks were offered. It was undetermined whether this was related to R1’s medical diagnosis or hunger. When given water during a hospice care visit, R1 observed to finished two full glasses and appeared to be thirsty. According to the interviews, there was no indication that facility staff had neglected R1 or refused to provide food or fluids to R1. Based on record review, R1 was dependent for all Activities of Daily Living (ADLs). R1 was being administered multiple medications in which one of side effects may be constipation. Throughout December 2021, R1’s main medical concern was constipation with no mentions or signs of dehydration. In January 2021, notes indicated that R1 was eating well. R1’s doctor instructed facility staff to encourage fluids daily as tolerated to promote bowel movement. In January 2021, there was no mention of R1 showing signs of dehydration. Given R1’s medical diagnosis, R1 remained at risk for multiple medical issues which included dehydration. Based on record review, a home health aide (HHA) from the hospice agency informed staff that prior to the hospice nurse visiting R1, HHA had also offered fluids and applesauce but R1 refused and spit it out. The Department has investigated the above allegation. Based on interviews and record review the Department has determined that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 15, 2022 · control 26-AS-20210127155001

Allegation investigated: Staff discontinued resident services without adequate notice

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to open the initial complaint investigation and met with Executive Director, Jolie Higgins and Resident Service Director (RSD), Ria Hernandez. During visit, LPA toured the assisted living section with RSD. LPA interviewed residents R1 – R6 and staff member, S1. The following records were obtained to include the resident roster, staff roster, facility’s admission agreement, monthly menu, resident counsil meeting minutues, and R1 – R9’s physician’s report and needs and services plan. See LIC9099-C. Unsubstantiated Based on interview, 6 out of 6 residents states to be receiving all services. 6 out of 6 residents states the facility was supplying the residents with water bottles but that service had been discontinued recently. Residents are informed they are now responsible in supplying their own water bottles, if preferred. 6 out of 6 residents states the facility does provide drinking water. The facility held a requested resident council meeting on 08/31/2022 and resident council meeting on 09/06/2022 to discuss the discontinuation of water bottles. Residents were informed of the discontinuation of the supply of water bottles through a resident council memo that was placed in the resident's mailbox on 09/06/2022. LPA interviewed the Executive Director, who states the supply of water bottles were a courtesy to the residents during outbreaks of communicable diseases. The purpose of supplying the residents with water bottles were to reduce the spread of the communicable disease. Based on records review, the supply of water bottles is not part of the resident’s services. The discontinuation of the water bottles were part of the resident council minutes that was provided to each resident. LPA observed the facility to have multiple hydration stations that are readily available to the residents. The Department has investigated the above allegation. Based on interviews and records review, the Department has determined that the above allegations is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Jolie Higgins and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 15, 2022 · control 26-AS-20220906164346

Type of visit: Case Management - COVID-19

Licensing Program Analyst (LPA) Christine Dolores conducted a scheduled technical assistance visit and met with Jeeteeh Gigliotti, Resident Service Director (RSD) and Jocelyne Bailon, Compass Rose Resident Service Director (CRRSD). During visit, LPA conducted a Facetime tour of the inside and outside of the facility with PCC Helen Shi and LPM Jackie Jin. The purpose of the visit was to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. The RSD reports that there are currently 8 COVID-19 positive residents and 2 COVID-19 positive staff. During today's tele-visit, the following recommendations were made to the facility by PCC Helen Shi: 1. Place foot operated trash bin with lid outside each isolation room in Assisted Living 2. Remind staff to change their N95 mask after stepping out of each isolation room 3. Limit the staff who goes into the isolation rooms in Assisted Living 4. Memory Care staff to discard PPE (N95s and wipes) inside a plastic bag after exiting each isolation room and then discard plastic bag in designated trash bin 5. Coordinate with staff, management and family in Memory Care to provide additional services for COVID-19 positive resident's prone to wandering The Department will provide additional PPE supplies. No deficiencies were cited as per California Code of Regulations, Title 22. This report was reviewed via telephone with Jeeteeh Gigliotti, RSD and an email copy will be provided for signature.the state’s words, verbatim · CDSS document, Dec 3, 2021

Allegation investigated: Staff caused injury to resident Staff pushed resident

On 10/29/2021, Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced visit to deliver investigation findings. LPA met with Executive Director, Jolie Higgins. On 11/14/2019, Community Care Licensing Division (CCLD) – Adult and Senior Care (ASC) received a complaint against the facility, alleging a facility staff caused injury to a resident and the resident sustained bruising while in care. Based on investigation, on 11/10/2019, R1 yelled out in pain due to discomfort while staff was assisting R1 with repositioning, which resulted in bruising on R1’s left chest wall. On 11/21/2019, LPAs Karen Taku and Natkarn Shugan, conducted an unannounced initial complaint investigation visit and met with Resident Services Directors (RSDs) Diane Martinez (S1) and Charmanie Verador (S2). Page 1. See continuation on page 2 of 3. Unsubstantiated On 01/28/2020, (LPA) Karen Taku and Licensing Program Manager (LPM) Romeo Manzano conducted a subsequent visit, and interviewed the Executive Director, Resident Services Director in Memory Care, and Assisted Living Director, and 5 direct staff and obtained copies from R1's facility records such as Physician's report, Incident reports, appraisal needs and services and centrally stored medication log. On 10/19/2020, LPAs Karen Taku and Grace Davis conducted an unannounced subsequent Complaint Investigation Tele-visit. During visit, LPAs requested resident records and interviewed staff. LPA interviewed 8 facility staff. 4 Out of 8 staff (S1-S4) are not familiar with R1's large mass on R1's left breast while 4 staff (S5 -S8), who stated that have observed R1's swollen left breast. Staff denied allegations of abuse and no incidents occurred prior to the observation of the mass. S5 stated S5's observed R1's bump on R1's chest and two hours later, the bump had grown in size, which resulted in emergency services being called (911) and R1 being transferred outside of the community. S6 stated S6 was aware of R1's swollen breast that resulted into R1's hospitalization. S6 stated that there were no incidents of abuse reported to S6 by staff, nor R1 was physically abused during R1's residency in the memory care. Based on review of R1's Internal Incident Report on 11/10/2019, S5 was notified by staff that R1 had a large mass on left breast which grew in size in about 2 hours resident complained of severe pain. R1 was sent out to be evaluated through 911 call. R1's primary care physician (PCP) was notified on the same day and R1's responsible parties. R1's PCP was also notified on same day that R1's left hand was still and pushes against R1's breast which causes bruising and there was also a tight hard mass on the upper part of R1's breast. Based on review of R1's Med Tech to Med Tech Communication Log between 10/9/2019 to 11/10/2019, staff noted on the following days R1's incidents: 10/9/2019, R1 was agitated wherein R1's responsible party was notified; 10/11/2019, R1 had an aggressive behavior, 10/18/2019; R1 noted to have skin discoloration on left breast and side area with no complaint of pain or discomfort; 11/1/2019 R1 complained of pain and discomfort on bottom wherein refused pain medication; 11/2/2019 R1 had a bruise under left arm and provided pain medication and on 11/10/2019, R1's swollen left breast with severe pain noted. Page 2 of 3 On 11/21/2019, LPA Shugan interviewed the Resident Service Director (S9) who stated awareness of R1's bruise, hard mass and complaints of severe pain but no mention of staff having caused the injury to resident. Staff denied allegation of abuse wherein R1 was pushed by staff resulted in R1 sustaining a left breast bruise and swelling. On 04/22/2021, S9 stated that there was no medical records findings received from the hospital. R1 was not interviewed. R1 did not return to the facility after R1's hospitalization in 11/10/2019 and no longer resides at the facility. The department has investigated the above allegations. Based on the record review and staff interviews the Department has found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Exit interview conducted with Executive Director, Jolie Higgins. A copy of this report was provided. Page 3 of 3.the state’s words, verbatim · CDSS document, Oct 29, 2021 · control 26-AS-20191114121715

Allegation investigated: Resident was sexually assaulted while in care

Licensing Program Analyst, Christine Dolores conducted an unannounced Complaint Investigation to deliver findings of the above allegations and met with Executive Director, Jolie Higgins. On 04/21/2020, the Department conducted an initial complaint investigation wherein the LPA requested documents. Between 8/19/2020 – 10/9/2020, the Department interviewed 8 staff members (S1 – S8). Based on interviews, staff were not aware of any abuse in the facility. Staff stated that R1 had multiple falls, but never expressed any concern or being abused by other residents or staff. Staff stated that R1 was cognizant but confused at times though able to verbalize the need for an assistance with bladder management. Staff stated residents' showers are provided by various staff, mostly female staff. R1 requires 2-person assist. Page 1 of 2. Unfounded On 04/11/2020, R1 was noted by facility staff to have green pus, foul odor and blood when changing R1's undergarment. R1 complained of leg pain and burning sensation. This incident was reported and R1 was taken to the hospital. R1 was interviewed. Despite R1's neurocognitive disorder, R1 does not remember going to the hospital on 04/11/2020 but does remember being admitted to the hospital for urinary tract infection (UTI). R1 denied recent sexual activity and being mistreated or sexually abuse by any staff members. R1 states feeling safe at the facility. Based on records review, R1 was admitted into the hospital on 04/11/2020 wherein R1 was indicative of a sexually transmitted infection and result of tests were negative. Test results revealed that R1 had inflammation of the bladder and subsequently treated for urinary tract infection (UTI). R1 has a history of UTI in 2019 and 2020. This Department has investigated this allegation. Based on interviews conducted, records reviewed, and LPAs observation, the Department has found that this allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted with Executive Director, Jolie Higgins and a copy provided. Page 2 of 2.the state’s words, verbatim · CDSS document, Oct 29, 2021 · control 26-AS-20200417170402

Allegation investigated: Facility feels cold to residents.

Licensing Program Analyst (LPA) Yatfai Eric Ng conducted a subsequent unannounced complaint investigation visit to deliver the investigation finding. LPA met with Executive Director Jolie Higgins. An initial unannounced investigation was conducted on 9/17/2019. LPA toured the facility and interviewed 9 residents (R1 to R9) with 6 residents (R1 to R3, R7 to R9) agreed to be interviewed, one visitor (V1), and one staff (S1). 5 out of 6 residents, 1 out of 1 visitor, and 1 out of 1 staff stated there was no concern about the temperature of the facility. Only 1 resident stated the temperature was too hot or too cold. Others stated the facility was in comfortable temperature. On 10/18/2019. LPA conducted a subsequent visit wherein the facility was toured and interviewed 3 residents (R10 to R12). 3 out of 3 residents stated there was no concern about the temperature of the facility. All 3 residents interviewed stated there was no concern about the temperature in the facility. Unsubstantiated On 9/17/2019 and 10/18/2019, 12 residents (R1 to R12) were interviewed with 9 successful interviews. 8 out of 9 residents (R1 to R3, R7 to R9) stated there was no concern about the temperature of the facility. R1 stated the temperature in the common area was okay, not hot, not cold. R2 stated that it was not too hot or too cold in the common area. R3 stated okay when being asked about the temperature. R4 refused to be interviewed. R5 refused to be interviewed. R6 refused to be interviewed. R7 stated the temperature was good and comfortable. R8 stated that the temperature was too hot nor too cold. R9 stated the temperature in public area was awful that sometimes it was too hot, sometimes it was too cold. R10 stated that there was no complaint regarding the temperature in the common area. R11 stated there was no complaint about the temperature in the facility. On 9/17/2019, 1 visitor (V1) was interviewed. 1 out of 1 visitor stated there was no concern about the temperature of the facility. V1 stated it was not too cold or too hot in the common area. On 9/17/2019, 1 staff (S1) was interviewed. 1 out of 1 staff stated there was no concern about the temperature of the facility. S1 stated anyone could adjust the direction of the vent so that the wind would not blow directly to the residents. On 10/18/2019, LPA observed the temperature inside the dining room and activity room in assisted living to be 79- and 80-degrees F respectively. According to regulation section 87303(b)(2) Maintenance and Operation: “the facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature.” It was evidenced that the temperature of the facility was within the regulation. This Department has investigated the above allegation. Based on observations, interviews conducted, and observation, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. This report was reviewed with Executive Director. A copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2021 · control 26-AS-20190910121732

Allegation investigated: Facility not providing services agreed to in Admissions Agreement. Staff failed to provide activities for resident(s). Resident(s) not provided adequate amount of food. Resident(s) not provided adequate amount of water. Staff failed to assist resident(s) with toileting needs.

Licensing Program Analyst (LPA) Yatfai Eric Ng conducted an unannounced subsequent complaint investigation visit. LPA met with Executive Director Jolie Higgins. An initial unannounced investigation was conducted by LPAs Yatfai Eric Ng and Gladys Kuizon on 7/25/2019. LPAs toured the facility and interviewed 2 residents. A subsequent unannounced investigation was conducted by LPA Ng on 9/17/2019. LPA interviewed additional 7 residents, and 2 staff. On 10/18/2019, LPA Ng conducted another subsequent unannounced investigation. LPA interviewed 4 residents, and 3 staff. Investigation visits conducted on 7/25/2019, 9/17/2019, and 10/18/2019, LPA Ng toured the facility. On 7/25/2019, LPA observed memory care unit residents were watching movie in library room. On 9/17/2019, LPA observed memory care unit residents were having a game in activity room. On 10/18/2019, LPA observed memory care unit residents were doing crafts in the activity room. LPA observed residents participated the activities. Unsubstantiated Based on review of the facility monthly calendar, there were daily activities in the facility from morning to afternoon and sometimes nighttime. For example, on 7/3/2019 the facility had morning exercise starting at 10:00 AM, BBQ in courtyard starting at 11:30 AM, and afternoon stretch, sponge art, bingo, and documentary starting at 1:15 PM. Another example, on 7/26/2019, the facility had morning exercise and daily chronicle with coffee starting at 10:00 AM, exercise with James, name that tune, sensory hand washing starting at 10:30 AM, sightseeing, bingo, and movie night starting at 1:00 PM. On 7/25/2019, LPA Ng interviewed 2 residents with null result. On 7/25/2019, LPA Ng interviewed 1 visitor of the resident. 1 out of 1 visitor stated the family had adequate food and water upon request. 1 out of 1 visitor stated the toileting need of the resident was met. On 7/25/2019, LPA Ng toured 2 residents’ rooms in the facility. 2 out of 2 residents needed assistance in toileting needs. Based on observation, LPA did not smell any foul odor inside the room. Thus, LPA did not observe any residents’ toileting needs were not met. On 9/17/2019, LPA Ng toured 1 resident’s room in the facility. 1 out of 1 resident needed assistance in toileting need. Based on observation, LPA did not smell any foul odor inside the room. Thus, LPA did not observe any residents’ toileting needs were not met. On 9/17/2019, 8 residents were interviewed with 5 results. 5 out of 5 residents stated that they did not feel the food and water were not adequate for them. 5 out of 5 residents stated their toileting needs were met. 5 out of 5 residents were not aware any resident’s food, drink, and toileting needs were not met. On 9/17/2019, 1 visitor of the resident was interviewed. 1 out of 1 visitor stated the family had adequate food and water upon request. 1 out of 1 visitor stated the toileting needs of the resident was met. On 9/17/2019, LPA interviewed 1 staff who was responsible to address the toileting needs of the residents. 1 out of 1 staff stated the residents in need, were checked at least 4 times per shift, 2 times per night, at least 8 times per day. On 10/18/2019, LPA interviewed 4 residents. 4 out of 4 residents stated there were adequate food and water in the facility. Based on observation, LPA did not smell any foul odor from the 2 out of 4 residents who needed assistance in toileting needs. Thus, LPA did not observe any resident’s toileting need was not met. On 10/18/2019, LPA interviewed 1 staff who was an activity director. 1 out of 1 staff stated many residents who were in memory unit liked to watch old television based on her professional experience. Showing modern television shows irritated some residents. Beside television shows, the entertainment system in the facility could also act as a karaoke, and gaming machine to entertain the residents. Due to physical and health condition, the family of R1 refused the facility to have R1 to participate the activities with other residents. On 10/18/2019, LPA interviewed 2 staff. 2 out of 2 staff stated care staff developed a system to check the residents in need routinely in order to make sure the residents’ needs were being met. Based on observation, LPA observed there were activities provided to residents who participated. LPA observed residents had their meals and observed staff assisting residents in eating and drinking. Also, LPA did not observe any residents’ toileting needs were not met. It was alleged that a med tech would serve R1 24 hours a day, that at least 3 staff available at all times, and the resident would be checked on every 10 minutes. Although it was alleged that it was agreed to provide a copy of admission agreement to LPA, LPA did not receive it when requesting it on 7/24/2019, and on 9/10/2019. No document was provided to support the allegation. Based on record review, LPA obtained a copy of the R1’s admission agreement documents from the facility. In reviewing the documents, the terms and agreements on services wherein the facility failed to provide to R1 are not mentioned. This Department has investigated the above allegations. Based on observations, interviews conducted and records review, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. This report was reviewed with Executive Director and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 24, 2021 · control 26-AS-20190722105729

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Christine Dolores and Marybeth Donovan conducted an unannounced Case Management Visit. LPAs met with Billy Mitchell, Executive Director (ED), Jocelyn Bailon, Compass Rose Resident Service Director, and Jeeteeh Gigliotti, Resident Service Director. LPAs explained the purpose of the visit to obtain additional information related to 4 incident reports received for the period 7/18/2021 to 7/25/2021 involving resident (R1). 911 was called for each of these incidents. LPAs toured the facility in part to include the lobby, dining room and Compass Rose Memory Care area and outdoor courtyard. LPAs interviewed ED and two staff LPAs reviewed resident (R1's) records to include physician reports, health and services evaluation reports, service plan and physician communications. R1 transitioned from Assisted Living to Memory Care unit on 7/15/2021. R1 exhibited exiting behaviors from the Memory Care unit. Staff were monitoring R1's transition. Family and primary care provider (PCP) were notified of changes in condition. Care conference was held to discuss plan of care. Staff directed to contact 911 in the event of emergency and for safety of residents in care and staff. No citation issued per the California Code of Regulations Title 22. Reviewed the report with Billy Mitchell, Executive Director and a copy provided.the state’s words, verbatim · CDSS document, Aug 25, 2021

Allegation investigated: Resident needs are not being meet by the facility Facility staff do not prevent resident to resident altercations Facility staff do not allow residents to have visitors Facility staff do not assist resident with medical and dental appointments. Facility does not serve food of good quality Facility does not safeguard resident's personal property

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Executive Director Billy Mitchell. On 07/08/2021, the Department received a complaint with the above allegations. On 07/09/2021, LPA Marrufo conducted an initial complaint investigation visit. LPA Marrufo conducted a facility tour and made observations of resident rooms, kitchen areas, and meals being served to residents. Throughout the investigation, LPA Marrufo interviewed 7 residents, 10 staff, and 4 witnesses. LPA Marrufo also obtained the following documents for residents R1-R5 throughout the investigation: Physician's Report, Admissions Agreements, Needs and Services Plan, Emergency Contact Form, and Daily Logs. See LIC9099-C for more information. Page 1 of 4. Unsubstantiated LPA Marrufo obtained copies of staff training logs related to resident care and abuse for staff S1-S8. LPA Marrufo also obtained a memory care activities calendar and Physician and Medical Visits Policy. 5 out of 7 interviewed residents stated the facility is meeting resident needs. 2 out of 7 declined to give a response. 10 out of 10 interviewed staff stated the facility is meeting resident needs. 4 out of 4 witnesses stated the facility is meeting resident needs. LPA Marrufo toured the living units of residents R1-R5. During interviews, facility staff and family members stated that resident R1 has a habit of hiding and losing R1’s dentures. LPA reviewed Daily Logs for R1 and observed there to be entries on 03/19/2021 and 07/06/2021 in which facility staff communicated to R1’s medical Power-of-Attorney (POA) stating that R1’s dentures had been lost. LPA Marrufo toured R1’s living unit and observed R1’s emergency call button to be located on top of R1’s dresser. LPA Marrufo observed the emergency call button did not have a lanyard attached to it. During visit, LPA Marrufo requested facility staff to attach the lanyard to the emergency call button and hang it over R1’s neck. During interviews, a facility staff and a witness stated that R1 has a habit of keeping R1’s walker brake’s locked, which wears down the brakes on the walker. Both staff and R1’s POA stated that R1’s POA is responsible for providing a replacement walker. 4 out of 7 interviewed residents stated facility staff prevent resident to resident altercations. 3 out of 7 interviewed residents declined to answer. 10 out of 10 interviewed staff stated facility staff prevent resident to resident altercations. 4 out of 4 interviewed witnesses stated facility staff prevent resident to resident altercations. See LIC9099-C for more information. Page 2 of 4. 3 out of 7 interviewed residents stated facility staff do allow residents to have visitors. 1 out of 7 interviewed residents stated facility staff do not allow residents to have visitors. 2 out of 7 residents declined to answer. 10 out of 10 interviewed staff stated facility staff do allow residents to have visitors. 4 out of 4 interviewed witnesses stated facility staff do allow residents to have visitors. 3 out of 7 interviewed residents stated facility staff assist residents with medical and dental appointments. 1 out of 7 interviewed residents stated facility staff do not assist residents with medical and dental appointments. 2 out of 7 residents stated they did not know if staff assist residents with medical and dental appointments. 2 out of 7 residents declined to answer. 10 out of 10 interviewed staff stated facility staff assist residents with medical and dental appointments. 4 out of 4 interviewed witnesses stated facility staff assist residents with medical and dental appointments. LPA Marrufo reviewed a copy of the Physician or Medical Visits policy, dated 10/19/2019. The policy states that if a resident is unsafe to be left without an escort to a physician or medical visit, the facility will arrange for a staff member to accompany the resident. During interviews with 3 out of 3 facility drivers, the drivers stated that it is the procedure of the facility to either meet a resident’s family member at a physician or doctor’s visit or escort the resident to the doctor’s visit and check the resident in to the appointment. 4 out of 7 interviewed residents stated the facility serves food of good quality. 1 out of 7 interviewed residents stated to not be sure if the facility offers food of good quality. 2 out of 7 residents declined to respond. 10 out of 10 interviewed staff stated the facility serves food of good quality. 4 out of 4 interviewed witnesses stated the facility serves food of good quality. See LIC9099-C for more information. Page 3 of 4. LPA Marrufo observed the facility kitchen as meals were being prepared, the food cart that takes meal trays to the facility memory care unit, and the kitchen and dining area in the facility memory care unit. LPA observed food to be warm and stored in ovens. During meal service, LPA interviewed 4 residents while they were being served lunch and all 4 residents stated they thought the lunch was of good quality. LPA attempted to interview a 5th resident during meal service, but the resident declined to be interviewed. LPA observed the food storage areas in the assisted living and memory care areas. LPA checked canned foods in the pantry and perishable foods in facility refrigerators and did not observe any expired foods or any unsealed foods. 4 out of 7 interviewed residents stated the facility safeguard’s resident’s personal property. 1 out of 7 interviewed residents stated to not know if the facility does not safeguard resident’s personal property. 2 out of 2 residents declined to respond. 10 out of 10 interviewed staff stated the facility safeguard’s resident’s personal property. 4 out of 4 interviewed witnesses stated the facility safeguard’s resident’s personal property. Based on information from interviews conducted with staff, residents, and witnesses, review of records, and observations, although the allegations listed above 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 allegations are unsubstantiated. An Advisory Note was issued. See LIC9102 for more information. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Executive Director Billy Mitchell and a copy of the report was provided. Page 4 of 4.the state’s words, verbatim · CDSS document, Aug 10, 2021 · control 26-AS-20210708115804

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Karen Taku conducted an unannounced Case Management visit today. LPA met with the Executive Director (ED) Billy Mitchell and the Resident Services Director (RSD’s) of Assisted Living -Jeeteeh Gigliottii and Memory Care-Jocelyne Bailon. The purpose of today’s visit is to conduct a welfare check on a resident (R1) who resides in Memory Care. Per the ED and RSD’s, R1 is doing and eats well. R1 had a couple falls last week and sustained no injuries. Per RSD, R1 wants to remain as independent as possible, but due to R1’s health condition (Alzheimer Dementia w/Behavioral Disturbances), R1 doesn’t realize assistance is needed. Per RSDs, to minimize additional incidents, R1 was given a pendant to call for assistance and Occupational Therapy, to ensure R1 knows how to properly transport using a walker and wheelchair. R1’s Physician's Report, Assessment, and Care Plan were reviewed during today's visit. At 11:18am, LPA observed R1 having a snack and speaking to staff. R1 appeared to be in good spirts. At 11:25am, LPA attempted to speak with R1. R1 was sitting in wheelchair with eyes slightly closed and vocal. R1 stated, doing okay and didn't have any concerns. Per Lifestyle Director, R1 is fairly involved in activities. R1 enjoys being read to, coloring, and the weekly scenic drive. No deficiencies cited during today’s visit. This report was reviewed with the ED and a copy was provided.the state’s words, verbatim · CDSS document, Jul 7, 2021