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Allegation investigated: Facility is over charging resident Licensee did not provide a refund to resident's responsible person

Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 10:05 AM LPA met with facility staff, who contacted the Administrator, Joseph Trupiano, via telephone. At approximately 10:15 A.M., the Administrator requested to speak witht the LPA. The Administrator stated they were unable to be present during today;s visit and authorized caregiver, Regie Dulay to sign the reoirt on their behalf. The LPA read the finding to the Administrator over the telephone. Entrance interview conducted. On 07/16/2026, LPA Conway conducted an initial 10-day visit. During the visit, between 10:10 A.M. and 2:00 P.M., the LPA conducted a physical plant tour, interviewed the administrator and reviewed files, medication logs and obtained copies of pertinent documents relevant to the investigation. Throughout the course of the investigation, LPA reviewed all documents obtained, conducted telephonic interviews with additional individuals. During today’s visit, LPA conducted a brief tour of the physical plant. The following was then determined: Continued on LIC 9099-C Unsubstantiated Continued from LIC 9099 Regarding the allegations of “Facility is over charging resident” and “Licensee did not provide a refund to resident's responsible person”, the Reporting Party alleged that the facility overcharged Resident #1’s (R1’s) family member for monthly rent and hospice services and failed to provide a refund following a 30-day written termination notice. Interviews with a R1’s Responsible Person (RP) revealed that they elected to provide a 30-day written notice of termination and relocate R1 five (5) days after admission due to their belief that the facility’s fees were excessive. The RP stated that they believed hospice services should be provided at no cost to the residents because they are government-funded. The Administrator stated that R1’s RP had toured the facility prior to admission and agreed to the fees presented. The admission agreement identified the applicable care level and associated fees. Records review revealed that the admission agreement was effective 07/08/2026 and was signed by R1’s RP. The agreement identified Level 5 care, which is provided to all residents that require hospice services. On 07/13/2026, R1’s RP emailed the facility a 30-day termination notice and inquired regarding the final amount due. The facility acknowledged receipt and provided a final invoice. R1 and their belongings were removed from the facility on 07/15/2026, prior to the expiration of the 30-day notice period. The Administrator stated that R1 could have remained at the facility through the end of the 30-day notice period; however, the RP elected to relocate R1 prior to the expiration of the notice. Records reviewed did not establish that the facility charged fees inconsistent with the signed admission agreement or that an unused balance remained due for refund. The Administrator stated that, as of today, all fees owed R1 have been paid and there is no outstanding balance on R1's account.Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Facility is over charging resident” and “Licensee did not provide a refund to resident's responsible person” is deemed Unsubstantiated at this time. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 25, 2026 · control 29-AS-20260716141324

Allegation investigated: Staff did not provide a copy of the admission agreement to resident's responsible person

Licensing Program Analyst (LPA) Valeria Conway conducted a 10-day initial complaint visit to investigate the above allegations. LPA met with staff, Regie Dulay, that contacted Administrator, Joseph Trupiano via telephone. At 10:43 A.M. Administrator arrived at the facility. LPA explained the reason for the visit. Entrance interview. During today’s visit, between 10:43 A.M. and 1:45 P.M., LPA Conway briefly toured the facility, conducted interviews with the Administrator and obtained copies of pertinent documents relevant to the investigation. At 11:40 A.M. Administrator departed the facility, however, authorized designated staff to sign this report on their behalf. The following was determined. Continued on LIC 9099-C Substantiated Continued from LIC 9099 Regarding allegation “Licensee did not provide a copy of the admission agreement to resident's responsible person”. It was alleged by the Reporting Party (RP) that upon Resident #1’s admission to the facility, on 07/8/2026, a copy of the Admission Agreement was not provided despite multiple requests for the document. During the investigation, the Licensee acknowledged that as of today, a copy of the Admission Agreement had not been provided to the RP. The Licensee stated that it was their intention to provide a copy; however, they explained that the Admission Agreements are in spiral-bound notebooks, and copies are not readily available. The Licensee explained that the documents would need to be removed from the binding in order to make copies. Based on the information obtained during the investigation, the licensee did not provide a copy of the signed and dated current Admission Agreement immediately upon signing it. LPA determined there is sufficient evidence to substantiate this allegation. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 20, 2026 · control 29-AS-20260716141324

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(e) · Plan of correction due date: Jul 21, 2026

87507 (e)The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement... This requirement is not met as evidenced by… Based on interviews, the licensee did not comply with the section cited above in that a copy of the admission agreement was not provided to the resident or representative which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 20, 2026

Plan of correction: The Licensee shall provide the resident's representative with a copy of the Adminission Agreement by emailing the document no later than 4 P.M. on 07/21/2026, and include the LPA on the email as verification of compliance.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

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

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced cased management – legal/non-compliance visit. The purpose of today’s visit was to ensure the facility is maintaining substantial compliance. LPA met with staff and explained the reason for the visit. Licensee Joseph Trupiano was contacted and stated they couldn't be onsite during the visit then stated Regie Dulay will sign in their place. LPA focused today’s visit on ensuring there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. At approx 12:31pm LPA conducted conducted a walk through of the facility. Resident rooms were observed to be furnished appropriately with sufficient lighting. One (1) resident was watching TV and (1) resident was eating at the dining table. Resident bathrooms were sufficiently stocked with supplies and paper towels. Hot water temperature was measured. Water temperature measured within 105- and 120-degrees Fahrenheit. Fire extinguishers were observed fully charged and last serviced on 09/11/2025. The facility has a sufficient supply of perishable and non-perishable food. No obstructions or hazards were observed inside or out. During today's visit LPA interviewed staff, resident and reviewed five (5) resident records for appraisals, medical records, admissions agreement, consent forms. All records were observed to be in order at this time. During today’s visit,LPA reviewed the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to facility’s emergency disaster plan is up to date and is adequate. The emergency disaster plan are reviewed/updated annually by the facility’s administrator. No deficiencies issued. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jun 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff and explained the reason for the visit. Licensee Joseph Tripuano was contacted, but stated they were not feeling well and unable to be onsite for the visit. Joseph Trupiano stated Staff Regie Dulay can sign in their place. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA inspected the kitchen/food service area at approx. 10:15 a.m. Knives and sharp objects are stored in a locked drawer to the left of the sink. Cleaning supplies were observed kept inaccessible underneath the sink. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. Staff room was located next to the kitchen. It was observed empty and inaccessible at this time. Dining area was observed to be clean and furniture in good condition. A sufficient supply of emergency food was observed stored in a cabinet next to the kitchen sliding door. Office area is located next to the dining room. LPA observed facility files and medication properly stored inaccessible to residents in care. There is an attached garage. LPA observed garage to be inaccessible to residents in care. LPA observed additional freezer to store extra perishable food. LPA also observed additional non-perishable supplies, canned goods, PPE, extra incontinent supplies, as well as additional furniture and medical equipment for facility use. Laundry area was located in the garage as well. At the time of the visit, the common area furniture's were observed to be in good condition. A sufficient supply of clean linen and towels were observed stored in the hallway cabinets. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguishers to be fully charged and serviced 09/11/2025. At approx 10:30 a family came to visit one of the residents. LPA observed four (4) resident bedrooms total. Resident bedrooms were observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bathrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common areas. The backyard has a covered outdoor area equipped with furniture including tables and chairs for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. There were no bodies of water noted at the time of the visit. Records review four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Six (6) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were observed to be in order at this time. At approx 11:30 a.m. a family member came to visit another resident. Medication review, medications for all residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. At approx 12:22 p.m. another family member came to visit a different resident. Infection control / Emergency Disaster plan: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are to be conducted quarterly; the facility’s last emergency disaster drill was conducted on 02/02/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. Smoke detectors and carbon monoxide detectors were tested, all alarms were functional at the time of the visit. The LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Mar 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival, the LPA met with staff and explained the reason for the visit. Licensee Joseph Tripuano was contacted, but stated they were unable to be onsite for the visit. Joseph Trupiano stated Staff Regie Dulay can sign in their place. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA inspected the kitchen/food service area at approx. 10:55 a.m. Knives and sharp objects are stored in a locked drawer to the left of the sink. Cleaning supplies were observed kept inaccessible underneath the sink. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. Staff room was located next to the kitchen. It was observed empty and inaccessible at this time. Dining area was observed to be clean and furniture appeared to be in good condition. Office area is located next to the dining room. LPA observed facility files and medication properly stored inaccessible to residents in care. There is an attached garage. LPA observed garage to be inaccessible to residents in care. LPA observed additional freezer to store extra perishable food. LPA also observed additional non-perishable supplies, canned goods, PPE, extra incontinent supplies, as well as additional furniture and medical equipment for facility use. Laundry area was located in the garage as well. At the time of the visit, the common area furniture's were observed to be in good condition. A sufficient supply of clean linen and towels were observed stored in the hallway cabinets. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguishers to be fully charged and serviced 09/06/2024. LPA observed four (4) resident bedrooms total. Resident bedrooms were observed furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bathrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common areas. The backyard has a covered outdoor area equipped with furniture including tables and chairs for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. There were no bodies of water noted at the time of the visit. Records review began at approx. 10:20 a.m. Six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At approx. 10:45 a.m. Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were observed to be in order at this time. Last emergency disaster drill was conducted on 01/03/2025. Medications review began at approx. 02:00 p.m. All medications including PRNs were labeled, stored and inaccessible to residents in care. Medications were observed to be administered as prescribed at this time. At approx. 03:00pm, LPA discussed Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE), and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. The LPA obtained the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. Exit interview conducted, discussed and copy of report issued.the state’s words, verbatim · CDSS document, Mar 10, 2025

Allegation investigated: Resident sustained pressure injuries while in care. Resident sustained unexplained bruises due to staff negligence.

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver final findings for the above allegations. During today’s visit, LPA met with staff Regie Dulay and explained the reason for the visit. Staff contacted Licensee/Administrator Joseph Trupiano who stated that he is unable to come to the facility due to transportation issues. LPA reviewed the investigation findings with Mr. Trupiano over the phone. Mr.Trupiano stated that staf may sign the report. On 05/23/2023, the Department received a complaint regarding allegations of Neglect/Lack of Supervision. It was alleged that Resident #1 (R1) sustained unstageable pressure injuries while in facility care and R1 sustained unexplained bruising due to staff negligence. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Heidy Bendana. This case was also referred to the Department’s Program Clinical Consultant (PCC) for review. On 05/24/2023, LPA Chochian conducted an initial 10-day complaint visit for the above allegations.During the visit, the LPA toured the facility with staff at approximately 10:00 a.m., reviewed resident records between 10:15 a.m. to 10:30 a.m., and obtained copies of pertinent records. (Continue to LIC9099C) Substantiated Investigator Bendana conducted interviews on 07/11/2023, at approximately 1:47 p.m., with Staff #1 (S1), Staff #2 (S2), Resident #2 (R2), and attempted to interview Resident #1 (R1) but R1 did not respond to questions or acknowledge the investigator; on 08/16/2023, from approximately 10:58 a.m. to 11:14 a.m., with the hospice nurse and R1’s resident representative; on 08/21/2023, at approximately 3:01 p.m., with the administrator; on 08/22/2023, at approximately 11:36 a.m., with the wound care specialist certified nurse; on 09/01/2023, at approximately 1:14 p.m., re-interviewed the administrator; and on 09/05/2023, at approximately 3:49 p.m., attempted to re-interview S1. In addition, the investigator reviewed R1’s medical records, photos of R1’s pressure injuries and bruises, and facility file documents related to R1. R1’s Physician Report, dated 02/27/2023, listed R1’s primary diagnosis as Alzheimer/Dementia. R1 needed assistance with all activities of daily living, needed routine check for skin breakdown, was considered non-ambulatory, and needed assistance transferring to and from bed. R1’s Appraisal Needs and Services Plan, dated 02/15/2023, documented R1 needed assistance with all activities of daily living, needed assistance when ambulating, and was a fall risk. A review of the text messages sent between the administrator and R1’s resident representative revealed that on 05/12/2023, at 12:42 p.m., the administrator notified R1’s resident representative that R1 had a rash on the left shoulder and hip and needed to be seen by a doctor. R1’s resident representative took R1 to the primary care physician on 05/15/2023 where R1 was assessed. During the visit, the nurse practitioner addressed a pressure injury of R1’s buttocks at stage 2, unspecified laterality. R1 was prescribed Doxycycline Hyclate and Mupirocin ointment. The orders included pressure setting on bed at the facility and move positions every two (2) hours to prevent damage to the skin. R1 was referred to the Tarzana Wound Care Center for further evaluation. On 05/22/2023, at 2:00 p.m., the wound care center noted multiple pressure injuries including right and left hip unstageable pressure injuries; left scapula deep tissue pressure injury; and right and left buttock stage 2 pressure injuries. R1 was also noted to have bruising on the right forehead and bilateral knees, the right knee worse than the left. R1 was referred to the Adventist Health Simi Valley Emergency Room for further evaluation. A review of the Adventist Health Simi Valley medical records revealed that on 05/22/2023, R1 was seen in the Emergency Room with the chief complaint of open wound in the coccyx, left buttock, and left shoulder since 05/12/2023. R1 was admitted to the hospital for further management and a wound care specialist consultation. (Continue to LIC9099C) It was noted that R1 had several areas of bruising to the lower extremities that suggests R1 had fallen relatively recently. The evaluation noted “evidence of ecchymosis (bruising) of the right knee consistent with a recent fall, there is also a deep wound to the right hip that may be related to the same injury”. Imaging was conducted and there was no evidence of fractures. The assessment included R1 had pressure ulcers, noting R1’s right hip wound appeared to be relatively deep and may be partially gangrenous. R1 was diagnosed with unspecified open wound of lower back and pelvis, stage 1 pressure ulcer of sacral region, unstageable pressure ulcer of left and right hip, and pressure induced deep tissue damage of right and left upper back. On 05/24/2023, R1 was discharged to hospice care. On the allegation “Neglect/Lack of Supervision - Resident sustained pressure injuries while in care”. The Department’s investigation provided sufficient evidence to substantiate the allegation. The interviews and medical records noted R1 had unstageable pressure injuries. The staff reported they repositioned R1 twice a day, in the morning and in the evening. Due to R1’s condition, R1 needed to be repositioned more than twice a day. The administrator and the staff were aware the pressure injuries were “progressively” worsening. The staff failed to reposition R1 every two (2) hours as instructed in the discharge notes. The staff failed to provide care according to the after-visit care plan. The facility neglected R1 causing pressure injuries to develop and progressively worsen. Therefore, the allegation “Neglect/Lack of Supervision - Resident sustained pressure injuries while in care” is deemed substantiated at this time. On the allegation “Neglect/Lack of Supervision - Resident sustained unexplained bruises due to staff negligence”. The Department’s investigation provided sufficient evidence to substantiate the allegation. During R1’s evaluation at the hospital, it was noted that R1 had several areas of bruising to the lower extremities that suggests R1 had fallen relatively recently. Based on R1’s facility file documents, R1 was a known fall risk. When initially questioned if R1 had any falls at the facility, the administrator and staff denied any falls. The administrator was later informed by S1 that R1 had slipped in the bathroom. Therefore, the allegation “Neglect/Lack of Supervision - Resident sustained unexplained bruises due to staff negligence” is deemed substantiated at this time. A $500 immediate civil penalty is assessed today. The Licensee/Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D) Exit interview conducted, civil penalty issued, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Mar 27, 2024 · control 29-AS-20230523101459

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Mar 28, 2024

(4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on medical records, photos, and interviews, licensee did not comply with the section cited. Staff did not provide the necessary care and supervision resulting in R1 sustaining pressure injuries and bruising while in care, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2024

Plan of correction: Licensee agreed to submit a plan on how they will ensure that residents are provided 24-hour care and supervision to meet their individual health care needs. Submit to CCL by POC due date. An immediate civil penalty of $500 is warranted in accordance with California Health and Safety Code Section 1548(c)(1)

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced Case Management Deficiency visit in conjunction with an initial 10-day complaint visit (CC # 29-AS-20230523101459). LPA met with staff Regie Dulay. Staff contacted Licensee/Administrator and LPA reviewed the report with Licensee. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. The facility failed to seek medical attention in a timely manner for Resident #1 (R1). During interviews, the staff and administrator acknowledged R1’s pressure injuries progressively worsened, and they did not seek medical attention. Staff and administrator continuously stated the prescribed ointment was not received; however, staff and administrator failed to seek medical attention and inform a medical professional that the discharge care treatment was not being done. The facility failed to report R1’s fall incident in the bathroom to Community Care Licensing (CCL). The fall resulted in R1 having bruises on forehead and lower extremities. It was noted in the 05/22/2023, Adventist Health Simi Valley medical records, that R1 had several areas of bruising to the forehead and lower extremities. The evaluation noted the bruising was consistent with a recent fall. The 05/12/2023 Special Incident Report (SIR) noting a “rash” to R1’s left shoulder and hip requiring a doctor visit, diagnosed as pressure injuries, was dated 05/25/2023, more than 7 days after the incident date. There is no evidence or confirmation that the SIR was submitted to CCL. R1’s hospice notification, dated 05/25/2023, was also not received by CCL. R1’s Physician Report, dated 02/27/2023, lists R1 as not on hospice and not able to perform any activities of daily living, which is considered a prohibited health condition. R1 was placed on hospice care on 05/24/2023. Citations issued, exit interview, appeal rights given.the state’s words, verbatim · CDSS document, Mar 27, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Mar 28, 2024

(a) A plan for incidental medical and dental care shall be developed by facility. The plan shall encourage routine medical and dental care.... (1) The licensee shall arrange.....for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interviews and medical records, the licensee did not comply with the section cited above. The licensee did not seek medical attention when R1’s pressure injuries progressively worsened, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2024

Plan of correction: The licensee agreed to submit a plan describing how they will ensure residents will receive timely medical care. Submit proof to CCL by due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87615(a)(5) · Plan of correction due date: Mar 28, 2024

(a) Persons who require health services for or have a health condition including, but not limited to, those specified....(5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. The licensee retained R1 who depended on others to perform all activities of daily living, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2024

Plan of correction: The licensee agreed to submit a memo of understanding that you have read Prohibited Health Conditions and Exceptions For Health Conditions. Submit proof to CCL by due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(B) · Plan of correction due date: Apr 3, 2024

(a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted...... within seven days of the occurrence of any of the events specified in.....(B) Any serious injury....while the resident is under facility supervision. This requirement is not met as evidenced by: Based on interviews and records review, licensee did not comply with the section cited above. No evidence or confirmation that the licensee submitted the 5/12/2023 SIR, dated 05/25/2023, to CCL. Licensee did not submit an SIR for R1’s fall , which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2024

Plan of correction: The licensee agreed to submit a plan describing how you will ensure reporting requirements are followed. Submit proof to CCL by due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(d)(2) · Plan of correction due date: Apr 3, 2024

(d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver....... (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally Ill resident..... This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. There is no evidence/confirmation that the licensee submitted a notification for R1’s 05/24/2023 initiation of hospice care services, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 27, 2024

Plan of correction: The licensee agreed to submit a plan describing how you will ensure notification of the initiation of hospice care services is met within the required time frame. Submit proof to CCL by due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian conducted a Required annual visit to the above facility. Upon arrival LPA met with staff and reason for visit was explained. Staff contacted Administrator Joseph Trupiano by phone. Mr. Trupiano was informed that LPA will be conducting the Annual inspection today. Mr. Tupiano stated that he is unable to be at the facility today due to transportation issues and informed LPA that staff designated will assist LPA with the Annual visit and sign for the report. A tour of the physical plant was conducted with staff at approximately 12:15pm. LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. The following was noted: Smoke detectors and Carbon Monoxide detectors were tested and functioned properly during time of visit. Fire extinguishers were observed to be fully charged with service tag dated 9/13/2023. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a locked drawer. Bedrooms: The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. Bathrooms: LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Sufficient amounts of supplies for personal hygiene observed. Common Areas: These included the living room and dining area; areas observed clean; furniture in good condition. Surrounding Grounds (Outdoors): There is a shaded area with proper furniture for outdoor use. No bodies of water on the premises. Staff files reviewed approximately 1pm observed to be complete with required documentation such as health screenings, updated first aid/CPR certifications, required annual training and all other pertinent documents required. Staff training records lack start time and information on what material was used for the training. Technical violation issued. (Continue to LIC809C) All resident files reviewed at approximately 1:45pm observed to be complete with required documentation such as admission agreements, updated physician reports, appraisals, and physicians orders for bed rails. Residents' needs and services plan reviewed observed three (3) out of four (4) plans on file were not signed by resident/resident responsible person. Discussed with Licensee, technical violation issued for this violation. Medications and medication records reviewed from approximately 1:45pm-3pm. Medications observed stored in locked cabinet. Centrally stored logs reviewed observed to be complete/accurate with medications on hand. One out of four residents medications and medication records reviewed revealed that R3 is taking PRN medication and it is indicated by the physician that R3 is unable to clearly communicated and clearly state symptoms for the PRN need. Staff do not have record of contacting physician before providing PRN medication. Tis was discussed with Licensee. Deficiency issued for this violation. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. Today's reports and appeal rights were discussed with Licensee over the phone. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 27, 2024

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.