Camarillo Senior Living

Allegation investigated: Facility has an outbreak of scabies due to staff neglect of infection control guidelines

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial complaint visit was conducted on 06/19/2026 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Scott Keawekane. Entrance interview. During the initial visit on 06/19/2026, approximately between 01:25pm and 02:00pm, the LPA interviewed three staff members and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099... It was alleged that facility has an outbreak of scabies due to staff neglect of infection control guidelines. It was reported that both staff and residents have contracted scabies due to facility staff not taking precautions and following infection control guidelines throughout the facility to avoid the spread. Interviews conducted with facility staff revealed that the Ventura County Public Health (VCPH) Department was notified the day following confirmation of a resident's scabies diagnosis. Record review of facility records indicated that on 06/16/2026, the facility received notification from a resident's physician assistant documenting a clinical diagnosis of scabies based on the resident's presenting signs and symptoms. On 06/17/2026, facility staff notified VCPH of the confirmed case. Facility staff stated that VCPH provided guidance and recommendations regarding resident isolation, treatment, infection prevention and control measures, and ongoing monitoring. Staff further stated that residents who tested positive for scabies were placed on self-isolation and remained isolated until they were no longer considered contagious. Staff also reported that all residents in both the Assisted Living and Memory Care units were receiving meals in their rooms to minimize resident contact. In addition, all group activities and congregations were suspended until further notice as an infection control measure to reduce and prevent further spread. Based on the information obtained during the course of the investigation, there is insufficient evidence to support the allegation of “facility has an outbreak of scabies due to staff neglect of infection control guidelines”. Therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 24, 2026 · control 29-AS-20260618164908

Allegation investigated: Staff did not provide resident's responsible party with itemization of additional fees charged Staff did not provide resident's responsible party with copy of reappraisal Resident is being charged for services not provided

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above noted allegations. The initial complaint visit was conducted on 05/18/2026 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Scott Keawekane. Entrance interview. During the initial visit on 05/18/2026, between 09:20 a.m. and 11:20 a.m., the LPA conducted interviews with three staff and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099... It was alleged that staff did not provide resident's responsible party with itemization of additional fees charged and resident is being charged for services not provided. It was reported that a rate sheet for add-on services that went above room and board were not provided and that the nebulizer treatments were a separate charge from the medication program. It was further reported that prior to Resident #1’s (R1’s) hospitalization, R1 was ambulatory, and had nebulizer treatments twice a week and upon R1’s return, R1 needed nebulizer treatments four times a day, which the facility notated to be a change in condition and started charging an additional fee of $1825 stating it was for the level of care change. However, the order was changed to “as needed” but the facility was still charging for the full amount monthly. Record review of the facility's Level of Care Fee Schedule revealed that the use of a nebulizer is assessed as a separate monthly charge from the medication program because it is considered a change in the resident's level of care. Per hospice care plan dated 02/17/2026, it indicated that R1 had physician's orders for Levalbuterol HCl Inhalation Nebulization Solution 1.25 mg, with one vial to be administered four times daily. On 04/20/2026, the physician's orders were revised to administer the medication every six hours as needed (PRN). Record review and interviews revealed that R1 returned from the hospital on 02/15/2026. A review of R1's monthly billing records showed that the facility began charging the $1,825 monthly nebulizer treatment fee effective 03/01/2026. Records further showed that the facility provided notice of this additional charge to R1's responsible party on 02/27/2026. Interviews with staff confirmed that nebulizer treatments were administered four times daily according to the physician's orders until the order was discontinued on 04/20/2026 and changed to PRN, every six hours. Interviews further revealed that R1 was charged for the nebulizer treatment from 03/01/2026 through 04/20/2026. The resident's responsible party was notified of the additional charge through telephone calls, emails, and in-person communication. Further review of billing records and staff interviews revealed that the facility prorated the nebulizer treatment charge for April 2026 and did not assess the monthly nebulizer fee for subsequent months after the routine nebulizer treatments were discontinued. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegations of “staff did not provide resident's responsible party with itemization of additional fees charged” and “resident is being charged for services not provided”. Therefore, these allegations are deemed Unsubstantiated at this time. Report Continued on LIC 9099C... Report Continued from LIC 9099C... It was also alleged that staff did not provide resident's responsible party with copy of reappraisal. It was reported that the facility claimed a level of care change due to the use of nebulizer treatments, however, a reappraisal was not provided to R1’s responsible party prior to the nebulizer charge. Record review of R1's Service Plan, dated 02/10/2026, indicated that the Medication Management section was updated to reflect new physician orders, including staff assistance with nebulizer treatments and inhaler administration, as prescribed. Additionally, the resident's responsible party received an updated Personal Care Assessment, effective 03/01/2026, documenting that R1 had begun receiving nebulizer treatments and that this additional service would result in an increased monthly charge of $1,825. Interviews conducted with staff revealed that an updated care plan was completed following R1's discharge from the hospital to reflect the resident's change in condition, including changes to R1’s medication management. Record review of facility documentation further indicated that R1's responsible party was informed of all changes. Staff stated that notification was provided through telephone calls, email correspondence, and in-person communication. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “staff did not provide resident's responsible party with copy of reappraisal”. Therefore, this allegation is deemed Unsubstantiated at this time. No citations issued at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 24, 2026 · control 29-AS-20260512091539

Type of visit: Required - 1 Year

In conjunction with complaint visit today, Licensing Program Analysts (LPA) Zabel Chochian initiated the annual inspection. LPA met with the Wellness Nurse, Brenda Morales and Executive Director Scott Keawekane. From approximately 11;45am-1:30pm, the LPA along with the Wellness Nurse, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: The LPA observed the dining room and common areas to be clean and in good condition. There are games and/or activity supplies in the activity rooms as well as throughout the facility. There was sufficient space to accommodate both indoor and outdoor activities. The facility maintained a comfortable temperature. Required postings were observed throughout the common space. Stairwells on the third (3rd) floor have emergency evacuation chairs. There were no obstructions and/or tripping hazards throughout the facility. Delay egress exit doors in the memory care were tested and functioned properly. Several fire extinguisher checked throughout the facility were observed to be fully charged and last serviced on 12/11/2025. RECORD REVIEW: The LPA reviewed resident files from approximately 2pm-3:45pm. Ten (10) resident files were reviewed for, but not limited to, signed admission agreements, current medical assessments, TB test results, Consent for Treatment form, and current needs and services plan. The Safeguards for Property/Valuables record was missing in 10 out 10 resident files reviewed today. All other records were in order. Due to time constraints, annual inspection will continue on a later date. No immediate health and safety issues observed during today's visit. Exit interview conducted. Copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 25, 2026

Allegation investigated: Staff are smoking marijuana while at the facility

Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint visit to investigate the allegation noted above. During today’s visit, the LPA met with Wellness Director (WD), Morgan Schioppi and Wellness Nurse (WN) and explained the reason for the visit. The Executive Director (ED), Scott Keawekane was informed of today’s visit telephonically. Entrance interview. During today’s visit, approximately between 11:35 a.m. and 01:25 p.m., the LPA conducted a brief tour, interviewed the ED telephonically, interviewed four staff members and six residents, and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099... It was alleged that staff are smoking marijuana while at the facility. It is the complainant's concern that facility staff are smoking marijuana while working at the facility and possibly driving under the influence. Interviews conducted with staff revealed that none had observed any staff members smoking marijuana or cigarettes while working at the facility. Resident interviews were consistent with staff statements, as residents also reported that they had not observed any staff members smoking marijuana or cigarettes. During the interviews, residents did not express any concerns regarding staff smoking while working and reported no additional concerns. Furthermore, interviews indicated that neighbors on the Skilled Nursing Facility (SNF) side had observed facility staff smoking cigarettes; however, there were no reports or observations of staff smoking on or near the Assisted Living side of the facility. Based on the information obtained and reviewed, although the allegation may have occurred or may be valid, there is insufficient evidence to determine whether the alleged violation did or did not occur. Therefore, allegation “Staff are smoking marijuana while at the facility” is deemed Unsubstantiated at this time. No citations issued at this time. Exit interview. A copy of the report was issued.the state’s words, verbatim · CDSS document, May 29, 2026 · control 29-AS-20260521082603

Allegation investigated: Staff is smoking inside of a resident's room Staff made inappropriate comments to a resident in care

Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint visit to investigate the allegations noted above. During today’s visit, the LPA met with Executive Director (ED), Scott Keawekane and Wellness Director (WD), Morgan Schioppi and the reason for the visit was explained. Entrance interview. During today’s visit, approximately between 09:45am and 11:30am, the LPA conducted a plant tour, interviewed four staff members and five residents and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099… It was alleged that staff is smoking inside of a resident's room. It was reported that staff smokes a vape inside the resident’s room. Interviews conducted revealed that the facility maintains a no-smoking policy within the building, with designated smoking areas located outside. During staff interviews, employees demonstrated awareness of the facility’s smoking policy and stated that they have not observed any staff smoking inside the facility at any time. During resident interviews, residents reported that neither residents nor staff are allowed to smoke indoors. Residents indicated that the courtyard is the only area where they have observed other residents smoking, though not staff. Furthermore, five out of five residents interviewed stated that they have not observed any staff smoking in bedrooms and expressed no concerns regarding staff in the facility. 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, therefore the allegation “staff is smoking inside of a resident's room” is deemed Unsubstantiated at this time. It was also alleged that staff made inappropriate comments to a resident in care. It was reported that a staff member told a resident that they could assist them with showering at any time and made additional comments about bending over. Interviews conducted with staff revealed that they have not observed any other staff making inappropriate comments to residents. Staff stated that information tends to spread quickly when residents talk among themselves; however, they reported that no other residents have reported concerns about staff making inappropriate comments. Interviews conducted with residents indicated that they have not observed staff making inappropriate comments or behaving inappropriately in any way, and they denied experiencing any such behavior themselves. Furthermore, five out of five residents interviewed reported no concerns regarding how staff treat them. 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, therefore allegation “staff made inappropriate comments to a resident in care” is deemed Unsubstantiated at this time. No citations issued at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2026 · control 29-AS-20260410114558

Allegation investigated: Staff are mishandling a resident's personal belongings Staff are mishandling a resident's pendant Staff do not treat resident with dignity or respect

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial complaint visit was conducted on 12/16/2025 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Executive Director (ED), Scott Keawekane and Wellness Director (WD), Morgan Schioppi. Entrance interview. During the initial visit on 12/16/2025, between 09:50 a.m. and 11:20 a.m., LPA Arroyo conducted interviews with five staff and six residents and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099... It was alleged that staff are mishandling a resident's personal belongings. It is the complainant’s concern that Resident #1 (R1’s) personal documents have been removed from their apartment. Interviews conducted revealed that R1 had been cleaning out old mail in their apartment and used the trash bin to separate and dispose of the mail. According to staff interviews, staff are responsible for removing residents’ trash when it accumulates in their apartments. Staff reported that the trash bin was full and was therefore removed. Staff further indicated that R1 later approached management stating that their old mail had been discarded without their consent. Staff stated that they were performing their assigned duties, as they observed a full trash bin and disposed of it accordingly. Additionally, during interviews, six out of six residents stated that they have not had any items missing from their apartments since moving in and reported no concerns regarding living at the facility. Based on the information obtained and reviewed, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, allegation “staff are mishandling a resident's personal belongings” is deemed Unsubstantiated at this time. It was also alleged that staff are mishandling a resident's pendant. It is the complainant’s concern that facility staff are turning off the resident’s pendant calls when asking for assistance. Records reviewed and interviews conducted revealed that both care staff and the front desk concierge receive notifications when a resident presses their call pendant. If the call is not answered by care staff within a specified time frame, the front desk concierge will page the care staff to ensure they are aware of any pending pendant calls. Interviews conducted with staff indicated that the primary purpose of call pendants is to notify care staff when a resident requires assistance. Staff reported that some residents misuse the call pendants by pressing them for simple questions or non-emergency requests. Staff stated that residents have been reminded of the appropriate use of call pendants. However, staff denied turning off any resident’s call pendant without first assisting the resident. During resident interviews, residents reported using their call pendants regularly without concern and stated that staff respond promptly. Based on the information obtained and reviewed, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, allegation “staff are mishandling a resident's pendant” is deemed Unsubstantiated at this time. Report Continued on LIC 9099C... Report Continued from LIC 9099C... It was further alleged that staff do not treat resident with dignity or respect. It is the complainant’s concern that facility staff is taunting and picking on residents. Interviews conducted revealed that Staff #1 (S1) at times speaks in a loud manner when addressing both residents and staff. Staff did not report any concerns with how S1 spoke to the residents. Furthermore, staff denied being disrespectful towards residents and denied observing other staff members being disrespectful toward residents. During resident interviews, residents did not express any concerns regarding being disrespected by Staff #1 (S1). Residents further reported that, although S1 has not directly disrespected them, the way in which S1 communicates with others may potentially be misinterpreted or perceived negatively. Based on interviews conducted with staff and residents, although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, allegation “staff do not treat resident with dignity or respect” is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 29-AS-20251215220551

Allegation investigated: Staff is mismanaging resident's medication.

Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegation. During today’s visit, the LPA met with Wellness Nurse, Brenda Morales, and explained the reason for the visit. Executive Director (ED), Scott Keawekane arrived during the visit. Entrance interview. During today's visit, between 09:40 a.m. and 11:30 a.m., the LPA conducted a plant tour, conducted interviews with three staff and one resident, conducted a medication review, a resident file review, and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C... Unsubstantiated Report Continued from LIC 9099... It was alleged that staff is mismanaging resident’s medication. It is the complainant’s concern that Resident #1 (R1) has been prescribed certain medications to help manage their pain; however, these medications are not being administered. Record review and interviews conducted revealed that R1’s current medication list includes the following pain medications: Norco 5-325 mg, 1 tablet by mouth every 6 hours as needed; Tylenol 8-Hour Extended Release 650 mg, 1 tablet by mouth every 8 hours as needed; and Tylenol 325 mg, 2 tablets by mouth every 4 hours as needed. According to the Medication Administration Record (MAR), the last time R1 received any PRNs was on 02/12/2025 for PRN Tylenol 650 mg. Staff interviews indicated that R1 frequently refuses medications, which has been ongoing since the beginning of the year. Staff also reported that they do not recall the last time R1 requested any PRN medication for pain. Further record review revealed that facility staff faxed R1’s Primary Care Physician (PCP) on 04/16/2025, to report R1’s repeated medication refusals and to inquire about possibly discontinuing the medications that R1 has been refusing. However, the facility has not received any orders or communication from the PCP regarding this matter. Staff stated that, in the meantime, they continue to document R1’s refusals on the MAR. Furthermore, during an interview, R1 stated that they have a low tolerance for pills and dislike taking medications. Based on the information obtained through record review and interviews, the Department has insufficient evidence to support the allegation of “staff is mismanaging resident’s medication”. Therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 29-AS-20251102182611

Allegation investigated: Facility staff are forcing resident to stay in their room alone Facility staff are not allowing resident to leave facility premises with responsible person

Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegations. Upon arrival, the LPA met with Health & Wellness Director, Marjorie Manning and explained the reason for the visit. The Executive Director, Scott Keawekane was unavailable during today's visit. Entrance interview. During today's visit, between 09:52 a.m. and 11:30 a.m., the LPA conducted a plant tour, observed the memory care unit, conducted interviews with three staff, two residents, attempted to interview Resident #1 (R1), and conducted a resident file review and obtained copies of pertinent documents relevant to the investigation. Report Continued on LIC 9099C… Unsubstantiated Report Continued from LIC 9099… It was alleged that facility staff are forcing resident to stay in their room alone. It was reported that R1 is being forced to stay inside their bedroom alone all day, and that staff redirect R1 back into the bedroom when R1 attempts to leave. Record review and interviews conducted revealed that R1 tested positive for COVID-19 on 09/05/2025. Staff stated they were instructed to follow public health guidelines, which include self-isolation for ten (10) days following a positive test, as well as wearing masks when around others. The facility has been conducting COVID-19 testing twice a week, with the last test being completed on 09/11/2025. However, staff reported that R1 refused to take the COVID-19 test on that date and has also refused testing today. Staff further added that R1 is allowed to leave their bedroom but is encouraged to wear a mask to help protect the other residents. Staff also noted that R1 is allowed to spend time outside in the garden when other residents are not present, as R1 does not like wearing a mask. Interviews conducted with other residents indicated that they have not witnessed staff forcing residents back into their rooms and stated that they are able to go anywhere they choose. During today’s visit, the LPA observed R1 walking in the hallway without a mask. Although staff encouraged R1 to wear one, the LPA did not observe staff forcing the resident to return to their bedroom or requiring them to wear a mask. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “facility staff are forcing resident to stay in their room alone”. Therefore, this allegation is deemed Unsubstantiated at this time. It was also alleged that facility staff are not allowing resident to leave facility premises with responsible person. It was reported that although R1 is allowed to have visitors and spend time in the courtyard, they are not allowed to participate in outings away from the facility unless the outing is strictly for medical appointments. Interviews with staff revealed that R1’s responsible person had inquired about taking R1 to a movie theater. Staff stated that the responsible person was strongly encouraged not to take R1 to public places, as R1 is unable to tolerate wearing a face mask for more than five (5) minutes at a time. Staff further explained that R1’s responsible person was advised that outings should be limited to essential medical appointments due to the potential health risk. Furthermore, although staff discouraged non-essential outings over concerns that R1 might still be contagious and pose a risk to the public, they acknowledged that it is ultimately R1’s responsible person final decision. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegation of “facility staff are not allowing resident to leave facility premises with responsible person”. Therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 12, 2025 · control 29-AS-20250905153606

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Case Management - Incident visit at the facility today. Upon arrival LPA met with Health and Wellness Director Marjorie Manning and explained the reason for the visit. The purpose of today's visit was to investigate, review records and obtain pertinent copies of facility records pertaining to a self reported incident of alleged sexual abuse received by Community Care Licensing (CCL). It is alleged that on 07/27/2025, facility staff (S1) sexually abused client #1 (C1). During today's visit the LPA conducted interview with the Health and Wellness Director, C1, reviewed C1's and S1's records and obtained copies of pertinent documents. Further investigation is needed regarding the alleged sexual abuse. Exit interview held. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Martha Arroyo and Valeria Conway conducted an unannounced annual inspection. Upon arrival, the LPAs met with the Health & Wellness Director, Marjorie Manning and explained the reason for the visit. Entrance interview conducted. Starting at 10:05am, the LPAs along with the Health & Wellness Director, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: RESIDENT ROOMS/RESTROOMS: The LPAs observed five (5) resident rooms in the assisted living side and six (6) resident rooms in memory care. All resident rooms were furnished appropriately, with clean linens and appropriate furnishings. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:20am, the hot water temperature was measured in five (5) assisted living bathrooms and six (6) memory care bathrooms, and the temperature measured within the required range of 105 – 120 degrees Fahrenheit. KITCHEN: Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. The LPAs observed sufficient perishable and non-perishable foods to meet the minimum two-day and seven-day supply of food and water. Refrigerator and food pantry were checked for proper labels and expiration dates and food labels had expiration date clearly marked. An adequate amount of emergency food and water was observed; properly stored. Report Continued on LIC 809C... Report Continued from LIC 809... COMMON AREAS: The LPAs observed common areas to be clean and in good condition. There are games and/or activity supplies in the activity rooms as well as throughout the facility. There was sufficient space to accommodate both indoor and outdoor activities. The facility maintained a comfortable temperature. Required postings were observed throughout the common space. The LPAs observed stairwells to have emergency evacuation chairs. There were no obstructions and/or tripping hazards throughout the facility. Emergency exiting plans/sketch are posted throughout the facility. Several fire extinguisher are located throughout the facility and were observed to be fully charged and last serviced on 04/18/2025. OUTDOOR SPACE: The LPAs observed the outdoor garden in assisted living and memory care which had shaded seating areas for resident use. All passageways were observed to be clear and free of hazards. RECORD REVIEW: The LPAs reviewed resident and staff records beginning at 12:25pm. Ten resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All records were in order. Ten personnel files were reviewed for, but not limited to: personnel records, health assessments with TB results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All files were complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPAs reviewed the facility's infection control policy as well as their emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Daily vehicle inspection list, current registration, and insurance was reviewed for facility vehicle. Report Continued on LIC 809C... Report Continued from LIC 809C... The last fire safety inspection was completed on 10/15/2024 and was found to be in compliance with Fire Code Regulations at the time of inspections. Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 04/18/2025. During today's visit, the LPAs interviewed one staff and two residents. No concerns were noted. MEDICATION REVIEW: The LPAs reviewed medications at approximately 11:25am. Medications are centrally stored in locked medication carts on the 2nd floor and on the 3rd floor. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications are properly documented on the centrally stored medications and destruction record. Medications appear to be given as prescribed. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Martha Arroyo conducted a Case Management - Deficiencies visit due to a deficiency observed during the investigation of a self-reported incident. During today’s walkthrough, the LPA observed a video camera in the bedrooms of two (2) residents. Facility staff indicated the camera was placed by the resident’s family. Record review and interview conducted revealed that there is not an approved exception request on file with the Department allowing the use of cameras inside either resident’s room. Citation issued. Exit interview. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569 · Plan of correction due date: Feb 19, 2025

Amended to reflect no citation issued.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management - Incident visit to follow up on a SOC 341 received by the department on 02/11/2025. Upon arrival, the LPA met with Health and Wellness Director, Marjorie Manning and explained the reason for the visit. Entrance interview conducted. The report stated that Resident #1’s (R1’s) family reported to the facility that Staff #1 (S1) is stealing medication from R1’s bedroom. During today’s visit, starting at 2:00pm., the LPA conducted a plant tour to ensure there are not health and safety hazards and observed eight (8) resident bedrooms. Additionally, between 2:15pm and 2:30pm, the LPA conducted interviews with four residents, conducted a staff interview at 12:25pm, and conducted a resident file review at approximately 12:45pm and obtained copies of pertinent documents relevant to the investigation. The LPA will return at a later date to complete the investigation if warranted. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management - Incident visit to follow up on an Incident Report (LIC 624) received by the department on 01/10/2025. Upon arrival, the LPA met with Executive Director (ED), Scott Keawekane and explained the reason for the visit. Entrance interview conducted. The written report stated that on 01/10/2025 at approximately 1:05am, Staff #1 (S1) reported that at 12:50am while assisting Resident #1 (R1) with repositioning, R1 began to caress S1’s arm. Although S1 told R1 “not to do that” and attempted to back away from R1 but was unsuccessful. S1 pushed R1 back and left room. S1 reported incident to Staff #2 (S2) and Staff #3 (S3) after leaving R1’s room. Ventura County Sherriff’s department were also called and arrived at the facility shortly after. During today’s visit, LPA Arroyo conducted a physical plant tour at 2:39pm, interviewed two staff and one resident between 2:50pm and 3:30pm, and obtained copies of pertinent documents. The LPA will return at a later date to complete the investigation if warranted. No immediate or potential health and safety concerns noted at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jan 21, 2025

Allegation investigated: Staff handled resident roughly resulting in injury Staff do not ensure resident hygiene needs are met Staff do not treat resident(s) with dignity and respect

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above. LPA arrived at the facility at 09:08AM and was greeted by front desk staff. LPA was informed Pending Administrator Scott Keawekane was unavailable during today’s visit. LPA met with Resident Care Director Marjorie Manning. Entrance interview conducted. During today’s visit, LPA interviewed Resident #1 (R1) at 09:25AM. During an initial visit conducted on 11/29/2023, LPA toured the facility with Health and Wellness Director at 01:48PM, interviewed Health and Wellness Director at 02:08PM, and LPA reviewed and received copies of documents pertinent to the investigation. No immediate health and safety concerns were observed during facility tour. During a subsequent complaint visit conducted on 11/05/2024, LPA toured the facility with pending Administrator at 11:35AM and LPA interviewed staff and residents between 10:35AM to 02:00PM. Throughout the course of the investigation, LPA reviewed all pertinent documents. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Allegation: Staff handled resident roughly resulting in injury: The complaint alleges that Staff #1 (S1) was observed being rough with residents, resulting in bruising to Resident #1 (R1)’s leg. Throughout the investigation, LPA interviewed various staff and residents, including S1, LPA observed R1 during the initial visit, and interviewed R1 during today's visit. LPA did not observe bruising on R1’s leg during the initial visit. Residents interviewed, including R1, indicated care staff is helpful and all residents interviewed denied the allegation. One resident interviewed did indicate staff rush when providing care, but clarified staff are not rough, just quicker than the resident prefers. Staff interviewed indicated they have never witnessed another staff nor have they heard from any residents that staff were rough. Staff also stated that any bruising or unusual marks observed are reported on a skin check form. R1 did not have any observed injuries at the time period of the complaint, therefore did not have any skin check forms to review. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “staff handled resident roughly resulting in injury” is deemed UNSUBSTANTIATED at this time. Allegation: Staff do not ensure resident hygiene needs are met: The complaint alleges that S1 does not encourage residents to shower and communicates to direct residents to deny shower assistance. Staff interviewed indicate that most residents receive shower assistance twice a week, which is documented in their shower schedule. If a resident declines a shower at a specific day or time, the staff will offer a sponge bath instead of a full shower or they will offer the shower at a different time. Shower refusals are documented and when a resident does refuse showers, the facility staff will communicate with the resident’s family. Staff indicated there are some residents who do not want to shower at a particular time, especially in the morning in the fall when the weather is cooler. But typically, the facility staff is able to provide a shower later in the day when the weather warms up. No staff interviewed reported ever witnessing this type of communication and said if anything, the facility staff are observed to be too accommodating. Residents interviewed felt their showering needs are met and had no concerns with the staff communication related to showering. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “staff do not ensure resident hygiene needs are met” is deemed UNSUBSTANTIATED at this time. Report Continued on LIC 9099-C Allegation: Staff do not treat resident(s) with dignity and respect: The complainant indicates that S1 is disrespectful in their communication with residents. LPA interviewed staff and residents, including R1, related to this allegation. Residents interviewed indicated that the staff are kind and helpful. One resident stated that the staff does not like her cat, but that they are nice to the resident. No residents reported any concerns with the staff being disrespectful or not treating them with dignity. Staff interviews revealed sometimes residents don’t like if the staff leave the door to their room open or cracked open, but no concerns about staff being disrespectful. All staff interviewed denied ever hearing any other staff not treating residents with respect. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation “staff do not treat resident with dignity and respect” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 26, 2024 · control 29-AS-20231128101329

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

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegations listed above. LPA arrived at the facility at 09:55AM and was greeted by front desk staff. LPA met with pending Administrator Scott Keawekane who is also the Administrator of the skilled nursing facility attached to this property. Entrance interview conducted. During today's visit, LPA toured the facility with pending Administrator at 11:35AM and LPA interviewed staff and residents between 10:35AM to 02:00PM. During an initial complaint visit conducted on 11/27/2023, LPA interviewed Executive Director at 01:08PM, toured the facility with Health and Wellness Director at 02:00PM, interviewed staff between 01:57PM and 03:00PM, and LPA reviewed and received copies of documents pertinent to the investigation. The following was then determined: Report Continued on LIC 9099-C Substantiated LPA conducted both resident and staff interviews as well as reviewed call response logs for the time period surrounding the complaint. Staff interviewed indicated they try to respond as soon as possible when a resident pushes their button for assistance. The facility policy is no more than a 5 (five) to 10 (ten) minute call response. At the time of the complaint, staff reported there had been some functionality issues with the computer system the facility utilizes. This resulted in calls not showing up even when a resident pushed their button for assistance, so staff were unaware the resident pushed their call button. Residents interviewed indicated that it takes too long for staff to respond when the resident needs assistance up to 30 minutes. Staff interviewed confirmed that at the time of the complaint, residents were waiting too long. A review of Code Alert Alarm Response Report provided for 8 (eight) days around the time of the complaint revealed 49 (forty nine) calls that had a call response time of greater than 10 (ten) minutes, of which 12 (twelve) had a response time of 20-30 minutes, and 2 (two) that were over 30-minute response. Based on interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided. It was alleged that staff were tested positive for COVID, yet continued to work at the facility wearing masks. During the initial visit, LPA did observe facility staff wearing surgical masks. LPA inquired as to why staff were wearing masks and facility management indicated it was a precaution due to flu season and the upcoming holidays. Interviews revealed that there was a staff on the skilled nursing side of the facility that had recently tested positive for COVID, but that this staff had not recently worked in the Assisted Living side of the facility. Management indicated there were no current active staff cases that had been reported. LPA confirmed with Ventura County Public Health that at the time of the complaint there was no active outbreak at this facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time. No citations issued related to the above allegation. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 29-AS-20231122165440

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 19, 2024

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. In addition to the rights listed...To care, 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: The licensee did not comply with the above cited section as interviews and record review of alert response times revealed many responses were not completed in a timely manner, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 5, 2024

Plan of correction: Administrator will submit a plan to conduct testing on the call buttons to ensure they are functioning properly and conduct audits on response times.

Allegation investigated: Neglect/Lack of Care and Supervision – Facility resident sustained multiple pressure injuries as a result of facility neglect. Staff did not address resident's change in condition in a timely manner. Staff did not ensure that resident's hygiene needs were met. Facility bathroom(s) is in disrepair. Staff did not ensure that resident's clothing needs were met.

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to deliver findings for the above allegations. LPA met with back-up administrator Scott Keawekane who is the administrator of the skilled nursing facility attached to this property. Administrator Gena Grundes is out on a leave of absence. LPA met with administrator Keawekane and explained the reason for the visit. On 04/29/2024, the Department received a complaint regarding an allegation for Neglect/Lack of Care and Supervision. Facility Resident #1 (R1) sustained multiple pressure injuries as a result of facility staff neglect. The complaint also alleged staff did not address R1’s change in condition in a timely manner. The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Dennis Seng. (continued on LIC9099C) Substantiated (continued from LIC9099A) Regarding the allegations "Staff did not ensure that resident was fed" and "Staff isolated resident", LPA reviewed records for resident #1 (R1) which indicated R1 could eat meals independently. R1 started out eating meals in the dining room but later requested all meals be served in their room. S1 recalled due to R1's condition with edema in their legs and R1's need for constant oxygen, walking was painful appeared to be uncomfortable due to the edema and shortness of breath. S1 suspected that was the reason R1 did not like to get out of their recliner and go to the dining room or participate in activities. R1 was brought trays for each meal. S1 observed R1 ate most of their meals. In addition, R1's physician's report indicated R1 was capable of communicating their needs and feeding themself. Based on this information, these allegations are deemed Unsubstantiated at this time. Regarding the allegation "Staff do not ensure that facility is kept in a clean condition", LPA interviewed the maintenance director who stated housekeeping cleans the residents' rooms a minimum of once a week or as needed if there is an accident. Trash is removed from the room daily by caregivers. S1 stated they remove trash from residents' rooms at least one time per shift. R2 stated trash was removed from their room three times per week and their room is cleaned by housekeeping once a week. During LPA's visit, LPA observed R2 had a full trash can sitting outside R2's door. R2 stated it had been a couple days since the trash was emptied and R2 called the front desk to let them know the trash can was full. R2 stated they had never done that before and it was very unusual. R2 thinks the caregiver forgot to take the trash out. R2 had no complaints about anything at the facility, including cleanliness. Based on interviews this allegation is deemed Unsubstantiated at this time. Exit interview conducted, appeal rights discussed, and a copy of this report issued. (continued from LIC9099) On 05/01/2024, from 9:15 a.m. to 10:47 a.m., LPA Kelly Dulek conducted an initial complaint visit. During the visit, from 9:18 a.m. to 10:05 a.m., the LPA interviewed and toured the facility with the Executive Director (ED) and reviewed and obtained copies of documents pertinent to the investigation. No immediate health and safety concerns were observed during the facility tour. On 05/15/2024, from approximately 11:35 a.m. to 3:39 p.m., Investigator Seng conducted interviews with R1’s Resident Representatives; on 05/16/2024, from approximately 1:03 p.m. to 3:09 p.m., with the facility Administrator, Director, Wellness Nurse, Med Tech, caregivers, and residents; on 07/05/2024, at approximately 4:24 p.m., with R1; on 08/09/2024, at approximately 3:23 p.m., with St. John’s Hospital Case Social Worker Supervisor; and on 08/23/2024, at approximately 3:27 p.m. with the Long Term Care Ombudsman (LTCO). In addition, the investigator reviewed St. John’s Hospital medical records, photos of R1’s pressure injuries, and facility file documents related to the investigation. According to R1’s Preplacement Appraisal conducted on 06/05/2024, R1 suffered from COPD, Congestive Heart Failure (CHF), Anxiety, High Cholesterol, High Blood Pressure, Type Two Diabetes, had thyroid and gallbladder removed, and used a walker or wheelchair. R1 was listed as non-ambulatory as R1 was able to use their walker to walk for short distances only. R1 required assistance with putting on and removing R1’s compression socks. The report also documented R1 showed signs of forgetfulness. Per R1’s Physician’s Report completed on 06/16/2023, R1 required assistance with showering, was non ambulatory, able to administer own oxygen, able to dress and groom self, feed self, take care of own toileting needs, but was unable to shower self, requiring showers with assistance. R1 had no history of skin breakdown. Because R1 had a history of CHF, this caused edema which resulted in R1’s legs swelling, thus the need for medication, leg elevation and compression socks to alleviate the swelling. The facility file records indicated R1 was admitted to the assisted living portion of the facility on 06/30/2023. (continued on LIC9099C) (continued from LIC9099C) A review and summary of the medical records documented on 04/23/2024 at approximately 5:52 p.m., R1 was admitted to St. John’s Hospital for treatment of a severe cough. The diagnosis included Congestive Heart Failure (CHF), Gait instability, Edema, Hypertension (HTN), Hyperlipidemia (HLD), Gastroesophageal Reflux Disease (GERD), Hypothyroidism, Restless leg, Dementia, Agitation due to dementia, and Dyspnea. R1 was seen for a consult on 04/25/2024 at approximately 6:32 a.m. by the Registered Nurse (RN) for shortness of breath (SOB), bilateral lower extremity (BLE) edema, venous stasis, HTN, dementia, obesity, incontinence, weakness, and agitation. R1’s pressure injuries consisted of multiple decubitus ulcers. R1 had several wounds and skin breakdowns on the sacral area, abdominal fold, feet, and breasts. R1 was discharged from the hospital on 05/02/2024. The investigation revealed R1 suffered from congestive heart failure (CHF) and was told to elevate R1’s legs. R1 was only able to do this on R1’s bed. Staff made multiple attempts to try and convince R1 to lie on R1’s bed to do this; however, R1 refused and instead sat in R1’s recliner, where R1 was unable to elevate R1’s legs. This sustained sitting caused R1 to develop pressure injuries to R1’s lower back and coccyx. Staff offered to bathe and change R1’s clothing multiple times; however, R1 also refused their assistance. As staff was unable to assist, they could not conduct body checks on R1 to determine whether R1 sustained any pressure injuries. Although the facility maintains R1 was independent and did not require any assistance, according to R1’s preplacement appraisal completed at the time of admission June 2023, R1 needed staff to assist R1 with R1’s compression socks. By February 2024, the facility noted that R1 was starting to show signs of dementia and depression, R1 began to withdraw and stayed in their room, yet R1’s level of care was not increased. Staff were aware that R1 would lie in R1’s recliner and was sleeping in it as well, but there is no indication the facility notified R1’s doctor or conducted a reappraisal to address this issue. While R1 has a personal right to sleep in R1’s chair overnight, allowing R1 to do so likely contributed to the development of R1’s pressure injuries. The facility’s failure to intervene also likely contributed to R1’s venous/stasis ulcers. (continued on LIC9099C) (continued from LIC9099C) Based on files obtained and interviews conducted, the Department found sufficient evidence to prove that the facility was responsible for the neglect leading to R1 sustaining multiple pressure injuries. This included the facility not conducting a reappraisal for R1 to address R1’s change of condition. Therefore, the allegations “Neglect/Lack of Care and Supervision – Facility resident sustained multiple pressure injuries as a result of facility neglect” and “Staff did not address resident's change in condition in a timely manner” are deemed Substantiated at this time. During LPA Camara's visit on 9/13/2024, LPA interviewed staff 1 (S1) at 11:11 a.m. S1 has been a caregiver at this facility for approximately eight (8) months and recalled providing care to R1. LPA also reviewed facility records pertaining to R1. The facility assessment completed on 7/31/2023, indicated R1 needed minimal assistance with clothing and required stand-by assistance with showering. S1 recalled when arriving in the mornings and R1 was already dressed sitting in their recliner. S1 would sometimes need to assist R1 with getting dressed, especially if R1's clothing was not smelling fresh. R1 would sometimes refused assistance with changing clothing. S1 did not work on R1's shower days but S1 recalled other caregivers stating R1 frequently refused showers. Caregivers would notify the facility nurses if R1 refused care. As stated previously in this report, there was no indication facility management contacted R1's physician regarding R1's refusal of care (self-neglect). Therefore, the allegations "Staff did not ensure that resident's hygiene needs were met" and "Staff did not ensure that resident's clothing needs were met" are deemed Substantiated at this time. (continued on LIC9099C) (continued from LIC9099C) S1 also recalled observing R1's toilet had overflowed at least twice. One time maintenance was there and fixed it immediately. Another time, S1 arrived in the morning and observed the toilet had overflowed. S1 was told it had overflowed the night before but maintenance staff was not at the facility during the night so R1 was told it would have to wait until the next day. S1 believes the staff at night did not know they should have called someone so maintenance could come and fix the toilet that night. LPA Camara had interviewed the maintenance director over the phone at 10:50 a.m. during LPA's 9/13/2024 visit, and the maintenance director stated they would come to the facility at night to fix an overflowing toilet as that is considered an emergency. Based on these interviews, the allegation "Facility bathroom(s) is in disrepair" (regarding R1's toilet), is deemed Substantiated at this time. A $500 immediate civil penalty is assessed today. The administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Sep 13, 2024 · control 29-AS-20240429161933

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(a) · Plan of correction due date: Sep 25, 2024

§1569.312(a) Basic services requirements. Basic services shall at a minimum include: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff neglect led to R1 sustaining multiple pressure injuries, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 13, 2024

Plan of correction: Licensee will submit a plan how they will ensure appropriate care and supervision to meet the needs of residents. Submit to CCL by 9/20/2024. An immediate civil penalty of $500 is warranted in accordance with California Health and Safety Code Section 1569.49(c)(1)

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a)(3) · Plan of correction due date: Sep 25, 2024

87463(a)(3) Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff did not conduct a reappraisal to address resident's change in condition, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 13, 2024

Plan of correction: Licensee will submit a plan how they will ensure reappraisals are conducted to address a resident’s change of condition. Submit to CCL by 9/20/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 25, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above. Facility staff left R1's toilet inoperable overnight, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 13, 2024

Plan of correction: Licensee will submit a plan how they will ensure all staff understand how to ensure the facility is properly maintained and what constitutes a maintenance emergency. Submit to CCL by 9/20/2024.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Teresa Camara conducted a Case Management - Deficiencies visit due to a deficiency observed during the investigation of complaint #29-AS-20240429161933. LPA met with back-up administrator Scott Keawekane who is the administrator of the skilled nursing facility attached to this property. Administrator Gena Grundes is out on a leave of absence. LPA met with administrator Keawekane and explained the reason for the visit. During the Department’s investigation of complaint #29-AS-20240429161933, the following deficiency was observed: The facility did not submit a Special Incident Report (SIR) to Community Care Licensing (CCL) to notify that on 04/23/2024 at approximately 5:52pm, Resident #1 (R1) was admitted to St. John’s Hospital for treatment for a severe cough. In addition, R1 was diagnosed with shortness of breath (SOB), bilateral lower extremity (BLE) edema, venous stasis, HTN, dementia, obesity, incontinence, weakness, and agitation. R1’s pressure injuries consisted of multiple decubitus ulcers. R1 had several wounds and skin breakdowns on the sacral area, abdominal fold, feet, and breasts. The facility also failed to notify R1's physician and the Department of R1's change of condition observed prior to 04/23/2024. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC809-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Sep 13, 2024

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87211(a)(1)(B) · Plan of correction due date: Sep 25, 2024

87211(a)(1)(B) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following…(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…..(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit an incident report when R1 was hospitalized on 04/23/2024, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 13, 2024

Plan of correction: The licensee will submit a plan describing how they will ensure reporting requirements are followed and have administrator and health director complete Reporting Requirement training. Submit proof to CCL by 9/20/2024.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Teresa Camara, Kelly Dulek, Angela Barutyan, and Trevor Byrne arrived unannounced to conduct a required annual visit. The LPAs met with Health and Wellness Director (HWD) Caitlan Hoslett and Executive Director (ED) Gena Grundeis. LPAs informed them of the reason for the visit. Entrance interview conducted. LPAs Camara, Barutyan, and Byrne along with the HWD conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. The following was observed: The facility is a three-story building. There are resident rooms on all three floors, units are designated for independent living residents on the third floor, assisted living residents on all three floors and a separate secured unit on the first floor is designated for residents in the memory care unit. There is a skilled nursing facility attached to the facility which is not under Community Care Licensing purview. Common Areas: There were no obstructions and/or tripping hazards observed during facility tour. The facility maintains a comfortable temperature throughout the building. There are fire extinguishers throughout the facility, which were fully charged and last serviced 12/8/2023. Carbon monoxide detectors, hardwired smoke detectors, fire doors and sprinkler system are inspected monthly by the maintenance team. Johnson Controls conducted an annual inspection of the sprinkler system and smoke detectors 10/16/2023 - 10/18/2023. Evacuation drills are conducted monthly with all shifts with the last drill being conducted on 5/30/2024. The facility has a current emergency disaster plan which was adequate. Planned activities are offered and the activity schedule is posted throughout the facility. All activity rooms and common spaces appeared clean and in good repair. Cleaning supplies and disinfectants are stored locked per regulation. A working telephone is present. The LPAs observed the required postings in the common area. Report Continued on LIC 809-C (continued from LIC809) Resident Rooms: The facility consists of shared and private resident rooms, of which the LPAs observed 10 resident rooms; 3 in Memory Care and 7 in Assisted Living. All resident rooms observed were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Resident Restrooms: Each resident room contains its own private restroom; full restrooms were observed in Assisted Living and half-bathrooms in Memory Care, with a common shower room. Resident restrooms observed contained sufficient grab bars and non-skid surfaces. Water temperatures were checked in all resident restrooms observed, and measured 112.5 degrees Fahrenheit to 117.3 degrees Fahrenheit which is within the required range. Outdoor Space: Multiple seating areas in both Assisted Living and Memory Care were observed with tables and chairs and shaded seating areas for resident use. Resident Record Review: LPA Dulek reviewed 5 (five) resident records for documents including, but not limited to: physician's report, TB test, needs and service appraisals, admission agreements, and personal rights. 5 (five) of 5 (five) resident records reviewed contained all appropriate documents. Kitchen: The LPAs observed the kitchen/dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food, including an emergency supply. Medication Review: The LPAs along with the HWD reviewed medications for three residents. All medications appeared to be given as prescribed, however staff do not correctly complete the Centrally Stored Medication and Destruction Record. Staff File Review: LPA Dulek reviewed files for 5 (five) staff. The files were reviewed for documents including but not limited to: fingerprint background clearance, health screening, TB test, and training. Four out of the five files reviewed lacked the required number of training hours, including medication training and dementia care training. interviews: The LPAs interviewed four residents and three staff. No concerns noted. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 21, 2024