Atria Walnut Creek

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

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

On 08/18/2026 at 10:15 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, the LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene. Licensing Program Manager (LPM) Lizette Chan arrived at 11:15 AM to accompany LPA. During this visit, the LPA and LPM observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 6 direct caregivers completing only direct caregiving tasks for the 36 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 36 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio). The Quality Evaluation Committee (QEC) completed the eleventh quarterly audit on 06/15/2026. The QEC sent a copy of the report to the Department on 07/10/2026. The LPA and LPM reviewed Stipulation Training and Stipulation Acknowledgement documents for April, May, and June 2026. The LPA and LPM verified that all staff were trained as required in the stipulation. The LPA and LPM verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA and LPM verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff in the cabinet behind the front desk. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 18, 2026

Type of visit: Case Management - Health Checks

On 08/04/2026, at 03:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a health and safety check as a result of a priority 1 complaint #15-AS-20260804084604. The LPA informed the Executive Director (ED) Anthony Jones of the purpose of the visit. At approximately 5:00 PM, the LPA and the ED toured the community's memory care area, Life Guidance (LG). The tour included both the first and the second floor of LG. The tour on each floor included, but was but not limited to, resident rooms and bathrooms, dining rooms, kitchens, and common areas. At 5:11 PM, the temperature in the hallway of the second floor was 77 degrees Fahrenheit. The maximum hot water temperature at 5:16 PM in the second floor kitchen was measured at 111 degrees Fahrenheit. The LPA and ED also toured the garden area on the first floor. There is more than the minimum of a 7-day supply of nonperishable foods and 2-day supply of perishable foods in the main kitchen. During the tour, the LPA observed adequate lighting for the comfort and safety of residents in all rooms. The passageways, inside and outside, are free of obstruction and there are no bodies of water. The fire extinguishers were fully charged and last serviced on 04/27/2026. The medications are stored in a locked medication cart on both the first and the second floor. The first aid kit is stored in the medication carts and it was observed to be complete. No citations were issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 4, 2026

Type of visit: Required - 1 Year

On 06/09/2026, at 04:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this Required Annual inspection. Upon entry, the LPA stated the purpose of the visit to Executive Director Anthony Jones, Sr. and Maintenance Director (MD) James Camper. The LPA toured the interior and exterior of the facility. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council. The LPA observed adequate lighting for the comfort and safety of residents throughout the community. The facility's fire extinguishers were last serviced on 01/08/2026. The walkways in both the interior and exterior of the facility are free from obstructions. There is a fish pond with a bridge over it. The wooden handrails on the sides of the bridge are approximately 2.5 feet in height along the entire length of the bridge. The rest of the pond is surrounded by a metal fence between 3.0 and 4.5 feet in height. The Emergency Disaster Plan was reviewed by the ED on 05/27/2026. Emergency and disaster drills are conducted monthly; the most recent was conducted on 05/27/2026. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The LPA reviewed 5 Resident, 5 Staff, and the Facility records. No citations were issued for deficiencies during this inspection. This annual inspection is not complete. The LPA will return unannounced at a later date and time to complete this inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 9, 2026

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

On 06/09/2026 at 03:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, the LPA stated the purpose of the visit to Executive Director (ED) Anthony Jones, Sr. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 6 direct caregivers completing only direct caregiving tasks for the 39 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 39 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio). The Quality Evaluation Committee (QEC) completed the tenth quarterly audit on 03/25/2026. The QEC sent a copy of the report to the Department on 04/14/2026. The LPA reviewed Stipulation Training and Stipulation Acknowledgement documents for January, February, and March 2026. The LPA verified that all staff were trained as required in the stipulation. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff in the cabinet behind the front desk. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 9, 2026

Type of visit: POC

On 05/18/2026, at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this visit concerning issues related to recent complaints. The LPA informed Executive Director (ED) Anthony Jones, Sr. of the reason for the visit. During the visit, the LPA met with the ED concerning the two (2) citations issued on 05/01/2026 for complaint 15-AS-20260318143914. The Plans Of Correction (POCs) issued on 05/01/2026 have due dates of 05/08/2026. During that meeting, the ED confirmed that no proof had been sent to the LPA on or before the due date of 05/08/2026 for those two (2) citations. Because no proof of correction was sent to the LPA, two civil penalties of $1,000 each, for a total of $2,000, were issued (refer to LIC421FC). No citations were issued during this visit. Exit interview conducted and a copy of this report and the LIC421FCs were provided.the state’s words, verbatim · CDSS document, May 18, 2026

Type of visit: Case Management - Other

On 04/28/2026, at 4:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to collect additional information and conduct interviews concerning complaint 15-AS-20260318143914. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) Anthony Jones, Sr. The LPA conducted the interviews and collected additional information. No citations issued during this visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Other

On 04/14/2026, at 8:30 AM, Licensing Program Analyst (LPA) James Sampair arrived at the facility unannounced to amend and to deliver that amended Complaint Investigation Report (LIC 9099) originally issued on 04/01/2025 for complaint 15-AS-20250328093839. The LPA met with Executive Director (ED) Anthony Jones, Sr. and explained the purpose of the visit. During the visit, the LPA amended the 04/01/2025 LIC 9099 and delivered the amended LIC 9099 to the ED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 14, 2026

Allegation investigated: Licensee is not ensuring faucets used by residents for personal care deliver hot water

On 03/25/2026, at 8:30 AM, Licensing Program Analyst (LPA) James Sampair arrived at the facility unannounced to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Staff Member Gianna "Gigi" MyerExecutive Director (ED) Anthony Jones, Sr. The complaint alleges the Licensee is not ensuring faucets used by residents for personal care deliver hot water. The LPA measured the maximum hot water temperature in the rooms of Residents R1, R2, R3, R4, and R5. Two of the measure ments were from the second floor and one from the first, third, and fourth floors of the facility. The measurements were collected from 9:07 AM to 10:50 AM. The readings collected were in a range between 105.0 and 111.5 degrees Fahrenheit. Continued on LIC 9099-C. . . . Unsubstantiated . . . .Continued from LIC 9099 The LPA interviewed R1, R2, R3, R4, and R5 about experiences with their use of hot water. R1 stated that they wanted hotter water than the 9:07 AM reading of 108.8. They stated that it was not hot enough according to state regulation; it should have been at least 110 degrees. After the LPA informed them that the minimum temperature of hot water in this type of facility was 105.0 degrees, they asked that he return to measure again when it's usually colder. When the LPA returned at 10:50 AM, the reading was higher, at 111.5 degrees, to which they commented, "I guess my hot water is okay." R5 stated "most of us have had a problem at one time or another with the hot water", but was pleased to know that theirs was over the minimum temperature. R2, R3, and R4 all said they had not had a problem with the hot water being hot enough. The data collected does not support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 25, 2026 · control 15-AS-20260318084207

Allegation investigated: Staff not ensuring the facility is clean, safe, and sanitary at all times.

On 03/10/2026, at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived at the facility unannounced to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) Anthony Jones, Sr. The complaint alleges that staff not ensuring the facility is clean, safe, and sanitary at all times. The LPA interviewed the ED and Maintenance Director (MD) James Campers. The ED and MD were shown pictures sent by the Reporting Party (RP) of what the RP referred to as "unsecured outdoor appliances" and a "property hazard". The MD identified the appliances as trash waiting to be hauled away in the trash enclosure area. The LPA and ED went to the trash enclosure area. The LPA observed a clean, organized trash enclosure with two trash bins and several pieces too large for the bins stored to the side to be hauled away later. The data collected does not support the allegation. Continued on LIC 9099-C. . . . Unsubstantiated . . . .Continued from LIC 9099 Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 10, 2026 · control 15-AS-20260306163953

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

On 03/10/2026 at 11:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, the LPA stated the purpose of the visit to Executive Director (ED) Anthony Jones, Sr. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 or 6 direct caregivers completing only direct care giving tasks for the 32 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 32 residents completing only direct care giving tasks (within the required 1 staff to 10 resident ratio). The Quality Evaluation Committee (QEC) completed the ninth quarterly audit on 12/22/2025. The QEC sent a copy of the report to the Department on 1/8/2026. The ED and LPA reviewed Stipulation Training documents for October, November, and December 2025 and all staff were trained as required in the stipulation. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 10, 2026

Allegation investigated: Staff did not dispense medications as prescribed.

On 2/19/2026, at 8:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) Anthony Jones, Sr. The complaint alleges that staff did not dispense medications as prescribed. The LPA interviewed the ED. The ED stated that on 2/17/2026, the medications were dispensed later than the facility standard due to a no show by Staff S1, who was subsequently terminated for job abandonment and insubordination. Since the facility's standard time for dispensing the medications is not the prescribed time, though they were short-staffed, all of the medications were dispensed as prescribed. The data collected does not support the allegation. Continued on LIC 9099-C. . . . Unsubstantiated . . . .Continued from LIC 9099 Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 19, 2026 · control 15-AS-20260217111037

Allegation investigated: Staff did not provide resident an itemized billing statement with cost of services. Staff do not treat resident with dignity or respect.

On 2/6/2026, at 1:45 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegations above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) Anthony Jones, Sr. The complaint alleges that staff did not provide resident an itemized billing statement with cost of services. The LPA interviewed Witnesses W1 and W2 by phone, met with the ED, and remotely met with Regional Care Director Alisa Salluce via Microsoft Teams. The LPA reviewed the Assisted Living Care Services and Rates form and the Resident Functional Needs Service Plan that were provided to the complainant. Together, the Assisted Living Care Services and Rates form and the Resident Functional Needs Service Plan provide the cost and the services to be provided to the resident. The data collected does not support the allegation. Continued on LIC 9099-C. . . . Unsubstantiated . . . .Continued from LIC 9099 The complaint alleges that staff do not treat resident with dignity or respect.. The LPA interviewed Witnesses W1 and W2 by phone, met with the ED, and interviewed Staff S1 in person. When asked if they or any other staff refer to residents as “baby”, both the ED and S1 said no. When asked if they or any other staff refer to a resident's undergarments as diapers, both the ED and S1 said no.The ED said that whenever a staff member makes an error like that, they are pulled aside and their error is corrected by a director. They both said that many residents refer to undergarments as diapers, but staff refer to them as briefs or pull-ups, without correcting residents. S1 said that she does everything she can to help R1 to feel comfortable and well cared for during her time assisting her with changing her briefs and going to bed, including the pulling up the covers and getting the television remote control in the right place so she can find it easily when she is in bed. The data collected does not support the allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove them; therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 6, 2026 · control 15-AS-20260202212822

Type of visit: Case Management - Other

On 1/8/2026 at 12:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to deliver amended complaints 15-AS-20250917124433 and 15-AS-20250925075747. Upon entry, the LPA stated the purpose of the visit to Executive Director (ED) Anthony Jones. The LPA and ED met. The LPA reviewed the amendments to the complaint report with the ED. The amended reports were signed by the LPA and ED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

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

On 10/27/2025 at 3:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, the LPA stated the purpose of the visit to Executive Director (ED) John O'Neil. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 or 6 direct caregivers completing only direct care giving tasks for the 33 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 33 residents completing only direct care giving tasks (within the required 1 staff to 10 resident ratio). The Quality Evaluation Committee (QEC) completed the eighth quarterly audit on 9/8/2025. The QEC sent a copy of the report to the Department on 9/24/2025. The ED and LPA reviewed Stipulation Training documents for July, August, and September 2025 and all staff were trained as required in the stipulation. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 27, 2025

Allegation investigated: Staff did not notify or mail a copy of the notice to quit to the resident's responsible person.

On 9/25/2025, at 2:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Community Business Director (CBD) Jobelle Dungca. The complaint alleges that staff did not notify or mail a copy of the notice to quit to Resident R1's responsible person. The LPA interviewed Witnesses W1 and W2 (R1's Responsible Person) by phone and the CBD in person at the facility. The LPA reviewed the notice to quit dated 9/22/2025 and served to R1 on 9/22/2025. Within the notice, it states that a copy of it was sent to W1 and W2. W1 and W2 stated that they had not received a copy, nor was W2 otherwise notified. This data supports the allegation. Continued on LIC 9099-C. . . . Substantiated . . . .Continued from LIC 9099 The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. The deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 25, 2025 · control 15-AS-20250925075747

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(c) · Plan of correction due date: Sep 26, 2025

87224 Eviction Procedures (c) The licensee shall, in addition to either serving the required thirty (30) days notice . . . notify or mail a copy of the notice to quit to the resident's responsible person. This requirement is not met as evidenced by: Based on an interview with Community Business Director Jobelle Dungca, the Department confirmed that staff had not notified or mailed a copy of the 9/22/2025 notice t o quit to W2, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: On or before the due date, the Licensee shall inform LPA Sampair that they have either: rescinded the 9/22/2025 notice to quit and served R1 and notified or mailed a copy of the recission to W2, or, they have issued a new notice to quit that has been served to R1 and notified or mailed a copy of the notice to quit to W2.

Allegation investigated: Staff did not notify or mail a copy of the notice to quit to the resident's responsible person.

On 9/25/2025, at 2:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Community Business Director (CBD) Jobelle Dungca. The complaint alleges that staff did not notify or mail a copy of the notice to quit to Resident R1's responsible person. The LPA interviewed Witnesses W1 and W2 (R1's Responsible Person) by phone and the CBD in person at the facility. The LPA reviewed the notice to quit dated 9/22/2025 and served to R1 on 9/22/2025. Within the notice, it states that a copy of it was sent to W1 and W2. W1 and W2 stated that they had not received a copy, nor was W2 otherwise notified. This data supports the allegation. Continued on LIC 9099-C. . . . Substantiated . . . .Continued from LIC 9099 The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. The deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 25, 2025 · control 15-AS-20250925075747

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(c) · Plan of correction due date: Sep 26, 2025

87224 Eviction Procedures (c) The licensee shall, in addition to either serving the required thirty (30) days notice . . . notify or mail a copy of the notice to quit to the resident's responsible person. This requirement is not met as evidenced by: Based on an interview with Community Business Director Jobelle Dungca, the Department confirmed that staff had not notified or mailed a copy of the 9/22/2025 notice t o quit to W2, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: On or before the due date, the Licensee shall inform LPA Sampair that they have either: rescinded the 9/22/2025 notice to quit and served R1 and notified or mailed a copy of the recission to W2, or, they have issued a new notice to quit that has been served to R1 and notified or mailed a copy of the notice to quit to W2.

Allegation investigated: Staff unlawfully evicted a resident.

On 9/18/2025, at 11:45 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) John O'Neil. The complaint alleges that staff unlawfully evicted a resident. The LPA interviewed Witness W1 by phone and the ED in person. The LPA reviewed the eviction notice sent to R1 dated 8/6/2025. The the eviction notice has the incorrect address and phone number for the Community Care Licensing Oakland Regional Office. The data collected supports the allegation. The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. Continued on LIC 9099-C. . . . Substantiated . . . .Continued from LIC 9099 The deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 18, 2025 · control 15-AS-20250917124433

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1)(C) · Plan of correction due date: Sep 19, 2025

87224 EVICTION PROCEDURES (d) . . . (1) The notice to quit shall include the following information: . . . (C) A statement informing residents of their right to file a complaint with the licensing agency . . . including the name, address and telephone number of the licensing office with whom the licensee normally conducts business . . . This requirement is not met as evidenced by: The eviction notice sent to R1 dated 8/6/2025 has the incorrect address and phone number for the Community Care Licensing Oakland Regional Office, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: On or before the due date, the Licensee shall deliver to Resident R1 a written eviction notice with the correct address and phone number of the Community Care Licensing Oakland Regional Office or a notice to R1 that the 8/6/2025 notice of eviction has been recinded.

Allegation investigated: Staff unlawfully evicted a resident.

On 9/18/2025, at 11:45 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegation above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) John O'Neil. The complaint alleges that staff unlawfully evicted a resident. The LPA interviewed Witness W1 by phone and the ED in person. The LPA reviewed the eviction notice sent to R1 dated 8/6/2025. The the eviction notice has the incorrect address and phone number for the Community Care Licensing Oakland Regional Office. The data collected supports the allegation. The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. Continued on LIC 9099-C. . . . Substantiated . . . .Continued from LIC 9099 The deficiency is cited under the California Code of Regulations listed on LIC 9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 18, 2025 · control 15-AS-20250917124433

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1)(C) · Plan of correction due date: Sep 19, 2025

87224 EVICTION PROCEDURES (d) . . . (1) The notice to quit shall include the following information: . . . (C) A statement informing residents of their right to file a complaint with the licensing agency . . . including the name, address and telephone number of the licensing office with whom the licensee normally conducts business . . . This requirement is not met as evidenced by: The eviction notice sent to R1 dated 8/6/2025 has the incorrect address and phone number for the Community Care Licensing Oakland Regional Office, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: On or before the due date, the Licensee shall deliver to Resident R1 a written eviction notice with the correct address and phone number of the Community Care Licensing Oakland Regional Office or a notice to R1 that the 8/6/2025 notice of eviction has been recinded.

Allegation investigated: Staff did not seek timely medical attention for a resident Staff did not provide healthful accommodations for the residents Staff mishandled a resident's personal belongings Staff mishandled a resident's medication Staff do not provide adequate care and supervision

On 8/25/2025, at 11:15 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to investigate the allegation above. Upon arrival, the LPA informed Executive Director (ED) Kelli Greene and ED John O’Neil of the purpose for this visit. The complaint alleges staff did not seek timely medical care for Resident R1. The LPA interviewed Witness W1 by phone. At the facility, the LPA interviewed ED Kelli Greene, who was the ED at the time of the incident. The LPA reviewed the Incident Report submitted to the Department that described the incident. The LPA reviewed R1’s individual service plan showing that R1 was independent and required no additional care. The data collected and analyzed by the LPA shows that staff did seek timely medical care for R1, which does not substantiate the allegation. Continued on LIC 9099-C . . . Unsubstantiated . . . Continued from LIC 9099 The complaint alleges staff did not provide healthful accommodations for R1. The LPA interviewed Witness W1 by phone. At the facility, the LPA interviewed ED John O’Neil. The LPA reviewed the Resident Monthly Assignment Reports for May, June, and July 2025, which showed that services were being provided by staff. The data collected and analyzed by the LPA shows that staff did provide healthful accommodations for R1, which does not substantiate the allegation. The complaint alleges staff mishandled R1’s personal belongings. The LPA interviewed Witness W1 by phone. At the facility, the LPA interviewed ED John O’Neil. The LPA reviewed the written statement by Staff S1 describing the incident wherein Witness W2 gave away items from R1’s room. The data collected and analyzed by the LPA shows that staff did not mishandle R1’s personal belongings, which does not substantiate the allegation. The complaint alleges staff mishandled R1’s medications. The LPA interviewed Witness W1 by phone. At the facility, the LPA interviewed ED John O’Neil. The LPA reviewed the Medication Release forms for R1’s medications. The data collected and analyzed by the LPA shows that staff did not mishandle R1’s medications, which does not substantiate the allegation. The complaint alleges staff did not provide adequate care and supervision for R1. The LPA interviewed Witness W1 by phone. At the facility, the LPA interviewed ED John O’Neil. The LPA reviewed the Service Care Plans and the Resident Monthly Assignment Reports for May, June, and July 2025, which showed that services were being provided by staff. The data collected and analyzed by the LPA shows that staff did provide adequate care and supervision for R1, which does not substantiate the allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove it; therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 15-AS-20250820094042

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

On 8/25/2025 at 9:15 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, the LPA stated the purpose of the visit to Community Business Director (CBD) Jobelle Dungca. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 or 6 direct caregivers completing only direct care giving tasks for the 38 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 38 residents completing only direct care giving tasks (within the required 1 staff to 10 resident ratio). The Quality Evaluation Committee (QEC) completed the seventh quarterly audit on 6/20/2025. The QEC sent a copy of the report to the Department on 7/14/2025. The CBD and LPA reviewed documents for May, June, and July 2025 pertaining to the stipulation requirements. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

Allegation investigated: Staff did not provide adequate supervision resulting in resident falling. Staff is overcharging resident. Staff did not safeguard resident's personal belongings.

On 2/07/2023 at 11:00 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with National Operations Specialist John O'Neil and explained the purpose of the visit. During the course of the investigation LPA interviewed W1 and S1, toured the Memory Care Unit and reviewed R1’s file. R1 was admitted to the facility on 10/27/21 to Assisted Living, R1 was transferred to Memory Care on 8/22/24. On 3/23/25 R1 was transferred John Muir Medical Center after a fall. R1 passed away on May 8, 2025. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** Allegation: Staff did not provide adequate supervision resulting in resident falling. W1 stated that she felt that if there were more staff in the Memory Care Unit her mother she wouldn’t have fallen. S1 stated that the staffing ratio in Memory Care is sufficient to meet the needs of the residents. LPA toured the Memory Care Unit and observed that staff were engaged with the residents. The unit was nicely decorated and free of odor. Review of R1’s Resident Functional Needs Assessment dated 2/06/25 documented that R1 was at a low risk for falls. Further review of R1’s file found that R1 had 2 falls in October 2024 and 1 in March 2025. This allegation is unsubstantiated. Allegation: Staff is overcharging resident. W1 feels that she shouldn’t have been charged six days in June. W1 voluntarily paid for April and May even though R1 was in the hospital because she wanted to keep R1’s room available to her if she recovered enough to return to the facility. At the end of May W1 decided R1 would not be returning to the facility but didn’t remove R1’s furniture from her apartment until 6/06/25. LPA reviewed the facility’s admission agreement with S1. The admission agreement states that “you will be responsible for payment of all charges…until you have removed all your possessions from the Community.” This allegation is unsubstantiated. Allegation: Staff did not safeguard resident's personal belongings W1 stated that when R1 was admitted to the facility she was wearing a diamond ring and at some point, the ring went missing. S1 stated that when a resident is transferred to Memory Care it is recommended to families to remove all valuable items for the safety of the residents. This allegation is unsubstantiated. This agency has investigated the above complaints. We have found that the complaints are unsubstantiated. Although the allegations 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 is UNSUBSTANTIATED Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 30, 2025 · control 15-AS-20250724103019

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

On 5/30/2025 at 9:00 AM, Licensing Program Analysts (LPAs) James Sampair and Andrew Christy arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, the LPAs stated the purpose of the visit to National Operations Specialist John O'Neil and Executive Director Kelli Greene. During this visit, the LPAs observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 6 direct caregivers completing only direct care giving tasks for the 30 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 30 residents completing only direct care giving tasks (within the required 1 staff to 10 resident ratio). The ED and LPAs reviewed documents pertaining to the stipulation requirements. The LPAs verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPAs verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The sixth quarterly audit was completed on 12/10/2024 and 12/11/2024. A copy of the report was sent to the Department on 3/18/2025. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 30, 2025

Type of visit: Required - 1 Year

On 05/30/2025 at 9:00 AM, Licensing Program Analysts (LPAs) James Sampair and Andrew Christy arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPAs stated the purpose of the visit to National Operations Specialist (NOS) John O'Neil. Executive Director (ED) Kelli Greene arrived at approximately 10:00 AM. The LPAs inspected the inside and outside of the facility, which included memory care (Life Guidance), the kitchen, dining room, common areas, resident rooms, and the grounds of the facility. An adequate amount of food supplies were observed, more than the required minimum of 2 days of perishable and 7 days of non-perishable food. The medication room serves as the central storage for medications, which was occupied during the inspection or locked when no staff member is present. The cleaning supplies and dangerous objects were inaccessible to residents. Fire extinguishers were last serviced on 04/10/2025 and the latest outside inspection of the fire suppression system was completed on 4/18/2025. The LPAs examined the chemical storage areas in Life Guidance, the Bistro, the Main Kitchen, and the fourth floor Housekeeping Storage. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. No citations issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 30, 2025

Type of visit: Case Management - Incident

On 5/7/2025, at 2:45 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a Case Management visit concerning an incident report submitted to the Department on 5/5/2025. Upon arrival, the LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene. The LPA met with the ED to gather the facts concerning the allegation by Resident R1 that they had been sexually molested by caregiver Staff S1 when S1 assisted R1 during a shower, as it had been reported to facility staff by family member W1. The ED reported the findings from a Walnut Creek Police officer and the internal investigation she had conducted. The finding was that no sexual molestation had occurred. No citations were issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 7, 2025

Allegation investigated: Staff did not ensure resident's room was free of bed bugs.

*****Amended Report from 04/01/2025 Delivered on 04/14/2026***** On 04/01/2025, at 1:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to investigate the allegations above. Upon arrival, the LPA informed Executive Director (ED) Kelli Greene of the purpose of the visit. The complaint alleges staff did not ensure resident's room was free of bed bugs. On 04/01/2025, the LPA interviewed Witness W1 by telephone, who stated that she had informed the ED two months earlier of the bed bug infestation in Resident R1’s room. On 04/01/2025, the LPA interviewed the ED and Regional Vice President (RVP) Natasha Georges in person. The ED and RVP stated that no bed bugs were found in R1’s room during the weekly bed bug checks conducted by housekeepers who inspect only beds. R1 does not sleep on her bed, she sleeps on her recliner so they missed the bed bugs there. On 04/01/2025, the LPA reviewed the 03/27/2025 Ecolab report for R1’s room that stated there was a “heavy infestation” of bed bugs in the room. The data collected supports the allegation. Continued on LIC 9099-C . . . Substantiated ....Continued from LIC 9099 Based on the information obtained by the LPA during the investigation, the preponderance of evidence standard has been met; therefore, the allegation above is SUBSTANTIATED. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099-D. Failure to submit Proof of Corrections (POCs) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 15-AS-20250328093839

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(2) · Plan of correction due date: Apr 2, 2025

87307 Personal Accommodations and Services (d) The following ... shall apply to all facilities: (2) The premises shall ... provide a safe and healthful environment. This requirement is not met as evidenced by: Based on record review of Ecolab report dated 03/27/2025 that states, "Bed bugs noted during inspection. Live activity found in room 326. Heavy infestation.", which poses an immediate health risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2025

Plan of correction: Facility cleared during inspection.

Allegation investigated: Staff did not ensure resident's a/c was not in disrepair.

*****Amended Report from 04/01/2025 Delivered on 04/14/2026***** On 04/01/2025, at 1:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to investigate the allegations above. Upon arrival, the LPA informed Executive Director (ED) Kelli Greene of the purpose of the visit. The complaint alleges staff did not ensure resident's a/c was not in disrepair. The LPA interviewed Witness W1 by telephone. The LPA interviewed the ED and Maintenance Director James Campers about the operation of the Heating, Ventilation, and Air Conditioning (HVAC) system. The system is fully operational. The data collected from the interviews shows that the staff are acting to ensure that it is not in disrepair, which does not confirm the allegation. Continued on LIC 9099-C . . . Unsubstantiated ....Continued from LIC 9099 Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 15-AS-20250328093839

Allegation investigated: Staff did not ensure resident's a/c was not in disrepair.

*****Amended Report from 04/01/2025 Delivered on 04/14/2026***** On 04/01/2025, at 1:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to investigate the allegations above. Upon arrival, the LPA informed Executive Director (ED) Kelli Greene of the purpose of the visit. The complaint alleges staff did not ensure resident's a/c was not in disrepair. The LPA interviewed Witness W1 by telephone. The LPA interviewed the ED and Maintenance Director James Campers about the operation of the Heating, Ventilation, and Air Conditioning (HVAC) system. The system is fully operational. The data collected from the interviews shows that the staff are acting to ensure that it is not in disrepair, which does not confirm the allegation. Continued on LIC 9099-C . . . Unsubstantiated ....Continued from LIC 9099 Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 1, 2025 · control 15-AS-20250328093839

Allegation investigated: Staff does not ensure resident is provided meals. Staff does not ensure admissions agreement is being followed.

On 2/20/2025, at 10:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to investigate the allegations above. Upon arrival, the LPA informed Executive Director (ED) Kelli Greene of the purpose of the visit. The complaint alleges staff does not ensure resident is provided meals. The LPA interviewed Witness W1 by telephone and in the resident’s room. The LPA reviewed the records concerning the resident, interviewed the ED, Compliance Director (CD) Patricia Hoguin, and interviewed the Resident Services Director (RSD) Risa Austria. The data collected from the interviews and record review shows the resident was provided meals, which does not confirm the allegation. Continued on LIC 9099-C . . . Unsubstantiated ....Continued from LIC 9099 The complaint alleges staff does not ensure admissions agreement is being followed. The LPA interviewed Witness W1 by telephone and in the resident’s room. The LPA reviewed the resident’s Admission Agreement, interviewed the ED, and interviewed the RSD. The data collected from the interviews and record review shows that the resident’s admission agreement was being followed, which does not confirm the allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 15-AS-20250219133726

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

On 2/20/2025 at 3:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene and Compliance Director (CD) Patricia Holguin. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 direct caregivers completing only direct care giving tasks for the 36 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 36 residents completing only direct care giving tasks (within the required 1 staff to 10 resident ratio). The CBD and LPA reviewed documents pertaining to the stipulation requirements. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The fifth quarterly audit was completed on 12/10/2024 and 12/11/2024. A copy of the report was sent to the Department on 12/17/2024. The facility passed all areas inspected of the first unannounced outside audit was completed on 10/02/2024 and by Chantelle Hudson of the RCS Allen Flores Consulting Group. A copy of the report was sent to the Department on 12/18/2024. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 20, 2025

Allegation investigated: Staff do not ensure that facility is maintained in good repair. Staff do not ensure that facility is maintained sanitary.

On 1/9/2025 at 2:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this initial 10-day complaint investigation concerning allegations above. LPA met with Executive Director (ED) Kelli Greene and informed her of the allegations. The complaint alleges staff do not ensure that facility is maintained in good repair. The LPA interviewed the ED and Maintenance Director (MD) James Campers. Both the MD and the ED were familiar with the leak. It is a major project for which they have already gotten a quote and approved the work order to make the necessary repairs that will be completed within 3 weeks. The data collected does not confirm the allegation. The complaint alleges staff do not ensure that facility is maintained in a sanitary manner. The LPA interviewed the ED, the MD, and Compliance Director (CD) Patty Hoguin. Based on the statements from the ED and MD concerning the needs of this resident and the services being provided to them on a daily basis, the staff have been working to support the needs of this resident and to maintain the facility in a sanitary manner. The data collected does not confirm the allegation. Continued on LIC 9099-C . . . Unsubstantiated .... Continued from LIC 9099 Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 15-AS-20250109115336

Allegation investigated: Staff do not ensure that facility is maintained in good repair. Staff do not ensure that facility is maintained sanitary.

On 12/26/2024 at 1:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this initial 10-day complaint investigation concerning allegations above. LPA met with Executive Director (ED) Kelli Greene and informed her of the allegations. The complaint alleges staff do not ensure that facility is maintained in good repair. The LPA interviewed the ED and Maintenance Director James Campers, both of whom stated that anytime there is a clogged toilet, Roto-Rooter is called and the repair is made as soon as possible. The data collected does not confirm the allegation. The complaint alleges staff do not ensure that facility is maintained in a sanitary manner. Based on the statements from the ED and Maintenance Director concerning the history of clogged toilets in the facility, especially since all of the toilets were replaced a month earlier, there was no evidence that any toilets were clogged and left unrepaired for more than one day. The data collected does not confirm the allegation. Continued on LIC 9099-C . . . Unsubstantiated ....Continued from LIC 9099 Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 26, 2024 · control 15-AS-20241224092714

Allegation investigated: Due to lack of supervision, resident eloped from the facility resulting in dealth from the heat.

On 12/05/2024 at 1:30 PM, Licensing Program Analysts (LPA) James Sampair and David Doidge arrived unannounced to deliver findings on the allegations above. The LPAs informed Executive Director Kelli Greene of the reason for the visit. The complaint alleges that due to lack of supervision, Resident R1 eloped from the facility resulting in death from the heat. The Department's investigation included, but was not limited to, interviews with staff and residents. The Department obtained and reviewed records pertaining to Resident R1, which included facility records, staff records, medical records, Walnut Creek Police Department (WCPD) records, Contra Costa County Fire Protection District Emergency Medical Services (EMS) records, and R1’s death certificate. Video footage from the facility shows R1 leaving the facility on their own. WCPD records show that after an extensive search R1 was found dead due to a cardiac arrest off the facility grounds. Continued on LIC 9099-C . . . Unsubstantiated . . . Continued from LIC 9099-A Facility records show that R1 required assistance with mobility, showering, and transferring in and out of bed. R1’s level of care was listed as Level 1. R1 was otherwise independent with no diagnosis of dementia. Staff reported that R1 was independent and often declined assistance with showering and other tasks. Due to R1’s level of independence, R1’s care plan did not include routine status checks. Staff interviews and facility records did not suggest a change in condition for R1. Care staff and management reported that they undergo elopement training once a month. Residents were interviewed and had no concern about the care provided by staff. Staffing records show that five care staff were on duty, a number consistent with the facility’s standard staffing level. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 5, 2024 · control 15-AS-20240711091855

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

On 11/19/2024 at 12:45 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, LPA stated the purpose of the visit to Community Business Director (CBD) Jobelle Dungca. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 direct caregivers completing only direct caregiving tasks for the 36 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 36 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio). The CBD and LPA reviewed documents pertaining to the stipulation requirements. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The fourth quarterly audit was completed 9/19/2024 and an audit report was provided to the Department on 10/14/2024. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 19, 2024

Allegation investigated: Staff did not seek medical attention to resident in a timely manner. Staff does not ensure residents are provided a comfortable temperature. Staff does not ensure residents are hydrated. Staff did not accord resident privacy. Staff does not provide activities.

On 10/08/24 around 03:45 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an initial 10-day complaint visit for the above allegations. LPA met with Kelli Greene, Executive Director (ED) and explained the purpose of the visit. During the course of the investigation and visits, LPA conducted resident (R1, R5, R7, R8) and staff (ED, S2) interviews. LPA requested the ID/Emergency contact information for five (5) memory care residents along with communication sent to responsible parties regarding visit, and the following documents: Current Personnel Report (LIC 500), LIC 500 dated 05/2024, Resident Roster, email and other communications regarding the air conditioning (AC), Community Event/Activities for the last week of 05/2024, UIR's for heat strokes or dehydration for memory care and assisted living for the last week of 05/2024 and documentation from the HVAC company confirming the AC has been repaired. Continued on LIC9099C... Unsubstantiated ...continued from LIC9099. For the allegation: Staff did not seek medical attention to resident in a timely manner. Reporting Party (RP) provided two different statements that were conflicting. One statement was that the RP and R9 were in Life Guidance - Memory Care (MC) and saw a woman bleeding while walking and no one could provide care, 911 was called. The second statement was that a woman was in the stairwell bleeding and no one knew the resident was there. RP stated that R9 did not say anything to the staff and later in the conversation RP stated that R9 alerted the front desk. LPA and ADM toured the facility, there was at least six staff available and assisting the residents in MC. The stairwells were secured with an electronic keypad and code for exiting. For allegation: Staff does not ensure residents are provided a comfortable temperature. Upon arrival on 07/15/24 LPA observed Bay City Maintenance on site monitoring the HVAC system that had been replaced the weekend prior. The temperature in the facility measured at 75 degrees Fahrenheit (F.) in the facility, R7’s room was 74 F., and on 10/08/24 the facility’s temperature was 75 F. For allegation: Staff does not ensure residents are hydrated. All residents had portable air conditioning units and hydration stations with coolers were in place with chilled water for residents, staff and families. For allegation: Staff did not accord resident privacy. RP stated that R9 wanted to remain anonymous. LPA could not confirm or deny that R9 was not accorded privacy. R1 stated that sometimes housekeeping knocks lightly, and R1 stated, "Maybe I didn’t hear them but no one entered uninvited". For allegation: Staff does not provide activities. LPA reviewed the activities calendar for Assisted Living and MC for 07/2024 and 10/2024 that provided a variety of activities. During the visit on 07/15/24, R1 stated that there’s lots of activities: Bingo, exercising, guest speakers, and meals in the community; MC has an activity director that does quite a few things with musicals and singing also. LPA observed the residents engaged and interacting with staff on two occasions during the visit on 10/08/24. Based on information obtained and observations, the above allegations are UNSUBSTANTIATED and no citations were issued during this visit. Exit interview conducted, and copy of this report provided to Kelli Greene, Executive Directorthe state’s words, verbatim · CDSS document, Oct 8, 2024 · control 15-AS-20240711085317

Type of visit: Case Management - Other

On 8/20/2024 at 2:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene. During this visit, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 direct caregivers completing only direct caregiving tasks for the 36 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 36 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio). The ED and LPA reviewed documents pertaining to the stipulation requirements. The LPA verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The third quarterly audit was completed 6/13/2024 and an audit report was provided to the Department within 14 days, on 6/26/2024. No citations issued during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 21, 2024

Type of visit: Case Management - Health Checks

On 07/12/2024 at 1:00 PM Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to conduct a Case Management. LPA met with Executive Director Kelli Greene, and explained the purpose of the visit. LPA came to the facility for a health and safety check relating to the facilities air conditioning being inoperable since April. S1 stated that they originally expected the broken part to be here in June but it was delayed by the manufacturer. The facility was informed on July 11th, 2024 that the part has been made and shipped, so they are waiting on its arrival to install it. To mitigate the heat the facility has purchased 110 fans, and 200 portable AC's along with renting commercial AC's to use in the common areas. S1 stated that they have at least one for every residents room and in some cases two if the room requires additional cooling. S1 also stated that they have hired additional staff to walk around and check each of the residents rooms to ensure the rooms are cool enough for the residents. They have also added water stations in the hallways. LPA toured the facility and checked the temperature in the common areas (dining room, movie room, activities rooms, workout room, cafe and library) along with 15 resident rooms. These common areas are at a comfortable temperature for residents use. Each residents room has the portable AC running and are measuring at 79 degrees or lower. Prior to the main AC breaking the third and fourth floor hallways had a Mini split AC for additional cooling that are currently functioning. After the tour LPA discussed with S1 PIN-23-13-CCLD titled PREPARATION FOR EXTREME HEAT, PUBLIC SAFETY POWER SHUTOFFS, AND WILDFIRES EMERGENCIES and encouraged to have all staff review the pin. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Jul 12, 2024

Type of visit: Case Management - Incident

On 7/10/2024 at 3:45pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 7/8/2024. LPA met with Kelli Greene, Executive Director and explained the purpose of the visit. The incident date of the incident was 7/4/2024. The incident report stated R1 had left the facility and wasn't able to be located. The facility contacted Walnut Creek Police Department 9-1-1. The Walnut Creek Police located R1 nearby, however, R1 was deceased. LPA L. Hall collected the following documents: physician's report, case notes, Oakland police report number, assessments, any similar incident report, staff schedule for July, and resident roster. At this time the cause of death is still unknown. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 10, 2024

Allegation investigated: Facility air conditioner is in disrepair.

On 07/08/2024 at 10:15 AM Licensing Program Analyst K. Nguyen arrived unannounced to conduct a complaint investigation for the above allegation. LPA met with Executive Director (ED), Kelli Greene, and explained the purpose of the visit. Allegation: Facility air conditioner is in disrepair: Substantiated During the course of the investigation, LPA interviewed staffs.It was alleged that Facility air conditioner is in disrepair, based on interview with ED the facility air condition was in disrepair since end of May and is in the process of being fix. ED stated that they are waiting for part from a third part vendor that created this main chiller (air conditionor), and there are no other places that we can purchase these parts from. We are working with the vendor to get this main chiller fix as soon as possible. LPA observed the thermostats on the first floor was at 89 degree Fahrenheit. Based on LPA interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. Exit interview conducted. A copy of this report and appeal rights provided via email. Substantiatedthe state’s words, verbatim · CDSS document, Jul 8, 2024 · control 15-AS-20240628093919

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b) · Plan of correction due date: Aug 31, 2024

(b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. (3) Nothing in this section shall prohibit residents from adjusting individual thermostatic controls. -This requirement is not met as evidenced by: Based on interview with ED the facility air condition was in disrepair since April and is in the process of fixing. LPA observed the thermostats on the first floor was at 89 degree Fahrenheit. Which posed a potential health & safety risk to residents in carethe state’s words, verbatim · CDSS document, Jul 8, 2024

Plan of correction: Executive Director will continue to follow-up with the third-party vendor regarding the missing parts. Executive Director agrees to fix the air conditioner and submit confirmation to CCLD of the air condition fully working condition by POC date.

Type of visit: Case Management - Annual Continuation

On 4/29/2024 at 9:00 AM, Licensing Program Analysts (LPAs) J. Sampair and A. Gharachorloo arrived unannounced to continue the Required Annual Inspection of the facility that began 4/24/2024. Upon arrival, the LPAs stated the purpose of the visit to Executive Director (ED) Kelli Greene. The LPA, ED, and Compliance Director Patricia Hoguin examined the emergency food and water supplies. The LPAs verified the completion of required staff training and the completion of quarterly emergency/disaster training for staff during every shift. The LPAs reviewed 7 resident and 5 staff files and interviewed 5 staff and 5 residents. The annual inspection is complete. No citations issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 30, 2024

Type of visit: Case Management - Other

On 4/30/2024 at 9:00 AM, Licensing Program Analyst (LPAs) J. Sampair and A. Gharachorloo arrived unannounced to conduct the quarterly inspection of the facility to ensure that the requirements of the 11/29/2023 stipulation are being followed. Upon arrival, LPAs stated the purpose of the visit to Executive Director (ED) Kelli Greene, and Compliance Director Patricia Hoguin. During this visit and when LPA Sampair was at the facility on 4/24/2024, the LPAs observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed within the required ratios from the stipulation: 5 direct caregivers completing only direct caregiving tasks for the 32 residents (within the required 1 staff to 8 resident ratio for day and afternoon/evening shifts) and 4 overnight staff for the 32 residents completing only direct caregiving tasks (within the required 1 staff to 10 resident ratio). The ED, Compliance Director Patricia Hoguin, and LPAs reviewed documents pertaining to the stipulation requirements. The LPAs verified that every new resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPAs verified that a Hazardous Materials and Policies and Procedures Manual was available to all staff at the front desk. The second quarterly audit was completed 3/6/2024 and an audit report was provided to the Department within 14 days, on 3/13/2024. No citations issued during visit. Exit interview conducted and a copy of this report provided to ED.the state’s words, verbatim · CDSS document, Apr 30, 2024

Allegation investigated: Staff neglect resulted in resident sustaining a fracture

On 4/24/2024 at 2:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to deliver findings on the allegation above. The LPA informed Executive Director (ED) Kelli Greene of the reason for the visit. The Department's investigation included, but was not limited to, interviews with current and former staff, residents, and the reporting party. The Department obtained and reviewed Resident R1’s records from the facility, hospital medical records, Walnut Creek Police Department records, Contra Costa County Fire Protection District records, Emergency Medical Services (EMS) records, and 911 audio call records from 12/17/2022. Report Continues on LIC9099-C Unsubstantiated ...Report Continued from LIC9099 The complaint alleges that staff neglect resulted in resident sustaining a fracture. On 5/19/2022, the Reporting Party (RP) stated that Resident 1 (R1) was independent, did not need help with anything, and was able to walk on her own without any assistance, nor had R1 complained of being mistreated at the facility. When interviewed about independent living Resident R1's fall on 12/17/2022, former Assistant Executive Director Jeffrey Freeth and 5 current and former staff members stated that the fall was unwitnessed. According to facility records and statements by staff, R1 had not had any falls at the facility before her 12/17/2022 fall, nor was R1 deemed to be a fall risk according to the assessment performed at the facility on 6/18/2022. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegations are UNSUBSTANTIATED. No citations issued during visit. Exit interview conducted with ED. Appeal Rights and a copy of this report provided. ...Report Continued from LIC9099 The complaint alleges that facility staff did not seek timely medical attention for resident. When interviewed about independent living Resident R1's unwitnessed fall on 12/17/2022, 5 current and former staff members, as well as former Assistant Executive Director Jeffrey Freeth, stated that they sought medical attention for R1 immediately after being found. A review of the Walnut Creek Police Department (WCPD) report and their 911 audio call on 12/17/2022 showed that R1 was found by facility staff at 12:00 PM. At 12:01 PM, WCPD were called by facility staff. At 12:02 PM, the ambulance was dispatched. The ambulance arrived at the facility at 12:07 PM and R1 transported to the hospital at 12:27 PM. Based on the data collected, the allegation is false, could not have happened, and/or is without a reasonable basis; therefore, the above allegation has been found to be UNFOUNDED. No citations issued during visit. Exit interview conducted with the ED. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 24, 2024 · control 15-AS-20221220103745

Type of visit: Required - 1 Year

On 4/24/2024 at 3:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the Required Annual Inspection of the facility. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene. The LPA inspected the physical plant with the ED and Maintenance Director Matthew Maroquin. In the Assisted Living and Memory Care areas they examined the kitchens, dining areas, restrooms, community living spaces, resident rooms, and storage. For the inspection of the exterior of the facility, the LPA examined the fish ponds that are made inaccessible to residents with wire fencing and the delayed egress of the Memory Care. In the kitchen, more than the required minimum of 7 days of nonperishable and 2 days of perishable foods were appropriately stored. Fire extinguishers were last serviced on 5/25/2023 and the latest outside inspection of the fire suppression system was completed 3/22/2024. The LPA, ED, and Compliance Director Patricia Hoguin examined the chemical storage areas in the first and second floor kitchens of Memory Care, and the Bistro and Main Kitchen on the first floor, and Housekeeping on the fourth floor. The LPA observed postings in the facility that included a complaint poster, Ombudsman and Personal Rights posters, Theft and Loss Policy, Rights to Resident Council, and Rights to Family Council. An administrator is on site more than the minimum of 20 hours a week to oversee the proper business operations. The annual inspection is not complete and the LPA will return to complete it at a later date. No citations issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 24, 2024

Allegation investigated: Staff did not follow resident's care plan Staff did not do a proper assessment of resident

On 3/20/2024 at 2:30 PM, Licensing Program Analyst (LPA) J. Sampair arrived at facility unannounced to conduct an initial 10-day complaint investigation visit of the allegations above. Upon entry, the LPA informed Resident Services Director (RSD) Stephanie Ann Arabos of the purpose of the visit. The RSD informed Executive Director (ED) Kelli Greene and Regional Vice President (RVP) Aron Alexander by phone. The complaint alleges that staff did not follow resident's care plan. On 3/20/2024, the LPA reviewed the 2/14/2024 needs and services plan (care plan), 11/3/2022 to 3/20/2024 resident notes, 10/14/2023 physician's report, 2/14/2024 assessment, 3/20/2024 task list, and report of tasks completed for the months of February and March 2024. LPA interviewed Witnesses W1 and W2, RSD, ED, and RVP. The LPA's analysis of the data showed that the staff is following the resident's care plan. Report Continued on LIC9099-C... Unsubstantiated ...Report Continued from LIC9099 The complaint alleges that staff did not do a proper assessment of resident. On 3/20/2024, the LPA reviewed the 2/14/2024 needs and services plan (care plan), 11/3/2022 to 3/20/2024 resident notes, 10/14/2023 physician's report, 2/14/2024 assessment, 3/20/2024 task list, and report of tasks completed for the months of February and March 2024. LPA interviewed Witnesses W1 and W2, RSD, ED, and RVP. The LPA's analysis of the data showed that the staff did do a proper assessment of resident. Although the allegations may have happened, or are valid, there is not a preponderance of evidence to prove them; therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted with RSD. Appeal Rights and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Mar 20, 2024 · control 15-AS-20240314092013

Type of visit: Case Management - Other

On 1/11/2024 at 1:00 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to: (1) deliver updated license that includes probationary status in the comments section of the license and (2) to conduct the initial inspection of the facility after the stipulation went into effect 11/29/2023. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene. During the visit, the LPA delivered the updated license to the ED, who replaced the existing license on the wall. The LPA and ED toured the facility. During the tour, the LPA observed: (1) stipulation posted in a conspicuous place, (2) kitchen and dining area signage posted that no food or beverage containers shall be used for any other purpose than food or beverage containment, and (3) Life Guidance was staffed with 4 direct caregivers for 30 residents, within the 1 staff to 8 resident ratio for day and afternoon/evening shifts and 4 overnight shift staff scheduled, all within the required ratios from the stipulation. ED and LPA reviewed documents pertaining to the stipulation requirements. The LPA verified that every resident and/or responsible party had acknowledged receipt of a copy of the stipulation. The LPA confirmed that all required staff and administrator training had been completed by every administrator and staff member. The LPA also verified that a Quality Evaluation Committee (QEC) had been formed with members as per the stipulation, a Hazardous Materials and Policies and Procedures Manual had been created by the QEC, the first quarterly QEC audit had been completed in December of 2023, an audit report had been completed within 14 days of that audit, and that a copy of that report was provided to the Department within 14 days. No citations issued during visit. Exit interview conducted and a copy of this report provided to ED via email.the state’s words, verbatim · CDSS document, Jan 11, 2024

Allegation investigated: Staff do not ensure a comfortable living environment for residents

On 12/04/2023 at 1:24 PM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced complaint visit pertaining to the allegation above. The LPA informed the Executive Director (ED) Kelli Greene of the purpose of the visit upon entry. The complaint alleges that staff do not ensure a comfortable living environment for residents due to the noises of Resident 2 (R2)'s pet. At 1:29 PM, the ED stated, and a review of the records confirmed, that R2's Responsible Party, Witness 1 (W1), did not disclose having a pet at lease signing and that it was brought to R2's room without notification. The ED has been actively working with W1 to remove the pet since first notification of the disturbance on 11/21/2023. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that staff do not ensure a comfortable living environment for residents. Therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted with the ED and a copy of this report was provided via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 4, 2023 · control 15-AS-20231201092619

Allegation investigated: Facility did not issue a refund to a resident in care.

On 11/29/2023 at 8:27 AM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced complaint visit pertaining to the allegation above. The LPA informed the Administrator (ADM) Kelli Greene of the purpose of the visit. The complaint alleges that the facility did not issue a refund of Resident 1 (R1)'s preadmission fee after departing the facility 08/18/2023. During the review of R1's Resident Account Summary and Admission Agreement, the ADM and LPA discovered a processing error that resulted in the non-payment of the portion of preadmission fee due to R1. To rectify their error, the facility issued a refund of $2,186.63, which was $908.63 more than $1,278.00 required. The preponderance of the evidence standard has been met, and the allegation is SUBSTANTIATED. One (1) Type-B citation issued (refer to LIC9099-D for details). Exit interview conducted with ADM and a copy of this report was provided via email. Substantiatedthe state’s words, verbatim · CDSS document, Nov 29, 2023 · control 15-AS-20231121171228

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(E)2.c. · Plan of correction due date: Dec 6, 2023

Admission Agreements (g) ... shall specify ... (5) Refund conditions. (E) ... 2. ... paid preadmission fees ... shall be refunded ... in the following manner: c. ... at least 40 percent in excess of $500 shall be provided if the resident leaves the facility for any reason during the third month of residency. This requirement is not met as evidenced by: Based on file review, the licensee did not comply with the section cited above. No refund had been issued to Resident 1 for the $1,278 in preadmission fees due, which posed a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 29, 2023

Plan of correction: Licensee corrected deficiency during visit by issuing a refund of $2,186.63, which was the Basic Services fee for the 18 days of residency from August 1 to 18 of 2023. That amount was $908.63 more than the $1,278.00 that was due to R1 according to Title 22 Regulation.

Allegation investigated: Staff changed the residents service plan without the consent of the residents authorized person Resident was billed for services not rendered

On 11/20/2023 at 1:15 PM, Licensing Program Analyst (LPA) J. Sampair performed an unannounced follow-up visit pertaining to the above allegations. Upon arrival, LPA stated the purpose of the visit to Executive Director (ED) Kelli Greene. The complaint alleges that staff changed the resident's service plan without the consent of resident's authorized person. On 11/20/2023 at 10:29 AM, the LPA spoke with the Reporting Party (RP) who identified themself as the responsible person for Resident 1 (R1). Documentation reviewed by LPA confirmed that facility was acting in the best interest of R1. CONTINUED ON LIC9099-C... Unsubstantiated ...CONTINUED FROM LIC9099 The complaint alleges that resident was billed for services not rendered. The LPA reviewed the "Resident Monthly Assignment Report" for October 2023, verifying that the services for R1 for which the RP had been billed were provided. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that staff did not notify residents of renovations made to the facility in a timely manner nor that staff did not follow a resident's medical needs while in care. Therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted with the ED and a copy of this report was provided via email.the state’s words, verbatim · CDSS document, Nov 20, 2023 · control 15-AS-20231116112221