Westmont of Pinole

Type of visit: Required - 1 Year

On 4/14/2026 at 9:45AM, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge conducted an unannounced 1-Year Required inspection. LPAs met with Executive Director Dianna Gonzales, and explained the purpose of the visit. The facility’s fire clearance was approved for one hundred twenty two (122) non-ambulatory and eighteen (18) bedridden residents. LPAs toured the facility including but not limited to apartments, bathrooms, kitchen, common area and backyard and patios. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 72 degree Fahrenheit. LPAs observed lighting in all hallways are adequate for the comfort and safety of the residents. Hot water temperature in the shared bathroom was measured at 120 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of 7-day non perishables and 2-day perishables foods. continue on LIC 809C CONTINUE FROM LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 04/14/2026. Emergency Disaster Plan was posted. First aid kit was observed to be complete. Fire drill was last conducted on 03/11/2026. Fire sprikler system last service 03/17/2026. LPAs reviewed six (6) resident files and five (5) staff files. All were complete. LPAs requested the following documents to be submitted to CCLD by 04/21/2026. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 610E Emergency Disaster Plan (9 pages) · Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 14, 2026

Allegation investigated: Facility staff are not answering call buttons in a timely manner

***THIS IS AN AMENDED REPORT FROM 01/28/2026*** On 01/28/2026 at 02:30pm, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to deliver complaint findings for the above allegation. LPA me with Richard Remigio, Executive Director and explained the reason for the visit. During the course of the investigation LPA toured the facility, interviewed five (5) staff, obtained and reviewed records including but not limited to residents' roster, staff schedule, menu, SMART Care pendant reports, and Emergency Disaster Plan. CONTINUE ON LIC 9099C Substantiated CONTINUE FROM LIC 9099 ***THIS IS AN AMENDED REPORT FROM 01/28/2026*** Allegation: Staff did not answer resident's call button in a timely manner. Investigation Finding: substantiated. W1 reported that staff did not respond to the call pendant in a timely manner, W1 also reported that the facility is low staffed. S1 reported that the facility has had issues with the SMART care pendants but staff are making rounds to assist residents as needed. S2 reported that residents have pendants that alerts the front desk, and the front desk alerts a badge pager to care staff and the main computer, if not cleared after 3 or 4 minutes time then the office will be notified the system generates reports if the pendants have not been answered. S2 stated that the facility had issues with the system it was reported and being repaired. S3 that the SMART care pendants have been updated but there is a glitch in the system and the company has been notified and are working on the system. Based on the evidence obtained this allegation is SUBSTANTIATED. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. 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, Mar 4, 2026 · control 15-AS-20250507082625

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(i)(1)(A)(B)(C) · Plan of correction due date: Mar 18, 2026

87303 Maintenance and Operation (i) Facilities shall have signal systems which ...criteria: (1) All facilities licensed for 16 or more and all... separate floors or ... have a signal system which shall...(A) Operate...(B) Transmit...(C) Identify...unit -This requirement is not met as evidenced by: Based on interviews, the Executive Director did not comply with the regulation cited above by not ensuring that the call pendants were working properly at all times and not providing care to residents’ in a timely manner which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 4, 2026

Plan of correction: ED agreed to continue to monitor the system for the call pendants systems, alert all parties of malfunctions, review regulation, provide in-service training to all staff, and submit a copy of training with staff signatures to CCLD by POC.

Type of visit: Case Management - Other

On 3/4/202 at 2:00PM, Licensing Program Analyst G.(LPA) Carol Fowler arrived unannounced to conduct a case management visit to deliver amended report originally dated 01/28/2026. LPA met with Administrator, Benjie Doctolero and informed him the reason for visit. During visit, LPA attempted to obtained original report dated 1/28/2026. The facility had a change of Administrator, the current Administrator was not able to locate the report. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Mar 4, 2026

Allegation investigated: Staff neglected resident after a fall Facility did not provide adequete incidental medical care Staff not competent to provide care

On 2/27/2026 at 10:30AM, Licensing Program Analyst (LPA), A Gomez arrived unannounced to deliver complaint investigation findings for the complaint allegations above. LPA met with Interium Executive Director, Benjie Doctolero and explained the reason for the visit During the course of the investigation LPA reviewed documents icluding but not limited to R1's care notes, Unusual incident reports, careplan and conducted interviews with staff and resident. LPA attempted to interview W1 however they were unavailable report continues on LIC9099-C Unfounded On the allegations "Staff neglected resident after a fall, Facility did not provide adequate incidental medical care, and Staff not competent to provide care" the following was found: LPA conducted interviews and reviewed records. It was alleged that R1 sustained a fall in their room on 9/12/2025 that resulted in injury and that S1 was present at the time of the fall and did not provide assistance after the fall. It was also alleged that R1 was sent out to the hospital on this date and that police were notified because S1 alleged that R1 sexually assaulted them. Through record review and interview LPA found that S1 did not provide any type of in room assistance to R1 and that their position does not provide care. S1 also stated that they were not aware of any falls with R1 because they do not provide care and that they never alleged R1 or anyone else at the facility assaulted them in any way. LPA also interviewed the previous Executive Director who corroborated that S1 has never been alone with R1 and that S1 does not provide care or go to residents room. Previous ED also stated that there was a history of R1 making false claims against S1. LPA was unable to identify any information to support any of the claims made in the complaint. LPA observed that staff reviewed were up to date on their required training for their position. LPA attempted to interview W1 via phone call however LPA was unable to reach them. LPA also contacted R1's medical provider who stated there are no records of them visiting the emergency room in September 2025. Before delivering findings LPA received a phone call with additional confidential information. Therefore the above allegations are UNFOUNDED. This agency has investigated the complaint alleging Staff neglected resident after a fall, Facility did not provide adequate incidental medical care, and Staff not competent to provide care. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 27, 2026 · control 15-AS-20251222115507

Allegation investigated: Resident sustained injuries due to staff neglect Staff are forcing resident to take medication Staff did not allow resident to have visitors Staff are not able to meet resident's needs

On 01/27/2026 at12:15pm, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to deliver complaint findings for the allegations above. During the course of the investigation LPA interview five (5) staff and one witness (W1), obtained and reviewed records including but not limited to residents' rosterinterview five (5) staff, obtained and reviewed records including but not limited to residents' roster 3/1/24 to 5/1/24, Continue on LIC9099C Unsubstantiated CONTINUE FROM LIC 9099 employee roster, personnel records, admission agreements, MAR, visiting roster for 4/1/24 to 5/1/24, physicians' reports, needs and services plans, level of care notes/factional assessments, special incident reports, hospice binder, and care notes. Allegation: Resident sustained unexplained injuries while in care. Investigation Finding: unsubstantiated. W1 reported that R1 had bruises and scratches from fighting with staff because R1 was refusing medication, W1 also reported that the facility would call W1 and ask if W1 could come and get R1 to take R1s medication and staff informed W1 that the facility wanted to keep R1 medicated due to R1s aggressive behaviors. . S2 further reported that S2 will try 2 or 3 times before charting. S5 reported that S5 has not seen any bruises or scratches on R1 however R1 would hit, and dig R1s nails in staff skin. S5 reported S5 has never witnessed any neglect to R1. S5 reported that the facility has never witnessed R1 with bruises and scratches, S5 stated that S5 worked directly with R1. Therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff are forcing resident to take medication Investigation Finding: unsubstantiated. W1 reported that staff would force R1 to take R1s medication, W1 reported that W1 has never witnessed staff forcing R1 to take R1s medication. W1 further reported that R1 was aggressive and violent and has slapped staff, and threw R1s walker at staff trying to give R1 medication. S2 reported that R1 would often refuse medication and S2 would continue to make rounds and come back and ask R1 again and if R1 would refuse S2 stated that S2 would try a third time and if R1 still refused S2 would chart R1 refused medication. S4 stated that when R1 would refused medication the Medication Technician would prompt R1 2 to 3 times and R1 would sometimes get aggressive and refused and it would be charted. Therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff did not allow resident to have visitors Investigation Finding: unsubstantiated. W1 reported that W1 was not allowed to visit with R1 for two weeks because the facility was lockdown due to COVID. W1 stated that W1 was told all staff and residents had COVID. W1 further reported that R1 was on hospice and W1 was denied visits. CONTINUE ON LIC 9099C2 CONTINUE FROM LIC 9099C W1 reported that W1 informed the Executive Director, and the Executive Director apologized to W1 for W1 not being allowed into the facility to visit. S1 reported that the facility had lockdown orders from the county, but families of hospice residents were allowed to visit their family. S1 further reported that it was brought to S1s attention W1 was at the facility visiting with R1 before R1 passing and W1 and another family member was at the facility while R1 was passing. LPA conducted a record review which showed that W1 had signed into the facility on some days during the period before the period of R1s passing. S5 informed LPA that W1 would sometimes enter the facility in the memory care area, which no one should enter because there is no sign in sheet and that’s the reason some of the days W1 visited the facility was not on the sign in log. Therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff are not able to meet resident's needs Investigation Finding: unsubstantiated. W1 reported that the facility was unable to meet resident needs, alleging that staff could not provide proper care for R1, including administering medications and preventing injuries. S1 stated that the facility was abe to adequately care for R1, noting that the facility was fully staffed and that R1 was receiving hospice services, ensuring continuous care. S2 reported that they attempted to assist R1 with getting out of bed, and when R1 declined, they returned R1 to bed. S2 further stated that R1 was monitored frequently throughout their shift. S3 reported working directly with R1 and indicated that R1 would occasionally refuse assistance with activities of daily living (ADLs). S3 stated that staff continued to check on R1, ensuring the resident was clean, repositioned as needed, and comfortable. S5 confirmed that staff routinely checked on R1 and ensured staff availability whenever care was needed. S2 additionally stated that R1 was on hospice care and received regular visits from hospice nursing staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. No deficiencies observed during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 27, 2026 · control 15-AS-20240909081424

Allegation investigated: Licensee does not sure facility is adequately staffed to properly supervise residents

On 09/10/2025 at 02:10 PM, Licensing Program Analysts (LPAs), Carol Fowler and David Doidge arrived unannounced to deliver findings regarding a complaint investigation for the allegation above. LPAs met with Nhi Nguyen, RSD, and explained the purpose for the visit During the investigation, LPAs toured the facility, interviewed three (3) staff, obtained and reviewed records including but not limited to residents' roster, staff roster and schedule, physcian report, face sheet, resident assessment, service plan and email a copy of the LIC 624. Continued on LIC9099C Unsubstantiated Continued from LIC9099 Interview with S1 revealed that R1's room had been moved and R1 was confused and attempting to enter R1's old room. S1 witnessed R1 on the floor outside of the old room. S1 stated that R1 had a hangnail that was dried and bleeding. S1 called for another staff to help S1 get R1 up from floor. R1 was confused and did not want to leave the room. S1 and S2 stayed with R1. R1 was saying R1 didn't know the staff that were trying to move R1. Interview with S2 revealed that R1 was on the floor, and S2 was called to help S1 get R1 up from floor, and R1 was a little combative and did not want to get up to leave the what R1 thought was R1's room. S2 observed that R1's fingure was bleeding from a drying hangnail. S3 stated that R1 was on the floor, and fell attempting to get into R1's old room. S1 and S2 were trying to assist R1 in getting up from floor. S3 stated R1 has a walked used for walking and was trying to get into room and fell. R1 calmed down and allowed staff to direct R1 to correct room. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 10, 2025 · control 15-AS-20250811142148

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to conduct a Case Management inspection to follow-up on an incident report received at the CCL office on 8/27/2025, regarding a medication error. LPAs met with Resident Service Director, RSD, Nhi Nguyen and discussed the details of the incident. On 8/17/2025 at approximately 11:00pm Incoming med tech on duty noticed new orders for R1 for Hydrocodone - Acetaminophen 5-325mg. Orders are to take half a tablet by mouth every 6 hours as needed for pain. S1 signed and gave R1 a whole tablet of Hydrocodone instead of half as ordered. During the visit, LPAs reviewed and received a copy of R1's MAR, and Progress Notes. RSD Nhi indicated that the facility contacted the appropriate parties such as R1’s physician and family. R1 was placed on monitoring and did not show any side effects from the medication error. RSD Nhi conducted in-service training on medication for all med techs. CONTINUE ON LIC 809C CONTINUE FROM LIC 809 The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalty. Exit interview conducted a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 10, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Sep 11, 2025

(c) If the resident's physician...PRN medication...met: (2) Once ordered...medication is given according to... directions Based on observation and record review, the licensee did not comply with the section cited above R1 being administered incorrect doseage of Hydrocodone - Acetaminophen, wich poses and immedicate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: Resident Service Director, RSD, conducted in-serive training with all medical technitions. DEFICIENCY CLEARED BEFORE DEPARTMENT'S VISIT In-service documents received.

Allegation investigated: Staff mismanaged resident's medications.

On this day, 7/25/25, at 3:05 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Executive Director (ED) Richard Remigio, and informed the reason for visit. During the course on investigation, LPA obtained copies of staff schedule and resident roster. LPA reviewed residents records and obtained copies of the following residents' (R1, R2 and R3) documents: LIC601 Identification and Emergency Information; LIC602A Physician's Report; Appraisal; doctor's order of medications; discontinued order of medications; Medication Administration Records (MARs). The following were interviewed: residents (R1, R2) on 3/09/22; staff (S1, S2) on 7/11/25 and staff (S6) on 7/23/25. .....continued on 9099C Substantiated The reporting party stated resident was given more medications than what should be given and medications were given late. Two out of 3 staff interviewed stated that it could happen that a resident is given a certain number of medications day prior and may be given different number of medications the succeeding days if there's a change in doctor's order. One of the residents interviewed stated this resident was given 11 medications in the morning of 02/19/2022 when this resident should be given only 9. This same resident was given 9 medications 02/27/2022. Review of doctor's order of medications dated 01/26/2022 and discontinued order of medications dated 01/26/2022 showed this resident has a total of 9 of the regular prescribed medications in tablet and capsule forms listed. Although notes in the MAR showed this resident was given medications on time, MAR for 02/2022 showed this resident was given one of the medications 1 1/2 tablets of the 10 mg tablet when prescription showed 10 mg only. MAR also showed only 6 medications in tablets and capsule forms listed of which 1 were administered at 5:00 pm on 02/2022. These findings were discussed with the ED. Based on review of records and interviews, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Jul 25, 2025 · control 15-AS-20220228155418

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 26, 2025

87465 Incidental Medical and Dental Care (a) .....(4) The licensee shall assist residents with self administered medications as needed. -This requirement is not met as evidenced by: -Based in records review and interviews, the licensee did not comply with the section above in mismanaging resident's medications and administering incorrectly which posed an immediate health and personal rights risks to person in care.the state’s words, verbatim · CDSS document, Jul 25, 2025

Plan of correction: Executive Director agreed to in-service the staff and submit proof by 7/26/25.

Allegation investigated: Staff mishandled resident's supplies.

On 03/28/2025 at 12:30 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director, Richard Remigio, to deliver the findings of above allegations. LPA explained the purpose of the visit with Richard Remigio. During investigation, LPA obtained the following documents: Admissions Agreement, Physician's Report, Face Sheet and Emergency Information, Progress Notes, Service Plan, Staff Schedules - Personal Care Assistant (PCA) for Assisted Living (AL) and Memory Care Unit (MCU) (September and October 2023), Medication Technician Staff Schedules - AL and MCU (September and October 2023), LIC9099-C Continued... Substantiated LIC9099-C (Page 2) Shower Schedules - AL and MCU (Updated 09/14/2023 and 10/04/2023, Facility Registry, E-mail for missing items for 1 resident, LIC 621 Client/Resident Personal Property and Valuables for 1 resident, Hospice Documents, Staff and Resident Rosters for 2025. Allegation: Staff mishandled resident's supplies. Finding: Substantiated On 11/06/2023, LPA interviewed witnesses (W) W1. W1 stated that R1 is on hospice and that hospice orders supplies for R1. W1 stated that the R1’s supplies are not left in their room and that when the hospice nurses come that can find the supplies. W1 stated that they were told that other residents can obtain and get access to the supplies. On 11/07/2023, LPA interviewed staff (S) S1. S1 stated that the facility has a program for incontinence supplies, “TENA” Program, which we order brief incontinence supplies for $125/mo. S1 stated that they have a lot of supplies, so we don’t have to use others. S1 also stated that they will buy supplies and then bill back to residents. S1 stated that supplies are locked in the Med Tech rooms and that only Med Techs have the keys. On 11/07/2023, LPA interviewed W3. W3 stated that R1’s supplies are missing from their room, and it has been ongoing. In addition, W3 stated R1’s personal items have also disappeared. W3 stated that they have labeled clothing, towels, sheets and 80% disappears. W3 stated that they have contacted Westmont but no response. W3 stated that Westmont finally responded and agreed to replace items. LIC9099-C Continued... LIC9099-C (Page 3) LPA reviewed corresponding e-mail dated 10/25/2023 between Executive Director and W3 indicating that the facility will place an order through Amazon to replace missing items. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided. LIC9099-C (Page 6) Shower Schedules - AL and MCU (Updated 09/14/2023 and 10/04/2023, Facility Registry, E-mail for missing items for 1 resident, LIC 621 Client/Resident Personal Property and Valuables for 1 resident, Hospice Documents, Staff and Resident Rosters for 2025. Allegation: Staff did not maintain accurate records on the resident. Finding: Unsubstantiated On 11/06/2023, LPA L. Alexander interviewed witnesses (W) W1 that stated that information was second hand from the patient's hospice providers. W1 stated that there were challenges gathering accurate reports of patient ADLS due to limited availability of staff and incomplete records, i.e., last bowel movement. On 11/08/2023 and 03/11/2025 LPA attempted contact with W2 and W3 and left messages for a call back in order to get further information. W2 and W3 have never returned calls after attempts. On 03/28/2025, LPA interviewed S2 and S4 that stated they have meetings with the next shift caregivers to report what happened during their scheduled shift. LPA interviewed S5 that stated the caregivers will inform the med techs and that the med techs will document in the resident's care notes an exception; for example resident did not have a bowel movement during the end of the day. Allegation: Staff did not meet resident's diapering needs. Finding: Unsubstantiated LIC9099-C Continued... LIC9099-C (Page 7) W3 stated that R1 was in the hospital in September. W3 stated that the family was notified of two (2) wounds on R1’s rectum and that the facility never informed the family. On 03/28/2025, LPA interviewed S2 and S4. S2 stated that during the "crossover meeting" that is when the caregivers report to each other the status of each resident. S2 stated that they strat their rounds by checking R1's diapers and if diaper was wet and soiled they will clean and change him. S4 stated that the first thing that they will do is check R1's diaper and if they were wet, they will change their diaper. S4 stated that they will check R1's diapers every 2 hours during their shift. LPA reviewed R1’s Service Plan (dated 05/19/2023) and need assessment indicated full assistance incontinent of bladder and bowels with proper personal hygiene daily. Allegation: Staff did not meet resident's hygiene needs. Finding: Unsubstantiated W3 stated that R1’s bed pads are not changed. W3 stated that if R1 has a bowel movement (BM) they are still not cleaned. W3 stated that R1’s fingernails and toenails were digging into his flesh. On 03/28/2025, LPA interviewed S2 and S4. S2 stated that they would give R1 a bed bath, feed him, make sure that R1 is dry and had no bed sores during their shift. S2 stated that R1 would not have a soaking diaper and they made sure that R1 was clean. S4 stated that they will shave R1 and give R1 bed bath. S4 stated that during 2023, the outside agency would come and give R1 a shower or bed bath. S4 stated that most residents are scheduled showers 2 times a week and some refuses to shower. S4 stated that during their shift R1 was cleaned up after wet soiled diaper changes. LIC9099-C Continued... LIC9099-C (Page 8) LPA reviewed MCU’s shower schedule (updated 10/04/2023) and observed that R1 was not on the shower schedule. LPA reviewed R1’s Service Plan (dated 05/19/2023) and observed that full assistance bathing is 2 times a week, full assistance grooming daily, full assistance daily oral care Allegation: Facility does not have sufficient staff to meet the needs of the resident. Finding: Unsubstantiated W1 stated that sometimes there is one (1) staff to maybe twenty (20) some patients, specifically memory care unit. On 03/28/2025, LPA interviewed S2, S3, and S4. S2 stated that on their shift they have been responsible for 5-6 residents. S2 stated that on their shift there were four (4) caregivers. S3 stated that in 2023 there wasn't as many staff at times but today there's not staffing issue. S3 stated during their there would be approximately four (4) caregiver aides available. S4 stated that there are four (4) staff on their shift. S2, S3 and S4 all stated that there were always staff available on their shifts and never had any issues completing their care needs to residents. LPA reviewed the October 2023 staff schedule for AM, PM and NOC shifts and three (3) to four (4) caregivers were scheduled on each shift. 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 allegations are UNSUBSTANTIATED. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 15-AS-20231101090259

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218 (a)(2) · Plan of correction due date: Apr 4, 2025

(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in by not ensuring a safeguard to R1's personal supplies and property which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 28, 2025

Plan of correction: Administrator agrees to read the regulation and self-certify understanding of this regulation and send self certification to CCLD by POC due date.

Allegation investigated: Staff did not prevent a resident from physically abusing another resident resulting in injury

On 12/23/2024 at 10:45AM, Licensing Program Analyst (LPA), K. Nguyen arrived unannounced to conduct an initial 10-day complaint investigation and deliver complaint findings for the allegation above. LPA met with Richard Remigio, Executive Director, Executive Director and explained the reason for the visit. During the course of the investigation LPA interview staff, residents, toured facility and obtained and reviewed records. Allegation: Staff did not prevent a resident from physically abusing another resident resulting in injury. Continue on LIC9099C Unsubstantiated Continue from LIC9099 It was alleged that staff did not prevent a resident from physically abusing another resident resulting in injury, however after records reviews, observation, and interview conducted reveals that R1 is with staff majority of the time due, confused, disoriented, aggressive behavior, and sun downing behavior. After the alleged incident facility conducted an internal investigation reveal that R1 being monitor by staff constantly for any physical or aggression R1 have or may have. Memory care director conducted an in service with all the staff and directed staff to pay attention to residents that have sun downing and to record keeping any sign or behavior. Interviewed with S1 revealed that staff conducts safety checks for all residents’ rooms every two hours. S2 also stated the residents are asked and encouraged to come out into the common areas to join activities. During the tour LPA observed R1 was being redirected by staff constantly, and staff is with R1 the entire time. Based on interviews, observation, and record review the Department has investigated the above allegation and found it to be Unsubstantiated. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 23, 2024 · control 15-AS-20241219124423

Type of visit: Case Management - Other

On 10/8/24 at 01:40 PM, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to conduct a case management. LPAs met with Richard Remigio, Executive Director, and explained the purpose of the visit. On 10/02/24, LPA received an LIC624A regrading the resident 1 hit by a car. LPAs reviewed R1’s files, interviewed Richard Remigio, Executive Director, Resident 1 and Staff 2 LPAs requested and received LIC602 Physician’s Report/Medical Assessment, and after visit summary. Interview with R1 and staff revealed that R1 was crossing Pinole Valley Road in the crosswalk with a green light and a car hit him. After being hit the driver of the car and people in the area helped him until the Police, Staff (from the facility) and ambulance arrived. R1 is able to leave the facility unassisted. No deficiencies were cited today. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 8, 2024

Allegation investigated: Resident sustained unexplained injuries while in care.

On 10/01/2024 at 9:50AM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with Richare Remigio, Executive Director and explained the reason for the visit. During the course of the investigation LPAs interviewed reporting party (RP) 1 resident (R1) and witness (W1). LPAs obtained documents (staff roster and residents’ roster, ID and emergency information, residency agreement, Physician's report, Appraisal Needs and Services Plan, list of medications). Continued on LIC9099C. Unsubstantiated CONTINUE FROM LIC 9099 Allegation: Resident sustained unexplained injuries while in care. Investigation Finding: unsubstantiated. RP reported that RP witnessed small wounds when RP would visit R1 at the facility. RP stated that RP had no evidence of anyone hurting R1. RP stated that R1 told RP when care staff would help R1 out of bed R1 would sometimes bump R1s leg, RP also stated that R1 was forgetful and sometimes R1 would not know what happened and how R1 got the small wounds. RP stated that RP has visited R1 4 to 5 times and noticed the small wounds and wanted to report what RP saw. W1 reported that W1 is not sure how the small wounds got on R1, W1 stated that R1 informed W1 that R1 leg was bumped when R1 was being helped out of bed by care staff. R1 stated that R1 was not sure how the small wounds got on R1 leg. R1 stated that it just happens to R1 skin. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that Resident sustained unexplained injuries while in care is unsubstantiated. No deficiencies observed during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 1, 2024 · control 15-AS-20240520082858

Allegation investigated: Staff did not safeguard resident's personal items. Staff did not provide resident medication as prescribed. Staff does not provide daily activities for resident.

On 06/12/2024 at 3:48PM, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to conduct an initial 10-day complaint investigation and deliver complaint findings for the allegation above. LPA met with Shanece Tupuola, Memory Care Coordinator and explained the reason for the visit During the course of the investigation LPA interview staff, toured facility and obtained and reviewed records. Allegations: Staff did not safeguard resident's personal items. Staff did not provide resident medication as prescribed. Staff does not provide daily activities for resident. Continue on LIC9099C Unsubstantiated Continue from LIC9099 Reporting party stated Staff did not safeguard resident's personal items, Staff did not provide resident medication as prescribed, Staff does not provide daily activities for resident. Interview with S1 revealed that family is asked to write residents name and room number on clothing items and facility also request that family not bring valuable items to residents in memory care. However if an item is missing the facility reports to staff to search for the missing item and it's charted and reported to the Executive Director and Business Office Director. Interview with S2 revealed that residents are given medication as prescribed by the Physician, S1 also stated that when a resident moves into the facility they will bring all medications they have and the facility will request an authorization from the Physician and any refills needed. R1 missed medication due to a prescription not covered by the residents medical coverage. LPA reviewed residents medical records which revealed the medications are given as prescribed. LPA toured facility and witnessed residents including R1 participating in arts and crafts, snacking, watching TV, watching TV, listening to music and getting hair cuts. Based on interviews, tour and record review the Department has investigated the above allegation and found it to be Unsubstantiated. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 12, 2024 · control 15-AS-20240603153742

Allegation investigated: Residents are isolated due to lack of staff.

On 06/12/2024 at 10:00AM, Licensing Program Analyst (LPA), Carol Fowler arrived unannounced to conduct an initial 10-day complaint investigation and deliver complaint findings for the allegation above. LPA met with Shanece Tupuola, Memory Care Coordinator and explained the reason for the visit During the course of the investigation LPA interview staff, toured facility and obtained and reviewed records. Allegation: Residents are isolated due to lack of staff. Continue on LIC9099C Unsubstantiated Continue from LIC9099 Reporting party stated residents are being isolated due to lack of staffing. Record review reveals that memory care and assisted living was fully staffed on the dates in question. Interview with S1 revealed that staff conducts safety checks for all residents rooms every two hours. S1 also stated the residents are asked and encouraged to come out into the common areas to join activities. LPA toured the memory care location and witness residents participating in arts and crafts, having snacks, watching TV, listening to music and getting hair cuts. Based on interviews and record review the Department has investigated the above allegation and found it to be Unsubstantiated. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 12, 2024 · control 15-AS-20240606145424

Type of visit: Case Management - Incident

On 3/7/2024, Licensing Program Analyst (LPA) Carol Fowler conducted a case management visit and met with the Kathleen Boyd, Business Office Manager. LPA explained to the Administrator purpose of the visit. During the investigation process conducted by the Department, S1 states R1 had an un-witnessed fall and was found by S2 in the bathroom on the floor, R1 was transferred to Richmond Kaiser. R1 returned to the community today 03/07/2024 and is doing well, R1 is able to transfer and take care of all activities of daily living (ADL's) with assistance. No deficiencies issued during the visit and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 7, 2024

Type of visit: Required - 1 Year

On 3/7/2024 at 9:45AM, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Kathleen Boyd Business Office Manager, and explained the purpose of the visit. The Administrator Richard Remigio arrived at 11:30AM and currently holds a certificate (#6051262740) that expired on 11/23/2023 and has been renewed. The facility’s fire clearance was approved for one hundred twenty two (122) non-ambulatory and eighteen (18) bedridden residents. LPA toured the facility including but not limited to apartments, bathrooms, kitchen, common area and backyard and patios. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 71 and 74 degree Fahrenheit. LPA observed lighting in all hallways are adequate for the comfort and safety of the residents. Hot water temperature in the shared bathroom was measured at 97.5 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients. There is a minimum of 7-day non perishables and 2-day perishables foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 1/17/2024. Emergency Disaster Plan was posted. First aid kit was observed to be complete. Fire drill was last conducted on 02/24/2024 continue on LIC 809C continued from LIC 809 LPA reviewed 5 staff record files. 5 of 5 staff have criminal record clearance or a criminal record exemption and holds a current first aid certificate. LPA reviewed 10 clients' files and a sample of clients’ medication log. LPA requested the following documents to be submitted to CCLD by 03/15/2024. · Resident Roster · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 pages) · Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 7, 2024