Merrill Gardens at Brentwood

Allegation investigated: Staff does not ensure resident is allowed to have private vists with family during reasonable hours in the facility

On 07/16/2026 at 10:21AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver the findings regarding the allegations above. LPA met with Lydia Hertzler, Executive Director, and explained the reason for the visit. During the investigation LPA, interviewed witnesses, staff members and resident (R1). LPA obtained the following documents: R1’s admission agreement, emergency contact information, physicians report, incident reports, appraisal needs and service plan, and staff contact information. Continue on LIC9099C... Substantiated Continued from LIC9099 Staff does not ensure resident is allowed to have private visits with family during reasonable hours in the facility Interviews with W1 revealed facility staff did not allow W1 to visit R1 due to R1’s daughter’s request. Interview with W2 revealed W2 doesn’t want W1 to visit R1 alone because W1 upsets R1 during visits. Interviews with S1 and S2 revealed staff did not allow W1 to visit R1 per the request of R1’s daughter. Based on LPAs interviews which were conducted, 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 and a copy of this report and appeal rights were given. Continued from LIC9099A Interviews with W1, revealed daughter took R1’s cell phone away preventing W1 from talking with R1. Interview with W2 revealed, R1 no longer has a cell phone, W1 can call the facility if W1 wants to talk to R1. Interview with S1 revealed R1 has access to the facility’s telephone when needed, and if R1 needs to make or receive an incoming call staff will take the telephone to R1 for use. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Jul 16, 2026 · control 15-AS-20251218154613

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Jul 26, 2026

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities....(1) To have a reasonable level of personal privacy in accommodations....This requirement is not met as evidence by: Based on interviews, the licensee did not comply with the section cited above by not ensuring resident is allowed visitors which poses a potential personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 16, 2026

Plan of correction: By POC date, licensee agreed to implement a plan and send email to CCL.

Type of visit: Required - 1 Year

On 04/22/2026 at 9:33AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to continue the 1-Year Annual Required inspection visit. LPA met with General Manager (GM), Lydia Hertzler, and explained the purpose of the visit. GM holds administrator certificate #7005283740 that expires 08/25/2026. The facility’s fire clearance was 135 non-ambulatory and 15 bedridden residents. Facility has hospice waiver for 15 residents. LPA toured the facility with James Alvarez, Senior Maintenance Director including but not limited to apartments, bathrooms, kitchens, med tech rooms, activity room, spa, salon, Wellness center, common areas and outside. LPA toured apartments #111, #114, #138, #240, #253 and #258. All outdoor and indoor passageways are kept free of obstruction. LPA observed a pool on the independent living side of the facility inaccessible to the Garden House residents. A comfortable temperature is maintained at 76 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 113.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-slip shower mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Continued on LIC809C. Continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 04/09/2026. First aid kit was observed to be complete. Fire drill was last conducted on 12/17/2025. Emergency Disaster Plan was last updated on 04/21/2026. LPA reviewed ten (10) staff records, and ten (10) resident records. LPA also reviewed E-MAR and the facility’s vehicle maintenance log during visit. LPA requested the following documents to be submitted to CCLD by 04/29/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (updated) Liability Insurance No deficiencies were cited during visit. Exit interview conducted. A copy of this report provided to Lydia Hertzler.the state’s words, verbatim · CDSS document, Apr 22, 2026

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

Allegation investigated: Staff did not seek timely medical attention for resident after a change in condition Staff do not ensure that resident call buttons are in proper working condition Licensee did not abide by the terms and conditions of resident's admission agreement Staff are not dispensing medications as prescribed

On 10/28/2025 at 10:45AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a complaint investigation and deliver the findings in regard to the allegations above. LPA met with Lydia Hertzler, Executive Director, and informed her of the reason for visit. During the investigation, LPA interviewed witness, staff members and obtained the following documents: staff roster, staff contact information, resident roster, R1’s admission agreement, preplacement appraisal, physicians report (LIC602), after visit summary, doctor notes dated April 08,2025, Medication Administration Record (MAR), unusual incident reports (LIC624), facility’s incident notes and facility’s pull cord log dated June 5, 2025 Continued on LIC9099C... Unsubstantiated Continued from LIC9099 Staff did not seek timely medical attention for resident after a change in condition During interviews and record review, it was revealed the facility contacted W1 to schedule a doctor appointment for R1, due to changes in condition observed observe by S2. Interviews revealed W1 stated she couldn’t schedule R1 an appointment due to R1 not having a doctor here in this area and the appointments were booked out for 6 months. Staff do not ensure that resident call buttons are in proper working condition During interviews, it was revealed that R1 pressed call button on June 5, 2025, and S3 responded timely. During interviews it was stated R1 pulled her pull cord and S3 arrived shortly and found R1 on the floor expressing suicidal intent. Record review revealed pull cord in R1’s bathroom was pulled at 5:16am and S3 arrived at 5:22am. Licensee did not abide by the terms and conditions of resident's admission agreement During interviews and record review, it was revealed that the facility did abide by the terms and conditions of R1’s admission agreement. Interviews revealed that the facility did abide by the terms of R1’s admission agreement, and that R1’s condition changes which resulted in a fee adjustment for R1’s care needs. Record review revealed, facility conducted another evaluation of the R1 and proposed an increase in fees to W1 due to an increase in care needs for R1 Continue on LIC9099C... Continued from LIC9099C Staff are not dispensing medications as prescribed. During interviews and record review, it was revealed that staff followed R1’s physician report regrading administering medications. Interviews revealed that S2 followed R1’s new Physician report (LIC602), dispensed the medications listed on LIC602 and informed W1 of the change in medications. Record review revealed that R1’s physician made adjustments to R1’s medications that was previously prescribed. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given to Lydia Hertzler.the state’s words, verbatim · CDSS document, Oct 28, 2025 · control 15-AS-20250717102256

Allegation investigated: Staff did not respond to resident's calls for assistance in a timely manner

On 08/28/2025 at 10:30AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct the 10-day initial visit and deliver complaint findings for the allegation above. LPA met with Lydia Hertzler, Executive Director, and explained the reason for the visit. During the course of the investigation, LPA interviewed 2 staff, and 3 residents. LPA reviewed and obtained documents including resident roster, staff schedule, staff in service training memo with signatures of participants, staff contact number and facility’s call button/pendant response time report. Continue on LIC9099C.... Substantiated Continued from LIC9099 Staff did not respond to resident’s calls for assistance in a timely manner Interviews with R1, S1, S2 and record review revealed that R1’s call for assistance was not responded to in a timely manner. R1 stated she pressed the call button around 11:00pm and staff arrived after 4:00am. Record review revealed that R1’s call button was initiated at 11:24pm on 08/23/2025 and the response time was 5:22am on 08/24/2025. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted with Lydia Hertzler. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 28, 2025 · control 15-AS-20250825144339

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Sep 4, 2025

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers...to provide the services necessary...In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care... This requirement is not met as evidenced by: Based on investigation, the licensee did not comply with the section cited above by not responding to call button in a timely manner which poses a potential health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: Executive Director (ED) held an in-service training course with staff on August 25, 2025, regarding understanding of facility’s policy pertaining to response time for call buttons and pendants. Deficiency cleared during visit.

Type of visit: Required - 1 Year

On 04/16/2025 at 10:00AM, Licensing Program Analyst (LPA) T. Syess-Gibson, arrived unannounced to continue the 1-Year Annual Required inspection visit. LPA met with General Manager (GM), Lydia Hertzler and explained the purpose of the visit. Administrator certificate #7005283740 expires 08/25/2026. The facility’s fire clearance was 135 non-ambulatory and 15 bedridden residents. Facility has hospice waiver for 15 residents. LPA toured the facility with Maintenance Director including but not limited to apartments, bathrooms, kitchen, med tech room, activity room, spa salon, Wellness center, common area and outside. LPA toured apartments #103, #115, #135 and #160. All outdoor and indoor passageways are kept free of obstruction. LPA observed a pool on the independent living side of the facility inaccessible to the Garden House residents. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-slip shower mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 04/14/2025. First aid kit was observed to be complete. Fire drill was last conducted on ##/##/####. Continued on LIC809C. Continued from LIC809. LPA reviewed ten (10) staff records, ten (10) resident record, and they were current and complete. LPA also reviewed the vehicle maintenance log. LPA requested the following documents to be submitted to CCLD by 04/23/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance LPA observed no deficiencies during visit: Exit interview conducted. A copy this report provided.the state’s words, verbatim · CDSS document, Apr 16, 2025

Allegation investigated: Staff do not ensure that medication is inaccessible to others

On 01/23/2025 at 10:00AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to deliver findings regarding the allegation above. LPA met with General Manager, Lydia Hertzler and explained the purpose of the visit. During the course of investigation, LPA interviewed complainant, resident and staff/MedTech. Allegation: Staff do not ensure that medication is inaccessible to others Interview with complainant, resident and staff/Med Tech (MT) reveled MT did leave Prilosec (acid reflux) over the counter medication in R1’s room after assisting R1 with medication and checking R1's blood sugar levels. R1 and granddaughter brought the medication to the front desk upon granddaughter leaving the facility after visiting her grandmother. Continue LIC9099C Substantiated Continue from LIC9099 Resident was hospitalized as a result of food poisoning. Interview with staff and record review revealed R1 wasn’t hospitalized as a result of food poisoning, however, was hospitalized for other health conditions. No one at the facility was sick and reported food poisoning. Staff are not providing adequate food service. Interviews with other residents and review of menu revealed that residents are satisfied with quality and quantity of the food provided and have many options to select from. Licensee does not ensure the facility has a full-time staff person responsible for food service Interviews with staff and record review revealed staff stepped up to assist in kitchen when needed to assure all residents had meals. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and this report provided continue from LIC9099 Based on LPA observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation 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. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Jan 23, 2025 · control 15-AS-20241209113103

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jan 24, 2025

(h) The following requirements shall apply to medications which are centrally stored: 2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication This requirement is not met as evidenced by: Based on interviews conducted, The licensee did not comply with the section cited above in not having medication inaccessible to resident which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 23, 2025

Plan of correction: General Manager will implement a written plan to prevent this from happening again and submit plan to CCLD by POC date.

Allegation investigated: Staff do not provide adequate care and supervision to the residents

On on12/23/2024 Licensing Program Analysts (LPAs) T. Syess-Gibson and L.Hall arrived unannounced to deliver finding on the above allegation and met with Lydia Hertzler. LPAs explained to Lydia Hertzler the purpose of the visit. It was alleged that staff do not provide adequate care and supervision to the residents. During the course of investigation, LPAs L. Fontanilla and T. Syess-Gibson interviewed staff and obtained the following records: May 2024 staff schedule, shower and laundry schedules, evaluation and Physician’s Reports. Based on interviews conducted with staff on 5/30/2024, the Memory Care unit has 19 residents, 2 caregivers each for AM and PM shifts, one Activity staff and one Medication Technician (MedTech). The MedTech sets up and passes medications for both the assisted living and memory care. Housekeeping is done once a week by the housekeeping staff. The care staff are responsible in assisting residents with activities of daily living (ADLs) including but not limited to giving showers, making beds, serving breakfast and lunch, assisting residents during mealtimes, feeding resident, if needed, tidying up residents’ rooms, washing/rinsing cups/utensils after each meal, and doing daily laundry for 2-3 residents daily. Substantiated Continued LIC9099 The activity staff assists residents during mealtimes. If one care staff needs to go on break or does not show up, there is only one caregiver available to assist residents with ADLs. Sometimes, the Med Techs assist residents with ADLs, if available. A review of the facility’s staff schedule for May 2024 shows that on May 12, 2024, only S4 worked in the morning shift. S4 confirmed with LPAs the information. When asked by LPAs how S4 managed to provide ADLs to all the residents, S4 states that it was impossible to provide all ADLs to all the residents. S4 states no residents were provided with showers and housekeeping. S4 added that although the Activity Director assisted during mealtimes and watched residents in the common areas, it was only S4 who provided care to all the residents in the unit. On 5/22/2024 when Resident 1 (R1) had a bowel accident, S4 was on break and one caregiver was with another resident. R1’s daughter requested assistance in cleaning up R1. There was no staff available to assist R1. R1’s daughter ended up giving R1 a shower to get cleaned. Staff interviewed state that there is one resident who needs 2-person assist (due to weight), 3 residents who wander and need constant redirection, 4 residents need two persons assist with showers/changing (due to behavior), 1 resident needs to be fed and 4 residents on hospice. Based on interviews and record reviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Health and Safety Code 1569.269(a)(6) is being cited on the attached LIC 9099D. Exit interview was conducted with Lydia Hertzler and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Dec 23, 2024 · control 15-AS-20240523140613

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(6) · Plan of correction due date: Dec 30, 2024

1569.269(a)(6) Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs This requirement is not met as evidenced by: Based on interviews conducted, The LIcensee did not comply with the section cited above in having sufficent staff to provide care for the residents which poses a potential risk to the health and safety of the residents under care.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: General Manager agreed to hire additonal staff along with a stafifng agency to have sufficent staff for facility, and submit new staff names and name of staff agency to CCLD by POC date. Deficiency cleared during visit.

Type of visit: Case Management - Other

On 12/23/2024 at 10:30AM Licensing Program analysts (LPAs) T. Syess-Gibson and L. Hall arrived unannounced to conduct a Case Management visit to provide the amended complaint from 12/17/2024. LPAs met with Lydia Hertzler, General Manager and explained the purpose of visit. While LPA T. Syess-Gibson was conducting a complaint investigation 15-AS-20241210103140 on 12/17/2024, LPA added substantiated the allegation of Facility is short staff; however, all allegations should have been unsubstantiated. LPA amended LIC9099 and LIC9099A to show unsubstantiated allegations. On 01/07/2025 at 10:00AM LPA T.Syess-Gibson arrived to deliver this report and obtain signature from facility representative which was generated on 12/23/2024 Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

Allegation investigated: Facility is short staff.

Amended to remove two unsubstantiated allegations. On 12/17/2024 at 10:13am, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to conduct the 10-day initial visit for the above allegations. LPA met with Lydia Hertzler, General Manager (GM), and explained the reason for the visit. During the visit LPA interviewed staff, residents, obtained and reviewed LIC500 (personnel record) and resident roster. Allegation: Facility is short staff During interview with S1, S2, and S3, it was determined that the facility had a lot of Staff calling out, which calls for other Staff members to fill in on Assisted LIving side. S3 stated faciilty has since hired two (2) medtechs and two (2) caregivers. Facility has also obtained contracts with the All Phases and Allegra staffing agencies.Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur,therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 17, 2024 · control 15-AS-20241210103140

Allegation investigated: Staff does not ensure infection control guidelines are being followed Staff do not ensure reporting requirements are being followed Facility is in disrepair Staff does not ensure facility temperatures are maintained between 78 - 85 degree Licensee does not ensure staff are in good health to perform assigned tasks

On 08/13/2024 at 11:30AM, Licensing Program Analysts (LPAs), T.Syess-Gibson and L.Fontanilla arrived unannounced to deliver complaint findings for the allegations above. LPAs met with Lydia Hertzler, General Manager/Administrator and explained the reason for the visit. On 07/17/2024 LPA coducted a Ten (10) day visit. During the course of the investigation, LPA interviewed staff, observed , obtained and reviewed records. Allegation: Staff does not ensure infection control guidelines are being followed Based on interviews with staff, the facility followed infection control guidelines by isolating the covid positive residents in their apartments and provided Personal Protective Equipment (PPE) located outside of every apartment that was affected with COVID-19. The General Manager (GM) also provided weekly status letters of the outbreak to the community, keeping the community informed of the positive count which were posted on the bulletin board and left under the door of all residents. **Continue LIC9099C** Unsubstantiated continue from LIC9099 Allegation: Staff do not ensure reporting requirements are being followed Based on observation the GM followed reporting guideline by submitting Unusual Incident Reports (UIR) to CCLD within the time frame of outbreak. LPA received the following (UIRs) on July 5, 2024, July 7,2024 and July 11, 2024. Allegation: Facility is in disrepair Based on observation and interviews with staff, the kitchen area was affected by the Heating, Ventilation, and Air conditioning (HVAC) unit , however the residents weren’t affected. The residents still had air conditioning in the common areas such as dining room, activity room and their rooms, which causes no health concerns to the residents in care. Allegation: staff does not ensure facility temperatures are maintained between 78 - 85 degrees Based on observation and interviews with staff, the facility has had a problem with the Heating, Ventilation, and Air conditioning (HVAC) since 06/07/2024. One of the two units located outside of the facility controls the dining room, library, and the kitchen area, that’s the unit that has a down compressor. An attempt to fix the problem was made however, unsuccessful so the repair man did a temporary fix by re-wiring the unit which will allow the unit to work but not all thermostats can run same time. Which causes the kitchen area to be warmer than usual during (breakfast, lunch and dinner) times when the residents are in the dining room. The GM provided large industrial fans to provide relief to staff working in the kitchen. LPA observed three (3) fans located near the cooking area, prep station and the dishwashing station. The GM also allowed staff to take extra breaks if needed for relief throughout the day. continue on LIC9099C continued from LIC9099C Allegation: Licensee does not ensure staff are in good health to perform assigned tasks Based on interviews with staff a staff member reported to work as scheduled and wasn’t feeling well, decided to take a COVID-19 test and it was negative. The staff member waited approximately 30 minutes took another test and it was positive. The staff member immediately left the community. Once at home the staff member called the MedTech who was working closely with her that and encourage her to also test. The MedTech tested herself and tested positive at that tine she notified her manager and left the community. Neither employee returned to community, until they both tested negative which was on the Sixth day after testing positive. Based upon the information obtained during investigation, the above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 13, 2024 · control 15-AS-20240709100543

Type of visit: Required - 1 Year

On 05/09/2024 at 2:05PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and C. Fowler, arrived unannounced to continue the 1-Year Annual Required inspection visit. LPAs met with Business Office Director (BOD), Carol Anthony, and explained the purpose of the visit. Administrator certificate #6017917740 expires 08/25/2024. The facility’s fire clearance was 135 non-ambulatory and 15 bedridden residents. Facility has hospice waiver for 15 residents. LPAs toured the facility with Administrator including but not limited to apartments, bathrooms, kitchen, common area, med tech room, and outside. LPAs toured apartments #106, #112 and #140. All outdoor and indoor passageways are kept free of obstruction. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 106.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non slip shower mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 07/27/2023. First aid kit was observed to be complete. Fire drill was last conducted on 04/07/2024. Continued on LIC809C. Continued from LIC809. LPAs reviewed ten (10) staff records, ten (10) resident record, and they were current and complete. LPAs also reviewed the vehicle maintenance log. LPA requested the following documents to be submitted to CCLD by 05/16/2024. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · Liability Insurance LPA observed no deficiencies during visit: Exit interview conducted. A copy this report provided.the state’s words, verbatim · CDSS document, May 9, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

.On 05/03/2024 at 2:40PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and L.Hall arrived unannounced to conduct a case management visit in regard to incident report received on 04/29/2024. LPAs met with Executive Director, Lydia Hertzler and informed him of the reason for the visit. Based on the incident report received on 04/29/2024, Resident 1 (R1) returned to the facility with a new diagnosis that the facility hadn't been made aware of previously. S1 stated when R1 returned the discharge summary documents indicated the diagnosis. Facility staff requested a new physician's report to indicate diagnosis. Facility staff had conference call with family regarding continuing care of R1. LPAs obtained the following documents: discharge summary notes from Kaiser hospital, physician report dated 6/14/2022 ,pre placement appraisal, and face sheet for R1. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, May 3, 2024

Allegation investigated: Staff does not prevent residents from falling in the shower. Facility does not have a backup generator.

On 3/7/2024 9:45am, Licensing Program Analysts (LPAs), L. Hall and T. Syess-Gibson arrived unannounced to conduct the 10-day initial visit for the above allegations. LPAs met with Lydia Hertzler, Executive Director (ED), and explained the reason for the visit. During the visit LPAs interviewed the Reporting party (RP), staff, residents, obtained and reviewed LIC500 (personnel record), resident roster, the crisis/emergency manual, and a copy of the monthly emergency checks, and an admission agreement. Allegation: Facility does not have a backup generator. The RP stated during interview that the facility does not have a backup generator. During interview with Staff 1 (S1) and Staff 2 (S2) it was stated that the facility has a inverter that has large battery packs that gives electricity for 90 minuets. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. During interview with Staff 1 (S1) and Staff 2 (S2) it was stated that the facility has an inverter that has large battery packs to give electricity for 90 minuets. S1 stated staff was informed that residents should be moved within an hour if power is out after the 90 minuets. S1 also stated the common areas, the lights in the apartments are dimly lit and the kitchen equipment still works when the inverter is working. S2 showed LPAs where the inverter is located during the visit. S2 stated that he completes safety training with all new employees. Based on the investigation the above allegations are unsubstantiated. Allegation: Staff does not prevent residents from falling in the shower. RP stated during initial interview some residents have concerns about other residents falling while exiting the shower and that additional grab bars should be installed. LPAs toured an apartment with and without the extra grab bars. S1 stated that the residents are offered a referral to have grab bars installed by a contractor at an additional cost. Review of the admission agreement indicates any alterations and maintenance has to be given written approval prior to any physical changes, which would include the installation of additional grab bars. The residents that were interviewed did have concerns about falling when exiting the shower but felt they should not be responsible for paying a contractor that is referred from the facility to install additional grab bars. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of this report provided,the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 15-AS-20240305143658