A1 Del Monte Stockton

Allegation investigated: Allegation: Staff not providing records to the authorized representative/resident

On 8/4/26 Licensing Program (LPA) Kimberly Kulich and Licensing Program Manager (LPM) Lisa Rios went to the A1 Del Monte facility to deliver complaint findings for a complaint filed on 7/10/26. During the investigation, it was learned that on June 16, 2026, Titan legal services requested R1’s records. It was also learned that R1 had previously been conserved by San Joaquin’s Guardian Office. Titan legal services did not represent R1’s conservator so permission from R1’s conservator needed to be sought. It was also determined that R1’s conservator wanted to reach out to Titan legal services to verify who the requestor of the documents was. On 7/8/26 R1’s conservator contacted the facility and stated that they did not object to the request for documents. On 7/13/26 the facility, after seeking legal advice, released the records. Based on the facility’s need to verify with the resident’s conservator that it was okay to release records on behalf of R1, there is not a preponderance of evidence to prove the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. Unsubstantiated Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 27-AS-20260710161945

Type of visit: Required - 1 Year

On August 4, 2026 at 9:00AM, Licensing Program Analyst (LPA) Kimberly Kulich and Licensing Program Manager (LPM) Lisa Rios, arrived at A1 Del Monte Assisted Living at 517 East Fulton Street, Stockton, CA, for an unannounced annual visit. LPA Kulich confirmed and photographed the front yard was landscaped and maintained. LPA Kulich and LPM Rios were greeted at the front door by Licensee/Administrator Sandeep Saini. LPM Rios began a file review of staff and residents. LPM verified all staff have background clearance and are associated to the facility. LPA and Licensee observed the kitchen. All appliances are operable and in good working condition. There are enough clean plates and cutlery to meet capacity. Knives and sharp objects are stored in a locked drawer: keys are with staff. Dishwasher soaps, fruit wash, paper towels were stored and locked under the sink. LPA Kulich measured the refrigerator at 50 degrees Fahrenheit and freezer temperature at 0 degrees Fahrenheit. The refrigerator was clean and free of odors. No medication kept in refrigerator or pantry. Perishable (2 days) and non-perishable (7 days) food supplies available. LPA and licensee, observed Bedroom #1. The thermostat was set at 70 Fahrenheit. Room was equipped with a bed, night stand, chair and overhead light. Linens were clean and furniture was well maintained and in good repair. LPA observed the bathroom. LPA observed grip bars and non-slip shower surface. LPA Kulich the non-slip flooring. Toilet, sink and shower are in good working order as demonstrated by licensee. LPA walked backyard area. There were 4 tanks of potable water and a cargo shed that contained PPE, laundry detergent, emergency supplies, water, holiday decorations, sports equipment, cleaning supplies, paper goods, and tools. LPA and Licensee entered the hallway where LPA asked staff member to open the cabinet where the fire extinguisher was stored. Staff member could not open cabinet as the fire extinguisher had been painted shut inside the cabinet. Licensee then attempted to open cabinet and forced it open. LPA noted a compliant fire extinguisher, and working smoke and carbon monoxide detectors, that were tested by licensee. The hallway was well lit, and wide enough for wheelchair access. Licensee opened laundry storage closet. LPA noted closet contained color coded towels and sheets, mattress covers, and additional supplies. Closet is organized and sheet assignments are easy to differentiate between residents. Each resident has their own towels and sheets. LPA Kulich observed multiple sets of additional spare linens, including bedding and towels. At LPA and licensee entered bedroom #2. Bedroom contained overhead lighting, chair, night stand w/drawer, desk and bed. All furniture was in good repair. LPA observed room had closet with space for clothes and personal belongings. LPM Rios and LPA Kulich conducted an exit interview. Licensee/Administrator were provided a copy of the report and their appeal rights.LPA, and Licensee observed the dining room. LPA noted seating and tables accommodated census. Activity Calendar posted on the wall which observed holiday and religious celebrations, arts and craft, games, dancing, and other social activities. ok Enough seating to accommodate census & capacity.the state’s words, verbatim · CDSS document, Aug 4, 2026

Type of visit: Office

On 4/21/26 at 10:00am, the regional office conducted an informal meeting with the facility to discuss current modifications to the facility as well as updates to the the program design. This meeting was held virtually via Teams Meeting. Present at the meeting were: Licensing Program Manager (LPM) Lisa Rios, Licensing Program Analyst (LPA) Albert Johnson, and Administrators for the facility. The purpose of this meeting was to discuss the allegations and appeal: • Facility modifications • Medication records • buildings and grounds • Food service • Levels of care. An appeal was submitted as required and will be reviewed by the department with additional information that was provided to the department. Licensee/Administrator has agreed to: Resume progress with building permit #BP24-03324 (Removal and relocating of the double swing doors) Obtain the proper permit for all partition walls built to divide the patients within the facility. Contact the Building Division for further information. The Building Division is located at 501 W. Weber Ave Building 2, First Floor Stockton, CA 95203. # (209) 937-8561. Provide updates to the buildings and grounds in memory care and other areas identified. (Doors propped open) The Regional Office will do the following: Continue to be available for Licensee for any guidance Continue to monitor facility for compliance and ensure the health and safety of the residents in care. Per California Code of Regulations (CCR), no deficiencies are being cited. An exit interview was held, and a copy of the report was provided via email.the state’s words, verbatim · CDSS document, Apr 21, 2026

Allegation investigated: Staff do not change the residents soiled linen in a timely manner Staff do not wash the residents clothing in a timely manner Staff do not meet resident’s incontinence needs Staff do not safeguard resident’s personal belongings Staff verbally assault resident Staff did not prevent resident from being hit in an aggressive manner by another resident

Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to open deliver findings into the above listed allegations. Allegation: Staff do not change the residents soiled linen in a timely manner. Based on records reviewed including daily records documenting each resident’s ADL status, including bathing, grooming, laundry, and linen changes. Notes also reflect any refusals and subsequent rescheduling efforts, consistent with the resident’s rights and preferences. Allegation: Staff do not wash the residents clothing in a timely manner. Records reviewed for Shower/Linen Schedule Indicates the planned schedule for showers, laundry services, and linen changes. If a resident declines, staff documented the refusal and rescheduled services consistent with Title 22 and the resident’s personal rights. Unsubstantiated Allegation: Staff do not meet resident’s incontinence needs. Based on interviews and records reviewed including daily records documenting each resident’s ADL status, including bathing, grooming, laundry, and linen changes. Notes also reflect any refusals and subsequent rescheduling efforts, consistent with the resident’s rights and preferences. Allegation: Staff do not safeguard resident’s personal belongings. Interviews with residents and review of the LIC 621 – Resident Personal Property and Valuables Inventory the facility updates form to reflect items reported or verified by the resident. Documentation demonstrates compliance with residents’ rights regarding property protection and inventory accuracy. Allegation: Staff verbally assault resident. Interviews conducted and records reviewed including entries documenting observable changes in behavior, mood, medical condition, or other matters pertinent to the resident’s care needs. Notes indicate staff interventions and follow-up actions. All resident interviewed denied staff verbally abusing residents. Allegation: Staff did not prevent resident from being hit in an aggressive manner by another resident. Based on records reviewed and interviews conducted the facility has intervened with aggression between residents. The incidents are reported and intervention techniques are used to assist the residents in alterative interactions. As a result, it is determined that there is not a preponderance of evidence to prove these allegations occurred, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conductedthe state’s words, verbatim · CDSS document, Apr 2, 2026 · control 27-AS-20251201111118

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to deliver findings and to conduct a case management visit to amend complaint report. LPA met with Neil and explained the purpose of the visit. During the walk through of the facility, LPA and staff assisting observed areas that need attention. These areas of concern included facility modifications, medication, buildings and grounds, food service and levels of care. The facility has made some changes to staffing in the areas of concern and as a result have identified some areas that need to be addressed to bring the facility into compliance. The facility is in support of utilizing technical support. Citation and advisories given. An informal meeting is scheduled for April 21, 2026 at 10:00 am. The informal meeting will be held via Teams platform. The attendance is mandatory. Exit interview conductedthe state’s words, verbatim · CDSS document, Apr 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87305(a) · Plan of correction due date: Apr 3, 2026

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirements is not met as evidenced by The facility has moved the memory care door back approximately 10 feet to expose additional rooms to be used for none memory care residents. This is an immediate saftey risk to residents in care.the state’s words, verbatim · CDSS document, Apr 2, 2026

Plan of correction: The Licensee will contact building permits or code enforcement to determine if the altercations to the buliding require a permit and if the work completed meets code. The information will be submitted to the department by the close POC date. If addtional time is needed please request the additional time by submitting a request in writting or email LPA

Allegation investigated: Staff unlawfully evicted the residents

LPA Albert Johnson made an unannounced visit to deliver complaint findings for the allegation listed above. LPA interviewed Staff and Clients. As a result of the interviews and facility visits, LPA learned that the resident was smoking in the room while on oxygen this is an immediate health and safety risk to all residents in care. R1 was sent out to the ER to be treated for COVID. R1 did not return to the facility, R1 was discharged to a skilled nursing facility and required a higher level of care. An eviction letter was given to the resident. As a result of the need for a higher level of care R1 will be discharged to a facility that can meet R1's needs. Unfounded R2 received multiple requested from the facility and corrective actions to stop drinking alcohol in the room along with smoking in the room. This is a safety risk regarding alcohol and fire to all residents in care. R2 moved out of the facility on September 11, 2025 and back to Sacramento, California. As a result of this investigation, the department finds allegation to be (U) Unfounded - A finding that the complaint is Unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Administrator/licensee and a copy of this report was provided to the licensee.the state’s words, verbatim · CDSS document, Oct 20, 2025 · control 27-AS-20250717093320

Allegation investigated: Staff neglect resulted in a resident sustaining injuries while in care Staff interfere with a resident's visitations Staff are mishandling a resident while in care

Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to deliver findings for the above listed allegations. Allegation: Staff neglect resulted in a resident sustaining injuries while in care. Based on records reviewed and interviews conducted with the facility staff and R1, the facility is providing support for fall prevention as identified in the service plans reviewed from 2021 to present. R1 has a history of falls and is supported through out the day with transferring, and mobility as needed. The facility has provided R1 with updated services plans and continues to provide services to meet the needs of R1. The allegation is unsubstantiated. Continued Unsubstantiated Allegation: Staff interfere with a resident's visitations. The facility has reviewed the visiting hours with R1 as identified in the facility admission agreement and the facility handbook. The facility's visiting hours are from 8am to 8pm or by arrangement. R1 is sharing a room with another and the facility emphasizes courtesy and consideration while entertaining visitors in the room with a roommate. The facility provides areas for visitation within the hours of visitation and is willing to make arrangements for special request within reason. Allegation: Staff are mishandling a resident while in care. Based on records reviewed and interviews conducted the facility, the department is unable to confirm that R1 has been mishandled. The records reviewed did not show any unusual marking's on R1 or any history of bruising or any other identifiers that would support mishandling of a resident. R1 has been a resident of the facility for seven years and has not made any complaint or allegation of being mishandled by the staff at this facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 22, 2025 · control 27-AS-20250613163526

Type of visit: Required - 1 Year

On 7/1/2025, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Sunny, Ana and explained the purpose of the visit. This is an ALWP (Assisted Living Wavier Program) facility with memory care. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 116.0 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications locked in each section of the facility. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident and staff files, including criminal record clearances. Fire drill was completed on 6/12/2025. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete. No deficiencies were cited. Exit interview conductedthe state’s words, verbatim · CDSS document, Jul 1, 2025

Allegation investigated: Staff did not prevent resident from being physically assaulted Staff did not assist resident in a timely manner Staff do not safeguard resident's personal belongings Staff are not assisting resident with grooming

Licensing Program Analysts (LPA) Albert Johnson arrived unannounced to deliver findings for the complaint allegations noted above. LPA met with Sunny and Director of Nursing Lucky Kaur and explained the purpose of the visit. Allegation: Staff did not prevent resident from being physically assaulted Based on interviews conducted and records reviewed there were no witnesses to alleged event or outstanding visible injuries noted by staff. Staff was made aware by family friend of the incident and followed up to determine if R-1 was attacked or injured. Staff working confirmed that there were no visible injuries and no witnesses to alleged incident noted. Continued Unsubstantiated Allegation: Staff did not assist resident in a timely manner. Based on interviews and record reviews, it was revealed that R1 has been experiencing changes in condition and has been increasing in verbal repetition, confusion and making allegations of missing items. The family has been made aware of the situation as well as the primary care physician. On 4/11/2025, Stockton Police officers conducted a welfare check (report number P250990565) and determined that R-1's welfare is not compromised. Allegation: Staff do not safeguard resident's personal belongings. The department reviewed the inventory record of R-1 and was able to match items from the list to actual items, however the counts were off for undergarments and socks. R-1 has been alleging that items are missing and will report these missing items to staff. Staff will locate these items and show R-1 that the items are not missing. Allegation: Staff are not assisting resident with grooming. Records reviewed and in-person visits by the department confirmed that R-1 has been receiving assistance with daily living hygiene and has been seen by the Podiatrist on a regular bases monthly. The Podiatrist is scheduled quarterly. However, R-1 has refused treatment for the last three months. As a result, it is determined that there is not a preponderance of evidence to prove these allegations occurred, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conductedthe state’s words, verbatim · CDSS document, Jun 5, 2025 · control 27-AS-20250409132624

Allegation investigated: Facility staff is not meeting dietary needs of residents. Facility staff is not providing adequate care of residents Facility staff is not safeguarding resident personal belongings

Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to deliver complaint investigation findings. Allegation: Facility staff is not meeting dietary needs of residents. Based on interviews with staff and residents along with records reviewed the department was unable to substantiate that resident's dietary needs were not met. Interviews conducted confirmed that residents have received meals in their rooms and are offered options when the items on the menu are not what they prefer. The review of records included menus, dietary assessments and intervention, weight monitoring, dietary modifications. These records were part of a quarterly report provided by a registered dietitian. The allegation is unsubstantiated. Unsubstantiated Allegation: Facility staff is not providing adequate care of residents. Records reviewed and interviews conducted with residents and staff provided the department with information for each resident including individual service plans, shower schedules, and care notes. This information documents overall care and supervision for residents. Based on the above information the department is not able to substantiate the above allegation. Allegation: Facility staff is not safeguarding resident personal belongings. Based on interviews with residents and Staff, the facility is following the theft and loss policy outlined in the resident handbook. The loss of items is not taken lightly and immediate action has been taken to remedy any missing or lost item. The facility has a lost and find area as well as an area for residents to obtain additional clothing ,shoes and other personal items they may be without or in need of. Based on the above information the department is not able to substantiate the above allegation.the state’s words, verbatim · CDSS document, Mar 5, 2025 · control 27-AS-20241127160259

Allegation investigated: Facility has scabies Facility staff is not following infection control precautions Facility staff did not inform responsible party of resident's change in condition

Allegation:Facility has scabies. LPA conducted interviews with staff and residents as noted above, and reviewed facility file documentation. Based on interviews and record reviews, it was determined that although a rash was existent on resident1 (R1) it was undetermined and unconfirmed through an appropriate skilled professional that said rash was scabies. Additionally, record review revealed treatment practices were in place for the diagnosed skin rash, and that no cases of scabies have been diagnosed at this time. Based on interviews and record reviews, there is not a preponderance of evidence to conclude that residents in care contained scabies, and this allegation is UNSUBSTANTIATED. Continued Unsubstantiated Allegation Facility staff is not following infection control precautions. LPA conducted facility observation on 9/14/2024, 10/15/2024 and 11/4/2024, and conducted interviews with staff and residents, and reviewed additional documentation. Based on observation and interviews, it was determined that although the facility was treated for a skin conditions the prescribing doctor did not diagnosis a case of scabies. As a result, there is not a preponderance of evidence to conclude that Facility staff is not following infection control precautions, therefore this allegation is UNSUBSTANTIATED. Allegation: Facility staff did not inform responsible party of resident's change in condition. The department interviewed the RP and the facility staff. The RP stated that she was not informed of the change in condition and the staff at the facility stated that R1 had identified condition identified in the pre appraisal. As a result, there is not a preponderance of evidence to conclude. therefore this allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 15, 2024 · control 27-AS-20241002085320

Type of visit: Case Management - Incident

On 10/23/2024, LPA Johnson arrived at the care facility to conduct a case management visit into an incident report received regarding a medical emergency. The report and supporting documents confirmed that R1 was able to leave the facility unassisted. On 10/16/2024, The facility received notification from Stockton police department that R1 was involved in a hit-and-run accident. R1 was walking when the event occurred and was struck by a vehicle. Nearby people called the authorities and She was taken to the hospital for further evaluation. The facility informed R1’s son of the situation, and he was able to speak with R1 directly. The hospital notified the facility that surgery would be required. On 10/17/2024, the facility received a call from the hospital and the coroner office, informing them that R1 had passed. LPA Johnson obtained copies of resident's file information. No deficiencies cited during this visit.the state’s words, verbatim · CDSS document, Oct 23, 2024

Type of visit: POC

The following deficiencies, initially cited during a visit on 05/01/2024, have been cleared:the state’s words, verbatim · CDSS document, Oct 14, 2024

Allegation investigated: Staff did not ensure the facility was free from bedbugs.

“On April 16th, 2024 the facility DON/AED had emailed LPA and self reported concerns about bed bugs in the facility based upon our regular facility inspection.” The facility provided proof that treatments to all suspected rooms were conducted the same day of self-reporting. You also advised that residents stayed in alternative rooms until treatment was completed and adhered to the recommended time frame the exterminator recommended for residents to remain out of the area for safety and health precaution. During the investigation it was determined that through record reviews and interviews, the facility is addressing the situation by maintaining an exterminator contract to provide routine bed bug treatment service. Based on this information the allegation is unfounded Unfoundedthe state’s words, verbatim · CDSS document, Oct 3, 2024 · control 27-AS-20240827092029

Allegation investigated: Facility staff are not providing adequate transportation services to residents

Based on records reviewed and interviews conducted the facility has been providing assistance in meeting necessary transportation to medical and dental appointments. The facility has been providing transportation for the residents to medical and dental appointments. The RP states when she is provided transportation, it is not wheelchair accessible. The facility uses their vehicles as well as outside agencies to meet the transportation needs for each resident's medical or dental appointments. At this time the facilities' bus was vandalized and some key components were stolen. The facility has ordered the parts and will get the bus back operational as soon as the part comes in and they can get it installed. continued Unsubstantiated The bus is not safe to transport residents at this time. It appears that the facility is making and has made arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services. The allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Oct 3, 2024 · control 27-AS-20240809134417

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct a Case management. LPA met with Lucky explained the purpose of the visit. LPA was following up on the request for an exception for R1. R1 has been under our care at the facility. This resident has recently been diagnosed with a Stage 3 wound. After careful consultation it has been determined that continuing treatment within our facility is in the residents’ best interest at this time because he stated , he is in comfortable environment and moving may cause him unnecessary stress. We have also explained to the resident that, should the wound treatment provided by Home Health Care One or Bay Area Mobile Medical Group not prove effective, Del Monte may need to transfer him to a skilled nursing facility for more advanced care. The resident’s Power of Attorney has been made aware of this possibility and agrees with the plan of action. Wound care will be managed by Home Health Care One’s professionals and Bay Area Mobile Medical Group who has wound specialist team and who will provide treatment on-site. Exit interview conductedthe state’s words, verbatim · CDSS document, Sep 24, 2024

Allegation investigated: Staff handled resident in a rough manner Staff did not administer residents medication in a timely manner Staff are not meeting residents diapering needs Staff are not meeting residents laundry needs Staff did not ensure the facility was free of mold

Allegation: Staff handled resident in a rough manner. During the investigation residents and staff were interviewed all interviewed denied witness or being handled in a rough manner. Residents stated that some of their housemates can be aggressive toward the staff when it comes time for medications and some residents are verbally aggressive and impatient with the Medtechs. The department has witnessed medication passes and confirmed that some residents are verbally agressive and impatient during the medication administration time. The allegation is unsubstantiated. Allegation: Staff did not administer residents medication in a timely manner. The department reviewed the medication administration record, witnessed medication passes and interviewed residents. The departemnt was not able to confirm that medication was not being given timely. During the monitoring of medication administration the facility was within the times of giving medication. The allegation is unsubstantiated. Unsubstantiated Allegation: Staff are not meeting residents diapering needs. ADL schedules were compared to the service plans and all residents who require the assistance with changing briefs are being assisted according to the times listed. Some residents are scheduled for every two hours or as needed and some more often. Based on records reviewed and observation the residents in memory care and assisted living side are being changed to meet their incontinence needs. The department was unable to establish a time that the residents on either side were not changed the records support the service plans reviewed by the department. The allegation is unsubstantiated. Allegation: Staff are not meeting residents laundry needs. The investigation into this matter included an inspection of the laundry area and residents rooms including the clothes hampers. Based on inspection and observation the facility is providing assistance with laundry the facility has scheduled times for residents to expect their laundry to be completed. The laundry area is well maintained and has the expected bundles of clothing that is either clean and being folded or dirty and waiting to be cleaned. The residents' clothes are marked with their initials. The allegation is unsubstantiated. Allegation: Staff did not ensure the facility was free of mold. Based on records reviewed and inspections of the facility the department was unable to identify an area that had mold the facility has a shower located on the second floor that was holding moisture after a resident showered. The resident was taking a shower for one hour and had to be redirected about showering. The moisture made the bathroom humid but did not create mold. The facility addressed the moisture problem with ventilation and cleaning. No mold was observed by the department on inspection. The allegation is unsubstantiated. As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of 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 was conducted with Administratorthe state’s words, verbatim · CDSS document, Aug 28, 2024 · control 27-AS-20240617091338

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 7/11/2024, Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced Case Management visit today at the facility. LPA was following -up on an incident dated 7/9/2024 During visit LPA Johnson reviewed records for R1 and obtained copies of R1's file. Record requested included the physician's report, pre-appraisal and service plan. The facility provided agencies with details of the incident on the SOC341 form. The department is requesting the facility submit a detailed information report on form LIC 624 Unusual incident Report. The Department may return at a later date to further investigate the incident. Exit interview held.the state’s words, verbatim · CDSS document, Jul 11, 2024

Type of visit: Required - 1 Year

On 6/18/2024, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Sunny and explained the purpose of the visit. This is an ALWP (Assisted Living Wavier Program) facility with memory care. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 122.0 degrees Fahrenheit in resident bathroom sink, which is not within the required range of 105 to 120 degrees. (Advisory given) Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications locked in each section of the facility. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident and staff files, including criminal record clearances. Fire drill was completed on 3/11/2024. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete. No deficiencies were cited, however an advisory was given for hot water. Exit interview conductedthe state’s words, verbatim · CDSS document, Jun 18, 2024

Allegation investigated: Facility has pests infestations

On 6/7/2024 LPA Johnson made an unannounced visit to deliver findings for the complaint investigation. Based on records reviewed the facility had an inspection of rooms and as a result there is an ongoing issue with bedbugs throughout facility. Various rooms at property have been positively identified with current bedbug activity during the past year. The exterminators suggest that service recommendation is a Monthly Proactive Continuous & Comprehensive, bedbug inspection & monitoring program. The service suggestion is to inspect 14 rooms per month at time of inspection and to perform inspection of all (84) rooms bi-annually. The technician will install bedbug interceptors or volcanoes (with approval of Delmonte management). The allegation is substantiated. An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility. Substantiated The Department was unable to confirm based on the investigation that the facility was falsifying medication records. The Department lacks evidence to support the allegation. As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of 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 was conducted with Administratorthe state’s words, verbatim · CDSS document, Jun 7, 2024 · control 27-AS-20240506133927

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 14, 2024

Maintenance and Operation. (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on record reviews and interviews, Licensee is addressing the situation with a routine bed bug treatment service after an initial bed bug occurrence.the state’s words, verbatim · CDSS document, Jun 7, 2024

Plan of correction: The facility is actively working with a local exterminator to remedy the incidents and to prevent reoccurrence.

Allegation investigated: Staff are not adequately trained Unqualified staff dispenses medication Staff are not following the monthly menu

On 5/9/2024, LPA Johnson arrived unannounced to deliver findings. LPA met with Sunny. Allegation: Staff are not adequately trained. Records reviewed and interviews conducted confirmed that the facility provided the required training for Personnel and Medtech. The facility is using the regulatory requirements as outlined in Title 22. (87411 Personnel Requirements) to maintain compliance. The department has investigated the allegation and was unable to confirm that staff are not adequately trained. The allegation is unsubstantiated. Allegation: Unqualified staff dispenses medication. Records review confirm that the facility is using only trained staff to provide medication administration. Continued Unsubstantiated The information included in the complaint refers to PRN(the medication can be administered on an as needed basis) medications being given by unqualified staff. The records confirm that the facility is having trained Medtech pass PRN medication. The department was unable to confirm that other unqualified staff members passed PRN medications during times. Regulation 87465 (d) reads: that If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met:(1)Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. (2)The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. (3)The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. The facility appears to be following this regulatory requirements, based on records reviewed. Allegation: Staff are not following the monthly menu. Based on review of the records, interviews with the residents and staff the facility provides monthly menus. Staff confirmed that they eat meals at the facility and the menu is accurate on most occasions.(If not the residents have usually eaten all the main items from the monthly menu.) The residents interviewed stated that if an items run out the facility will have alternative items to choose from. The residents enjoy the variety of food offered and had no complaints about the food choices. All allegations are Unsubstantiated.the state’s words, verbatim · CDSS document, May 9, 2024 · control 27-AS-20240209094219

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.

Allegation investigated: Questionable death Resident’s wound worsened due to staff neglect

Allegation: Questionable death. Based on the death certificate and medical records obtained, R1 showed signs of a change of condition on the morning of 1-30-2024, and R1 was sent to the hospital. R1 was admitted for “acute hypoxic respiratory failure and status epilepticus.” R1 had a past medical history of end-stage renal disease on hemodialysis, bipolar disorder, seizure disorder, and reported history of paroxysmal atrial fibrillation. R1 passed away on 2-11-2024 due to Acute Respiratory Failure with Hypoxia, Status Epilepticus and Covid-19. End Stage Renal Disease was listed as a secondary cause of death. Based on records reviewed and information obtained, R1 passed away due to medical complications. As there is nothing to indicate questionable death, this case has been investigated and is unfounded. Unfounded Allegation: Resident’s wound worsened due to staff neglect. Based on review of the medical records by the department the facility assisted R1 with the new and existing medical conditions. R1's medical history on examination from the ER detailed a variety of conditions all conditions had been or were being addressed by the facility. The ER did not suspect or address any concerns of neglect of lack of care resulting in the worsening of wounds or death. The ER summarized a complete body check with no signs of lower extremity edema. Based on the records reviewed and information obtained, R1 did not have medical need for wound care or was being treated for wounds of the lower extremities, this case has been investigated and is unfounded. Allegation: Staff did not respond to resident’s calls for assistance in a timely manner. Review of records and interviews with residents the facility is answering calls, the times vary in each situations and on the average the calls are being answered within 5 to 15 minutes after the call buttons are pushed. Residents interviewed confirmed that the staff make good efforts at trying to answer all calls timely. The facility has installed an updated call system in each residents room. The system notifies the front desk and alerts staff on their communication devices when the call buttons are pushed. by residents. Allegation: Staff did not ensure the facility was clean and sanitized. Based on observation on multiple visits on 1/24/2024, 2/15/2024, 2/21/2024 and 3/25/2024. The facility appears to be clean. However, photos taken by the reporting party show a blood stain on the bathroom wall of R1 and toilet paper on the ground. These photos are not complete stories of the cleanliness of the facility but they do show that the facility was not clean when the pictures were taken. This could have been immediately after a resident finished in the bathroom before a staff could get to it or it may have been there for sometime. The department is unable to determine if the photos of the two issues represent the facilities lack of cleanliness or sanitation. The department has investigated the allegations and determined them to be unsubstantiated. There is not a preponderance of evidence to conclude the allegations are factual, therefore, these allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, May 1, 2024 · control 27-AS-20240220142324

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(c) · Plan of correction due date: May 15, 2024

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement was not met as evidenced by based on touring the facility and interviews with the staff. R1's room was an access point for the shower and the bathroom.the state’s words, verbatim · CDSS document, May 1, 2024

Plan of correction: The facility has addressed the room access point and has established an alternative enrty into the shower /bathroom area. POC cleared.

Type of visit: POC

LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the complaint investigation conducted on 1/24/24 . LPA toured the facility, reviewed document submitted for plans of correction observed that the deficiencies cited on 01/24/24 have been cleared. Deficiencies cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC by POC due date. Facility was provided POC cleared letter. Exit interview conductedthe state’s words, verbatim · CDSS document, Apr 11, 2024

Allegation investigated: Staff are financially abusing a previous resident

On 3-27-24 at 10:27am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with licensee Sunny Saini and explained the purpose of the visit. The above allegation stated facility continued to take hundreds of dollars out of a Supplemental Security Income (SSI) account belonging to resident1 (R1). During this investigation, LPA conducted an interview with Administrator and reviewed facility internal financial documentation of transactions with R1 between the period of January 2023 and June 2023. Additionally, the Department conducted a review of subpoenaed financial documentation of R1 and conducted additional interviews with R1, R1’s responsible person, and facility Administrator. Based on these record reviews and interviews, it was determined that R1 moved out of facility on 5-9-23 and a transaction of $1,324.82 was transferred to A1 Delmonte Stockton on 6-2-2023 via Automated Clearing House (ACH), however, on 6-22-2023, A1 Delmonte Stockton refunded R1 the amount of $1,324.82 to R1’s bank account. {Cont. on 9099C} Unfounded Additional record reviews revealed that in June and July of 2023, multiple payments were sent out from R1’s checking account via an outside app. The subpoenaed transaction records disclosed that on 6-29-23 payments of $345 and $300 were sent to two different individuals, and on 7-10-23 $460 was sent to another individual. The interviews and record reviews conducted as part of this investigation revealed that these identified individuals had no current or past association with the facility. As a result, there is not a preponderance of evidence to conclude that the facility financially abused R1, a previous resident, therefore, this allegation is UNFOUNDED. A finding of unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Sunny Saini and a copy of this report was provided to Sunny.the state’s words, verbatim · CDSS document, Mar 27, 2024 · control 27-AS-20230721170313

Allegation investigated: Facility staff is not responding to residents' request in a timely manner Facility staff is serving residents' meals too cold

On 3/25/24, LPA Johnson arrived unannounced to deliver findings. LPA met with Sunny and Lucky. Allegation: Facility staff is not responding to residents' request in a timely manner. Review of records and interviews with residents the facility is answering calls, the times vary in each situations and on the average the calls are being answered within 5 to 15 minutes after the call buttons are pushed. Residents interviewed confirmed that the staff make good efforts at trying to answer all calls timely. The facility has installed an updated call system in each residents room. The system notifies the front desk and alerts staff on their communication devices when the call buttons are pushed. by residents. Unsubstantiated Allegation: Facility staff is serving residents' meals too cold. The department reviewed the food temperature record with the desired temperatures and actual food temperatures for three meals daily. The records reviewed indicated that the facility's kitchen is maintaining the desired temperatures according to regulatory requirements. Some residents interviewed confirmed that the facility is serve hot food to their expectation and other say the food is "warm; not cold and not hot." The department has investigated the allegations and determined them to be unsubstantiated. There is not a preponderance of evidence to conclude the allegations are factual, therefore, these allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Mar 25, 2024 · control 27-AS-20240123152134

Type of visit: Case Management - Incident

LPA Johnson arrived to the facility unannounced to conduct a Case management visit regarding a self reported incident that occurred on 2/26/2024. SIR, details R1 visit to the ER for a headache on 2/26/2024, while at the ER, R1 informed the hospital that there was an altercation with the roommate and that is the reason for the visit to the ER. The facility was unaware of the altercation until 2/27/2024. The facility reviewed the discharge papers on 2/27/2024 and this is when the situation was discovered. The facility took action and notified the police department and the resident was moved to another room. No deficiencies were cited on today's date. LPA was able to obtained copies of resident's service plan and other pertinent information. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 5, 2024

Allegation investigated: unlawful eviction

On 1/29/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegation. LPA Jensen met with Sunny Saini and explained the purpose of today's visit. During the course of the investigation LPA Jensen interviewed 2 staff members and reviewed records related to resident 1 (R1) including the Admission Agreement, Individual Service Plan, Physician's Report and Resident Notice to Leave Facility Voluntarily. Staff 1 (S1) and Staff 2 (S2) were interviewed separately and both stated that R1 expressed a desire to leave the facility and was not stopped from doing so. Based on the records reviewed R1 signed and dated a notice to leave the facility voluntarily in October of 2023. The signature on the notice to leave voluntarily matches the signature on the admission agreement dated 11/18/21. Unfounded The Physician's report states R1 is able to leave the facility unassisted and is able to manage their own cash resources. The Admission Agreement sections related to termination of the agreement was determined to be in compliance with regulation. Based on LPA Jensen's review of the aforementioned documentation and the interviews conducted the allegation of unlawful eviction is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis. No deficiencies are being cited as a result of this investigation. An exit interview was conducted with Anu Sainin and a copy of this report was handed to her.the state’s words, verbatim · CDSS document, Jan 29, 2024 · control 27-AS-20231211164202

Allegation investigated: Staff hit resident. Staff caused injury to resident.

This report has been amended to include additional information that was reported by the facility. On 1/24/24 at approximately 1:00pm Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to continue the compliant investigation into the above listed allegations. LPA Johnson met via phone with Elizabeth Phitsanovkanh and explained the purpose of today's visit. LPA Johnson entered the facility but was informed that there is a Covid Outbreak. LPA went back to the car to finish the report. Allegations: Staff hit resident and Staff caused injury to resident. Based on records reviewed on 1/18/2024 it was discovered that on date unknown R1 was knocking on the cafeteria door when S1 aggressively swung the door open and hit R1 with the door. As a result of the incident R1 had a “knot” on her head. R1 was transported to St. Jospeh Hospital to be examined. R1 did not have any fractures. The allegations are substantiated. An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility. Substantiated Allegation: Staff does not administer medication as prescribed. Review of R1's medication administration record did not indicate R1 was being given any excessive amounts of Lorazepam. LPA reviewed the medication administration record for R1 and did not find any medication errors for R1 or any other resident record reviewed. LPA reviewed five other residents' records. Based on this information LPA was unable to identify any other medication errors. The allegation is unsubstantiated Allegation: Staff did not properly supervise resident causing resident to fall. Based on records reviewed R2 did have a fall on 9/20/2023 and was sent to the ER, R2 was not on a stand assist for toileting or dressing. The facility did assess R2 for fall risk and it was not targeted as support. The facility revised the service plan to support R2 as a fall risk after this incident. R2 has a new service plan that addresses the potential for falls. The allegation is unsubstantiated. Allegation: Staff left resident in disrepair bed. Based on records reviewed the department was able to determine that on 8/21/2023, R2's bed was making a squeaking noise when R2 would move, Staff heard the noise and went to inspect the bed and noticed that the bed was broken(a support beam was loose). Staff notified the maintenance director and the bed was replaced. The duration of how long the bed was making noise is unknown. The allegation is unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred. The Department has determined that the allegations are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22the state’s words, verbatim · CDSS document, Jan 24, 2024 · control 27-AS-20231005125740

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Jan 25, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by the actions of S1 opening the door to the kitchen without regard causing an injury to R1. This is an immediate safety risk for residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2024

Plan of correction: Licensee is to ensure that all inservice trainings are documented and residents' personal rights are upheld at all times. Please submit a letter of understanding and a copy of the completed in-service training to include date and signatures of trainer and attendees by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Mar 6, 2024

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by R1 sustaining an injury.the state’s words, verbatim · CDSS document, Jan 24, 2024

Plan of correction: The facility has completed the in service training fro Personal rights. The plan of correction was completed on 1/25/2024.

Allegation investigated: Questionable death.

On 1/12/24, LPA Johnson arrived to deliver findings for the above listed allegations. LPA met with Staff. The department investigated the questionable death allegation and discovered that R1's cause of death was listed on R1's death certificate as cardiac arrest and senile degeneration of the brain. There were no other significant conditions contributing to R1's death and no indication there was anything questionable about R1's death. Review of R1's medication administration record did not indicate R1 was being given any excessive amounts of Lorazepam. The department has investigated the complaint alleging an questionable death. The department has found that the complaint is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Unfoundedthe state’s words, verbatim · CDSS document, Jan 12, 2024 · control 27-AS-20231005125740

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced Case Management visit on this date and met with Assistant Executive Director (AED) Lakhbir Kaur. The Case Management visit pertains to an alleged sexual assault that the family self-reported. During the visit, LPA Campbell collected documents and attempted to conduct interviews that were pertinent to the incident report. LPA Campbell reviewed R1’s Physician’s report and R1’s Admission Agreement policy regarding Sexual Behaviors. When LPA Campbell attempted to speak to R1, the resident stated they “did not wish to talk about it”. LPA Campbell then attempted to call R1’s emergency contact and was able to interview them. The personnel file for S1 was reviewed and documentation of S1’s suspension was observed. As part of the investigation into the incident, the AED attempted to view camera footage and interview residents to identify further incidents of alleged abuse. Per licensing regulations, licensing and emergency contacts were notified and an SOC 341 was submitted to the Ombudsman office. The police were contacted, and a copy of the police report requested. The facility investigation is ongoing while staff work to guard R1’s privacy and avoid upsetting current residents. Per the AED, there is no facility protocol regarding unwanted sexual advances. LPA Campbell suggested adding such information to the admission agreement. At this time, the facility will provide the police report, 602, employee suspension letter and the sexual behavior page from the admission agreement. Later, the facility will provide further in-service training and protocols addressing unwanted sexual advances. No deficiencies were issued during the visit. Exit interview conducted with Lakhbir Kaur, AED and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 7, 2023

Allegation investigated: Staff are violating resident's personal rights Staff made inappropriate comments toward resident Staff interfers in resident's financial affairs Staff threatened residents with eviction

On 12-5-23 at 10:28am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegations noted above. LPA met with assistant executive director Lucky Kaur and explained the purpose of the visit. During this investigation LPA conducted interviews with 6 staff members and 6 residents and additional witnesses. Additionally, LPA reviewed facility file documentation including admission agreements, safeguard agreements, inventory sheets, surety bond, various eviction notices previously issued, and facility’s plan of operation. LPA also conducted facility observation on 10-17-23. Allegation: Staff are violating resident’s personal rights. LPA conducted interviews as stated above. This allegation included the facility allegedly calling social security offices on behalf of residents without permission. Based on interviews conducted, it was revealed that no corroborated statements exist which determine a violation of personal rights. It was further determined through interviews that social security offices do not reveal information without the resident, or resident’s responsible party present. {Cont. on 9099C} Unsubstantiated Additionally, interviews conducted revealed no further violation of other personal rights. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. Allegation: Staff made inappropriate comments towards resident. LPA conducted interviews as stated above. The investigation revealed staff addressed residents appropriately. LPA did not observe staff making inappropriate comments towards a resident or in reference to a resident. Based on interviews conducted, it was revealed that no corroborated statements exist which determine staff making inappropriate comments towards residents. As a result, the preponderance of evidence standard is not met, and this allegation UNSUBSTANTIATED. Allegation: Staff interferes in resident’s financial affairs. LPA conducted interviews and record reviews including admission agreements, plan of operation, surety bond, inventory sheets, and safeguard agreements stating facility may hold debit cards for specific residents who have agreed to this practice. Based on interviews and record reviews, it was revealed that licensee currently holds debit cards for eight (8) residents in care. It was further revealed through record reviews and interviews that all residents and applicable responsible parties have signed and agreed to safeguard agreements allowing licensee to manage debit cards and withdraw funds on behalf of residents for purposes of paying monthly rents. As a result, there is not a preponderance of evidence to conclude that facility staff have engaged in a practice of interfering in residents’ financial affairs, therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff threatened residents with eviction. LPA conducted interviews as stated above. Based on interviews conducted, there were no corroborated statements which reveal threats of eviction given by staff towards residents. Furthermore, the investigation revealed that although facility has previously issued eviction notices, such notices contained required regulatory language and components to determine a legitimate reason for evictions, or have been revised accordingly to meet regulation requirements. As a result, there is not a preponderance of evidence to conclude staff have threatened residents with eviction, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky. Appeal rights provided.the state’s words, verbatim · CDSS document, Dec 5, 2023 · control 27-AS-20230825145223

Type of visit: Case Management - Other

On 12-5-23 at 1:45pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management regarding facility’s plan of operation. LPA met with assistant executive director Lucky Kaur and explained the purpose of the visit. LPA reviewed current plan of operation on file with the department as well as facility’s theft and loss policy. It was determined through record review and interviews related to complaint # 27-AS-20230825145223, that licensee currently holds debit cards for eight (8) residents in care. It was further revealed through record reviews and interviews that all residents and applicable responsible parties have signed and agreed to safeguard agreement allowing licensee to manage debit cards and withdraw funds on behalf of residents, however, such a procedure has not been included in the facility’s plan of operation currently on file with the Department. As a result of today’s case management, citations are issued under Title 22, Division 6. An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky. Appeal rights provided.the state’s words, verbatim · CDSS document, Dec 5, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(9) · Plan of correction due date: Dec 15, 2023

Plan of Operation. (a) Each facility shall have and maintain a current, written definitive plan of operation… Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval…(9) A statement whether or not the applicant will handle residents' money and/or valuables. If money or valuables will be handled, the method for safeguarding…This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not ensure the practice and method of maintaining and using resident debit card for purposes of obtaining monthly rent be explained in the facility’s plan of operation which resulted in a potential health, safety, and resident rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 5, 2023

Plan of correction: Licensee will ensure an updated plan of operation be submitted to LPA by POC due date to include, but not be limited to: Policies on safeguarding resident properties including debit cards and how such cards are stored and utilized.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(d)(2) · Plan of correction due date: Dec 15, 2023

Administrator - Qualifications and Duties. (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)… (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on record review, Administrator did not exercise the practice of initiating a necessary change in plan of operation and submit to the Department. This resulted in a potential health, safety, and resident rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 5, 2023

Plan of correction: Administrator will read regulation 87405(d)(2) and reference regulation 87208(a). Administrator will submit a signed declaration of understanding these regulations to LPA by POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Johnson conducted a health and safety check on this day. LPA met with Director of Nursing. Health and Safety check included food supply, physical plant and staffing. based on this inspection/visit the facility is in compliance. No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 20, 2023

Allegation investigated: Facility staff are not cleaning residents’ room(s). Facility staff stole residents’ personal property. Facility staff are not ensuring that residents have toilet paper in their rooms. Staff are denying food to residents.

On 11-3-23 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with Assistant Executive Director (AED) Lucky Kaur and explained the purpose of the visit. Administrator Anuradha Saini was made aware of LPAs visit and purpose. During this investigation, LPA conducted interviews with 6 staff members and 4 residents in care. Additionally, LPA reviewed facility file documentation including housekeeping task schedule, behavior progress notes, physician reports , facility menu, inventory sheets, and admission agreements. LPA also conducted a facility observation on 9-12-23 and 10-17-23. Allegation: Facility staff are not cleaning residents’ rooms. LPA conducted interviews, record reviews, and facility observations as stated above. LPA also conducted facility observations as noted above. Based on interviews, it was revealed that housekeeping staff are observed to be regularly attending to residents’ rooms as scheduled and perform duties as required with the exception of residents who may decline services for various reasons. Unsubstantiated LPA’s review of housekeeping tasks schedule revealed rooms are scheduled to be clean on specific days which includes deep cleaning in various rooms as necessary. LPA’s observation revealed a presence of adequate housekeeping staff performing cleaning duties. LPA also observed various resident rooms to be adequately cleaned with no foul odors or stains on walls and floors within resident rooms and throughout facility. As a result, there is not a preponderance of evidence to conclude facility staff are not cleaning residents’ rooms. Therefore, this allegation is UNSUBSTANTIATED. Allegation: Facility staff stole residents’ personal property. LPA conducted interviews and record reviews as stated above. Based on interviews, it was revealed that residents are presented with the option to inventory items upon admission and thereafter. Additionally, interviews did not reveal any corroborated statements of facility staff stealing residents’ personal property. Interviews conducted with residents further revealed all items were accounted for within resident rooms. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. Allegation: Facility staff are not ensuring that residents have toilet paper in their rooms. LPA conducted interviews, record reviews, and facility observations as stated above. Based on interviews, it was revealed that toilet paper and other related necessary personal supplies are provided to residents regularly and per request. LPA facility observations further revealed toilet paper on holders and additional supply of toilet paper on countertops in various resident bathrooms. LPA’s observation of housekeeping supplies closet revealed an adequate amount of toilet paper on hand. As a result, there is not a preponderance of evidence to conclude facility staff are not ensuring residents have toilet paper in their rooms, therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff are denying food to residents. LPA conducted interviews, record review, and facility observations as stated above. Based on interviews conducted, there were no corroborated statements of facility staff denying food to residents. Observations by LPA revealed adequate amounts of food supply in kitchen for the resident current census. Observations also revealed residents receiving food items which matched the menu items for the given days. Interviews conducted revealed that the facility makes available and provides additional food items to residents upon request prior to and after scheduled mealtimes. Furthermore, interviews did not reveal corroborated statements of residents being denied food for any reason. As a result, there is not a preponderance of evidence to conclude staff are denying food to residents, therefore, this allegation is UNSUBSTANTIATED An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky. Appeal rights provided.the state’s words, verbatim · CDSS document, Nov 3, 2023 · control 27-AS-20230908081138