Aegis Assisted Living of Aptos

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a case management - incident visit. LPA met with General Manager (GM) JP Rollet. LPA stated the purpose of the visit. Medication Error 7/25/2025 The purpose of the visit was to address 2 medication errors that occurred on 7/25/2025 and 4/16/2026. On 7/30/2025, the Department received an incident report regarding a medication error on 07/25/2025 involving Staff S1 giving resident R1 another resident's medication. The incident report states S1 "accidentally gave the medication to another resident." S1 reported the medication error to management, and 911 was called. R1 was taken for observation to the hospital, and returned back to the facility the same day with no injuries. The reports states R1 was monitored by staff for changes in condition after the medication error, and R1's family and primary care physician were notified. On 9/19/2025, a Case Management visit was conducted. During visit, LPA requested copies of the following documents: Disciplinary Notice, In-Service Training Records, physician's reports, Service Plans, Centrally Stored Medication and Destruction Records, and Medication Administration Records (MAR). Medication Error 4/16/2026 On 4/21/2026 the Department received an incident report regarding a medication error on 4/16/2026, involving Staff S2 giving Resident R2, an incorrect dose of medication. Page 1 of 2 The incident report states "Wellness nurse administered the medication but immediately realized that a double dose of the medication was administered. Wellness Nurse admitted to not completely reading the medication order thereby committing the mistake." The incident report notes R2 was observed, vitals were taken and R2 monitored for side effects. During today's visit, LPA interviewed 3 Staff (S1 to S3), 2 Residents (R1 to R2), and 1 Witness (W1). Based on investigation on 4/23/2026, S1 and S2 reported the medication errors to facility management when the errors occurred. Documents were obtained to include S1 and S2 training records, S1 and S2's written disciplinary action, and R1 and R2 physician's reports and care plans. LPA Tarin also conducted a safety check on R1 and R2. LPA observed R1 watching tv in his/her room. R1 did not respond to LPA's questions due to cognitive impairment. LPA observed R2 sleeping in his/her room. LPA observed R2 had a private companion. A civil penalty is being assessed for the amount of $250 for a repeat violation for CCR 87411(a). A previous licensing report issued on 3/16/2026 cited the same deficiency. Please see LIC421FC. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. A Deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. An exit interview was conducted with GM JP Rollet and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Apr 24, 2026

87411 Personnel Requirements - General (a) Facility personnel shall at all times be...competent to provide the services necessary to meet resident needs This requirement was not met as evidenced by: Based on observation, record review and interviews,on 7/25/2025 Staff S1 gave another resident's medications to R1. On 4/16/2026, S2 gave an incorrect dose of medication to R2 which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 23, 2026

Plan of correction: Licensee will submit a plan of action on how the facility with work to prevent medication errors by POC due date of 4/23/2026.

Allegation investigated: Facility staff are not allowing resident the right to participate in decision making regarding the care and services to be provided.

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint investigation. LPA met with General Manager (GM) JP Rollet. LPA stated the purpose of the visit. On 4/7/2026 the Department received a complaint with the above allegation. On 4/7/2026 the Department interviewed the Reporting Party (RP). RP states a resident, referred to as R1, was not allowed to participate in decision making regarding care. RP states he/she does not agree with the prices the facility charges for resident care. On 4/9/2026 the Department reviewed the facility roster. LPA observed R1 was not a resident of the facility. Page 1 of 2 Unfounded This agency has investigated the complaint alleging facility staff are not allowing resident the right to participate in decision making regarding the care and services to be provided. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited, per California Code of Regulations, Title 22. An exit interview was conducted with GM JP Rollet and a copy of this report was provided. Page 2 of 2 END OF REPORT.the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 26-AS-20260407090909

Type of visit: POC

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Plan of Correction (POC) visit. LPA met with General Manger (GM) JP Rollet. LPA stated the purpose of the visit. On 3/16/2026 the facility was citing the following Type A deficiency: 87411 Personnel Requirements - (a) LPA received the Plan of Corrections by POC due date. The deficiency is being cleared during today's visit. A Letter of Deficiencies Citations Cleared was provided to GM during visit. No deficiencies were cited, per California Code of Regulations, Title 22. An exit interview was conducted with GM JP Rollet and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with General Manager (GM) J.P. Rollet. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with GM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA observed the facility to be clean, safe, sanitary and in good repair. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 30 F and Freezer at 0 F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The facility fire alarm system was inspected by a third party vendor on 9/9/2025 and passed inspection. Fire extinguishers were last serviced on 10/20/2025. The facility emergency drill log was reviewed. The facility's last drill was on 12/20/2025. Page 1 of 2 LPA toured 10 resident bedrooms, residents have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 10 resident bathrooms. All 10 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 109.2 F to 113.5 F. During inspection of Resident R1's bathroom, LPA observed inside an unlocked bathroom cabinet above the toilet, a clear plastic bag with oval shaped capsules. LPA observed the pills were half blue and half red in color. LPA also observed a small white prescription pill bottle on the second shelf. To the right of the small white prescription bottle, LPA observed 5 yellow capsules inside a clear plastic storage bin. GM stated R1 could manage his/her medications. Review of R1's physician's report dated 10/2/2023, R1 cannot manage or store his/her medications. R1 also has neurocognitive impairment, with confusion and disorientation. A deficiency is being cited today. LPA reviewed 4 resident records. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 4 staff records. A deficiency was cited during today's visit per California Code of Regulations Title 22, see LIC809D for more information. An exit interview was conducted with GM J.P. Rollet and a signed copy of this report and appeal rights were provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management-Deficiencies visit to follow up on a deficiency cited on 9/11/2025. LPA also followed up on a self reported incident of a medication error reported to the Department on 7/30/2025. LPA met with General Manager (GM) J.P. Rollet. LPA stated the purpose of the visit. The facility was cited the following Type A deficiency on September 11, 2025: 87468.1 Personal Rights: (a)(2), POC due 9/12/2025. LPA received plan of corrections by POC date. Deficiencies cleared during todays visit. POC cleared letter provided to GM. On 7/30/2025, the Department received an incident report regarding a medication error on 07/25/2025 involving Staff S1 giving resident R1 another resident's medication. The incident report states S1 reported the medication error to management, and 911 was called. R1 was taken for observation at the hospital, and returned back to the facility the same day with no injuries. The reports states R1 was monitored by staff for changes in condition after the medication error, and R1's family and primary care physician were notified. During visit, LPA request copies of the following documents: Disciplinary Notice, In-Service Training Records, physician's reports, Service Plans, Centrally Stored Medication and Destruction Records, and Medication Administration Records (MAR). LPA determined the medication error requires further investigation. No deficiencies were cited at this time as per California Code of Regulations Title 22. An exit interview was conducted with GM and signed copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced case management visit to follow up on an incident where a resident eloped from the facility. LPA met with General Manager (GM) J.P. Rollet. LPA stated the purpose of the visit. On 7/21/2025, the Department received an Incident Report (IR) dated July 18, 2025, stating Resident R1 had eloped from the facility at approximately 2:50PM. The IR states staff received a report from Staff S7 at approximately 2:50PM, where S7 reported ‘seeing a lady on the street that resembles one our residents.” The facility began a search for R1 and did not locate R1 in his/her room. Staff began a search in the area outside of the facility where S7 reportedly observed R1. R1 was located by facility staff at approximately 3:05PM, sitting on the side of the street across from the local fire station. R1 was being taken by paramedics for assessment due to falling and sustaining an injury to the head. Based on Google Maps search, R1 was located approximately 0.7 miles away from the facility. On 7/22/2025 and 9/11/2025, LPA Tarin interviewed Staff S1 to S6. 3 out of 6 staff did not observe R1 on the day of elopement. S1 and S4 stated he/she saw R1 in the facility between 2:45PM and 2:50PM. S6 states he/she observed R1 between 2:00PM and 2:30PM. 6 out of 6 staff stated R1 has a history of wandering behavior. 2 out of 6 staff stated R1 has eloped from the facility before 7/18/2025. S2 and S4 states R1 eloped in May 2024 but did not provide additional information. 5 out of 6 staff stated R1 has a history of cutting his/her wanderguard bracelet off. S6 did not provide additional information. LPA interviewed General Manager (GM). GM states the elopement occurred during a shift change, and "a lot of traffic was going through the front, which is the only way in and out of the community." Based on review R1’s physician’s report dated 3/27/2024, lists R1’s diagnosis as neurocognitive disorder. R1’s mental condition is listed as confused/disoriented, has wandering behaviors, and R1 is not able to leave the facility unassisted. R1’s service plans dated 6/27/2024 states R1 has exiting seeking behavior, seeks out, loiters near or attempts to exit through doors and/or windows. R1’s Elopement Risk Assessment dated 7/13/2025 states R1 showing wandering and exit seeking behaviors, verbalize a desire to leave community/to go home, resident has a history of previous elopement. R1’s Elopement Risk Assessment also states “ Resident currently with wanderguard, However, resident have been finding ways to cut wanderguard bracelets…in the meantime will continue to replace wanderguard. LPA reviewed previous incident submitted to the Department for R1 and found an elopement that was reported on 5/17/2024, where R1 eloped from the facility on 5/11/2024 when out on a walk. R1 was returned to the facility unharmed. Based on review of R1’s hospital discharge paperwork dated 7/18/2025, R1 sustained a fractured left wrist and a closed head injury during the elopement. An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with General Manager J.P. Rollet and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Sep 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 12, 2025

87468.1 Personal Rights: (a)(2) Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview and record reviews, on 7/18/2025, R1 has neurocognitive disorder and left the facility unassisted and was found by facility staff outside of the community, sustaining injuries. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: ADM stated he will send a written plan of action on how the facility ensures residents with wandering behaviors and neurocognitive disorder will be kept safe. ADM stated he will also send a written letter of understanding regarding the regulation. ADM will submit POC to CCLD by POC due date 9/12/2025.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management-Incident visit regarding an Incident Report submitted to the Department on 7/21/2025. LPA met with Health Services Director (HSD) Noel Sapitan and Resident Services Director (RSD) Gloria Escoto. On 7/21/2025 the Department received an incident report for an incident involving Resident R1 on 7/18/2025. LPA toured 1 resident room and the front lobby area with RSD and observed the facility's Wanderguard alarm system. LPA interviewed 1 resident and 6 staff. LPA requested documentation to include needs and services plan, physician's reports, and Wanderguard activity log. LPA determined this incident requires further investigation. No deficiencies were cited during today's visit per California Code of Regulations (CCR) Title 22. An exit interview was conducted with RSD Gloria Escoto and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct the facility's Required -1 Year inspection and met with General Manager (GM) J.P. Rollet and stated the purpose of the visit. GM states previous General Manager Griselda Galvan retired on 3/21/2025. GM states the facility has 84 residents and 26 staff. LPA toured the interior and exterior of the facility with GM to include but not limited to lobby, dining rooms, kitchen, laundry rooms, 10 resident rooms, 10 bathrooms, and facility activity rooms. All exits and passage ways are free and clear of obstruction. LPA interviewed 6 residents and 3 staff. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed refrigerator temperature at 31 degrees F and Freezer at 0 degrees F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. Fire and smoke detectors were last inspected on 2/20/2025. The facility's emergency drill log was reviewed. The facility's last emergency drill was conducted on 1/26/2025. Facility fire extinguisher was last serviced on 10/14/2024. Page 1 of 2 LPA toured 10 resident rooms and 10 resident bathrooms. LPA measured water temperature with a range of 111.9 to 113.9 degrees F. LPA reviewed 7 resident records. Resident records included emergency contact information, physician’s report, needs and service plans, and personal rights. LPA reviewed 7 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 7 staff records. 7 out of 7 staff records were found to be complete. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. LPA requested the following documentation during inspection for change of administrator: • LIC501 • LIC500 showing J.P. Rollet as ADM (Personnel Record) • LIC200 (application for Community Care Facility or Residential Care Facility for the Elderly License) • LIC308 • LIC 9182 with Admin box checked • Copy of Valid photo ID/DL No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with General Manager (GM) J.P. Rollet and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 26, 2025

Allegation investigated: Administrator is not on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility. Staff are not ensuring that food is prepared and served in a safe and healthful manner to residents in care.

Allegation: Administrator is not on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility. During the investigation LPA observed kitchen in need of additional supervision, lack of activities for scheduled time and residents sitting without supervision in the dining area with toxin unlocked and accessible to residents. LPA was told that the Administrator has given notice and other staff are taking the lead when the Administrator is out. Allegation: Staff are not ensuring that food is prepared and served in a safe and healthful manner to residents in care. During the inspection of the kitchen LPA observed mold on bread and missing documentation of Consulting services for dietary requirements needs and overall quality of food services. The Department has investigated the above allegations. Based on interview, record review and observation, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. Deficiencies were cited per California Code of Regulations Title 22. See LIC9099-D. Substantiated Allegation: Staff do not ensure that residents' showering needs are being met while in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if staff did not ensure that residents were being showered while in care based on the information available. Unsubstantiated. Allegation: Resident developed a bladder infection due to staff neglect. Records reviewed for R1 included discharge summaries and notes at the facility including correspondence with the primary care doctor, the record did not identify lack of supervision or neglect as a cause for treatment of R1's bladder infection. Discharge summaries advise follow-up with the primary care physician and hydration. The department was unable to determine if Resident developed a bladder infection due to staff neglect while in care based on the information available. Unsubstantiated. Allegation: Staff do not respond to residents' requests for assistance in a timely manner. Based on records reviewed and observation the facility did respond in a reasonable amount of time during the department unannounced visits. The facility provided residents with assistance that varied also noted is the activated call button announce the call. The department was unable to determine if Staff did not respond to residents' requests for assistance in a timely manner based on the information available. Unsubstantiated. Allegation: Staff do not ensure that residents receive medical attention in a timely manner. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if Staff did not ensure that residents receive medical attention in a timely manner while in care based on the information available. Unsubstantiated. Allegation: Staff do not ensure that there is communication which encourages family/responsible party involvement with the resident in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The facility provides information in three place including a current life enrichment activities sheet. The department was unable to determine if at the time of the complaint that Staff did not ensure that there was communication which encourages family/responsible party involvement with the resident in care based on the information available. Unsubstantiated. Allegation: Facility is understaffed, Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if at the time of the complaint the facility was under staffed. Unsubstantiated. Based on this investigation the allegations may have happened or are valid, however, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore these allegations are unsubstantiated.the state’s words, verbatim · CDSS document, Jan 25, 2025 · control 26-AS-20230511142716

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(H)(1-8) · Plan of correction due date: Jan 27, 2025

The administrator shall have the responsibility to:(1) Administer the facility in accordance with these regulations and established policy, program and budget. (2) Where applicable, report to the licensee on the operation of the facility, and provide the licensee with necessary interpretations of recognized standards of care and supervision. (3) Develop an administrative plan and procedures to ensure clear definition of lines of responsibility, equitable workloads, and adequate supervision. This requirement was not met as evidenced by the kitchen in need of additional supervision, lack of activities for scheduled time and residents sitting without supervision in the dining area with toxin unlocked and accessible to residents. LPA was told that the Administrator has given notice and other staff are taking the lead when the Administrator is out.the state’s words, verbatim · CDSS document, Jan 25, 2025

Plan of correction: The facility has appointed a new Administrator.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Feb 14, 2025

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. The licensee did not provide food of good quality. During the inspection of the kitchen LPA observed mold on bread and missing documentation of Consulting services for dietary requirements needs and overall quality of food services. This poses a potential health risk to residents in care. Staff disposed the expired non-perishable food immediately upon discovery.the state’s words, verbatim · CDSS document, Jan 25, 2025

Plan of correction: Licensee to check all the non-perishable food in the pantry and dispose expired food immediately. Consulting services will be included in the plan of correction and sent to the department by 2/14/2025

Allegation investigated: Facility elevator is in disrepair.

Licensing Program Analysts (LPAs) Marcella Tarin and David Marrufo arrived unannounced to conduct the initial complaint investigation visit. LPAs met with Assisted Living Director Gloria Escoto. On 12/18/2024, the Department received a complaint with the above allegation. The following documents were obtained for this investigation: resident roster, visitor log, maintenance repair invoice, emergency disaster manual, facility emergency disaster plan. It was alleged that the facility elevator is in disrepair. LPAs observed the elevator permit with a date of inspection of 8/8/2024, and an expiration date of 8/8/2025. See 9099-C Page 1 of 3. Unsubstantiated The permit was issued by the State of California, Department of Industrial Relations, Division of Occupational Safety & Health. LPAs reviewed a copy of the Disaster Response Procedures: Elevator Failure guidelines. The guidelines state staff should check to see if there is anyone is the elevator, the general manager should notify the elevator company for repair and initiate communication protocol. On 12/26/2024, LPAs interviewed Assisted Living Director (ALD). ALD stated the elevator was in disrepair on 12/18/2024. ALD states the elevator was out of service and was repaired that same day. ALD stated the elevator was stuck on the second floor and maintenance was notified. ALD stated the elevator was repaired and working at 2:30PM. ALD states staff and residents were informed of the elevator being in disrepair on 12/18/2024. LPAs interviewed 5 staff. 2 out of 5 staff state the elevator was in disrepair last week. Staff S2, Maintenance Director, stated the elevator was in disrepair on 12/18/2024 at 9am. S2 states he/she was notified by the facility at 9am on 12/18/2024. S2 states before he/she started repairs he/she made sure no one was inside the elevator. S2 was unable to fix the elevator. S2 states staff, residents and visitors were notified that the elevator was not working. S2 states an elevator repair company was called and the elevator was repaired by 2:30PM that same day. Staff S3 states the elevator was in disrepair on 12/18/2024 and was repaired that same day. 3 out 5 staff stated the elevator has not been in disrepair. LPAs interviewed 6 residents. 4 out of 6 residents state the elevator has not been in disrepair. 2 residents declined to be interviewed. LPAs reviewed the elevator repair invoice from the company contracted to repair the elevator. The invoice is dated 12/18/2024, with an incident time of 9:14AM, arrival time of 1:30PM and completion time of 2:30PM. The invoice states the description of the elevator as "elev passenger unit/not resp/stk on 2nd flr". The invoice states the resolution for the elevator as "top floor spirator." The invoice notes the labor hours as 1 hours and 0 minutes for the repair. See 9099-C Page 2 of 3. LPAs reviewed the facility's Disaster and Emergency Manual. Under Emergency Generators, the Manual states that if the facility does not have have a generator, the community will identity at least 2 local rental companies to provide an appropriate generator for the community to rent during an emergency or disaster. LPAs reviewed ALD's file for emergency training. LPAs observed ALD's documentation of Employee Safety Orientation Checklist which includes a training titled "Emergency and Disaster Manual-Location and Contents" which was completed on 1/25/2023. LPAs reviewed the facility's Emergency and Disaster Plan. Under A.) Provisions for Emergency Power, the facility listed 1 generator rental company. During interview, ALD stated the facility does not have a backup generator. ALD stated he/she did not call a generator rental company on 12/14/2024 when the facility experienced a power outage from 6:45 AM to 9:45 PM. ALD stated no attempts were made to restore power on 12/14/2024. ALD stated the electric company was notified about the power outage. ALD states staff conducted extra safety check on residents, meals were delivered to residents, and activities were brought into residents rooms. ALD states all residents were given flashlights and lanterns to use in their rooms. LPAs interviewed 5 staff. 5 out of 5 staff stated the facility has experienced power outages and that the facility does not have a back up generator. 5 staff state when there is a power outage, staff will conduct extra safety checks on residents, assist residents with going upstairs and downstairs, and bring meals to resident rooms. LPAs interviewed 6 residents. 4 out 6 residents stated the facility had a power outage but did not know if the facility had a backup generator. R2 states the facility had one power outage, but did not know the date of the outage. R2 states the power outage did not impact his/her every day routine. R3 states the facility had a power outage about a week and a half ago,and it lasted the whole day. R3 states the staff brought all his/her meals to the room, and had no concerns during the power outage. R6 states the facility has a power outage, but did not remember the date. R6 states he/she has a flashlight and latern in his/her room that was provided by the facility. R6 states he/she uses oxygen, and has back up battery charged oxygen tanks in the event of a power outage. 2 residents declined to be interviewed. See LIC9099-C Page 2 of 3. The Department has investigated the above allegation. Based on interview, record review and observation, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. A deficiency was cited per California Code of Regulations Title 22. See LIC9099-D. This report was reviewed with Assisted Living Director, Gloria Escoto, and a signed copy of this report and appeal rights were provided. Page 3 of 3. Based on the interviews conducted with residents, and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegation is unsubstantiated. This report was reviewed with Assisted Living Director, Gloria Escoto, and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 26, 2024 · control 26-AS-20241218160216

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Dec 27, 2024

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Licensee did not ensure that the Emergency Disaster Plan included the contact information for at least two backup generator rental companies and Licensee did not ensure that staff attempted to contact the listed backup generator rental company when the facility was without power from 6:45AM to 9:45PM on 12/14/2024 which poses an immediate safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 26, 2024

Plan of correction: Licensee agrees to submit a plan to CCL by POC date 12/27/2024 to ensure that the Emergency Disaster Plan includes the contact information for at least two backup generator rental companies and staff are provided with in-service training on contacting back up generator rental companies when there is a power outage at the facility. Once in-service training is completed, Licensee shall provide copies of training records to CCL, includings names, dates, training topics, and names and qualifications of trainers.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Albert Johnson conducted a case management visit on today's date for a health and safety deficiency found during the tour of the facility The following deficiency was observed by staff and LPA: Unlocked toxins under the sink in the memory care unit. The cabinet has a locking devise, however, it is broken and unable to be locked. The toxin were accessible to the four resident seated in the dining area unsupervised. There are 12 resident in the memory care area and two staff working on this date. Deficiency cited on the following 809-D to Title 22 regulations. Exit interview conducted and appeal rights discussed and given. A copy of this report was left with the Lead/the state’s words, verbatim · CDSS document, Nov 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Nov 25, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidenced by observation and photo taken there was unlocked toxins under the sink in the memory care unit. This is an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 23, 2024

Plan of correction: Administrator shall submit a plan to Licensing on how toxins will be locked up in facility and provide toxin training to maintenance staff or any other staff responsible for cleaning. Licensee shall submit curriculum and date of training to Licensing by 11/25/2024. If additional time is needed please request additional time by POC date via email provided on LPA's busniess card.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced case management visit to follow up on an Incident Report (IR) that was received by the Department on 11/5/2024. The IR states a resident eloped from the facility on 11/1/2024. LPA met with General Manager (GM) Griselda Galvan. LPA toured the exterior and interior of the facility, which included Assisted Living (2nd floor), Memory Care (1st floor), the kitchen, office area, resident bedrooms, resident dining area, and courtyards. The facility temperature was 72 degrees F.. During tour of the Memory Care courtyard, LPA observed a gate locked in with zip ties. Staff stated the gate had a work order due to the gate alarm malfunctioning. Staff stated a work order was in place to fix the gate. During a tour of the Assisted Living courtyard, LPA observed gate #5 locked (an emergency exit). Staff unlocked the gate, and the gate key is located in the front office where staff can access in an emergency. All remaining outdoor exits were clear and free of obstruction. LPA toured 5 out of 5 resident bedrooms. Each resident bedroom has functioning lights, a bed, a chair, table/dresser and storage room for personal belongings. The following documentation was requested: resident's service plan, physician's report, resident roster, staff schedule, updated facility sketch, updated emergency disaster plan (LIC610E), and an updated fire clearance. LPA determined the above incident requires further investigation. This report was reviewed with General Manager, Griselda Galvan and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 6, 2024

Allegation investigated: Inadequate staff supervision resulting in medical emergency.

On 10/22/2024, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with Health Services Director Noel Sapitan and LPA explained the purpose of the visit. Regarding the allegation of inadequate staff supervision resulting in medical emergency, reporting party (RP) stated that resident (R1) has diabetes and needs to be closely monitored for complications. This is a known condition that the staff is aware about. The diabetes was not adequately monitored by staff and R1’s foot became infected, gangrenous and resulted in R1 losing half of of the foot. RP believes that this was an oversight of the staff and care and supervision was not adequately provided. page 1 of 2 Unfounded According to the records provided by the facility, based on the assessment done by the facility around April 2021, R1 is independent when it comes to bathing needs, grooming and dressing. Also noted in the progress notes, on 7/19/2021 when it was reported to facility staff that R1 had wounds in his/her toes the, a staff (S1) assessed the wound and advised responsible person (F1) to bring R1 to the emergency room. It was also noted that the R1 was asked when was his/her last shower and the R1 stated that he/she hasn't showered in a while and didn't notice the condition on the toes. LPA was also able to obtain the blood sugar monitoring log. Part of the log reviewed was from April 04, 2021 to July 7/11/2021. Blood sugar was checked every 7 days, every morning per doctors orders. It is noted on the notes every Sunday. The facility uses the finger stick blood glucose monitoring. Based on records review, the department has determined that that the allegation was false, could not have happened and/or is without a reasonable basis, therefore the allegation is UNFOUNDED. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Oct 22, 2024 · control 26-AS-20210802092325

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required annual inspection and met with facility Administrator (ADM) Griselda Galvan The facility's census is 82 resident and 82 staff. LPA toured the facility, including entryway, common room, dining room, kitchen, laundry room, 6 bedrooms, 6 bathrooms, medicine room, and activities room. LPA toured the exterior of the facility and observed all walkways are free from obstruction. No prohibited items were observed in the resident rooms. All emergency exits are clear from obstruction. The facility has housekeeping schedule for the residents. LPA toured the memory care section and tested the door alarms and found it to be in good working condition. Facility has activities scheduled posted for the whole month. LPA observed residents participating during activity time. LPA tested the facility water temperature. Water temperature measured between 112 to 116 degree Fahrenheit. LPA observed sufficient supply of food, 2 days of perishable food and 7 days for non-perishable food. Fire extinguisher was last inspected on 10/16/2023. All toxins are kept in a locked room. Knives are locked and is not accessible to residents. LPA reviewed the facility's fire alarm log. The fire alarms system for the entire building were tested on 3/6/2024 and 3/7/2024 and found to be in good working conditions. continued to LIC 809C page 1 of 2 LPA interviewed 2 facility staff. LPA reviewed 4 resident files and 4 staff files and found records to be complete and updated. LPA reviewed the Centrally Stored Medication and Destruction Report for 4 residents and found all records to be updated. No deficiency was cited during today's visit per CCR Title 22. This report was reviewed with Administrator Griselda Galvan and a copy of the signed report was provided. End of Report page 2 of 2the state’s words, verbatim · CDSS document, Mar 13, 2024