Aegis Living Ventura

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 11:00AM. Upon arrival, LPA was greeted by front desk staff. LPA met with General Manager (GM) John Washko at 11:20AM. Entrance interview conducted. Beginning at 11:30AM, the LPA along with GM toured the facility inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: The facility is a two-story building that consists of 2 (two) memory care units named Creekside and Oceanside respectively, and an assisted living (AL) unit. The LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced 06/02/2026. The LPA tested 1 (one) delayed egress door in the Creekside Unit and was observed to be functional. The LPA observed all required postings in the hallway near the entrance area. BEDROOMS: During today’s visit, the LPA observed 10 (ten) resident rooms of which 3 (three) were in the Creekside unit, 2 (two) were in the Oceanside unit, and 5 (five) were in the AL unit. The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens. The LPA observed a bottle of Tussin in room 211, and a bottle of S.T. 37 a topical first-aid antiseptic and oral pain reliever liquid in room 204. INTERVIEWS: During today’s visit, the LPA conducted 4 (four) resident interviews No concerns voiced during the interviews. Report Continued on LIC 809-C BATHROOMS: The LPA observed 10 (ten) resident bathrooms which were properly supplied and had functional fixtures. The LPA observed grab bars by the toilet/shower and slip-resistant surfaces in all bathrooms. Hot water was measured in all 10 bathrooms and within the required temperature. COMMON AREAS/GROUNDS/OUTDOORS: These included the beauty salon, library, bistro and dining areas in assisted living and memory care units. The common areas were checked for cleanliness and furniture was checked for functionality. The facility maintained a comfortable temperature. There are multiple fireplaces throughout the community, all of which were observed to be adequately screened. There were no obstructions and/or tripping hazards throughout the facility. The LPA observed appropriate outdoor furniture, with covered shaded areas for residents in both memory care units’ courtyards and the assisted living courtyard. Parking is available for residents and visitors. The LPA observed a water fountain with an appropriate amount of water that does not pose a risk for residents. KITCHEN: The LPA, GM and chef toured the kitchen. Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 7 (seven) days non-perishable and 2 (two) days perishable food. LPA observed dietary restrictions and accommodations for residents posted throughout the kitchen. Food is prepared based on the menu. Snacks and beverages are available for residents at the bistro. Emergency food and water supply was observed and was adequate. RECORD REVIEW: LPA began record review at 2:00PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. The LPA reviewed 5 (five) resident files and the following was observed, three out of five residents did not have documentation of an annual routine visit within the last year or documentation of refusal, and residents in rooms 204 and 211 cannot administer or store medications per their Physicians reports, otherwise all required documents were complete and current. The LPA reviewed 5 (five) staff files. All files reviewed were observed to contain all required documents. Due to time constraint the LPA will return at a later time to complete the annual. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): General Manager was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted and copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 2, 2026

Allegation investigated: Staff did not ensure adequate supervision was provided resulting in resident sustaining injury

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findinds for the above noted allegation. LPA was initially greeted by front desk staff. LPA met with General Manager (GM) John Washko and Health Services Director Aleesha Zuniga at 02:53PM Entrance interview conducted. During an initial complaint visit conducted on 09/02/2025, LPA interviewed GM at 10:38AM, toured the facility at 11:55AM, conducted staff interviews at 10:50AM, 12:27PM, 01:05PM, 02:20PM, and 02:45PM. Additionally, LPA spoke with Resident #1 (R1's) family member telephonically and LPA reviewed and obtained copies of pertinent documents. Throughout the course of the investigation, LPA had a follow up telephone conversation with R1’s family member and LPA reviewed all relevant documents. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated The complaint alleges that due to lack of supervision, R1 fell, resulting in hip fracture. LPA reviewed the incident report for the resident’s fall, which indicated that R1 “was seated in common area activity room with care staff present...staff observed [R1] to lose [their] balance and fall to the ground, care staff attempted to stop the fall, but [R1] continued to fall to the ground.” Interviews revealed that during the time of the incident, there were 3 (three) care staff working and 15 (fifteen) residents. Also present were a medication technician and a lead care manager. 1 (one) care staff was on their lunch break, leaving 2 (two) care staff directly supervising the 15 (fifteen) residents. 1 (one) resident had set off an alarm, leaving only Staff #1 (S1) present with the remaining residents. S1 was present in the common area, however was moving the laundry at the time they saw R1 up from their chair and ambulating. S1 stated they saw R1 fall, but they could not stop the fall. Record review revealed that R1 did not require 1:1 supervision and typically R1 did not attempt to stand on their own. Record review revealed that both R1’s physician’s report and R1’s individualized service plan state R1 is independent with transfers. Staff interviewed stated that usually staff would bring R1 their walker and verbally prompt R1 to stand. While staff stated R1 was capable of standing on their own, this was unusual behavior for R1. The family member interviewed indicated that after the fall, R1 was diagnosed with a hip fracture and a urinary tract infection (UTI.) Family member stated that it’s possible R1 was confused due to the UTI, which caused the resident to stand unassisted. Interviews with staff revealed that there are no residents in this memory care unit that require 1:1 supervision. Staff interviewed stated they can visually see residents in the common area when doing laundry; LPA confirmed the proximity of the laundry area to the area R1 was seated at the time of the incident. Although R1 did fall resulting in a hip fracture, R1 did not require direct supervision at all times and staff were present at the time of the incident. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff did not ensure adequate supervision was provided resulting in resident sustaining injury” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today’s report was provided.the state’s words, verbatim · CDSS document, Sep 11, 2025 · control 29-AS-20250825150106

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:20AM. Upon arrival, LPA was greeted by front desk staff. LPA met with General Manager (GM) John Washko at 09:34AM. Entrance interview conducted. Beginning at 10:13AM, LPA along with GM toured the facility inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Facility is a two-story building that consists of 2 (two) memory care units named Creekside and Oceanside respectively, and an assisted living (AL) unit. The LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced 06/03/2025. The LPA reviewed an annual fire alarm testing and inspection report completed on 04/07/2025 where all smoke alarms and carbon monoxide detectors were tested and functioned properly. Sprinkler system report dated 04/15/2025 was reviewed and all systems passed. LPA tested 1 (one) delayed egress door in the Oceanside unit and was observed to be functional. The LPA observed all required postings in the hallway near the entrance area. BEDROOMS: During today’s visit, the LPAs observed 11 (eleven) resident rooms of which 3 (three) were in the Creekside unit, 3 (three) were in the Oceanside unit, and 5 (five) were in the AL unit. The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Report Continued on LIC 809-C BATHROOMS: The LPA observed 11 (eleven) resident bathrooms which were properly supplied and had functional fixtures at the time of the visit. The LPA observed grab bars by the toilet/shower and slip-resistant surfaces in all bathrooms. LPA was unable to test water temperature during today's visit, as the LPA's equipment was not functioning properly. COMMON AREAS: These included the beauty salon, library, bistro and dining areas in assisted living and memory care units. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature throughout the visit. There are multiple fireplaces throughout the community, all of which were observed to be adequately screened. There were no obstructions and/or tripping hazards throughout the facility. GROUNDS/OUTDOORS: The LPA observed appropriate outdoor furniture, with covered shaded areas for residents in both memory care units’ courtyards and the assisted living courtyard. Parking is available for residents and visitors. The LPA observed a water fountain with an appropriate amount of water that does not pose a risk for residents. INFECTION CONTROL/EMERGENCY DISASTER PLAN: LPA reviewed both the facility's infection control plan and Emergency Disaster plan, both of which were observed to be complete and updated annually as required. The community's policies and procedures pertaining to infection control are adequate. Emergency drills are conducted monthly, with the last documented drill on 06/26/2025. RECORD REVIEW: LPA began record review at 12:25PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. LPA reviewed 5 (five) resident files and 5 (five) staff files. All files reviewed were observed to contain all required documents. MEDICATION REVIEW: At 03:07PM, medication review began. Medications for 2 (two) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. KITCHEN: At 03:45PM, the LPA, GM and chef toured the kitchen. Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 7 (seven) days non-perishable and 2 (two) days perishable food. Food is delivered twice weekly. LPA observed dietary Report Continued on LIC 809-C restrictions and accommodations for residents posted throughout the kitchen. Food is prepared based on the menu. Snacks and beverages are available for residents at the bistro. Emergency food and water supply was observed and was adequate. INTERVIEWS: During today’s visit, the LPA conducted 5 (five) resident interviews and five (5) staff interviews. No concerns voiced during the interviews. During today's visit, LPA reviewed the facility's liability insurance and personnel report. No deficiencies cited. Exit interview conducted. A copy of today's report was provided via email.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced case management visit to issue an amended report. LPA met with Brittany Cramer, Marketing Director and explained the purpose of the visit. On 07/23/2024, a 1-year required annual inspection was conducted. During the annual visit, a citation was issued for Criminal Record Clearance. Based on information provided in an appeal, the 07/23/2024 citation is being revised. Please refer to LIC 809-D issued today for the amended citation. Exit interview, report given, deficiency cited on 809-D.the state’s words, verbatim · CDSS document, Jun 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jul 23, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review...prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in that 1 (one) staff member did not have a transfer of criminal record clearance which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 6, 2025

Plan of correction: Administrator agrees to have staff member associated to the facility by the plan of correction due date. POC cleared 07/23/2024.

Allegation investigated: Staff did not follow medication protocol as prescribed. Staff did not respond to resident's call pendent timely. Staff are not following client's special diet orders. Facility canceled resident's medical appointment

Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival, LPA met with the concierge and explained the reason for the visit. General Manager John Washko was unable to be present during the visit and authorized Health Services Director Aleesha Zuniga to review and sign the report. On 03/19/24, the LPA interviewed one (1) staff and obtained copies of records and other pertinent documents relevant to the investigation. On 04/10/24, the LPA conducted a file review and interviewed four (4) staff. On 04/18/24, the LPA interviewed two (2) staff, eight (8) residents, observed lunch, and toured the kitchen. During today's visit the LPA conducted one (1) staff interview, and conducted a file review. Report will continue on LIC9099-C, 2nd page. Unsubstantiated Regarding the allegation, “Staff did not follow medication protocol as prescribed” it is the concern of the reporting party that the staff at the community were not picking up Resident #1’s (R1’s) medicine from the pharmacy, were trying to give R1 different medications and not the correct brand and took away all R1’s pain rubs. Staff interviews revealed that they submitted refills and picked up R1’s medication on time, denied R1 was ever without medication due to the community not picking up their medication, and revealed that R1 could not store medications in their room due to their physician’s report. LPA reviewed records which indicated R1 refused medications many times and staff would notify R1’s physician. Charting notes and interviews with staff confirmed R1 was being provided their medication, however R1 would refuse due to medications being ordered by a different pharmacy than R1 was accustomed and the medication looked different even though the medication and dosage were the same. Furthermore, both of R1’s Physician Reports (LIC602) dated 07/25/23 and 08/07/24 indicated that R1 could not store their own medications. Lastly, all interviews with residents who are under medication management at the community revealed that they have no concerns regarding medications and have never been given the wrong medication. Based on interviews and records reviewed this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation, “Staff did not respond to resident's call pendent timely” it is the concern of the reporting party that Resident #1 (R1) pushes their pendant and has to wait for two hours before staff can help them go to the restroom. No date(s) provided. All staff and residents interviewed revealed that when a resident needs assistance they press the pendant that is on their person. Staff revealed that response time depends on different factors such as if they are assisting another resident at the time, or the time of day as mornings are usually busy, however all stated that they go ass soon as possible and they help each other out to ensure a timely response. Staff further revealed that R1 had a history of complaining that they waited a long time for assistance even though they assisted within 5 to 10 minutes, and that R1 would refuse their help and often not let them reset the pendant when they went to assist. All residents interviewed revealed that staff is very responsive, and they understand there are times staff cannot go right away but have not waited two hours for assistance as staff to go within minutes. LPA reviewed pendant records for R1 from 03/07/24, starting at 4:17 AM to 03/20/24 ending at 07:14 AM. R1’s pendant records revealed that out of 93 pendant calls R1 made, the staff average response time was 8.05 minutes, and the LPA did not observe any pendant response call times that took an hour or two hours to response. Based on interviews and records reviewed this allegation is deemed UNSUBSTANTIATED at this time. Report will continue on LIC9099-C, 3rd page. Regarding the allegation, “Staff are not following client's special diet orders” it is the concern of the reporting party that Resident #1 (R1) is out of food for their special diet for their gastric issues. It was further reported that R1 makes their own food in the microwave, and they are out of food. On 04/18/25 at 12:00 p.m. the LPA observed residents eating lunch in the dining room. At 3:40 p.m. the LPA observed a diet board with all resident’s diets listed and sufficient food in the kitchen. Staff interview revealed that the community provides breakfast, lunch and dinner, as well as snacks, the kitchen is open from 7:00 a.m. to 7:00 p.m., the community has a bistro that always has snacks and drinks available, and there has never been a time that the community has ran out of food. All residents interviewed including those with special diets stated that they have no concerns regarding the food provided and staff knows what the residents can and cannot eat. Furthermore, staff interviews revealed that R1 was very particular about their food and bought their own food or the community bought them their own groceries, but the community always had food available and followed all the resident’s diets and even accommodated to the residents’ preferences. If R1 ever ran out of food they always had the option to eat the food provided by the community. Lastly, file review revealed that based on R1’s physician report R1’s special diet indicated no concentrated sweets, and R1’s Diet Fax Form dated 07/25/23 and signed by a physician indicated R1’s diet consisted of controlled carbohydrates, and regular texture. Interview with the communities Chef revealed that for a resident with a controlled carbohydrate they would ensure that everything is portioned, minimize carbs, and serve more veggies and protein if the special of the day was high in carbs, and that a dietician revises all of the menus. Based on interviews, observations and records reviewed this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation, “Facility canceled resident's medical appointment” it is the concern of the reporting party that staff cancelled a Gastric medical appointment for Resident #1 (R1) at UCLA. LPA interviewed staff and all denied ever canceling any medical appointments for R1 or any resident and further stated that appointments would be cancelled either by the medical provider or the resident/authorized person. Staff stated sometimes R1 would refuse to go to scheduled appointments, cancel appointments or refused to be seen. LPA interviewed residents and none of them have ever experienced or witnessed staff canceling resident's medical appointments. Lastly, LPA reviewed charting notes dated 03/19/24 and 03/20/24 that revealed physicians canceling medical appointments with R1, Staff offering R1 assistance to set up appointments with a Gastroenterology, and R1 refusing staff's assistance. Based on interviews and file review this allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Today's report was reviewed and provided..the state’s words, verbatim · CDSS document, Apr 21, 2025 · control 29-AS-20240318095251

Allegation investigated: Staff do not ensure residents care needs are being met Staff do not ensure transportation arrangements are being provided Staff do not ensure resident is spoken to in an appropriate manner

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegations. LPA intially met with Health Services Director (HSD) Aleesha Zuniga, LVN as the Executive Director (ED) John Washko was in a meeting and unavailable. LPA later met with the ED. Starting at 10:08 a.m. LPA interviewed five residents. On 3/27/2025, LPA interviewed resident 1 (R1) and a witness telephonically. On 3/13/2025, LPA interviewed two staff and a resident. On 9/25/2024, LPA interviewed three staff and reviewed records. (continued on LIC9099-C) Unsubstantiated (continued from LIC9099) Regarding the allegation staff do not ensure residents care needs are being met: LPA reviewed records which indicated R1 was receiving medical care with area physicians and clinics. R1 received home health services at the facility. R1 received assistance from facility nurses as well. Interviews with staff confirmed R1 was receiving treatment, however sometimes R1 would refuse care or refuse to go to scheduled appointments. Interviews with other residents confirmed they receive the care they need from staff and appointments are scheduled with their medical care providers. Residents stated all of their care needs were met. There were two residents who considered R1 a friend and stated R1 did complain about their medical condition but staff did they best they could to assist R1. Based on interviews and records reviewed this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation staff do not ensure transportation arrangements are being provided: LPA interviewed staff who stated they have a full time driver for their bus and they also have a town car available. If more than one resident has a medical appointment in the same area around the same time they will confirm with the residents that it is ok with them to go together and they will take the bus. If the bus is being used for activities then they take residents to their appointments in the town car. R1 would use both options. Staff stated sometimes R1 would refuse to go to scheduled appointments. All of the residents interviewed stated the staff keep a list of appointments at the front desk and the driver reminds residents of their appointments and the time they need to leave. Based on interviews this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation staff do not ensure resident is spoken to in an appropriate manner: This allegation specifically referred to staff using foul language around residents. LPA interviewed staff and none of them ever witnessed any staff using foul language around residents. LPA interviewed residents and none of them have ever experienced or witnessed staff using foul language around residents. Based on interviews this allegation is deemed UNSUBSTANTIATED at this time. No deficiencies observed. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 29-AS-20240917093718

Allegation investigated: Staff are not properly caring for the residents Staff are not checking on residents during the night Staff took away residents medication

Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced subsequent complaint visit for the above allegations. Upon arrival, LPA met with Genral Manager John Washko, and was explained the reason for the visit. Entrance interview conducted. Acting administrator J.P. Rollet arrived shortly thereafter and was explained the reason for the visit. On 12/22/2023, between 01:30 p.m. and 3:30 p.m., the LPA interviewed the Executive Director, three (3) residents, conducted a resident file review and obtained copies of resident records and other pertinent documents relevant to the investigation. During today's visit the LPA conducted a file reiew, three (3) resident, six (6) staff interviews and interviewed R1's family member. Report will continue on LIC9099-C, 2nd page. Unsubstantiated On the allegations, “Staff are not properly caring for the residents, and Staff are not checking on residents during the night,”; it is the concern of the reporting party that staff are not checking on Resident 1 (R1) during the night and staff do not know what is wrong with R1 therefore do not provide proper care. Interviews with random residents revealed that they do not have any concerns with the care being provided and staff check on them frequently including during the night. Interviews conducted with staff revealed that they believe they provide adequate care to all residents. Residents are checked every two (2) hours throughout the day and night however it depends on each residents care plan, some residents may be checked on every hour, and if any resident requests assistance they are ready to help. Staff from all shifts including the NOC shift revealed that R1 was frequently checked on and would press their pendant quite often. Additionally, staff revealed that they have access to the resident’s care needs plan and if there’s ever a time, they are not knowledgeable regarding something in the resident’s care needs plan, they will call their care lead or nurses to be able to assist the residents. Furthermore, interviews conducted with R1’s family revealed they had no concerns with the care provided to R1. R1’s family stated that staff have gone out of their way to assist R1. Based on all the information gathered during the course of the investigation, the above allegations, are deemed Unsubstantiated at this time. On the allegation, “Staff took away residents’ medication”; it is the concern of the reporting party (RP) that staff took away Resident 1’s (R1’s) medications. RP did not provide additional information. To investigate the allegation the LPA conducted interviews and file review. Staff revealed that R1 had always been under medication management and could not have access to medication, therefore staff would need to confiscate medication from R1. A review of R1’s Physician’s Report (LIC602A), dated 07/25/2023, indicated R1 is not able to administer or store their own prescription and PRN medications. Based on interviews and file review the above allegation is deemed Unsubstantiated at this time. Exit interview conducted. No citations issued. Report was reviewed and a copy was issued.the state’s words, verbatim · CDSS document, Dec 30, 2024 · control 29-AS-20231215145245

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Incident inspection at the facility today. At 10:46 a.m., the LPA met with Administrator Jeanphilippe Rollet and explained the reason for today's inspection. The reason for today's inspection is to follow up on a self-reported incident received on 07/10/2024. The report pertains to Resident #1 (R1) reporting a stolen vehicle that was taken by Staff #1 (S1). At 10:55 a.m., the LPA conducted an interview with the Administrator. At 11:02 a.m., the LPA received copies of pertinent document. At 11:20 a.m., the LPA along with the Administrator conducted a physical plant tour. At 11:37 a.m., the LPA conducted an interview with R1. No immediate health and safety concerns were observed during today's inspection. Additional report may follow if warranted. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Angela Barutyan and Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:09AM. LPAs met with Health Services Director (HSD) Aleesha Zuniga, and Administrator Jeanphilippe Rollet. Entrance interview conducted. At 10:41AM, LPAs began file review while Administrator finished up a tour of the facility. At 01:12PM, the LPAs conducted a tour of the physical plant with Administrator Rollet to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a double-story residence that consists of 2 (two) memory care units named Creekside and Oceanside respectively, and an assisted living (AL) unit. The LPAs observed fire extinguishers throughout the facility, which were fully charged and last serviced 06/05/2024. The Administrator provided an annual fire alarm testing and inspection report done on 04/04/2024 where all smoke alarms and carbon monoxide detectors were tested and functioned properly. At 1:22PM, LPAs tested 1 (one) delayed egress door in the Creekside unit and was observed to be functional. The LPAs observed all required postings in the hallway near the entrance area. The facility serves residents with dementia, and the auditory alarms on the exit doors were tested and functioned properly at the time of visit. KITCHEN: At 1:25PM, LPAs toured the kitchen. Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 7 (seven) days non-perishable and 2 (two) days perishable food. LPAs observed dietary restrictions and accommodations for residents posted throughout the kitchen. Food is prepared based on the menu. Snacks and beverages are available for residents at the bistro. Report Continued on LIC 809-C BEDROOMS: During today’s visit, the LPAs observed 10 (ten) resident rooms of which 3 (three) were in the Creekside unit, 3 (three) were in the Oceanside unit, and 4 (four) were in the AL unit. The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. BATHROOMS: The LPAs observed 10 (ten) resident bathrooms which were properly supplied and had functional fixtures at the time of the visit. The LPAs observed grab bars by the toilet/shower and non-skid surfaces in all bathrooms. Between 1:20PM and 2:32PM, water temperatures in all 10 (ten) bathrooms were measured between 107.5 and 116.7 degrees Fahrenheit, which is within the required range. COMMON AREAS: These included the beauty salon, library, bistro and dining areas in assisted living and memory care units. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature of 71 degrees. There were no obstructions and/or tripping hazards throughout the facility. GROUNDS/OUTDOORS: The LPAs observed appropriate outdoor furniture, with covered shaded areas for residents in both memory care units’ courtyards and the assisted living courtyard. Parking is available for residents and visitors. The LPAs observed a water fountain with an appropriate amount of water that does not pose a risk for residents. INFECTION CONTROL: The community's policies and procedures pertaining to infection control are adequate. RECORD REVIEW: LPAs began record review at 10:41AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. LPA Byrne reviewed 5 (five) of 79 (seventy-nine) resident files and were observed to contain all required documents. LPA Barutyan reviewed 5 (five) staff files and were observed to contain all required documents. Report Continued on LIC 809-C MEDICATION REVIEW: Medications for 5 (five) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INTERVIEWS: During today’s visit, the LPAs conducted 5 (five) resident interviews and five (5) staff interviews. No concerns voiced during the interviews. During today's visit, LPAs obtained a copy of the facility's liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Civil penalty was issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted and copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 23, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Annual Continuation Visit to the facility to continue the annual inspection visit initiated on 07/11/2023. The LPA was greeted by Business Office Manager Hannah Robertson and informed them of the reason for the visit. Administrator Lance Shenk arrived during the visit. Today the LPA conducted a medication audit and finished the record review initiated on 7/11/2023. Record Review: The LPA observed documentation of Disaster prevention and last fire drill (conducted on 12/12/2023). Medications: At 2:30 p.m. a medication review was initiated for two out of five residents and the following was observed. The medications were stored in Med carts, which are locked and inaccessible to the residents. During Resident #1 (R#1's) audit, the LPA observed the expiration date for fifteen (15) medications not properly documented as they did do not match the Facility Centrally Stored Medication and Destruction Record (CSMDR). During R#2’s audit, there were two medications that were not documented on the centrally stored log. Staff stated the CSMDR for those medications were stored in a different location due to the date they were filled. The LPA also observed the expiration date for nine (9) medications of R2 not properly documented as they did not match the CSMDR. R2’s date started for Vitamin D2 1.25mg and Lorazepam 1mg were not properly documented, as R2 has not started the medication and a start date was documented. Staff documented the correct expiration dates and corrected the start dates upon observation. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 16, 2024