Alexandria Victoria

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) John Gryspos Jr. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with ADM 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 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 40 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. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were purchased on 2/1/2026 and 11/19/2025, both were observed to be fully charged. The facility drill log was not available for review during inspection. ADM stated he would provide a copy of drills for 2025 to the CCL by 2/5/2026. ADM conducted an emergency drill during the visit. LPA toured 7 resident rooms. All 7 resident rooms have a bed, functioning lights, a dresser and space for personal belongings. Page 1 of 2 LPA measured water temperature in 3 resident bathrooms with a range from 106.1 F to 107.2 F. LPA reviewed 4 resident files and 2 residents CSMDRs. LPA reviewed 4 staff files. LPA observed there were no staff training documents for 2025. ADM stated he was working on staff files and the training documents were not at the facility. ADM stated he would submit staff training documents to CCL by 2/5/2026. A Technical Violation was issued. LPA observed facility doors to have an auditory signal which alarmed in the facility kitchen dining area. No deficiencies were issued during today's visit per California Code of Regulations, Title 22. A Technical Violation was issued. An exit interview was conducted with ADM and signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Feb 4, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained fracture while in care Staff did not seek timely medical care for resident in care Staff did not report resident's incident to appropriate parties

On at 03/08/25, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with staff Rosie Gryspos and explained the purpose of the visit. Staff called administrator John Grayspos to informed that CCLD was present. Approximately 10 minutes later administrator arrived at the facility. The purpose of this visit is to deliver complaint finding for the allegation above. The current census is 9. A brief interview with conducted with the administrator. It was alleged that resident sustained a fracture while in care, that staff did not seek timely medical attention for the resident in care, and that staff did not report the incident to the appropriate parties. This investigation involved interviews with facility staff and residents. Based on the interviews, 5 out of 5 staff members denied the allegations and stated that they did not witness the incident. LPA interviewed 2 out of 2 resident who stated that they feel safe and does get medical care when needed. Continued LIC 9099-C Unsubstantiated During a facility visit on 11/23/24, LPA Lee was unable to obtain relevant records regarding resident (R1). Administrator John Gryspos informed LPA Lee that (R1)'s file had been stored in the facility basement but was destroyed in a flood in 2022; therefore, LPA Lee was unable to interview resident (R1) or (R1)'s responsible party. Due to the lack of documentation and insufficient information, there was no clear indication that the alleged incident occurred. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited. A copy of this report was provided. Exit interview.the state’s words, verbatim · CDSS document, Mar 8, 2025 · control 26-AS-20220607080558

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced at 9:35AM to conduct a Required- 1 Year annual inspection and met with Administrator (ADM) John Gryspos, Jr. ADM states the facility has 7 residents. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. Facility thermostat temperature display was observed at 70 degrees F. All exit and passageways were free and clear of obstruction. LPA observed 4 residents in the dining room eating breakfast and watching TV, with 2 staff members serving breakfast and talking to residents. LPA toured 11 resident bedrooms. 11 out of 11 resident bedrooms have a bed, functioning lights, dresser/table, a chair, bedding and space for personal belongings. LPA toured 7 resident bathrooms. 7 out of 7 resident bathrooms have hand soap, paper towel, functioning lights, and covered trash bins. LPA measured water in 7 resident bathrooms with a temperature range from 105 to 112 degrees F. 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 knives and cleaning product storage area as locked and inaccessible to residents in care. LPA observed the medication storage area in the living room as locked and inaccessible to residents in care. LPA reviewed 5 resident records. 5 out of 5 resident records were found to be complete. Resident records included emergency contact information, physician’s report, appraisal/needs and service plans, and personal rights. See LIC809C All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 8/8/2024. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was conducted on 2/12/2025. LPA reviewed 5 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). 4 out of 5 CSMDR’s were observed to be complete with all medication documented. LPA observed Resident R2's CSMDR prescription medications fill date was not current. ADM updated R2's prescription medication fill dates during inspection. LPA advised ADM to ensure all resident's CSMDRs are documented and recorded accurately. LPA reviewed 5 staff records. 5 out of 5 staff records were found to be complete. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record and staff training. ADM provided LPA with an updated copy of Administrator Certificate. No deficiencies cited during today's visit per California Code of Regulation Title 22. A Technical Violation was issued during today's visit. An exit interview was conducted with ADM John Gryspos, Jr and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 18, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator John Gryspos Jr. The purpose of the Case Management visit was to amend a prior complaint investigation report. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator John Gryspos Jr. and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 26, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Annual Continuation visit and met with Administrator John Gryspos Jr. During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the kitchen area. LPA observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA Marrufo observed the first aid kit and found it to be complete. LPA Marrufo toured 11 out of 11 resident bedrooms. Each bedroom had functioning lights and available bedding and clothing storage areas. LPA Marrufo tested the smoke detectors in the bedrooms and hallways and found them to function properly when tested. LPA Marrufo observed the resident bathrooms and found them to have functioning lights and available soap and paper towels. The bathroom water temperatures were measured at 119 F and 107 F. LPA Marrufo reviewed the Centrally Stored Medication Logs and the resident and staff records. Resident R1's Physician's Report indicated R1 is diagnosed with dementia and the most recent Physician's Report was from 2021. LPA Marrufo toured the outside area and found the exits to be clear of obstructions. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D for more information. This report was reviewed with Administrator John Gryspos Jr. and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 31, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Jun 7, 2024

87705(c)(5) Care of Persons with Dementia: c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: Licensee did not ensure resident R1 with dementia had a Physician's Report that is annually updated.the state’s words, verbatim · CDSS document, May 31, 2024

Plan of correction: Licensee agrees to submit an updated medical assessment (Physician's Report) for resident R1 and any other residents with dementia who have medical assessments that are over a year old to CCL by POC date.

Allegation investigated: Staff do not ensure bathroom is cleaned properly Staff do not ensure the shower mat would not slip Staff do not ensure residents linens are clean Staff did not ensure residents door seal was fixed properly

On 5/8/2024, Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannouced complaint investigation and met with the facility administrator Adrian Mendoza and John Gryspos. LPA stated the purpose of the visit is to address a complaint that was received on 5/7/2024. This agency has investigated the complaint alleging, bathroom is not cleaned properly, staff do not ensure the shower mat would not slip, lines are not clean, door seal was not fixed properly. LPA found that the complaint was unfounded the individual does not reside in the facility. No deficiencies are cited during today's visit. An exit interview was conducted with Administrator John Gryspos. A copy of the report was provided. Unfoundedthe state’s words, verbatim · CDSS document, May 8, 2024 · control 26-AS-20240507105422

Allegation investigated: Facility staff handled resident in a rough manner Facility staff spoke inappropriately to resident

*This report was amended on 07/26/2024 to change the allegation finding from unfounded to unsubstantiated.* Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator John Gryspos Jr. LPA Marrufo reviewed resident records and determined that the alleged victim of the allegations was not admitted to this facility. LPA interviewed 7 residents on 04/11/2024. 1 out of 7 interviewed residents stated to have observed a staff handle him/her in a rough manner and speak to residents inappropriately, although the resident could not identify the staff. On 07/26/2024, LPA interviewed 3 staff and Administrator. The three staff and the Administrator stated to have never observed staff handling residents in a rough manner or staff speaking inappropriately to residents. This agency has investigated the complaint allegations listed. Based on information from interviews conducted with residents and staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to provewas the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. This report reviewed with Administrator John Gryspos Jr. and a copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 19, 2024 · control 26-AS-20240405133726

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Ophelia Gryspos. During visit, LPA Marrufo toured the facility inside and out. Due to time constraints, the facility inspection visit will need to be continued at a later time. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Ophelia Gryspos and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 27, 2024