Almond Grove Assisted Living

We haven’t transcribed this report yet. The complete document is on the state’s site.

Allegation investigated: Staff sexually abused resident. Resident sustained bruises and scratches due to staff neglect or physical abuse.

On 9/9/26, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Staff, Megan Puckett during today's visit and explained the purpose of the visit. The department conducted records review and interviews with staff and residents to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated ****Report continued..... Allegation- Staff sexually abused resident. UNSUBSTANTIATED. Interviews conducted with residents indicated that they felt safe at the facility and no one has ever hurt them at the facility. Interviews conducted with staff indicated there has not been any reports of inappropriate behavior or touching from staff. Staff ensure to report anything out of the ordinary during brief changes. Records reviewed indicated that there were no reports of sexual abuse or suspected sexual abuse from staff towards residents in care.Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. Allegation- Resident sustained bruises and scratches due to staff neglect or physical abuse. UNSUBSTANTIATED. Department conducted record review, staff and residents interviews to investigate this allegation. Residents interviewed did not indicate any staff neglect or physical abuse. Residents stated that they felt safe at the facility. Staff interviewed indicated that they were aware of bruises and red marks on resident, R1s inner thighs and legs but it was not due to staff neglect or physical abuse in any manner. It was learned that R1 was scratching their legs and arms which might have been caused by those bruising. Record review reflected that staff were notifying R1s doctor regarding those bruises and redness and were following doctor’s orders to treat them. Based on this information, this allegation was UNSUBSTANTIATED. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit meeting conducted .A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Sep 9, 2026 · control 59-AS-20260811085849

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 7/13/26 to conduct a case management inspection to follow up on a choking incident on 7/8/26 for resident, R1 at the facility. LPA met with Administrator,Preston Summerhays and explained the purpose of the visit. Facility submitted incident report to department on 7/8/26 about resident, R1 who had choking incident on 7/8/26 in the dining room around 9AM. Facility staff took appropriate measures and performed Heimlick Manuever on R1. R1 was back to their baseline after this incident. Facility notified R1s responsible party, physician and other required agencies as required. After reviewing the incident report and information gathered, it has been determined that facility took appropriate measures to address R1s choking incident on 7/8/26. No citations were observed or cited per Title 22 Regulations. Exit interview conducted and copy of the report has been provided.the state’s words, verbatim · CDSS document, Jul 13, 2026

Allegation investigated: Staff did not prevent the spread of a communicable disease.

On 6/18/26, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Administrator, Preston Summerhays during today's visit and explained the purpose of the visit. The department conducted records review and interviews with staff and residents to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated ** continued from 9099.... Allegation- Staff did not prevent the spread of a communicable disease. Unsubstantiated. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. Based on observation, record review, and statement reviewed, the facility was following universal precautions to address scabies cases at the facility. As a precaution, during the first sign of a rash of any resident, facility puts out PPE outside the resident room, notifies staff of the potential of scabies, and an in-service to staff is reviewed on proper hand washing and universal precautions. Facility encouraged residents to stay in their room during the episode. Regarding scabies case for resident, R1, it was noted that R1 has scabies in February 2026 and facility provided proper treatment per R1s physician’ s order to address that. Additionally, R1 was seen scratching their skin around 4/25/26 and R1 was sent to hospital as assessed by staff to sought medical help. R1 returned from hospital after getting the treatment for possible scabies and staff administered the treatment as ordered by medical professional. R1 was also seen by their dermatologist on 4/29/26 related to this issue. It was also noted that facility notified all scabies cases to local health department and followed their guidelines to handle these cases. Based on the information gathered, it was evaluated that facility took appropriate measures to address scabies cases for resident, R1 and other residents and there were no concerns, therefore, the allegation is Unsubstantiated. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit meeting conducted .A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Jun 18, 2026 · control 59-AS-20260503133957

Allegation investigated: Facility did not complete doctors order timely.

On 4/22/26, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Administrator, Preston Summerhays during today's visit and explained the purpose of the visit. The department conducted records review, interviews with staff to investigate this allegation. Staff interviews reflected that residents medical and dental needs were met and there were no issues. This complaint allegation was about facility was not completing Cologuard (stool test) for resident, R1 which was ordered by R1s physician without any specific timeframe. Record review and staff interviews indicated that facility was not successful to get the stool specimen from R1 due to R1s health conditions, but it was learnt that facility has completed this task during the complaint investigation. There was insufficient information available as how facility was not completing doctor’s orders in timely way for R1, therefore, this allegation was Unsubstantiated. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted. A copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 22, 2026 · control 59-AS-20260401114751

Type of visit: Case Management - Incident

On 02/05/26, Licensing Program Manager (LPM ) Laura Munoz and Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct case management visit. LPM and LPA met with Administrator, Preston Summerhays and explained the purpose of today's visit. SOC341 for residents R1, R2, R3--Department followed up on SOC 341 sent by facility on 01/14/26 stating that resident, Resident R1 was physically and verbally abusive to two residents (R2, R3) on 01/14/26 on two different occasions in common areas at the facility. Staff intervening for both incidents and checked R1,R2,R3 for any injuries but none were present. It was learnt that R1, R2, R3 were at their baseline and doing fine as of today. Facility was working with R1s responsible party, physician and other agencies to address this matter per department guidelines. After reviewing the incidents reports and information gathered, it has been determined that facility took appropriate measures to address these incidents. No citations were observed or cited per Title 22 Regulations however Technical Advisory has been issued. Exit interview conducted and copy of the report has been provided.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Required - 1 Year

On 02/05/26, Licensing Program Manager (LPM ) Laura Munoz and Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct the annual inspection. LPM and LPA met with Administrator, Preston Summerhays and explained the purpose of today's visit. LPA and LPM toured facility with to ensure the health and safety of residents in care. LPA and LPM toured resident’s rooms, medication room, bathrooms, kitchen, dining room, common areas and activity areas. LPM and LPA observed residents in common areas participating in activities and in the dining room having lunch. The facility was found to be clean, safe, sanitary and in good condition. LPA and LPM observed the facility to have the mandated posters posted. Fire extinguishers are maintained and ready for emergency use. Facility has required food supplies. There are appropriate staff present to meet the needs of residents. Inside temperature was 72–74-degree F. Hot water measured between 116-118 in two different areas at facility was in required range 105-120 degree F. LPA and LPM reviewed five (5) residents files and five (5) staff files. Staff records reviewed indicated training completed and other required paperwork. Resident’s files found to have required documentation. LPM, LPA observed that medications were secured and were inaccessible to residents. LPA completed the full care tool, and no deficiencies were observed or cited per Title 22 Regulations. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 02/25/26. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Feb 5, 2026

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: Licensee does not ensure that staff have health screening.

On 12/17/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Administrator, Preston Summerhays during today's visit and explained the purpose of the visit. Throughout the course of the investigation, the department reviewed records and conducted interviews with staff relevant to the complaint allegation. Staff interviews indicated that facility did not ensure all new hired staff have TB tests completed as required per Regulations. Record review reflected that facility did not complete TB test for seven (7) out of (8) staff hired from August to September 2025 which was required per Title 22 Regulations under regulation 87411(f). Based on the information gathered, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached LIC 9099-D page. Exit interview conducted. Appeal rights and a copy of this report were provided. Substantiatedthe state’s words, verbatim · CDSS document, Dec 17, 2025 · control 59-AS-20251103113029

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Jan 15, 2026

87411(f)- All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physical not more than six (6) months prior to or seven (7) days after employment or licensure. This requirement was not met as evidenced by: Record review indicated that facility did not complete TB test for 7 out of 8 new hired staff which get hired from August to September 2025 which poses potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: Administrator shall send a letter of understanding of this Regulation. The facility will ensure that all staff have a physical exam and TB test as per Regulation timelines. POC due date is 01/15/26.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 11/04/25 to conduct a case management inspection. LPA met with staff, Preston Summerhays and explained the purpose of the visit. R1’s AWOL Incident- The facility submitted a completed Unusual Incident/Injury Report (LIC624) on 10/31/25 regarding resident (R1) attempted to leave the facility unattended on 10/29/25 , at approximately 3PM. Per incident report, R1 was brought back to the facility uninjured by staff . Facility notified R1s doctor and family regarding this AWOL incident. R1's physician's report indicates that R1 cannot leave the facility unassisted. Although no injuries resulted from R1s AWOL incident, R1s LIC602 indicated they were unable to leave the facility unassisted. Staff reported that it was R1s first attempt to leave the facility unassisted. R2 Choking Incident- Facility submitted incident report to department on 10/31/25 about resident, R2 who had choking incident on 10/29/25 in the main dining room around 9AM. Facility staff took appropriate measures and performed Heimlick Manuever on R2. R2 was back to their baseline after this incident. Facility notified R2s family, physician and other required agencies as required. After reviewing the incident report and information gathered, it has been determined that facility took appropriate measures to address R2 s choking incident. **Report continued ......... ***Report continued .... SOC341 for residents R3,R4--Department followed up on SOC 341 sent by facility on 10/29/25 stating that resident, R4 reported to staff on 10/29/25 that R3 punched them in their face twice in their room . Report indicated that R4 moved in to the facility on 10/28/25 and R3 was their roommate. After that incident, R4 was moved to another room. Facility notified law enforcement regarding this incident . Facility staff checked R4 for any injurers and none were present. After reviewing the incidents reports and information gathered, it has been determined that facility took appropriate measures to address these incidents and notified all required parties in timely way. No citations were observed or cited per Title 22 Regulations. Exit interview conducted and copy of the report has been provided.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Case Management - Incident

On 10/06/25, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 09/29/25. LPA met with Staff, LVN, Tiffany Gibson and explained reason for visit. Special Incident Report (LIC 624) submitted by facility on 10/03/25 to CCL stated that resident, R1 was given wrong medications by staff on 09/29/25 around 08.30AM . Incident report indicated that R1 was given medications, Hydralazine HCI Oral Tablet 50 MG -1tablet, Lisinopril 20 mg-1tablet,Metoprolol Succinate ER Oral Tablet Extended Release 24 Hour 100 MG -1 tablet, Pantoprazole Sodium Oral Tablet Delayed Release 40 MG -1tablet, Ranolazine ER Oral Tablet Extended Release 12 Hour 500 MG -1 tablet, Clopidogrel Bisulfate Oral Tablet 75 MG – 1tablet, Furosemide oral tablet 40 mg- 1tablet which were not prescribed by thier physician. Facility notified R1s physician and responsible party on 09/29/25 regarding medication error. LPA was notified by administrator that facility took appropriate action with staff regarding this incident per facility policy who was associated with this incident . Based on incident report, staff interviews and medication record review from the facility, R1 was given these medications by mistake. It was determined that facility administered wrong medications to R1 which poses a immediate health and safety risks to residents in care. Deficiencies are cited on LIC809D, pursuant to California Code of Regulations, Title 22, Section 87465(a)(4) and documented on the attached LIC809D. Civil penalties may be assessed if facility does not comply with POC requirements which were issued today. The report was reviewed, appeal rights and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 7, 2025

87465 Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on incident report and staff interview, it was concluded that administered wrong medications to resident, R1 which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 6, 2025

Plan of correction: Administrator shall conduct staff training for medication management and to send into CCL a copy of the training by POC date- 10/07/25.

Allegation investigated: Staff are not allowing a resident to have private visits while in care. Staff threatened a resident in care.

On 10/02/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Staff, LVN , Tiffany Gibson during today's visit and explained the purpose of the visit. During the course of the investigation, it was learned that R1 and R2 developed a romantic relationship. Facility contacted R1’s responsible party to discuss the relationship as there was a question as to R1’s capacity. Based on documentation from R1’s primary care physician and R1’s responsible party, R1 has the capacity to make decisions on engaging in a physical relationship with R2. The facility puts perimeters in place to ensure R1’s safety while ensuring R1’s personal rights are preserved. As of this date, all parties have agreed to a plan with R1, R2 and facility staff in regard to R1 and R2’s relationship. Furthermore, During the course of the investigation, there is no evidence found that staff threatened residents in care. Based on this information, these allegations were UNSUBSTANTIATED. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit meeting conducted .A copy of this report has been provided to facility. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 2, 2025 · control 59-AS-20250902104518

Allegation investigated: Staff do not follow infection control guidelines. Staff did not prevent outbreak of contagious disease. Licensee does not ensure staff have required training. Staff are not providing adequate food service. Staff do not follow reporting requirements.

On 09/09/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Administrator, Kim Jackson during today's visit and explained the purpose of the visit. The department conducted records review and interviews with staff and residents to investigate the complaint. **Report continued on LIC9099-C** Unfounded **Report continued from 9099.... Allegation- Staff do not follow infection control guidelines. Staff did not prevent outbreak of contagious disease. -UNFOUNDED Based on observation, record review, and statements reviewed, the facility was following infection control guidelines with recent covid+ cases outbreak. It was noted that facility followed all directives from the department and from health department with handling of recent covid outbreak at the facility, and an in-service to staff is reviewed on proper hand washing and universal precautions. Facility encouraged residents to stay in their rooms during the episode. Four residents and seven staff interviews did not indicate any concerns about this matter. It was observed the facility had required PPE outside the resident’s room; therefore, the allegation is UNFOUNDED. Allegation- Licensee does not ensure staff have required training. -UNFOUNDED The Department conducted interviews with seven staff members and reviewed record regarding the allegation cited above. Staff interviews revealed that staff have adequate training (on boarding and ongoing) regarding infection control guidelines and other required topics and there were no issues. Staff interviews also reflected that the facility has adequate supplies of PPE and other care items to take care of residents. Four resident interviews indicated that staff were properly trained, and residents felt safe with the staff’s care without any problems. Record review indicated that facility has all required documentation regarding staff’s training per Title 22 Regulations, therefore these allegations were found to be Unfounded. *** Report continued ..... ***Report continued from 9099..... Allegation- Staff are not providing adequate food service. -UNFOUNDED An investigation has been conducted regarding the above allegation. LPA observed the facility’s food supply as well as interviewed residents regarding the food service. Based on observation and interviews, the facility keeps the required amount of food supply in the facility per Title 22 Regulations. Additionally, four (4) residents interviews indicated that residents are satisfied with the food service at the facility and deny they missing any meal there. During resident’s interviews, it has been found out that the main dining room was closed temporarily during recent covid+ cases outbreak per health department’s directive, but their meal services were fine. Seven staff interviewed indicated that there were no issues related to residents meal services at the facility. Based on the information, this allegation is found to be Unfounded. Allegation- Staff do not follow reporting requirements. -UNFOUNDED The Department conducted interviews with seven staff, and reviewed records to investigate this allegation. Staff interviews indicated that the facility was notifying all reportable incidents to residents, responsible parties and other required agencies including recent covid+ cases and there were no concerns. Record review reflected that the facility kept proper call logs, email communications and other modes of communications by which facility was notifying residents, responsible parties and other agencies any reportable items per regulations and there were no issues . Based on this information, this allegation is Unfounded. A finding that the allegations are Unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Sep 9, 2025 · control 59-AS-20250807082444

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 08/27/25 to do case management visit . LPA met with Staff, LVN,Tiiffany Gibson and explained the purpose of the visit. Department followed up on SOC 341 sent by facility on 08/26/25 regarding residents, R1 and R2. Facility notified law enforcement and long term care ombudsman (LTCO) regarding this incident. LPA requested documents related to this incident and facility will submit all documents by 09/03/25. At this time, this case in under review and department will do follow up as needed. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Aug 27, 2025

Allegation investigated: Facility staff did not provide adequate supervision resulting in resident elopement. Facility staff did not provide adequate bathing service to resident care.

On 06/12/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Administrator, Darrell Price during today's visit and explained the purpose of the visit. The department conducted records review and interviews with staff and residents to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated ***Report continued from 9099.... Allegation- Facility staff did not provide adequate supervision resulting in resident elopement. Department conducted records review and staff’s interviews to investigate this allegation. Record review indicated that per LIC602 (dated-03/28/25) for resident, R1 indicated that R1 was able to leave the facility unassisted without staff’s assistance or supervision. Additionally, R1s needs and service plan did not indicate that R1 was AWOL/Elopement risks when R1 moved into the facility on 04/01/25. Three staff interviews reflected that staff were not aware that R1 was AWOL/Elopement risk but were aware that R1 can leave facility unassisted. Staff interviews reflected that on 04/27/25 around 1pm, R1 exited from facility and went to main street with suicidal thoughts but staff immediately provided necessary help to R1 and brought back R1 to facility with presence of law enforcement. Facility sent out R1 to hospital on 04/27/25 to seek the appropriate medical care for R1 to ensure their health and safety. From gathered information, it has been concluded that even R1 eloped from facility on 04/27/25, it was not due to staff’s lack and supervision, so this allegation was found to be UNSUBSTANTIATED. Allegation- Facility staff did not provide adequate bathing service to resident care. Department conducted records review and staff’s interviews to investigate this allegation. Record review indicated that per LIC602 (dated-03/28/25) for resident, R1 indicated that R1 was able to take their shower Independently and stand by assistance needed by staff. During staff’s interviews, staff, S3 who were main morning caregiver during R1s facility stay from 04/01/25 till incident date (04/27/25), indicated that they assisted with R1s showers 5-6 times and R1 expressed no concerns. Record review and interviews did not indicate any concerns regarding R1s bathing services at facility, so this allegation was found to be UNSUBSTANTIATED. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit meeting conducted .A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Jun 12, 2025 · control 59-AS-20250502153659

Type of visit: Case Management - Incident

On 06/12/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a case management visit and met with Administrator, Darrell Price and explained the purpose of today's visit. Case management visit was conducted regarding a incident report and SOC 341 received by department regarding residents, R1 and R2 for date- 05/30/25. R1 and R2 files were reviewed, and it appeared that appropriate action was taken regarding this incident by facility . It was learnt that both residents were at their baseline and there were no other incident(s) related to this matter. Facility notified all required parties regarding this matter. No deficiencies were cited due to this incident. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 12, 2025

Type of visit: Case Management - Incident

On 06/12/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a case management visit and met with Administrator, Darrell Price and explained the purpose of today's visit. Case management visit was conducted regarding following incidents reports reported by facility for residents: Regarding resident, R1- Incident report (LIC624) submitted by facility indicated that resident, R1 was sent to hospital on 05/16/25 as R1 was having suicidal thoughts. It was learnt from record review that R1 returned from hospital on same day without any changes in their medications were doing fine as of today with no further incident(s). Regarding resident, R2- Incident report (LIC624) submitted by facility indicated that resident, R2 was sent to hospital on 05/14/25 around 1130am, as staff noticed R2 with open wound on scalp bleeding, not getting any better with a foul odor. Record review that R1 returned from hospital on 05/16/25 with new treatment order for wound management and with home health orders. Regarding resident, R3- Incident report (LIC624) submitted by facility indicated that resident, R3 attempted to leave facility premises on 05/26/25 around 08:50AM without staff’s assistance. Report indicated that R3 was sitting in the patio area and staff saw R3 going on sidewalk of the facility without staff’s presence. Staff brought back R3 to the facility without any injuries. It was learnt that R3 was doing fine as of today with no further incident(s). ....report continued.... ***Report continued from 809.... Regarding resident, R4- During complaint investigation of 59-AS-20250502153659, department noticed during record review that R4 got admitted to facility on 04/01/25 and pre-admission appraisal was done by facility on 03/26/25 but facility could not verified if R4 and/or responsible party was involved during the draft of this document as there were no signatures by R4 and/or responsible party on pre-admission appraisal as required per regulations. Regarding resident, R5- Incident report (LIC624) submitted by facility indicated that resident, R1 was sent to hospital on 06/10/25 after R5 sustained a fall at the facility around 1:00AM. LIC624 reflected that R5 did not complain any pain after the fall and refused to go to hospital but complained later around 06:30AM regarding pain in the back and been sent out to hospital to sought medical care. It was learnt from record review that R1 returned from hospital on same day with diagnosis of spinal fracture and with order of back brace to be used while walking. Files were reviewed for above residents, and it appeared that appropriate actions were taken regarding these incidents by facility. Facility notified all required parties regarding these incidents. No deficiencies were cited per Title 22 Regulations however Technical Assistance(s) have been issued. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 12, 2025

Type of visit: Case Management - Incident

On 05/06/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct a case management inspection related to an SOC341 reported to the Department on 05/02/25 involving two residents. LPA met with Staff, LVN,Tiiffany Gibson and stated the reason for the inspection. A SOC341 (Report of Suspected Abuse) was submitted by the facility on 05/02/25 following the incident involving two residents, R1 and R2 on 05/01/25 around 7PM at facility. Neither resident sustained any injuries. SOC341 indicated that on 05/01/25 around 7PM, R1 was sitting in chair in front lobby when R2 approached R1 and asked to sit on the same chair where R1 was sitting. R1 refused to give the chair to R2 and R2 got upset. R2 grabbed R1 by their shirt and throw cup of ice on R1. Staff immediately intervene the situation and separated both residents for further altercation. No deficiencies issued in this report as the facility timely reported the incident to the Department, law enforcement, family members and physicians, and there were no injuries sustained to both residents. Exit interview. Copy of the report was provided.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 04/10/25 to do case management visit. LPA met with staff, Jasmine Malone and explained the purpose of the visit. Department followed up on SOC 341 sent by facility on 04/04/25 regarding resident, R1. R1 reported to facility staff that they believed they were abused while in care. Facility notified R1s responsible party, law enforcement and Long-Term Care Ombudsman (LTCO) regarding this incident. Per facility records, there were no visible injuries to R1 after this incident and R1 was at their baseline. During today’s visit, LPA interviewed resident, R1 and staff regarding the incident. LPA requested documents related to this incident and facility will submit all documents by 04/14/25 by 5pm via email. At this time, this case in under review and department will do follow up if warranted. No citations were issued on this date per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Apr 10, 2025

Type of visit: Required - 1 Year

On 03/04/25, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to conduct the annual inspection. LPA met with Assistant Director, Tosha Devi and explained the purpose of today's visit. Administrator, Darrel Price came after short while and assisted LPA with today's visit. LPA toured facility with to ensure the health and safety of residents in care. LPA toured resident’s rooms, medication room, bathrooms, kitchen, dining room, common areas and activity areas. LPA observed residents in common areas participating in activities and in the dining room having lunch. The facility was found to be clean, safe, sanitary and in good condition. LPA observed the facility to have the mandated posters posted. Fire extinguishers are maintained and ready for emergency use. Facility has required food supplies. There are appropriate staff present to meet the needs of residents. Inside temperature was 72–74-degree F. Hot water measured between 110-120 in three different areas at facility was in required range 105-120 degree F. Facility was conducting fire and disaster drills per requirement. LPA reviewed five (5) residents files and five (5) staff files. Staff records reviewed indicated training completed and other required paperwork. Resident’s files found to have required documentation. LPA reviewed two (2) residents medications comparing with current physician orders and found it to be correct. LPA checked the current narcotic medications log with staff and found no errors. LPA observed that medications were secured and were inaccessible to residents. LPA completed the full care tool, and no deficiencies were observed or cited per Title 22 Regulations. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Mar 4, 2025

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) Talwinder Bains arrived at the facility unannounced on 01/06/25 to do case management visit . LPA met with Assistant Director, Tosha Devi and explained the purpose of the visit. Department followed up on SOC 341 sent by facility on 01/02/25 regarding resident, R1. Facility notified R1s responsible party, law enforcement and Long Term Care Ombudsman (LTCO) regarding this incident. Per facility records, there were no visible injuries to R1 after this incident and R1 was at their baseline. During today’s visit, LPA interviewed resident, R1 and staff ,S1 regarding this incident. LPA requested documents related to this incident and facility will submit all documents by 01/12/25 by 5pm. At this time, this case in under review and department will do follow up if warranted. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, Jan 6, 2025

Allegation investigated: Staff steals resident’s money. Staff mishandling resident’s medication. Staff did not provide resident with lunch. Facility heat and air conditioner is in disrepair. Staff searching residents personal belongings. Staff not providing a comfortable room temperature for residents. Facility does not have clean towels for resident(s). Staff does not treat resident with respect. Staff tested positive for covid.

On 12/10/24, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. The department conducted records review ,facility observations and interviews with staff and residents to investigate the complaint. **Report continued on LIC9099-C** Unfounded ***Report continued from 9099..... Allegation- Staff steals resident’s money.-Unfounded The Department conducted record review, interviewed four (4) residents and four (4) staff members to investigate this allegation. Record review indicated that facility was collecting residents monthly charges per their admissions agreement and there were no indications for any misusing of residents funds in any manner. Additionally, facility was keeping proper log and records for residents payments and receipts without any problems. Residents interviews did not indicate any staff were stealing residents money or funds . Staff interviews reflected that staff facility was managing residents accounts well and they were not aware about any wrong doings with residents funds or money in any way. Based on gathered information, this allegation was found to be Unfounded. Allegation- Staff mishandling resident’s medication. .-Unfounded The Department conducted record review, interviewed four (4) residents and four (4) staff members to investigate this allegation. During these interviews with four (4) staff and four (4) residents, it was revealed that the facility dispensed all residents' medications on time and administered them as scheduled. Residents’ interviews indicated that staff were assisting them with their medications without any issues. Furthermore, a review of the records for the month of October 2024, indicated that the facility maintained a proper logs for all medications in the centrally stored medication log, following physician's orders, and documenting them in the Medication Administration Record (MAR) without any errors. Staff interviews reflected that residents were given medications on time per their physician’s orders and there were no problems to address. Based on these findings, this allegation is considered UNFOUNDED. Allegation- Staff did not provide resident with lunch. .-Unfounded An investigation has been conducted regarding the above allegation. LPA observed the facility’s food supply as well as interviewed residents regarding the food service. Based on observation and interviews, the facility keeps the required amount of food supply in the facility. Additionally, four (4) residents interviews indicated that residents are satisfied with the food service at the facility and denying missing any meal there. During resident’s interviews, it has been found out that residents can request their meal tray in their rooms if they do not want to eat in dining room. Residents stated that there were no issues with tray delivery service to their rooms and they did not miss any meals. Four (4) staff interviewed indicated that they were not aware of any issues with residents missing their meals. Based on the information, this allegation is found to be Unfounded. (report continued....) **Report continued from 9099.... Allegation- Facility heat and air conditioner is in disrepair. Staff not providing a comfortable room temperature for residents. .-Unfounded The Department conducted record review, interviewed four (4) residents and four (4) staff members to investigate this allegation. Four resident’s interviews did not indicate any issues with facility’s physical operations including working A/C unit or comfortable temperature at the facility. Residents stated that sometime in June or July 2024, one of A/C unit was not working properly but facility followed up on that issue in timely manner and that issue has been resolved completely. Residents care or safety were not affected by issues with A/C unit not been working at that time. Four staff interviews reflected that facility A/C was operating without any problems and there were no issues in this area. Furthermore, staff stated that facility administration follow up in in timely manner if there were any issues with any physical operations at the facility, therefore the allegation is UNFOUNDED. Allegation- Staff searching residents personal belongings. .-Unfounded The Department interviewed four (4) residents and four (4) staff members to investigate this allegation. Residents interviews did not indicate any staff were searching their personal belongings or stealing stuff from them. Staff interviews reflected that facility was safeguarding residents personal belongings well and they were not aware if any staff were stealing or searching residents personal belongings. Based on gathered information, this allegation was found to be Unfounded. Allegation- Facility does not have clean towels for resident(s). .-Unfounded The Department conducted record review, interviewed four (4) residents and four (4) staff members to investigate this allegation. Residents interviews reflected that facility has adequate supply of linens to take care of residents and there were no problems. Staff interviews indicated that facility provide adequate supplies of towels, other linens for residents care without any issues and denied any shortage. During Department’s visits, it has been observed that facility has enough supplies of all kind of linens to take care of residents. Based on these findings, this allegation is considered UNFOUNDED. (Report continued.....) **Report continued from 9099..... Allegation- Staff does not treat resident with respect. .-Unfounded The Department interviewed four (4) residents and four (4) staff members to investigate this allegation. Interviews did not indicate any residents, staff and/or witness observed that staff are not providing privacy to residents in care. Department observed during facility visits that facility staff were attentive to resident’s needs and providing them privacy while taking care of them and during resident’s personal time with families and visitors. During residents’ interviews, residents stated that facility staff are meeting their care needs and did not express any concerns with privacy, respect or dignity. Residents’ interviews indicated that staff were treating all residents with dignity and respect and did not express any issues. Resident’s interviews indicated their satisfaction with staff’s professionalism and did not express any issue with staff were being rough with their care or speaking to them in any inappropriate manner. Staff interviews reflected that staff were treating all residents with respect and dignity and were not speaking inappropriately to any residents. Based on facility tour, interviews and observation, the department found this allegation is to be UNFOUNDED. Allegation- Staff tested positive for covid. .-Unfounded The Department conducted record review, interviewed four (4) residents and four (4) staff members to investigate this allegation. Staff interviews reflected that facility was following infection control guidelines regarding COVID-19 illness for staff and residents and there were no issues to report. Residents interviews indicated that facility was complaint with infection control guidelines and they were satisfied with staff’s care at the facility. Staff and residents were not aware if facility allowed any COVID positive staff to work the facility. Based on these findings, this allegation is considered UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Dec 10, 2024 · control 59-AS-20241029121652

Allegation investigated: Staff are not following resident's medical care plan.

On 11/26/24, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegation listed above. LPA met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. The department conducted staff and residents' interviews, reviewed records to investigate the allegation. During five (5) residents’ interviews, four (4) out five (5) residents stated that staff respond in a timely manner, however sometimes there is a delay in response due to staff assisting other resident’s needs. Interviews and record review indicated that resident’s ADL’s which includes residents showering, incontinence and care needs are met as required and documented accordingly. Residents’ interviews indicated that staff were providing care in a professional manner and did not express any concerns. During interviews with facility staff and residents, it was revealed that facility was giving residents medications timely and there were no concerns. Resident’s interviews indicated that staff were aware about their care needs per their needs and service plans and were following them without any concerns. Three (3) staff interviews reflected that staff were aware about resident’s medical care needs and were following their care plan as drafted in their files and there were no issues. Based on gathered information, this allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.Exit interview was conducted and copy of the report has been provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 26, 2024 · control 59-AS-20241018110855

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 11/26/24 to do case management visit for Resident, R1. LPA met with Assistant Director, Tosha Devi and explained the purpose of the visit. The facility submitted a completed Unusual Incident/Injury Report (LIC624) on 11/04/24 regarding resident (R1) leaving the facility (AWOL) unattended on 11/02/24 at approximately 09:00 AM. Per incident report, it was discovered that R1 exited from main lobby door and facility was notified by one of their neighbors that R1 was located at their property around 09:30AM. R1 was brought back to the facility by staff uninjured. Facility notified R1’s doctor and family regarding this AWOL incident. R1's physician's report (LIC602) dated 01/19/24 indicates that resident has diagnosis of dementia and cannot leave the facility unassisted. Although no injuries resulted from R2’s AWOL, R1 was unable to leave the facility unassisted. Facility staff did not provide care and supervision to R1 resulting in R1 leaving the facility unassisted. Immediate Civil penalties of $250.00 were assessed on LIC421FC today due to repeat violations of the same regulations within 12 months for Regulation 87468.2(a)(4). Deficiencies issued are noted on the LIC809D per Title 22 Regulations. Failure to correct the deficiencies may also result in civil penalties. Exit interview conducted. Appeal rights were provided and copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 26, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 27, 2024

87468.2-Additional Personal Rights of Residents in Privately Operated Facilities (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; Based on gathered information, it has been concluded that facility did not provide proper care of supervision to resident, R1 on 11/02/24 resulting R1 leaving the facility unattended which pose a immediate risk to health and safety of residents in care.the state’s words, verbatim · CDSS document, Nov 26, 2024

Plan of correction: Licensee /Administrator shall submit a letter of understanding of this regulation and will do all staff training regarding this incident. Furthermore, facility shall submit written plan to provide proper care and supervision for residents with elopement risk. All POC documents are due by POC date-11/27/24. In addition, facility shall conduct monthly training with staff till January 2025 and send copy of those documents to Department.

Allegation investigated: Facility staff did not seek medical attention for resident in a timely manner. Staff did not notify resident’s representative of incidents.

On 07/18/24, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. . The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unfounded **Report continued from 9099... Allegation- Facility staff did not seek medical attention for resident in a timely manner.-Unfounded The Department conducted interviews with Administrator, three (3) staff, and reviewed records to investigate this allegation. Administrator and three staff interviews indicated that facility noticed change in condition for resident, R1 around 01/23/24 and send them out to local hospital to sought medical care. Record review indicated that facility kept proper documentation regarding R1s health status and reported to R1s responsible party, physician and CCLD per requirements. Based on this information, this allegation is Unfounded. Allegation- Staff did not notify resident’s representative of incidents.-Unfounded The Department conducted interviews with Administrator, three (3) staff, and reviewed records to investigate this allegation. Administrator and three staff interviews indicated that facility was notifying R1s responsible party for any change of condition and to update any health changes related to R1 without any issues. Record review reflected that facility kept proper call logs, email communications and other modes of communications by which facility was notifying R1s responsible party to notify R1s health related incidents per regulations and there were no concerns. Based on this information, this allegation is Unfounded. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Jul 18, 2024 · control 59-AS-20240228115229

Allegation investigated: Staff does not provide adequate supervision to residents in care.

On 07/18/24, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegation listed above. LPA met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Substantiated ***Report continued from 9099...... Allegation- Staff does not provide adequate supervision to residents in care. -Substantiated The Department conducted record review, interviewed staff and residents to investigate this allegation. Record review indicated that resident, R1, left the facility and AWOL on 06/23/24 around 8.30am and was found by law enforcement 0.5 miles away from facility in their wheelchair. R1 was transferred to nearby hospital for 51/50 and facility was notified by law enforcement around 10 am that they found R1 on street unattended and unsupervised. Staff interviews indicated that staff saw R1 sitting outside the facility around 8.30am on 06/23/24 but did not provide adequate care and supervision resulting R1 leaving the facility unattended. Record review indicated that R1's physician's report, dated 10/27/23, indicates that resident has diagnosis of stroke and cannot leave the facility unassisted. Although no injuries resulted from R1’s AWOL, R1 was unable to leave the facility unassisted. Facility staff did not provide care and supervision to R1 resulting in R1 leaving the facility unassisted therefore this allegation was found to be Substantiated. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted, appeal rights and copy of report was provided. **Report continued from 9099-A...... Allegation- Staff does not have adequate staffing to meet resident's needs. - Unsubstantiated Throughout the course of the investigation, the Department reviewed facility notes, resident files, and conducted relevant party interviews, obtained relevant documentation and evidence. Record review indicated that facility has adequate staffing to meet resident’s needs. Through staff interviews, the Department was able to verify that there were enough staff to meet the residents' needs and there were no concerns. Residents interview indicated that their care needs were met by staff and there were no issues in this area. Record review by Department indicated that facility has adequate staffing to take care of resident’s needs and there were no concerns. Based on gathered information, this allegation was found to be Unsubstantiated. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and copy of the report has been provided.the state’s words, verbatim · CDSS document, Jul 18, 2024 · control 59-AS-20240624153835

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jul 19, 2024

87468.2-Additional Personal Rights of Residents in Privately Operated Facilities (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; Based on gathered information, it has been concluded that facility did not provide proper care of supervision to resident, R1 on 06/23/24 resulting R1 leaving the facility unattended which pose a immediate risk to health and safety of residents in care.the state’s words, verbatim · CDSS document, Jul 18, 2024

Plan of correction: Licensee /Administrator shall submit a letter of understanding of this regulation and will do all staff training regarding this incident. Furthermore, facility shall submit written plan to provide proper care and supervision for residents with elopement risk. All POC documents are due by POC date-07/19/24.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 07/18/24 to do case management visit. LPA met with Assistant Director, Tosha Devi and explained the purpose of the visit. Incident for resident, R1- During complaint investigation (59-AS-20240228115229), LPA learned that resident, R1 was sent to hospital /ER due to Fall Incidents on 07/20/23 and on 10/12/23. Furthermore, R1 has been placed in Skilled Rehab Facility with diagnosis of trauma to left hip around 06/26/23 till 07/19/23. All these incidents for R1 should have been reported to Department as required per Title 22 Regulation, 87211 within 7 days but facility did not comply with this reporting requirement. Incident for resident, R2- During complaint investigation (59-AS-20240624153835), LPA learned that resident, R2 had AWOL incident on 06/23/24 around 9am and R2 was found in their wheelchair 0.5 mile away from the facility unattended and unsupervised by law enforcement who notified the facility around 10am regarding R2’s AWOL incident. Although, R2 was found uninjured, R2 was sent to local hospital under 51/50 hold. This incident for R2 should have been reported to Department as required per Title 22 Regulation, 87211 within 24 hours but facility did not comply with this reporting requirement. Based on the records reviewed and information gathered, it has been determined that the facility did not report these incidents for residents R1 and R2 to Department as required. Based on this information, citation has been issued per Title 22 Regulations as indicated on 809-D. Exit interview conducted. Appeal Rights and copy of this report has been provided.the state’s words, verbatim · CDSS document, Jul 18, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a) · Plan of correction due date: Aug 1, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department [...]: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident [...] (D) Any incident which threatens the welfare, safety or health of any resident [...]..This requirement is not met as evidenced by: Based on interviews and records review, the facility did not comply with the section cited above by not reporting incidents which threatened the welfare of residents, R1 and R2. This poses a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 18, 2024

Plan of correction: Licensee /Administrator to review section 87211- Reporting Requirements and send a letter of understanding to Community Care Licensing and will conduct staff training. Additionally, licensee to ensure incident reports are filled out and faxed to CCL with confirmation. All POC documents are due by 08/01/24.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA) Talwinder Bains arrived at the facility unannounced on 05/29/24 to do case management visit . LPA met with Assistant Director,Tosha Devi and explained the purpose of the visit. Department followed up on Incident Report sent by facility on 05/24/24 for date -05/24/24 regarding resident, R1 where R1 alleged that they fell in the transportation vehicle ( a non -medical ambulance) during a medical appointment on 05/24/24 when they returned around 1pm and refused to come out from vehicle . Facility Directors and staff members assessed R1 and suggested ER visit for possible injuries. R1 stated that they had some discomfort and pain on their left hip and right elbow. Facility Director contacted and spoke to the transportation company owner, they stated all transportation vehicles have a camera, and they have reviewed the footage and no fall occurred during this visit. Facility directors and staff contacted Alpha one ambulance to have the resident, R1 assessed for injuries, but R1 refused and signed AMA to be seen in the ER department. Staff checked R1 for any possible injuries, but none were observed. Facility notified R1s physician, responsible party, and long-term care ombudsman (LTCO) regarding this incident. Department conducted interview with resident, R1 regarding this incident during today’s visit. LPA requested documents related to this incident and facility will submit all documents by 05/31/24 by 5pm. At this time, this case in under review and department will do follow up as needed. No citations were issued per Title 22 Regulations. Exit interview conducted and copy of the report left at facility.the state’s words, verbatim · CDSS document, May 29, 2024

Allegation investigated: Staff do not administer resident's medications as prescribed. Staff do not assist resident with ADLs. Staff do not assist resident with ambulating.

On 03/27/24, Licensing Program Analysts (LPAs) Talwinder Bains and Cheyenne Ratajczak arrived unannounced to deliver complaint findings for allegations listed above. LPAs met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. . The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated ***Report continued from 9099....... Allegation- Staff do not administer resident's medications as prescribed. Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff (4) and residents (4) to investigate the complaint allegation. During these interviews, it was revealed that the facility dispensed 4 residents' medications on time and administered them as scheduled. 3 out of 4 residents’ interviews indicated that staff were assisting them with their medications without any issues. Furthermore, a review of the records for resident, R1 the months of January and February 2024, indicated that the facility maintained a proper logs for all medications in the centrally stored medication log, following physician's orders, and documenting them in the Medication Administration Record (MAR) without any errors. Based on these findings, this allegation is considered UNSUBSTANTIATED. Allegation- Staff do not assist resident with ADLs. The department conducted staff and residents' interviews, reviewed records to investigate the allegation. During residents’ (4) interviews, 3 out of 4 residents stated that staff respond to residents needs in a timely manner, however sometimes there is a delay in response due to staff assisting other residents’ needs. Interviews and record reviews for 4 residents indicated that resident’s ADL’s which includes residents showering, incontinence and care needs are met as required and documented accordingly. 3 out of 4 residents’ interviews indicated that staff were providing care in a professional manner and did not express any concerns. Furthermore, LPA observed facility found to be clean and odor free during department visits and residents interviews indicated no issues with care, therefore this allegation is found to be UNSUBSTANTIATED. Allegation- Staff do not assist resident with ambulating. The department conducted staff (4) and residents' (4) interviews, reviewed records to investigate the allegation. Record review indicated that facility was assisting residents with their activities of daily living per residents needs and service planning including assisting with ambulation and documenting accordingly. 3 out of 4 residents interviewed reflected that staff were assisting with their ADL care needs and did not express any concerns. Staff interviews (4) indicated that staff were helping residents with their care needs and there were no issues. Based on this information,this allegation is found to be UNSUBSTANTIATED. A copy of this report has been provided to facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 27, 2024 · control 59-AS-20240209143516

Allegation investigated: Staff are not following physician's instructions. Staff did not ensure resident's oxygen tank is accessible to resident. Staff did not provide a beverage to resident as requested. Staff did not ensure resident was given a meal.

On 03/27/24, Licensing Program Analysts (LPAs) Talwinder Bains and Cheyenne Ratajczak arrived unannounced to deliver complaint findings for allegations listed above. LPAs met with Assistant Director, Tosha Devi during today's visit and explained the purpose of the visit. . The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated ***Report continued from 9099....... Allegation- Staff are not following physician's instructions. Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. During these interviews, it was revealed that the facility follows physicians’ orders to take care of residents’ needs and document accordingly. 3 out of 4 Resident’s interviews indicated that staff were assisting them with their medications and other care needs without any issues. Furthermore, a review of the records for the months of January and February 2024, indicated that the facility maintained a proper logs for all medications administration and other care notes for residents per their physician’s orders without any errors. Based on these findings, this allegation is considered UNSUBSTANTIATED. Allegation- Staff did not ensure resident's oxygen tank is accessible to resident. Based on the information provided, the investigation conducted by the department involved facility observations, record review, and interviews with staff and residents to investigate the complaint allegation. During department visits, it has been observed that residents have access to their oxygen tanks and other assistive equipment per their physician’s orders and staff were assisting residents without any issues. 3 out of 4 resident’s interviews indicated that staff were assisting them with their care needs on daily basis and there were no problems. Based on this information, this allegation is found to be UNSUBSTANTIATED. Allegation- Staff did not provide a beverage to resident as requested. Staff did not ensure resident was given a meal. An investigation has been conducted regarding the above allegation. LPA observed the facility’s food supply as well as interviewed residents regarding the food service. Based on observation and interviews, the facility keeps the required amount of food supply in the facility. Additionally, 3 out of 4 residents interviews indicated that residents are satisfied with the food service at the facility and feel that they have enough food to eat at every meal. During resident’s interviews, it has been found out that residents can request their meal tray in their rooms if they do not want to eat in dining room. 3 out of 4 residents stated that there were no issues with tray delivery service to their rooms and they did not miss any meals. 4 out of 4 staff interviewed indicated that they were not aware of any issues with residents missing their meals. Based on the information, this allegation is found to be UNSUBSTANTIATED. A copy of this report has been provided to facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Mar 27, 2024 · control 59-AS-20240213104120

Type of visit: Required - 1 Year

On 03/27/24 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Talwinder Bains arrived at the facility unannounced to conduct a required 1 year inspection utilizing the care tool. LPAs met with Administrator Darrell Price and explained the purpose of the visit. LPAs and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to residents bedrooms, kitchen, dining room, common areas, storage area, and laundry room. LPAs observed the second door of the laundry room to be unlocked and accessible to residents in care. LPAs observed required furniture, and lighting throughout the residents' bedrooms and facility. LPAs observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Hot water temperature was measured at 111 degrees Fahrenheit in a residents bathroom, which is within the required range of 105 to 120 degrees. The temperature in the facility was 75 degrees. First aid kit was completed. LPAs observed fire detectors and carbon monoxide detectors to be operable. LPAs observed the fire extinguisher, located in the dining room, which was last inspected on 12/08/2023. LPAs reviewed fire and disaster drill logs, which are conducted quarterly. LPAs observed required Licensing posters posted throughout the facility. LPAs conducted a file review of five (5) personnel and five (5) residents records. Both personnel and resident records are incomplete. Medications are centrally stored, locked, and appear to be given per doctor order. LPAs compared medications to those being given for three (3) residents and found no discrepancies. Facility is correctly using the Medication Administration Records (MAR). Deficiencies are being cited during today's inspection per Title 22 regulations. Exit interview conducted and copy of the report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Mar 27, 2024