Anaheim Crown Plaza

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a three story building and has a capacity of 200. The census was 136 during the annual inspection and residents were observed in their rooms, common areas, and exterior portions of the facility. Bedrooms: All resident bedrooms are equipped with the required furnishings and an operational pull cord. Bathroom(s): Resident bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in the range of 109 – 118.5 degrees F. Kitchen: The kitchen area is off limits to residents. Kitchen appliances are operational. Refrigerator/freezer log are available for review. Sharps are hanging on a wall. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements were observed. The facility receives two food deliveries a week. Resident & Staff Files: Resident and staff files are stored in the Administrator’s office. File Review: 14 resident files were reviewed during the inspection, and 12 staff files were reviewed during the visit. Medications/First-Aid Kit: Resident medications are stored in a locked medication room in the dining room area. Two first Aid kits with all the required elements was observed in the medication room. Medication Review: 13 resident medications were reviewed during the inspection. No discrepancies were noted. Medications are being administered as prescribed. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in the resident bathroom areas. Additional Linens were observed in the locked laundry room. There is an open laundry room available to resident who want to do their own laundry. Common Area: There’s a TV/activity room on the first and third floors. There’s an open courtyard area in the middle of the community. Two smoking sections were observed; one smoking area was observed on the patio area outside the activity area on the third floor, and a second smoking area was observed right outside the dining room. Exterior: In the middle of the community there’s a courtyard area equipped with shaded seating. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Johnson Controls inspected Fire Alarm System June 22, 2026. Fire Extinguisher: Fire extinguishers was observed mounted on the walls on all three levels of the facility. An emergency evacuation drill: Evacuation drill was conducted July 21, 2026. Drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the postings board on the first floor. Additional Comments: An emergency food and water supply was observed in one of the storage rooms in the kitchen. Chemicals are stored in a separate storage room in the kitchen. A list of residents on a special diet is available for review in the kitchen and on the server line. Hydration stations were observed on all three floors. A phone for residents to use was observed on all three floors. A beauty shop is open and available to all the residents every Wednesday. Facility contact information was reviewed during the visit. Seven staff members were interviewed during the inspection. No deficiencies will be cited as a result of todays visit. An exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 1, 2026

Allegation investigated: Staff violated resident's personal rights.

On August 22, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to continue the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Gerardo Jerry Rodriguez was notified via telephone and later arrived to assist with the inspection. During the course of the investigation, the Department conducted resident interviews, staff interviews, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, staff violated resident's personal rights, the following has been concluded: During the investigation, the Department conducted ten resident interviews. Ten out of the ten residents interviewed denied the allegation. The residents interviewed reported that they have never been hit by staff or forced to take medication. The residents also reported that staff have not violated their personal rights in any other way. The Department conducted six staff interviews. Six out of the six staff interviewed also denied the allegation. CONTINUED ON LIC9099-C Unsubstantiated The staff reported that they have never observed any resident being hit and or forced to take medication. The staff interviewed also reported that resident's personal rights have not been violated in any other way. Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the one allegation above is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Gerardo Jerry Rodriguez and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, Aug 22, 2026 · control 22-AS-20240424092045

Allegation investigated: Lack of supervision and neglect resulted in resident being left on the floor for an extended period of time.

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Jerry Rodriguez and discussed the purpose of the visit. The investigation into the facility allegation of Lack of supervision and neglect resulted in resident being left on the floor for an extended period of time revealed the following: It was alleged that Resident #1 (R1) sustained a fall and was left on the floor for 12 hours. LPA reviewed an Admission Agreement for R1 stating that they were admitted to the facility on June 9, 2021. LPA reviewed a medical assessment dated August 12, 2025, stating that R1 does not have any cognitive conditions, does not have motor impairment and is marked as ambulatory. This assessment was signed by a medical professional. LPA reviewed a needs and services plan for R1 dated July 9, 2025, stating that R1 is ambulatory with a walker for balance and safety. Continue on 9099C Unsubstantiated The needs and services plan also states that R1 functions independently with all activities of daily living. This plan was signed by facility staff and R1. LPA reviewed an incident report dated December 1, 2025, stating that on November 27, 2025, R1 had an unwitnessed fall and was found by staff on the floor. Staff called 911 and R1 was taken to the hospital. LPA reviewed daily assignment lists for staff to assist with residents activities of daily living with high fall risk indications. R1 was not observed on the lists dated November 23, 2025, through November 27, 2025, as a resident needing assistance or a fall risk. LPA reviewed discharge documentation for R1 dated January 23, 2026, stating that R1 has a history of a fall and was stable and ready to discharge back to the facility. The documentation did not indicate how long R1 was left on the floor. LPA interviewed eleven residents including R1. Eight of eleven residents informed LPA that they have no problem with the staff assisting them. Eight of eleven residents informed LPA that the staff will come when they need assistance in a timely manner, including R1. Three of eleven residents did not confirm or deny the allegation. Two of eleven residents informed LPA that staff will come around and check on residents throughout the day and night even when they have not called for assistance. R1 denied the allegation and stated that they did not think to call for assistance but is confident that if they did, staff would have come. LPA interviewed six staff. One of six staff informed LPA they found R1 on the floor and called for assistance immediately. Six of six staff did not know how long R1 had been on the floor. Two of six staff informed LPA that R1 is independent and able to ambulate on their own. LPA reviewed an in service staff training that was conducted on April 22, 2026, for four of six staff on the topic of fall precautions. One of six staff does not provide care and one of six staff conducted the in service training. Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 30, 2026 · control 22-AS-20251201144600

Allegation investigated: Staff stole residents medication(s). Staff are mismanaging resident's medication(s). Staff are not administering resident's medications according to their physician. Staff are falsifying resident(s) medical documentation.

On June 16, 2026 at 11:20 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted a Microsoft Teams meeting with the facility designated administrator for the purpose of delivering complaint findings for the above allegations. During this investigation, LPA Martinez reviewed facility records and conducted interviews. When interviewed, resident 1 (R1) reported that they did not know if their medication was stolen by staff. R1 reported that they were informed that their medication was running low by a staff member. However, the medication was refilled prior to running out. R1 reported their medicaiton was admistered to them as needed. R1 reported they currently have no issues or concerns with their medication. In addition, R1's August and September 2022 medication administration records did not have any discrepencies. Continued... Unsubstantiated Due to the above noted information, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 22-AS-20220923085113

Allegation investigated: Facility staff are not preventing inappropriate interactions between residents.

On May 12, 2026 at 1:00 PM, Licensing Program Analyst (LPA) Avelina Martinez conducted a MicrosoTeams meeting with Facility Designated Administrators for the purpose of delivering complaint findings for the allegation above. Throughout the course of this investigation, LPA Martinez conducted interviews. The Orange County Regional Office obtained facility records. The investigation revealed there are no concerns relating to facility staff are not preventing inappropriate interactions between residents in care. When interviewed, resident 1 (R1) reported that they have not recently had any inappropriate interactions with other residents in care. R1 reported they have no concerns regarding staff are not preventing inappropriate interactions between residents in care. Due to the above noted information, 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, and therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 12, 2026 · control 22-AS-20241112115343

Allegation investigated: Staff did not give resident personal belonging. Staff did not provide resident with comfortable accommodation.

On May 11, 2026, 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced initial complaint visit at the facility for the above allegations. LPA Kim met with Administrator Gerardo Rodriguez and explained the purpose of the visit. LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed three resident’s record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, Incident reports, and other pertinent records. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Staff did not give resident personal belonging It is alleged a resident #1 (R1) left their walker, wheelchair and luggage at the facility and the facility stole R1’s walker, wheelchair, and luggage. It is alleged the R1 has tried communicating with the facility regarding the whereabouts of their belongings and the facility will not answer or return their phone calls. Based on record review, R1’s admission agreement stated they were admitted to the facility on January 23, 2025. R1’s LIC621 was left blank and does not list a wheelchair, walker, or luggage. On November 21, 2025, R1 wrote a 30-day notice that they were leaving the facility on December 31, 2025. The facility move out form was filled out and signed by R1 stating that R1 has returned the keys, removed all of their belongings and cleaned the room, and all remaining belongings can be donated/disposed of. In a handwritten letter by R1 dated December 29, 2025, R1 stated R2 could have their suitcase, recliner chair, small table with chair, 43-inch TV, and miscellaneous stuff. There is no mention of R1’s wheelchair or walker to be in care or given to R2. Based on interviews, Staff #1 (S1) stated that prior to R1 leaving the facility, that R1 signed that all belongings were accounted for. S1 stated that the R1 did not ask the facility to watch over their stuff or come into agreement to hold onto R1’s belongings. S1 has not been contacted by R1 about the situation with their belongings. S2 stated they were contacted and explained to R1 that they left the facility on their wheelchair. S1 and S2 stated the resident left the facility on their wheelchair. Based on observation, LPA did not observe R1’s wheelchair, walker, or luggage in the facility. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Allegation: Staff did not provide resident with comfortable accommodation It is alleged R1’s mattress was uncomfortable and that it made their back hurt. R1 complained to staff about the mattress, however, staff did not address the matter. Based on interviews conducted, two out of three residents and two out of two staff denied the allegation. One out of three residents confirmed the allegation. Two out of three residents stated they have not heard issues about a mattress causing back pain for R1. R2 stated they recall R1 having back pain but does not recall R1 stating a faulty mattress caused it. Continued on LIC9099C S1 stated that if any resident requested a new mattress or reported a problem with the mattress, the facility would replace it and provide a new mattress. S1 stated that the Licensee told them that they replaced R1's mattress, but could not provide the record of when it was replace. Based on record review, there is no record of R1 communicating the faulty mattress prior to written correspondence on November 21, 2025, and December 3, 2025. Based on observation, LPA observed R1’s mattress was in good condition. There was no issues showing that the mattress was faulty or in poor condition. Based on information gathered, there is not sufficient evidence to corroborate the above allegation. Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegations Staff did not give resident personal belonging and Staff did not provide resident with comfortable accommodation.. Although the allegations 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 allegations are UNSUBSTANTIATED. Exit interview was conducted a copy of the report was provided to Administrator Gerardo Rodriguez.the state’s words, verbatim · CDSS document, May 11, 2026 · control 22-AS-20260501094216

Allegation investigated: Staff do not ensure that residents receive medical services as necessary. Staff falsify documents regarding residents. Staff do not ensure that residents are accorded privacy.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged staff do not ensure that residents receive medical services as necessary, staff falsify documents regarding residents, and staff do not ensure that residents are accorded privacy. LPA conducted interviews with staff and residents. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation staff do not ensure that residents receive medical services as necessary, it was reported staff refuses to transport residents a few miles to physician appointments. Interviews with three out of nine residents stated they have taken the facility van for medical appointments or outings. Four out of the remaining six residents stated the facility has assisted in arranging transportation for medical appointments. Unfounded Interviews with four out of four staff stated residents can select the physician of their choice and are not obligated to choose a specific one. Two out of the four staff added the facility does not recommend any particular physician to residents. Based on resident and staff interviews, the allegation is therefore deemed unsubstantiated meaning 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. An exit interview was conducted and a copy of the report was left with the facility representative. One out of remaining two residents stated they are aware of the transportation services but has not asked to use it. The remaining resident stated they drive themselves to appointments. Interviews with four out of four staff stated the facility staff will assist in arranging transportation for residents. Record review revealed six sign up sheets from March 6, 2026 through April 28, 2026 for dinner and shopping outings listing multiple residents. In addition, LPA reviewed five daily appointment calendars for medical appointments for several residents dated April 23, 2026 through April 29, 2026. The facility admission agreement, plan of operation, and resident handbook state the facility will provide transportation for medical and non-medical appointments up to a five mile radius. Regarding the allegation staff falsify documents regarding residents, it was reported the in house home health staff documents resident therapies that do not take place. Interviews with three out four staff stated the home health nurse that is at the facility often is not an employee. Two out of the three staff added the home health nurse works for a separate entity not related to the facility or licensee. The remaining staff did not add anything relevant to the allegation. Interview with witness 1 (W1) stated they are not an employee of the facility and is employed by Healthy Life Home Care. W1 added although they spend a significant amount of time at the facility due to the number of residents they attend to, they also support residents at another facility through the home health agency. LPA reviewed the LIC500 facility staff roster form and did not see W1 listed as a staff member. LPA conducted a business search on the California Secretary of State website and did not find any relation between Anaheim Crown Plaza and Healthy Life Home Care. Regarding the allegation staff do not ensure that residents are accorded privacy, it was reported staff members are present during physician consults with residents. Nine out of nine residents stated they have never had facility staff present when meeting with their physician. Three out of four staff stated physicians may be escorted to resident rooms to assist in locating residents or opening resident doors. Those three staff stated they leave the room before the physician begins the consultation. The remaining staff stated staff is not present in the rooms during a physician consultation. Based on interviews and record review, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report was left with the facility.the state’s words, verbatim · CDSS document, Apr 29, 2026 · control 22-AS-20260421135811

Allegation investigated: Staff withheld resident P&I monies

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gerardo Rodriguez and discussed the purpose of the visit. The investigation into the allegation of Staff withheld resident P&I monies revealed the following: LPA observed an admission agreement for Resident #1(R1) that was signed by R1 on April 14, 2023. R1 moved out from the facility on December 3, 2025. LPA observed an identification and emergency information form for R1 stating that ROG services and OASIS is the responsible party for R1s financial affairs. LPA observed a letter from OASIS to ROG services stating how they will split R1s financials. LPA observed an email correspondence from R1s payee representative from ROG services with facility staff that confirms the identification of R1s payee. LPA observed a pre-placement appraisal for R1 dated April 11, 2023, stating that R1 is independent with all activities of daily living. LPA also observed that help in managing own cash resources was marked as yes and noted that R1 has a payee. Continue on LIC9099C Unfounded This document was signed by facility staff and R1. LPA observed a physicians report for R1 dated February 20, 2023, stating that R1 can manage their own cash resources. Upon interviews it was revealed by R1 that the facility never handled their money. It was revealed by R1 that they had a payee and the payee handled their cash resources. R1 revealed to LPA that the facility never owed them money, but the payee did. Upon interviews with two of two staff it was revealed that the facility does not manage resident cash resources, including R1. Two of two staff informed LPA that R1 had a payee that handled their cash resources. One of two staff informed LPA that the payee would pay the rent and then give R1 their left over allowance. Based on the evidence gathered and interviews conducted, the Department finds that the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 15, 2026 · control 22-AS-20260109133915

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Hanna Gough made an unannounced health and safety case management visit due to an Incident Report received by the regional office on October 28, 2025. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gerardo Rodriguez and discussed the purpose of the visit. LPA toured and inspected the facility, conducted health and safety checks on residents in care and observed no health and safety concerns. LPA reviewed and requested copies of pertinent documents. No health and safety violations were noted during today’s visit. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 31, 2025

Allegation investigated: Staff does not ensure facility is free of bed bugs. Staff did not seek timely medical attention for resident.

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility for the purpose of investigating the above mentioned allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gerardo Rodriguez and discussed the purpose of the visit. The investigation into the allegations of Staff does not ensure facility is free of bed bugs and Staff did not seek timely medical attention for resident revealed the following: During the course of the investigation LPA observed Resident 1 (R1) was admitted to the facility on June 10, 2024. LPA observed a physicians report for R1 dated May 13th, 2025, stating that R1 has bladder impairment, motor impairment, is not able to dress themselves and is non ambulatory due to their physical condition. LPA observed a needs and services plan that was signed and dated August 29th, 2025 by facility staff and R1s responsible party stating that R1 needs assistance with ADLs including incontinence care, grooming, and dressing in which facility staff are responsible for implementation. Continue on 9099C Substantiated . LPA observed an incident report dated October 6, 2025, stating that R1 was sent to the hospital on October 4, 2025, due to weakness and feeling sleepy. LPA observed a physicians order for a urinary analysis sample to be done for R1 on September 30, 2025. Interviews with staff 2 of 4 staff revealed that R1 had bed bugs in their room that were treated by facility staff. 2 of 4 staff revealed that they did not call a pest control company, but took care of the problem internally. 2 of 4 staff revealed that to their knowledge the facility is free of bedbugs at the time of the investigation. 1 of 4 staff informed LPA that another room previously had bedbugs about a month ago that has since been eradicated. LPA toured the facility with staff and observed R1s room had no bedbugs on the bed or wheelchair. LPA observed an insect with Staff 1 (S1) that was found in R1s closet. LPA observed R1s room to be cleaned and given a new mattress that is in a mattress cover. Interviews with 4 of 4 staff revealed that R1 was in the hospital at the time of the investigation. 3 of 4 staff informed LPA that R1 was sent to the hospital on October 4, 2025, due to an UTI suspicion. 3 of 4 staff informed LPA that on September 30, 2025, it was brought to staffs attention that R1 had a foul smell in their urine. Facility staff called R1s responsible party and physician. 3 of 4 staff informed LPA that R1 was delayed getting a sample due to R1 refusing to provide a urine sample and then once obtained the sample expired before it could be sent to the lab for testing. 3 of 4 staff informed LPA that R1s responsible party requested for R1 to go to the hospital due to it being days since suspicion and nothing had been accomplished. Based on observation, interviews, record review and information gathered during the investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 are being cited on the attached LIC9099D. An exit interview was conducted with AD and a copy of this report, LIC9099D and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Oct 14, 2025 · control 22-AS-20251006160722

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Oct 15, 2025

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidence by: LPA observed a bug in R1s closet and 2 of 4 staff informed LPA that R1s room had bedbugs that they had to treat. This poses an immediate health safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 14, 2025

Plan of correction: Administrator stated that they will do an in service for staff regarding bedbugs and schedule a pest control company to come for inspection and treatment if necessary and send proof of confirmation date to LPA by POC due date. AD will send LPA reports upon completion.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: Oct 15, 2025

87465(a)(2) Incidental Medical and Dental Care The licensee shall provide assistance in meeting necessary medical... needs.... This requirement was not met as evidence by: 3 of 4 staff informed LPA that R1 was suspected with a UTI on September 30, 2025 and was taken to the hospital only after R1s responsible party requested it on October 4, 2025 after attempting to send a urinary sample to a lab for testing. This poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 14, 2025

Plan of correction: Administrator stated they will do an in service with staff regarding symptoms of a UTI, when to call 9-11 and what to do if a resident refuses to be sent out or give samples for lab testing and send proof to LPA by POC due date.

Allegation investigated: Resident sustained multiple unexplained fractures while in care. Resident sustained an unexplained laceration while in care.

Licensing Program Analyst (LPA) Celine Rodrguez conducted an unannounced visit to the facility to deliver the amended findings report. LPA Rodriguez explained the purpose of today's visit and was greeted by Administrator (AD) Gerardo "Jerry" Rodriguez. It was alleged that resident sustained multiple unexplained fractures while in care & resident sustained an unexplained laceration while in care. The investigation determined as follows: Per documentation review, of resident 1 (R1) physician report dated for August 31, 2017, R1 had mild cognitive impairment, needed continued wound care, and secondary diagnoses was generalized weakness. It was also indicated that R1 was ambulatory, unable to independently transfer to and from bed, and was placed on fall precautions, despite R1 not having a history of falls. Three out of three staff interviews did not corroborate with the allegation by denying that R1 sustained a fracture. Substantiated Per incident report Community Care Licensing received on November 13, 2023, incident dated for November 3, 2023, facility staff observed R1 on the floor “around 5:00 AM” and reported that R1 denied of pain, however 9-1-1 was contacted due to R1 being observed with a bump on their head. R1 was transferred to UCI Medical hospital the same day. Per hospital discharge summary dated for November 6, 2023, R1 had “dementia” and was “nonverbal at baseline in a fetal position found down…next to bed with head bleeding for an unknown amount of time with laceration…and not following commands”. R1 was admitted to UCI hospital on November 3, 2023, and discharged on November 6, 2023. R1’s principal diagnosis was “mechanical GLF c/b C1-C2 fracture, right femur”. According to the hospital physician, R1 was not a surgical candidate due to R1 having “poor functional status”. Per UCI discharge summary, R1 sustained a hangman’s fracture, multiple compression fractures, and intertrochanteric femur fracture. R1 was placed on “home with home hospice” upon discharge from the hospital and was receiving continued wound care from November 3, 2023 to November 30, 2023. In December 2023, R1 passed away in the middle of the night. Based on the information gathered during the investigation and review of documents obtained the preponderance of evidence standard has been met, therefore the allegations are determined to be SUBSTANTIATED. The following is being cited and the Immediate Civil Penalty has been assessed and issued per California Code of Regulations, Title 22 Division 6 Chapter 8, per H&S Code Section 1569.49(f). An exit interview was conducted with AD Rodriguez. A copy of this report was explained, and appeal rights were provided during the visit.the state’s words, verbatim · CDSS document, Oct 13, 2025 · control 22-AS-20231107165640

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Oct 14, 2025

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs…the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidence by: Based on the reviewed documents obtained and interviews conducted during the investigation, the facility failed to ensure that the resident was regularly checked and did not adhere to the fall precautions as stated in R1’s physician report, therefore sustaining a fracture during fall. This poses an immediate health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: As a plan of correction (POC) facility will conduct an in-service training to all staff regarding the regulation cited. In addition, facility will also formulate a plan for residents who are a fall risk and will submit plan to assigned LPA on or by 10/14/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Oct 13, 2025

87464(f)(1) Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: Based on the reviewed documents obtained and interviews conducted during the investigation, the facility failed to ensure that R1 was provided care and supervision with the fall precautions that were implemented by R1’s physician. This resulted in R1 sustaining a laceration to the head during R1’s fall. This poses an immediate health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: As a plan of correction (POC) facility will conduct an in-service training to all staff regarding the regulation cited on or by 10/14/2025.

Allegation investigated: Staff engaged in sexual favors with resident Staff financially abused resident

Licensing Program Analyst (LPA) Joseph Alejandre conducted an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA was greeted and granted entry into the facility. LPA met with Administrator Jerry Rodriguez and explained the reason for the visit. During the course of the investigation, the department interviewed staff, residents, and witnesses as well as reviewed and obtained pertinent documentation such as Police records, Resident records and facility policy documents. It was alleged that staff engaged in sexual favors with resident. The investigation revealed the following. Staff 1 (S1) reported that in June 2024, Resident 1 (R1) informed them that they had paid Staff 2 (S2) to let them see and touch their breasts. Anaheim Police Department was contacted and visited the facility on July 1, 2024, and interviewed R1. Anaheim Police Department did not believe a crime had been committed and no report was written. According to Anaheim Police Department dispatch records the call was cleared with a visit and alleged victim (R1) reported no financial or sexual abuse and R1 reported they did not need assistance. Substantiated During the investigation the Department interviewed R1. R1 denied the allegation. R1 reported they have never engaged in any type of sexual activity with any staff member. S2 was interviewed and admitted to taking off their blouse and bra and allowing R1 to touch their breasts for $100.00. S2 reported that it only happened one time and they did not touch R1. S2 denied having any other sexual relations with any other residents. S2 could not recall the exact date and time of the incident. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore the allegation, staff engaged in sexual favors with resident, is substantiated. The investigation into the allegation, staff financially abused resident, revealed the following. It was alleged that staff was taking money from a resident to pay for their expenses. Staff 1 (S1) reported that Resident 1 (R1) informed them that they had given $600.00 to Staff 2 (S2). Staff 3 (S3) reported that S2 informed them they had received a gift card from R1, but they did not actually see it. Three residents interviewed reported no staff members have ever asked them for money. The Administrator reported that they have not received any reports of staff asking for money from residents. The Administrator reported that accepting gifts or asking for money from residents is against company policy. R1 reported that they gave S2 $40.00 for a parking ticket and told S2 to pay it back and they also gave S2 $50.00 for a manicure. S2 reported that R1 had given them $35.00 for a parking ticket and $50.00 for a manicure. S2 denied taking any other money from R1. S2 would not explain if the money was a gift or a loan. 4 out of 4 residents interviewed reported staff have never asked for money and they have never given money to staff. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore the allegation is substantiated. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to the facility representative along with appeal rights. The Administrator reported that all the staff interviewed denied taking anyone’s money or belongings. The Administrator reported that R4’s report was investigated but there was no evidence to prove anyone at the facility took their money. The Administrator reported that R5 never reported any type of theft, so it was not investigated. No witnesses were identified who had firsthand knowledge of the incidents where money was taken from residents. Based on the evidence gathered, LPA is unable to ascertain if the allegation, staff did not prevent residents from financial abuse by unknown perpetrator, occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be unsubstantiated, meaning there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Aug 22, 2025 · control 22-AS-20240701161612

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 25, 2025

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by, Staff 2 (S2) admitted to letting Resident 1 (R1) see and touch their breasts for money. This poses an immediate, health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 22, 2025

Plan of correction: Licensee will retrain all staff on resident rights (CCR 87468.1) and sign a statement of understanding for CCR 87468.1. Licensee to forward proof to LPA by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Aug 25, 2025

To be free from punishment, humiliation, abuse or other actions of a punitive nature… This requirement is not being met was evidenced by, Staff 2 (S2) admitted to accepting and keeping money from Resident 1 (R1) which poses an immediate personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 22, 2025

Plan of correction: Licensee will retrain all staff on resident rights (CCR 87468.1) and sign a statement of understanding for CCR 87468.1. Licensee to forward proof to LPA by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Jerry Rodriguez and discussed the purpose of the visit. The facility currently has 139 residents in care. The facility is a three story building with resident apartments, 2 activities rooms, dining room, laundry rooms, kitchen, staff offices, and medication room. The facility appears clean, safe, and sanitary. LPA observed residents engaging in an ice cream social in the activity room at the time of the inspection. LPA observed the required departmental postings throughout the facility. LPA observed the resident apartments to have the required components and furnishings. LPA observed the resident bathrooms to have soap, toilet paper, and non-slip mats. LPA tested the water to be between 115.1-122.5 degrees Fahrenheit in the resident bathrooms. LPA observed the dining room between food services while staff was cleaning and preparing for the next seating. LPA observed the kitchen to be clean and free of vermin. LPA observed the kitchen doors to lock making the knives inaccessible to residents in care when not in use. LPA observed the emergency food and water supply in a closet located in the kitchen. LPA observed a seven day nonperishable and two day perishable food supply on hand. LPA observed fire extinguishers in the kitchen and throughout the facility charged and with service dates of September 5, 2024. LPA observed the medication room to have a lock making it inaccessible to residents in care. LPA observed the laundry rooms for staff to be locked and the resident laundry room to be operational. LPA observed toxins and chemicals to be in a closet located in the kitchen and in a closet on the second floor. LPA observed the courtyard to be free of debris and obstructions and has a shaded seating area for resident use. Continue on LIC809-C LPA reviewed resident files and no discrepancies were observed. LPA reviewed resident medications and no discrepancies were observed. LPA reviewed staff files and 3 of 5 staff do not have the required annual training's. LPA observed the last fire drill was conducted on July 21, 2025. LPA reviewed an annual report by Cal Fire dated October 31, 2024, stating that the fire alarms were tested and passed inspection. All staff present are background cleared and associated to the facility. Based on today’s observations two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Jerry Rodriguez and a copy of this report along with LIC 809-D, LIC 859,LIC 811 and appeal rights were given at the time of inspection.the state’s words, verbatim · CDSS document, Aug 4, 2025

Allegation investigated: Resident was left in soiled clothing for an extended period of time Facility staff did not respond to the resident's call cord in a timely manner Facility staff do not offer snacks between meals Facility staff is not providing a good quality of food

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to investigation the above identified complaint allegation. LPA arrived at facility and was greeted at the door and granted entry receptionist. LPA spoke with Jerry Perez, Administrator, and explained the purpose of the visit. Findings are based upon this investigation which included resident/facility file review, and interviews conducted. It is alleged residents are left in soiled clothing for extended period of time. Interviews with staff stated that resident (R1) refuses to have staff change their clothes or diapers. Records review revealed that facility notes from March 2020 to September 2021 R1 refused to be changed clothing and/or diaper from staff. Continue on LIC9099 Unsubstantiated On some occasions it reflects refusal by R1 on multiple times throughout the day. It is alleged that facility staff did not respond to the resident’s call cord in a timely manner. Interview with staff stated that when a resident pulls the cord, there is a beep that goes off throughout building, staff carry radios. As a secondary to the notification on the radio. If there is a Staff who is closed to the main notification in the receptionist area they send a message through radio or through intercom and they will respond to call. Staff have never taken more than 5-10 minutes to respond. Interview with 9 of 9 residents stated that they have never had issues with the pull cord and staff do not take long to respond. They have waited anywhere from 2-15 minutes. It is alleged facility staff do not offer snacks between meals. Interview with staff stated that residents get snacks, facility has a vending machine and there is a box of snack in the front reception office for residents use. Interview with 9 of 9 residents stated that they get snacks every day, there is a vending machine on the 3rd floor and there is a snack box in the office for them to have as alternatives for all residents. It is alleged facility is not providing good quality food. LPA toured the facility kitchen, and it was observed that there was sufficient amount of quality and quantity of perishable and nonperishable food for residents. LPA observed food being prepped and staff preparing the food for the residents. In addition, LPA obtained a copy of the facility weekly menu for review with meal options. Interviews with 9 of 9 residents stated that they didn’t have an issue with the food served and the food was good and/or great. A resident stated food is very soft melts in your mouth and not in your hand, which is really good because many seniors cannot eat hard food. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Jul 24, 2025 · control 22-AS-20211006143415

Type of visit: POC

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of conduction a Plan of Correction inspection for a deficiency given on May 21, 2025 during a case management inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Jerry Rodriguez and explained the purpose of the visit. LPA toured the facility and checked that resident rooms were clear of medications. LPA observed an in service training that was held on May 22, 2025 for medication and administration storage and how they should be made inaccessible to residents in care if they are not allowed to store or manage their own medication per their physicians report. Based on today’s observations the Plan of Correction has been fulfilled by the assigned Plan of Correction due date of May 22, 2025, thus clearing the Type A deficiency CCR 80075(k)(1). An exit interview was conducted with Administrator Jerry Rodriguez and a copy of this report was provided at the time of the inspection.the state’s words, verbatim · CDSS document, May 23, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to conduct a case management follow up on an incident report submitted to the Orange County Regional Office on May 14, 2025. LPA was greeted and granted entry by staff. LPA met with Operations Manager Pinky Quintana and explained the purpose of the visit. The incident report submitted to the Orange County Regional Office stated that on May 12, 2025 Resident #1 (R1) was found lying in bed anxious with traces of vomit on their mouth with a white residue. R1 was found by staff, 911 was called and the resident was transported to the hospital. After file review it was revealed that R1s physician report stated that supervision is needed for medication administration and storage. It also states on R1s physician report that they do not have a substance abuse problem, is not depressed and does not have suicidal ideation. LPA interviewed Staff #1(S1) and it was revealed that the resident ingested Tylenol and that the medication should not have been in R1s possession. S1 informed LPA that facility staff notified R1s doctor and responsible party of the incident. LPA toured the facility and did a health and safety check on R1. LPA observed R1 relaxing in their bed. R1 did not want to talk about the incident with LPA but informed LPA that they are feeling okay and happy. LPA did not observe any medications in R1s room at the time of inspection. Based on today’s inspection a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Operations Manager Pinky Quintana and a copy of this report along with LIC 809-D, LIC 811 and appeal rights were given at the time of inspection.the state’s words, verbatim · CDSS document, May 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80075(k)(1) · Plan of correction due date: May 22, 2025

(1) Medication shall be kept in a safe and locked place that is not accessible... other than employees responsible for the supervision of... medication. This requirement is not met as evidenced by: LPA reviewed residents physician report stating they cannot manage or store their medication.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: LPA observed no medication in the Residents room. Licensee stated that they will check all residents rooms who are not able to manage their medication and do an in service training for staff and send proof to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Dwayne Mason Jr. and Nancy Guillen arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPAs were greeted at the facility by facility staff. LPAs met with Jerry Rodriguez, Administrator and explained the purpose of the inspection. The facility is three-story building with 107 resident rooms. The first floor houses 34 resident rooms as well as a family room, lobby, reception area, administrative office, break room, medication room, laundry rooms and kitchen. The second floor houses 37 resident rooms, maintenance office, beauty shop and break room. The third floor houses 36 resident rooms, break room, activity office, library and temporary office space. All resident rooms had the required elements, including bed, chair, closet space and ample lighting. Facility has toxins, chemicals and cleaning supplies locked in storage closets on the second floor. Restrooms are stocked with soap and paper towels. Hot water measured between 105 and 120 degrees F. LPA observed facility has emergency food and water supply as well as additional emergency supplies. LPAs reviewed six staff files and ten resident files. LPAs conducted interviews with ten residents and three staff. LPAs reviewed medication. Based on medication review. LPAs determined facility staff could not locate two PRN medications prescribed to one resident and one non-PRN medication prescribed to a different resident. LPAs also observed missing signatures on multiple Medication Administration Records. Three deficiencies are being issued. LPAs observed two PRN medications prescribed to one resident that had hand-written labels taped over the printed labels. Facility Staff stated they created the labels when the physician's order changed for the PRN medications. Facility staff called the pharmacy and verified the information written on the label was correct. LPAs advised facility staff of regulations prohibiting handwriting or altering prescription labels. A technical violation was issued. Based on today's inspection, three deficiencies and one technical violation are being issued. An exit interview was conducted and a copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Nov 15, 2024

Allegation investigated: The licensee refused to accept resident back into the facility.

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on May 13, 2024. LPA was greeted and granted entry into the facility and met with Administrator Asistant Michelle Cateron and facility designee Gerardo Rodriguez. LPA explained the reason for the visit. This Department has investigated the complaint alleging that Licensee refused to accept the resident back into the facility. Resident 1 (R1) was admitted to the facility on February 04, 2021. Documents reviewed included the Physician Report (LIC602) dated September 20, 2023 for R1. Per Physician report R1’s diagnosis is Chronic Obstructive Pulmonary Disease (COPD). During the investigation LPA reviewed documents including the Chapman Global Medical Center Discharged paperwork dated May 15, 2024 for Resident 1 (R1). Per Chapman Global Medical Center R1 was admitted to the Hospital on May 01, 2024 due to increased agitation and paranoid. Per Chapman Global Medical Center Discharged paperwork R1 was discharged on May 15, 2024. Per Discharge paperwork R1 to discharge today 05/15/2024 per doctor order to CONTINUED ON LIC9099-C... Unsubstantiated Skill Nursing Facility (SNF), Anaheim Point Healthcare and Wellness Center. During the course of the interviews Operations Manager (OM) stated that the Licensee did not refused to accept R1 back into the facility. During the course of the interviews with residents, R2 reported that if she needed to go to the Hospital that the Licensee would accept her back into the facility right away and stated that she has not heard about residents not being accepted back into the facility. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with facility representative, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 15, 2024 · control 22-AS-20240513161807

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit. LPA met with Jerry Perez the Health Services Director and explained the reason for the visit. During the complaint investigation visit for complaint # 22-AS-20240701161612, LPA observed that the See Something, Say Something Poster (PUB 475) is posted in a hallway next to the elevator and measures 8 1/2 by 11 inches. LPA informed Jerry Perez that the poster must be 20 by 26 inches and posted in the main entry way of the facility. An exit interview was conducted and a copy of the report along with a technical violation (LIC 9102) was provided.the state’s words, verbatim · CDSS document, Jul 3, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jessica Cho continued the case management visit for the purpose to deliver an amended report in connection to Complaint Control #: 22-AS-20230921121149. During today's visit, LPA Cho met with Administrator Cammy Johnson and explained the reason for the visit. LPA reviewed and addressed the changes on the amended report with Administrator Johnson. An exit interview was conducted with Administrator Cammy Johnson, and a copy of this report along with the amended complaint report (LIC9099 and LIC9099C) were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jan 30, 2024

Allegation investigated: Staff mismanaged resident's medication.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of continuing the investigation and delivering the findings into the above allegation. LPA explained the reason for the visit and reviewed the allegation with Administrator (Admin) Cammy Johnson. On September 28, 2023, LPA Cho initiated the complaint investigation received on September 21, 2023. During the course of the investigation, LPA interviewed staff and obtained documentation pertaining to Resident #1 (R1). The following was determined: It is alleged that the staff mismanaged the resident’s medication. R1 was admitted to the facility on December 23, 2022. R1 was independent and was able to manage their own prescription medications per the Physician’s Report dated December 13, 2022. Although the resident was able to self-administer their own medications per the physician’s assessment, R1's medication was managed by the facility. On January 19, 2023, the medication was given to R1 for self-management. Unsubstantiated Based on the LPA's review of the Medication Administration Record (MAR), medications were administered properly between December 24, 2022 to January 29, 2023. Per interviews conducted, four out of the four staff indicated that the medications were administered as prescribed at the time when R1’s medications were managed including the pain medication. Based on observations, there were no sufficient evidence to support the allegation. Therefore, based on the interviews which were conducted and the records that were reviewed, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegation: Staff mismanaged resident’s medication is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Cammy Johnson, and a copy of this report including the LIC811 were provided at the end of the visit.the state’s words, verbatim · CDSS document, Dec 28, 2023 · control 22-AS-20230921121149