Ansel Park Senior Living Community

Allegation investigated: Staff did not provide a safe environment for resident in care

Licensing Program Analyst (LPA) Graham Gunby arrived on 06/23/2026 to deliver findings to a complaint the department received on 04/10/2026. LPA met with ED, Aileen Enriquez and explained the purpose of this visit. The department conducted staff and residents' interviews, reviewed records to investigate the allegation. Through interviews with staff, it was stated R1 did not have unwanted visitors when residing at the facility. R1’s medical assessment (LIC602) which the facility provided, stated R1 is diagnosed with bipolar disorder and resided in memory care. Entry into the memory care unit requires a sign in and escort to the residents. Interviews with staff indicated R1 was typically in good spirits, but would have behaviors consist with sundowning. R1 explained that a fungus had appeared on their skin while at the facility. The facility provided prescription orders for a topical cream to be applied to the area. Through MAR review, there is no evidence that staff fail to properly administer resident's medications. Medications appear to be given as prescribed. This agency has investigated the complaint alleging staff did not provide a safe environment. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview was conducted and copy of the report has been provided. Unfoundedthe state’s words, verbatim · CDSS document, Jun 23, 2026 · control 59-AS-20260410110400

Allegation investigated: Staff do not ensure residents are being assessed prior to admission

Licensing Program Analyst (LPA) Graham Gunby arrived on 06/23/2026 to deliver findings to a complaint the department received on 05/27/2026. LPA met with ED, Aileen Enriquez and explained the purpose of this visit. The department conducted staff and residents' interviews, reviewed records to investigate the allegation. It was alleged that facility did not conduct R1, R2 and R3's medical assessments prior to admission at the facility. The facility provided a medical assessment prior to R1, R2 and R3 moving to the facility as stated in their admission agreements. LPA observed that medical assessment was completed by facility nurse per Department’s guidelines. Furthermore, the facility nurse provided R1, R2 and R3’s updated physician assessment with care plans. Based on observations, interviews, and documented collected, facility ensured that a medical assessment was conducted timely. This agency has investigated the complaint alleging staff did not conduct resident’s medical assessment prior to admission. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview was conducted and copy of the report has been provided. Unfoundedthe state’s words, verbatim · CDSS document, Jun 23, 2026 · control 59-AS-20260527081935

Allegation investigated: Staff did not assist resident in a timely manner after a fall.

Licensing Program Analyst (LPA) Calzada arrived unannounced to complete an investigation for a complaint received on September 29, 2025. LPA initially met with the concierge and later met with Administrator, Keith Payne, stating the reason for today's inspection. During the course of the investigation, LPA interviewed the Administrator, (2) Med-Techs and a family member of resident (R1). LPA attempted multiple times to interview (S1), the assigned caregiver to (R1) on the morning of September 26, 2025 when (R1) fell in the bathroom. LPA reviewed documentation relating to (R1) including their physician's report, service plan, incident report and the 911 report for that incident. The results of the investigation are as follows: Resident (R1) moved to the Assisted Living side of the community on December 31, 2022. The physician's report (dated 12/22/2023) states resident has a primary diagnosis of Hypertension, Diabetes Melliutus II and a secondary diagnosis of anxiety, depression and has mild cognitive impairment. *cont 812C-1.. Substantiated 9099C-1. The physician's report also notes (R1) is ambulatory and independent with bathing, dressing, feeding and toileting but needs assistance with taking all medications. The results of the investigation are as follows: Staff did not assist resident in a timely manner after a fall. The allegation states that resident’s (R1’s) family was contacted by the facility around 1:00 PM to report that (R1) had fallen and was being transported to the hospital, and that (R1) was on the ground in the shower for approximately five hours before staff was made aware. The facility's internal incident report states that on September 26, 2025, at 12:30 pm, staff (S1) went to check on (R1) due to the front desk not seeing (R1) earlier in the day. When (S1) went to check on (R1), she found (R1) on the floor in the shower. (R1) was unable to recall any details of the fall. (S1) came running out of (R1's) room calling for additional staff to assist. The report notes (R1) was pulled off the wall as their neck was in an uncomfortable position, and their vitals were taken. 911 was called and took (R1) to the emergency room due to being confused, high blood pressure and pain in their hip/neck/arm. Family was contacted at this time. The 911 report from local fire states they received a call from the facility on September 26, 2025, at 12:30 pm, for an unwitnessed ground level fall, and they arrived to the facility at 12:42 pm. (R1) was found lying on the shower floor of their apartment. Staff on the scene reported (R1) was last seen at baseline at approximately 7:30 am earlier that day, and when (R1) was checked again, shortly before 12:30 pm, (R1) was found on the floor. The report notes "trauma assessment reveals pain to patient's left hip, increase of pain upon manipulation of the leg". No other trauma was noted as well as no bleeding. The report also states "vitals on scene reveal hypertensive blood pressure but patient believed to have missed morning medications due to fall". Resident was taken to the emergency room for further medical evaluation. Resident (R1's) care plan (dated September 16, 2025), notes resident is independent with mobility and ambulation, does not require assistance with bathing and is at moderate potential for falls. The care plan also states that (R1) requires assistance with all aspects of taking medications and a Med-Tech will administer (R1's) scheduled and PRN medications. *cont on 9099C-2.. 9099C-2.. The Medication Administration Record (MAR) was reviewed for the month of September, 2025, and shows (R1) was prescribed multiple (7) scheduled medications at/around 8:00 am. One of (R1's) morning medications, Glipizide 10mg, is used to treat Diabetes Mellitus II, and a second morning medication, Metropolol Succinate 50 mg, is used to treat high blood pressure. The MAR documentation notes the Med-Tech's initials entered for the morning medications, as if they were given; however, an interview with the Med-Tech (S2) confirmed that (R1's) medications were left on the counter in their room around 7:00 am. Another Med-Tech who was interviewed stated, "I watch them take their meds- we are not supposed to leave meds on the counter" and confirmed that sometimes this happens with other Med-Techs". This same Med-Tech staff explained that (R1) "follows a strict schedule with their showers and is usually finished by 7:30 am with their shower" and confirmed (R1) is "independent" with showers. This staff explained that 7:30 am is the "usual medication time for (R1) and they are sitting in their chair waiting for the Med-Tech" to arrive to administer their medications. Staff (S2) confirmed that she was the Med-Tech on duty on the morning of September 26, 2025, and she went to give (R1) their medications at 7:00 am, but (R1) was "on the toilet". (S2) stated (R1) had a "robe and underwear on" while in the bathroom and that she told (R1) she "would return soon", and (R1) said "okay". (S2) explained (R1) is independent with all except for medications- there is no standby needed" and confirmed she left (R1's) medications on the counter" in their room but alerted (R1) who said okay". (S2) explained that although she didn't have time to circle back and check on (R1) later that morning, the caregiver should have checked on (R1) every two hours. (S2) further stated she went to assist (S1) and observed (R1) to be "laying on their back with their neck raised, and their head was on the wall". (S2) stated she got (R1's) vitals and they called 9-1-1 instantly. (S2) stated it appeared that (R1) fell when stepping into the shower" as (R1's) hair was "not wet and they had not showered". Staff further stated that (R1) doesn't normally use the pendant and has called staff "by accident" only before. Staff also confirmed (R1's) shower was a "walk-in" type, without a step, and "thinks (R1) became dizzy and fell back" when trying to walk in. (S2) confirmed that (R1) "didn't take their medications on the morning of the fall and may have missed their noon meds that day also. The MAR does not indicate (R1) had any scheduled medications at noon in the month of September. *cont on 9099C-3. 9099C-3.. (R1's) family member confirmed that (R1) is "independent with showers" and takes them regularly at 7:30 am. The family member commented further she is "not sure" if (R1) is able to take meds on their own and "needs staff support to watch (R1) take them". The family member stated she has "seen little cups of Metamucil powder left out" in (R1's) room before. The family member indicated she was previously told by a facility manager that staff was trained to go and look in a resident's room if they are not at a meal, asserting "(R1)does not go to lunch but does go to breakfast and dinner". Based on information obtained, the allegation is found to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) citation is issued on the 9099-D page. As a result of resident’s injury, the violation warrants a civil penalty assessment based on Health and Safety Code §1569.49. At this time, the civil penalty assessment is under review. LPA will return at a future date to assess a civil penalty, if warranted. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 25, 2025 · control 59-AS-20250929150828

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Nov 26, 2025

87464 Basic Services (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that (R1) was provided with assistance in taking their precribed medications on the morning of September 26, 2025, which posed an immediate health and safety risk to residents in care. (R1) missed taking multiple prescribed medications, including those for diabetes and high blood pressure, and fell when trying to get in the shower, sustaining a hip fracture. (R1) was not checked on by staff from approximately 7:00 am until 12:30 pm, when they were found on the floor near the shower.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: Licensee/Administrator agrees to conduct staff training on correctly administering medications. Will train staff again on checking on all residents in Assisted Living at least every 2 hours. Training plan and date to be scheduled by tomorrow 11/26/25- email LPA. Training itself is due by 12/9/25.

Allegation investigated: Staff is not meeting resident care needs

On 11/21/2025, Licensing Program Analyst (LPA) Graham Gunby arrived unannounced and met with the Executive Director, Keith Payne, to deliver complaint findings for the above allegation. LPA reviewed resident records, facility records and conducted interviews. Staff kept progress notes for R1 which stated that R1 is refusing incontinence care. Through interviews with staff, R1 does not like to be changed constantly. Through record review and staff interviews, R1 has no control over their bowel movements and will refuse changing until it is convenient for them. R1 stated they have no concerns about the level of care being provided by the facility. Based on information above, the department concluded that the allegation is unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Nothe state’s words, verbatim · CDSS document, Nov 21, 2025 · control 59-AS-20251114121656

Type of visit: Case Management - Incident

On 11/18/2025, Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratacjzak arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 11/03/2025 for resident for medication error as reported by facility on 11/14/2025 by Incident Report ( LIC624). LPAs met with Executive Director, Keith Payne, and explained the reason for visit. On 11/03/2025 the p.m. med tech called off and the NOC med tech was called in early to pass medications. The NOC mtd Tech missed the window to pass medication and let staff know hours later. This communication error led to 24 residents missing their p.m. medication. As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Nov 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 25, 2025

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. ...(4) The licensee shall assist residents with self-administered medications as needed. This poses a potential risk to health and safety for residents in care. This requirement was not met based on record review and the facility's plan was not followed for correct medication administration.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Executive Director will submit statement of understanding to CCLD by the POC date of 11/25/2025.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratajczak arrived on Tuesday November 18, 2025 to conduct the unannounced annual inspection. LPAs met with Executive Director (ED) Keith Payne and explained the purpose of visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed resident (8) and staff (6) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. LPAs and ED toured the facility together to ensure the health and safety of residents in care. The areas toured included common areas, bedrooms, bathrooms, kitchen, laundry room. LPA checked the kitchen area for the ability to prepare and store food. Facility has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kits are maintained and ready for emergency use. In the areas toured, there were no health or safety violations observed. No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the ED.the state’s words, verbatim · CDSS document, Nov 18, 2025

Allegation investigated: -Staff does not have criminal background clearance

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director (ED), Keith Payne, and the Assistant Executive Director, Amanda Farley, to open a complaint investigation and deliver complaint investigation findings regarding the above stated allegation. During today's visit, LPA conducted interviews and obtained documentation pertinent to the investigation. Interview with ED indicated that staff (S1) is employed in the independent living section of the facility as a transportation driver. S1 provides transportation periodically for residents in the assisted living and memory care sections of the facility. S1 does not have fingerprint clearance or exemption and is not associated to the facility. Based on interviews conducted, the preponderance of evidence standards have 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 conducted. A copy of this report and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Jul 10, 2025 · control 59-AS-20250709102716

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(d)(3) · Plan of correction due date: Jul 11, 2025

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted... (3) The licensee shall submit these fingerprints to the California Department of Justice, along with a second set of fingerprints for the purpose of searching the records of the Federal Bureau of Investigation, or comply with Section 87355(c), prior to the individual's employment, residence, or initial presence in the facility. This requirement was not met as evidenced by: Based on interviews conducted, facility did not ensure that a criminal record clearance was obtained for one (1) staff member, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Facility will ensure that staff member will obtain a criminal background clearance or exemption before transporting residents in assisted living and memory care. Facility will submit to LPA by POC due date.

Allegation investigated: -Staff interfered with the residents' visitation

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 11/14/24, and met with the Executive Director (ED), Keith Payne, to deliver complaint investigation findings into the above stated allegation. During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation. Interviews with staff (S1, S2, and S3) indicated that S3, who is a former staff member, arrived at the care home on 11/2/24 to visit residents (R1 & R2). Interviews with S2, S3, R1, and R2 indicated that S3 signed in at the front desk to visit R1 and R2. Interview with S2 indicated that they contacted the ED by phone and informed them that S3 was in the building visiting R1 and R2. According to Human Resources, ED, and S2, S3 is required to obtain written approval from the ED prior to visiting any residents at the care home. **********************************************Continued on LIC9099-C************************************************** Unsubstantiated According to the Associate Handbook approved by CCLD, dated August 2019, "Any associate who voluntarily resigns or is terminated will not be afforded the privilege of having access to our community in order to visit residents as they please. A former associate can no longer visit the community without first obtaining the written approval of the Executive Director prior to visiting a resident". Interview with Human Resources indicated that S3 was familiar with the Associate Handbook and had actively followed protocol with terminated staff members while they were employed at the care home. Human Resources also provided LPA with a letter that was sent to S3 on June 14, 2024 indicating the information from the Associate Handbook regarding visiting residents in the care home. Interviews with ED, S3, R1, and R2 indicated that S3 did not seek prior approval before visiting R1 and R2. Interviews with R1, R2 and resident (R3) indicated that they are able to receive visits at the care home. Based on documentation and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 14, 2024 · control 59-AS-20241104155417

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 11/14/24, and met with the Executive Director (ED), Keith Payne, to follow-up on additional findings discovered during a complaint investigation #59-AS-20241104155417. During the course of the investigation, it was discovered that staff (S3), who is a former staff member, went to visit residents (R1 & R2) on 11/2/24. S3 was to request prior written approval from the ED in order to visit R1 and R2. S3 did not request approval and was informed by staff (S1 and S2) that they needed to leave the facility. Interviews conducted with R1 and R2 indicated that staff did not ask S3 to leave in a respectful manner. R1 and R2 indicated that the visit was ended abruptly and the conversation with S3 was done in front of both residents leaving them confused as to why S3 needed to leave. R1 and R2 stated that their front door was open and that the conversation with S3 was in the hallway in front of their apartment. Interviews with staff (S1, S2, and S3) indicated that the conversation regarding S3 needing to leave the facility was in the hallway in front of R1 and R2's doorway. R1 and R2 indicated that the situation could have been handled differently and that S1 and S2 could have talked to S3 in private. R1 and R2 were not accorded dignity in their personal relationships with staff and other persons. As a result of today's visit, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Section 87468.1(a)(1) regarding personal rights of residents in all facilities. The deficiency is listed on the LIC809-D. Exit interview conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 28, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews conducted, the facility did not ensure that residents (R1 and R2) were accorded dignity when their visitor, former staff (S3), was told to leave the facility, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Facility agrees to complete a statement of understanding and train staff on how to handle situations when a former staff member arrives at the care home to visit residents and submit to LPA by the POC due date of 11/28/24.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 11/8/24 and met with the Executive Director, Keith Payne, to continue the Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed three (3) bedrooms in assisted living, two (2) bedrooms in memory care, and five (5) common area bathrooms. LPA observed apartments to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kits are maintained and ready for emergency use. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Nov 8, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 11/7/24, and met with the Executive Director, Keith Payne, to follow-up on a plan of correction (POC). During today's visit, LPA checked the water temperature in three (3) apartments in Assisted Living and one (1) in Pathways Memory Care. Apartment #100 had a water temperature of 105.2 degrees F in the bathroom sink. Apartment #168 had a water temperature of 112.5 degrees F in the kitchen sink. Apartment #169 had a water temperature of 112.3 degrees F in the bathroom sink. Apartment #179 had a water temperature of 111.4 degrees F in the bathroom sink. All apartments had water temperatures within regulatory range. Facility provided the most recent invoice for the repairs made to resolve the water temperature issue, as well as the facility's most current water temperature log. The POC was cleared during today's visit. Exit interview conducted. A copy of report provided.the state’s words, verbatim · CDSS document, Nov 7, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 11/7/24 and met with the Executive Director, Keith Payne, to conduct a Required-1 Year Inspection. During today's visit, LPA reviewed four (4) Assisted Living resident files and two (2) Pathways Memory Care resident files. LPA also reviewed six (6) staff files. LPA checked the water temperature in three (3) rooms in Assisted Living and one (1) room in Pathways Memory Care. Apartment #100 had a water temperature of 105.2 degrees F in the bathroom sink. Apartment #168 had a water temperature of 112.5 degrees F in the kitchen sink. Apartment #169 had a water temperature of 112.3 degrees F in the bathroom sink. Apartment #179 had a water temperature of 111.4 degrees F in the bathroom sink. All apartments had water temperatures within regulatory range. As a result of today's visit, no deficiencies were cited per California Code of Regulations, Title 22. LPA will return at a later time to complete annual inspection. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Nov 7, 2024

Allegation investigated: -Staff do not ensure that facility faucets deliver hot water

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 10/30/24, and met with the Executive Director, Keith Payne, to open a complaint investigation into the above stated allegation. LPA delivered findings as well. During today's visit, LPA conducted interviews and checked the water temperature in five (5) apartments in Assisted Living and two (2) apartments in Pathways Memory Care. The water temperature was within the regulatory range of 105-120 degrees F in four (4) of five (5) apartments in Assisted Living and one (1) of two (2) apartments in Memory Care. Apartment #100 bathroom sink took approximately 15 minutes to indicate a water temperature of 104 degrees F. LPA rechecked the temperature later in the visit and it was 107.1 degrees F. Apartment #168 had a water temperature of 78.6 degrees F in the kitchen sink. Apartment #179 had a water temperature of 103 degrees F in the bathroom sink. ************************************************Continued on LIC9099-C************************************************* Substantiated Interview with resident (R1) indicated that they had been having issues with their water temperature heating up for approximately a week prior to them moving to a new apartment. Interview with Administrator indicated that the facility has been working to repair the water temperature issue in apartment #169. Administrator indicated that R1 signed a residency agreement amendment to move apartments to resolve the issue of not receiving hot water. Interview with resident (R4) indicated that their water takes quite some time to heat up. Residents (R2 & R3) stated that they always have hot water. During today's visit, LPA observed a plumber working on the water temperature issue in apartment #169. Interview with the Maintenance Director indicated that the plumbing business first began their service to repair the water temperature issue on 10/23/24. According to the plumbing company invoice, with a work order date of 10/23/24, on 10/24/24, they "arrived to unit #169 pulled and replaced the shower cartridge. Did not fix water temperature issue. Tried to adjust settings on cartridge but no issues. Inspected water heater running fine. Turned up setting on recirculation pump". The work order also indicated that on 10/25/24 the plumbing company "came back and problem was still occurring ran more tests in the unit. Problem with the way it is plumbed. Replaced shower cartridge and still had issues with water temperature. Will give estimate to replace shower valve". Maintenance Director indicated that the plumbing company will provide another invoice after today's visit, which will be provided to LPA. Interview with Administrator indicated that they are going to schedule an appointment with the vendor that repairs any issues with the water heaters to ensure there are no issues with the water heaters. LPA observed the three (3) waters heaters and they were set at 129 degrees F. LPA reviewed the facility temperature log, which indicated that the Maintenance Director checked eleven (11) locations' water temperatures in the facility the week of 10/1/24. They checked five (5) locations' water temperatures the week of 10/8/24 and three (3) the week of 10/15/24. All the temperature checks were within regulatory standards. The log does not indicate any temperature checks were conducted the week of 10/22/24. Based on observation, interviews conducted, and records reviewed, the preponderance of evidence standards have 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 conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 59-AS-20241025105323

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Nov 13, 2024

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed, the facility did not ensure that two (2) of seven (7) residents' apartments are receiving hot water, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Facility agrees to contact the vendor that would repair any issues with the water heaters to ensure they are in good repair and continue working with the plumbing company to resolve water temperature issues. Facility agrees to provide LPA with all work orders regarding repairs as well as a current water temperature log by the POC due date of 11/13/24. LPA will return on a later date to recheck the water temperature.

Allegation investigated: -Residents' rooms are not being kept clean and sanitary

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced today, 5/9/24, and met with the Executive Director, Deborah Taylor, to open and deliver complaint investigation findings into the above stated allegation. During today's visit, LPA toured five (5) residents' (R1, R2, R3, R4 and R5) apartments and interviewed the Maintenance Director. **********************************************Continued on LIC9099-C**************************************************** Unsubstantiated LPA observed that R1, R2, R3, R4, and R5's apartments had clean floors, furniture, counter tops, cabinets, toilets, showers, and windows. The garbage bins were empty and the rooms were dust free. All rooms appeared to be clean, safe, sanitary and in good repair. LPA also observed cleaning staff cleaning residents' rooms. Interview with the Maintenance Director indicated that there are currently 2 cleaning staff that clean residents' rooms 7 days per week. Interview indicated that each of the 2 cleaning staff have 8 rooms to clean everyday. The weekly cleaning includes the kitchen, bathrooms, bedroom, living room, sheets, towels, counter tops, floors, toilets, showers, and emptying the trash bins. Interview also indicated that the 2 cleaning staff do a deep cleaning of the residents' rooms monthly, which includes dusting (blinds, windows, and hard furniture) and cleaning the refrigerator and microwave. Based on observation and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 9, 2024 · control 59-AS-20240506134242

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Hood arrived at the care home unannounced today, 5/9/24, to conduct a case management visit regarding information obtained during a complaint investigation #59-AS-20240306093035 that was completed on 4/17/24. Resident (R1) was receiving home health services from 3/28/23-12/30/23. According to home health records, R1 had a stage three pressure wound located on the right ischial tuberosity with an onset date of 7/25/23. Interviews with Home Health staff indicated that R1 was receiving wound care approximately once or twice per week. The facility did not request an exception from the Department for the prohibited health condition and R1 was not receiving hospice care while residing at the care home. Due to the information above, per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 809-D page. Exit interview was conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, May 9, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87616(a) · Plan of correction due date: May 10, 2024

87616 Exceptions for Health Conditions (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, the facility did not request or obtain an exception for resident, R1's, stage 3 pressure wound, which posed an immeidate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 9, 2024

Plan of correction: Faciltiy agrees to submit a statement of understanding. Facility will conduct an in-service training with care staff regarding the importance of communication with home health nurses. Facility will submit to LPA information regarding in-service, including time and date of in-service and training material, by POC due date of 5/10/24.

Allegation investigated: -Residents are not receiving ADLs. -Facility is not providing adequate food services.

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 4/17/24, and met with the Executive Director, Deborah Taylor, to deliver complaint investigation findings into the above stated allegations. During the course of the investigation, the Department conducted interviews, obtained documentation pertinent to the investigation, and conducted an inspection of the food supply. Allegation: Residents are not receiving ADLs. Interviews with residents (R2 and R3) indicated that they are receiving all ADLs from care staff. R2 and R3 indicated that if they need anything staff are there and ready to assist. R2 and R3 indicated that all of their needs are being met by facility staff. Staff (S1 and S2) indicated that they have never observed other care staff not providing ADLs to residents in care. *********************************************Continued on LIC9099-C*********************************************** Unsubstantiated Allegation: Facility is not providing adequate food services. Facility provided their menu for the week of 4/14/24-4/20/24. The facility provides a variety of food options for residents in care. Facility also provides an always available menu for residents, which also offers low sodium and vegetarian/vegan options upon request. LPA toured the kitchen area, and the facility has the required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed kitchen staff preparing salads. LPA observed the food order invoices and the facility orders fresh produce almost daily. Facility orders all other food supplies approximately three times per week. LPA observed the sample food from the 4/16/24 lunch menu, which was all fresh food items. Interview with Culinary Director indicated that residents eat a lot of fresh fruit and vegetables in their meals. Interviews with R2 and R3 indicated that the facility provides nutritious meals to residents at the care home. Based on observation, interviews conducted, and documentation obtained, although the allegations 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 allegations are UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided. The onset date was noted as 7/25/23 and resolved as of 8/11/23. On 12/18/23, the final date that R1 was seen by home health, R1 had a stage two pressure wound on their left buttock and a stage two pressure injury on their right ischial tuberosity. Both wounds were noted to be improving. Interview with Home Health Staff indicated that R1 was receiving wound care approximately once per week. Interview also indicated that how often R1 was seen by Home Health was to the discretion of the Nurse and is based on the pressure injury status. Interview with Home Health Nurse indicated that R1 was receiving care twice per week and was receiving wound care for a pressure injury. Home Health Nurse indicated that they had no concerns regarding the care that R1 was receiving from the care home. Home Health Nurse indicated that they were not concerned with R1’s pressure wound as it was progressing and improving. Allegation: Resident sustained multiple falls resulting in fractures. Interview with R1’s responsible party indicated that R1 sustained a toe fracture in September of 2021. Responsible party indicated that there were other instances that R1 sustained fractures, however, was unable to provide dates of injury. According to Unusual Incident/Injury Report dated 9/13/21, R1 had pushed their pendant and was found by staff sitting on the floor of their bedroom. R1 had reported that their slipper had gotten caught under their mat and they fell. R1 returned from the hospital with a walking boot. The Department conducted a complaint investigation #25-AS-20210916083105 regarding the 9/13/21 fall incident with Unsubstantiated findings. The facility provided all Unusual Incident/Injury Reports for R1 and there was no record of any other fractures sustained. Interview with ED indicated that they are not aware of any falls that resulted in fracture besides the incident that occurred on 9/13/21. No fractures were noted in the Home Health Records between 3/8/23-12/30/23. Allegation: Staff left resident on floor for an extended period of time. According to the facility’s incident log, R1 sustained a fall on 11/28/23 with no injuries reported. Interview with R1’s responsible party indicated that R1 had a fall in November 2023 and R1 did not sustain any serious injuries or fractures as a result of the fall. Facility’s call button log indicated that R1 pushed their emergency call button pendant at 5:01pm. Facility’s incident report indicated that the time of the incident was 5:15pm. **********************************************Continued on LIC9099-C************************************************ Interview with Rocklin Fire Department indicated that the 911 call was made from the facility at 5:15pm. Rocklin Fire Department report #202311280268 indicated that the alarm for service was made at 5:17pm. The report also indicated that Rocklin Fire Department arrived at the facility at 5:24pm to provide lift assistance for R1. The report indicated that R1 had no injuries and was only in need of lift assistance. Interviews with staff (S2) indicated that they were present during the 11/28/23 incident and that 911 was contacted immediately. Interviews with staff (S1) and S2 indicated that the first priority is assessing the resident when they push their emergency call button pendant to ensure the health and safety of the resident. Interviews indicated that, following their assessment, staff would clear the pendant. Interviews with residents (R2 and R3) indicated that staff respond to their emergency call buttons immediately. According to the facility’s Procedures for Resident in the case of an accident or emergency, if a resident has fallen, do not immediately move him/her. Also, if a resident appears to have no serious injuries and the resident is too heavy for two care associates to lift together call 911. Interviews with ED, S1, and S2 indicated that on 11/28/23, staff were unable to lift R1 and required assistance from emergency services. Allegation: Staff did not provide a 60-day notice of rate increases. Interview with ED indicated that R1 had a rent increase while residing at the care home. The facility issued a 60-day notice for rent increase to R1 on 11/1/22. The 60-day notice indicated that rent would increase by $343 effective 1/1/23 and that the enclosed Residency Agreement Addendum Form must be returned to the community Business Office by 12/15/22. The Residency Agreement Addendum regarding rent increase was signed by R1 on 12/15/22. According to R1’s Emergency Information Sheet, R1 is their own responsible party and have a medical Power of Attorney. Facility invoices dated 12/1/22-4/30/23 indicated that the rent increase for R1 became effective 1/1/23. Based on interviews conducted and documentation reviewed, the above allegations are found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2024 · control 59-AS-20240306093035

Allegation investigated: Staff do not provide adequate food service. Facility staff are not ensuring the facility is maintained.

On 10/25/2023 LPA Tryon visited the facility to open this complaint. LPA met with Executive Director Deborah Taylor. LPA spoke with E.D., staff and residents; reviewed kitchen sanitation training records and viewed lunch meal, food supplies, dishes and utensils. Regarding the allegation that staff do not provide adequate food service, LPA found that food supplies appeared to be plentiful, varied and fresh. LPA viewed open bread packs/sandwiches on plates and saw no sign that the bread was not fresh; it appeared very fresh. LPA learned that bread is purchased and stored frozen, (or made fresh daily), is only taken out of the freezer one day before being used. Bread is taken out in quantities that are estimated to be needed, and most supplies are used each day as opened. Any leftovers are put on the front of the bread carts to be used first the next day. LPA viewed lettuce supplies which were fresh, and viewed plated salads/sandwiches, lettuce appeared fresh and not wilted. LPA learned that lettuce is ordered 3 or 4 times fresh a week; cases are only used for 3 days at the most. LPA viewed ranch and other salad dressings. Ranch was stored in a large rectangular container, was tightly covered with plastic wrap and dated with expiration date. LPA learned that the dressing is made fresh at the facility with buttermilk and ranch powder mix. Unfounded The mix contains preservatives that keep the dressing for up to 30 days. This practice was listed on the directions for the dressing; and confirmed with the facility dietician. Regarding the cook using unwashed hands with no gloves to handle raw meat, LPA learned that under the safe handling food practices the cook does not need gloves to handle/trim meat before cooking. Cook always use gloves to handle all prepared/cooked foods that will be served. Hands are washed before and after handling meat and other food. Hands are washed before donning gloves, between glove changes and after using gloves. LPA spoke with 12 residents during lunch; all stated the food was good and had no complaints. LPA found no evidence that there is any substandard food being served or of unsafe food handling. Allegation is UNFOUNDED, Regarding the allegation that facility staff are not ensuring the facility is maintained, LPA viewed dining room, kitchen, food prep areas, cooler, freezer, food storage. LPA also viewed flatware, dishes, etc. LPA reviewed dishwasher temperature logs. Water temperature was within appropriate temperature range for all meals each day over a span of 5 months. LPA learned that flatware is washed 3 times each time it is used, It is washed once flat on a dishwasher tray/rack; one time with tines face up in silverware "cups" in the dishwasher; and one time tines down. LPA reviewed clean flatware and found no food particles or stains, LPA viewed the kitchen floor. The floor did not appear spotless, in that there were some marks/scuffs, etc. It should be noted that the floor was viewed during the lunch meal as kitchen staff were busy working all around. LPA learned that the floor is mopped daily; staff are asked to sweep under things to keep any stray items, dirt, etc. cleaned out. LPA learned that the floor is deep cleaned quarterly. Although the floor did not appear spotless or "perfect", it was also not covered with food items, dirt, etc, and appeared within the range of acceptably clean given the heavy traffic and use. LPA finds the allegation to be unfounded. A finding of unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 25, 2023 · control 59-AS-20231019160403