Atria Collwood

Allegation investigated: Staff provided medical service to resident in care. Staff does not respect resident's privacy.

Licensing Program Analyst (LPA)Tiffany Holmes arrived at the facility to deliver findings for a complaint investigation. LPA identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Julia Lopez, Executive Director. LPA previously conducted interviews with residents, staff, and outside sources, made observations, and obtained and reviewed pertinent records. LPA Miller conducted the initial visit on 05/31/2023 and conducted a tour of the facility. It was alleged that staff provided medical service to resident in care and staff does not respect resident's privacy. Interviews revealed that istaff denied that staff provided medical service to residents in care and staff does not respect resident's privacy is not true. Interviews revealed that the staff knock on the doors to the resident rooms before entering. Interviews also revealed that there are times that residents think the staff walks in without knocking but ultimately stated the staff could have knocked and they possibly did not hear the staff knocking. Other interviews revealed on 05/31/2023 LPA Miller observed a staff knock on a door and the staff waited, knocked again. After no answer, they reached for their keys, opened the door and announced themself before walking in. Interviews revealed that after the staff exited the room without clothing, the staff locked door and thats when they were approached by LPA Miller. Interviews revealed that the staff do not perform medical services to residents. Interviews revealed that no reports of staff providing medical services to residents has been reported. The Department has investigated the above-mentioned allegations and based on interviews, LPA observations, and records review, it was determined that the complaint allegations are Unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Julia Lopez, Executive Director and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided via email. An electronic email read receipt confirms the documents were received. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 18, 2026 · control 08-AS-20230522110815

Allegation investigated: -Licensee locked resident out of their own apartment. -Licensee did not negotiate with resident in good faith.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Julia Lopez. The Complainant alleged that there was a day that Licensee locked Resident #1 (R1) out of their own apartment, and that Licensee did not negotiate with R1 in good faith. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved multiple unannounced facility tours/welfare checks and interviews of R1 and pertinent facility staff and outside sources. The Department also reviewed video footage and billing-related documents relevant to this case. Records and interviews aligned to show: On 03/11/2026, Licensee served R1 with a valid 30-day eviction notice for nonpayment of owed rent and care/medication fees; R1 had until 04/24/2026 to pay a past due balance $25,986.81, or they were required to vacate the premises. [CONTINUED ON LIC 9099-C, 1 of 3] Substantiated [CONTINUED FROM LIC 9099] Soon after the aforementioned letter was served, R1 and their collaborating outside social worker, Person #1 (P1), entered into negotiations with facility management to explore a potential repayment plan. On 03/19/2026, Licensee extended their first offer verbally to R1 and P1: If R1 were to both vacate their facility apartment and pay one lump sum of $10,000 in full by/on 04/01/2026, then Licensee would waive/forgive the remainder of R1’s final balance owed. R1 and P1 counteroffered (“Counteroffer #1”), saying they could both pay $3,000 upfront and vacate the apartment by/on 04/01/2026, and then pay an additional $7,000 in $500 monthly installments thereafter, if Licensee agreed to waive/forgive the remainder of R1’s final balance owed. Interviews disputed what occurred next: The Complainant said during the above meeting, the facility administrator, Staff #1 (S1), verbally accepted R1/P1’s Counteroffer #1, as witnessed by billing manager Staff #2 (S2). However, in their own interviews, S1 and S2 said on this date, they agreed only to forward R1/P1’s Counteroffer #1 to Atria’s corporate office in Kentucky for review/decision. S1 and S2 both said S1 clearly told R1 and P1 that Licensee had not yet committed to accepting this counteroffer, and that the corporate office’s approval would be required. Reviews and interviews converged/aligned again to show: The next day on 03/20/2026, R1, accompanied by their friend/advocate Person #2 (P2), handed a $3,000 cashier’s check to S1. S1 told R1 that Atria’s corporate office had not yet decided whether to accept Counteroffer #1, but S1 pledged to place R1’s cashier’s check in a secure/locked office space at the facility and not yet cash it, pending the corporate office’s decision/instruction. Over the next week or more, S1 was intermittently on and off duty (i.e., not at work continuously). P1’s phone calls to S1 were not timely returned during this period, leading R1/P1 to falsely assume that Licensee had accepted Counteroffer #1, since they received zero communication to the contrary. On 03/31/2026, R1 and P2 began to physically move R1’s personal belongings out of R1’s apartment. At the start of this moving, S1 and S2 presented a document ("Settlement Contract #1") to R1, P1, and P2, which essentially stated: Licensee would accept $3,000 from R1 upfront and required R1 to vacate their apartment by/on 04/01/2026, for which they would then allow R1 to pay their remaining balance of $23,347.02 in $500 monthly installments thereafter. (Settlement Contract #1 thus offered no waiver/forgiveness of any part of R1’s debt.) P1 quickly phoned S1 to alert them that this document seemed to significantly deviate from what was earlier discussed; S1 immediately agreed/replied that Settlement Contract #1 contained a major defect/error regarding the amount to be paid in installments, and that they would have Atria’s corporate office amend and reissue it. [CONTINUED ON LIC 9099-C, 2 of 3] [CONTINUED FROM LIC 9099-C, 1 of 2] R1 and S2 thus continued with their moving of belongings out of R1’s apartment, which continued into 04/01/2026. Subsequently, S1 and S2 gave R1, P1, and P2 and amended document ("Settlement Contract #2"), which essentially stated: If R1 paid $3,000 upfront and vacated their apartment on 04/01/2026 and then paid another $10,000 in $500 monthly installments thereafter, Licensee would waive/forgive the remainder of R1’s final balance owed (“Counteroffer #2”). Upon P1 receiving a copy of Settlement Contract #2, P1 immediately communicated to S1 and S2 that the contract was again in error (i.e., P1 said the installment balance should be $7,000 and not $10,000, as a reflection of the $3,000 cashier’s check that R1 already handed to Licensee). S1 now, for the first time, communicated to R1, P1, P2 that Counteroffer #1 was rejected, and that this Counteroffer #2 (as articulated in Settlement Contract #2) was Licensee’s last and final offer. Interviews disputed when said rejection, along with Settlement Contract #2 / Counteroffer #2, was presented to R1, P1, and P2, in practice: S1 and S2 claimed they presented such on 03/31/2026, whereas P1 and P2 claimed it was on 04/01/2026. In protest, R1 and P1 refused to sign Settlement Contract #2. R1 physically and administratively moved out of Atria Collwood on 04/01/2026. S1 affirmed to CCLD: a) The $3,000 cashier’s check which R1 earlier handed to them was strictly given as a down-payment/security on what was expected to be a later repayment/installment plan contract. It was not a standard monthly rent payment, and S1 was supposed to return it to R1 if negotiations fell through.; and, b) Negotiations indeed ultimately fell through. Interviews of the other pertinent individuals in this case corroborated these same two truths; they are not under dispute. During his own 04/07/2026 site visit, LPA asked S1 for R1’s cashier’s check. S1 replied that it had been mailed to the Atria corporate office in Kentucky. LPA allowed S1 three (3) business days to contact the corporate office to inquire as to the status of this cashier’s check, and whether it was still returnable to R1. On 04/10/2026, S1 informed LPA that said cashier’s check was not returnable to R1. Additionally, interviews aligned to show: During R1’s move out, S1 instructed maintenance manager Staff #3 (S3) to change out the lock on R1’s apartment door. S3 performed this action before close of business (i.e., 5:00 PM) on 04/01/2026, while R1’s recliner chair was still inside their apartment, and while having constructive knowledge that: R1 had not yet surrendered/relinquished their apartment key to Licensee’s staff and that R1 had not yet submitted / turned-in their “Atria Resident Move Out Form,” which represents the resident’s written attestation that they have finished removing “all personal property” from their apartment. (This form is part of the facility’s standard operating procedure). [CONTINUED ON LIC 9099-C, 3 of 3] [CONTINUED FROM LIC 9099-C, 2 of 3] CCLD also reviewed date and timestamped video footage showing: a) R1 and P2 attempting to open R1’s apartment door with R1’s issued key, unsuccessfully (4:30 PM on 04/01/2026, per the metadata); b) R1 and P2 trying the numeric-code on the side facility entry door, unsuccessfully (4:31 PM on 04/01/2026, per the metadata); and, c) R1 at the facility’s front desk asking for staff to unlock their own apartment door so that they could retrieve their recliner chair (4:50 PM on 04/01/2026, per the metadata). In their own interviews with LPA on 04/07/2026, S1, S2, and S3 each told LPA that R1 had earlier announced their intent to abandon (not take) their own recliner chair with them, and that this chair was still sitting inside R1’s former apartment. When LPA entered said apartment on 04/07/2026, he observed that while the room had not yet been cleaned/turned-over, R1’s recliner chair was not there, indicating R1 and/or S2 had retrieved it. The Department concluded: a) R1 and P2 started the process of vacating R1’s apartment on 03/31/2026 under the sincere belief that the terms of Counteroffer #1 would be followed; b) Licensee allowed R1 and P2 to keep moving R1 out under this false belief on 03/31/2026, despite Licensee themselves knowing on that date that they had no intention of accepting Counteroffer #1; c) Licensee waited until most of R1’s belongings were physically out of the apartment before effectively communicating their rejection of Counteroffer #1; d) In locking R1 out of their apartment, Licensee eliminated R1’s right to walk away from a deal; e) In cashing R1’s downpayment cashier’s check, Licensee forfeited its own right to walk away from a deal; and, f) Prior to negotiations, R1 was legally entitled to occupy their apartment through 04/24/2026, but R1 instead vacated the premises twenty-three (23) days early, on the date of Licensee’s choosing, and to Licensee’s significant advantage. Given the totality of events, CCLD determined that a deal was struck in spirit, by action, and that the terms of Counteroffer #1 have precedence over those of Counteroffer #2. Based on records and interviews, a preponderance of evidence exists to show that Licensee locked R1 out of their own apartment, and that Licensee did not negotiate with R1 in good faith. Both allegations are therefore Substantiated, and deficiencies were cited for them per California Code of Regulations, Title 22 (refer to the LIC 9099-D page). Plans of Correction were jointly developed with the Licensee. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 10, 2026 · control 08-AS-20260402162318

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 10, 2026

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…” This requirement was not met, as evidenced by: Based on records and interviews, Licensee did not treat 1 of 83 residents (R1) with dignity. This posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 10, 2026

Plan of correction: Licensee agreed to extend a new written Settlement Agreement (“Settlement Agreement #3”) to R1 which reflects the following (in line with Counteroffer #1): a) R1 already paid Licensee $3,000 during March 2026, b) R1 now owes Licensee just $7,000 left, to be paid in $500 monthly installments, c) Licensee will credit/write off the remaining balance of $16,347.02 and not charge any further late fees, and d) So long as R1 is on time with their $500 monthly installment payments, the matter will continue to be handled internally and not be reported to collection agencies or affect credit score. Licensee will provide R1 at least fourteen (14) calendar days from date of service to sign and return this document to Licensee, otherwise the deal will expire. (Licensee shall utilize both P1 and P2 to facilitate communications with R1, since R1 has since moved out and not yet established a forwarding mailing address, and since R1 does not personally use E-mail. Licensee shall CC’ LPA on all E-mailed correspondence to P1/P2 specifically regarding this transaction.) By the POC due date, Licensee will E-mail LPA either a fully-signed/executed Settlement Agreement #3, or written proof that R1 has refused to sign it (which CCLD has the right to independently verify, if such is claimed). The Department reserves the right to continue to monitor this situation, amending the POC if needed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: Apr 10, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions.” Based on records and interviews, Licensee did ensure that 1 of 83 residents (R1) was protected from involuntary discharge and/or eviction. This posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 10, 2026

Plan of correction: As of the date of deficiency issuance, R1 no longer sought to live at Atria Collwood, and Licensee had self-determined to not charge R1 for rent, care, or medication fees for the date of 04/01/2026. These actions resolve the deficiency, and no further Plan of Correction was formed.

Allegation investigated: Licensee did not meet notification requirements regarding increase(s) in resident’s care level(s).

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Community Business Director Patricia “Kitty” Totorica and Resident Services Director Ashley Baino-Jaimes. LPA also met with Executive Director Julia Lopez, who arrived shortly after. The Complainant alleged that Licensee did not meet notification requirements regarding increase(s) in Resident #1’s (R1’s) care level(s). [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of relevant residents, facility managers, and outside sources. The Department also reviewed pertinent billing and care records. Available records and interviews showed: [CONTINUED ON LIC 9099-C, 1 of 3] Substantiated [CONTINUED FROM LIC 9099] When R1 moved into the facility during August 2024, Licensee had assessed R1 as needing no staff assistance with either medications or care at that time. (In other words, R1 was charged only for room and board, but was not charged for either a medication level or a care level then). R1 had a responsible person (RP) other than themselves who signed R1's admissions agreement contract and acted as R1’s payee. (While the RP did later relinquish their role on 02/23/2026, the RP was still in force in this legal capacity throughout the time-period that is pertinent to this complaint.) California Health and Safety Code Section 1569.657 states: “(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.” The burden of proof for timely service of such written notices falls to the Licensee. Per the official website of the United States Postal Service (USPS), First Class Mail (letters and cards) typically arrive in between one (1) to five (5) business days. On Thursday 02/13/2025, Licensee reassessed R1 and determined that R1 now needed facility staff to help R1 with storing and taking their prescribed medicines. R1 thus went from no medication level ($0) to Medication Level 1 ($500 per month), effective 02/13/2025 and continuing through present. Per facility manager Staff #1 (S1), they phoned R1’s RP around this time asking to discuss the change but the RP did not answer; S1 left the RP a voicemail, which was not returned. S1 did not discuss fee/cost changes in their voicemail. Per HSC 1569.657(a), written notice of this change in R1’s medication level (and accompanying change in fee) was required to be served to the RP no later than Friday 02/14/2025. However, the written notice of such was first authored and put in outgoing mail (non-certified) by facility manager Staff #2 (S2) on Sunday 02/16/2025 (as confirmed by both the printed date on the letter and interview of S2). This letter was thus picked up by USPS no sooner than Monday 02/17/2025. Per a conservative estimate, this letter would have arrived at the RP’s mailing address at the latest by Friday 02/21/2025, seven (7) days after the service due date. The preponderance of evidence shows that there were up to seven (7) days when R1 was billed for Med Level 1 (up from no med level) without the required legal notice to the RP. [CONTINUED FROM LIC 9099-C, 2 of 3] [CONTINUED FROM LIC 9099-C, 1 of 3] On Sunday 03/02/2025, Licensee reassessed R1 and determined that R1 now needed facility staff to help with personal care, at least temporarily. R1 thus went from no care level ($0) to Care Level 2 ($1,460 per month), effective 03/03/2025. Per S1, they phoned R1’s RP around this time asking to discuss the change but the RP did not answer; S1 left the RP a voicemail, which was not returned. S1 did not discuss fee/cost changes in their voicemail. Per HSC 1569.657(a), written notice of this change in R1’s care level (and accompanying change in fee) was required to be served to the RP no later than Tuesday 03/04/2025. The written notice of such was first authored and put in outgoing mail (non-certified) by S2 on Monday 03/03/2025 (as confirmed by both the printed date on the letter and interview of S2). Per a conservative estimate, this letter would have arrived at the RP’s mailing address at the latest by Friday 03/07/2025, three (3) days after the service due date. The preponderance of evidence shows that there were up to three (3) days when R1 was billed for Care Level 2 (up from no care level) without the required legal notice to the RP. R1’s Care Level 2 was billed only through 04/08/2025, because Licensee subsequently reassessed R1 and put them back on no care level, again. On Thursday 12/11/2025, Licensee reassessed R1 and determined that R1 again needed facility staff to help with personal care. R1 thus went from no care level ($0) to Care Level 1 ($730 per month), effective 12/11/2025 and continuing through present. Per S1, they phoned R1’s RP around this time to discuss the change but the RP did not answer; S1 left the RP a voicemail, which was not returned. S1 did not discuss fee/cost changes in their voicemail. This time around, S1 also sent the RP a follow up E-mail, but did not discuss fee/cost changes in said E-mail, either. Per HSC 1569.657(a), written notice of this change in R1’s care level (and accompanying change in fee) was required to be served to the RP no later than Friday 12/12/2025. However, the written notice of such was first authored and put in outgoing mail (non-certified) by S2 on Sunday 12/14/2025 (as confirmed by both the printed date on the letter and interview of S2). This letter was thus picked up by USPS no sooner than Monday 02/15/2025. Per a conservative estimate, this letter would have arrived at the RP’s mailing address at the latest by Friday 12/19/2025, seven (7) days after the service due date. The preponderance of evidence shows that there were up to seven (7) days when R1 was billed for Care Level 1 (up from no care level) without the required legal notice to the RP. [CONTINUED ON LIC 9099-C, 3 of 3] [CONTINUED FROM LIC 9099-C, 2 of 3] Based on records and interviews, a preponderance of evidence exists to show that Licensee did not meet notification requirements regarding increases in R1’s care levels. The allegation is therefore Substantiated, and one (1) deficiency was cited for it per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Community Business Director Patricia “Kitty” Totorica, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 1, 2026 · control 08-AS-20260401100114

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.657 · Plan of correction due date: Apr 24, 2026

Health and Safety Code 1569.657: “(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.” This requirement was not met, as evidenced by: Based on records review and interviews: For 1 of 83 residents (R1) who had a rate increase due to change in level of care, Licensee did not provide the resident and the resident’s representative written notice of the rate increase, to include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges, within two business days after initially providing services at the new level of care. This posted a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 1, 2026

Plan of correction: Licensee agreed use its preexisting “365-day” method / standard protocol for calculating prorations to generate a total credit/refund to R1’s account in the following amount: seven (7) days of Med Level 1 (at the 2025 rate), plus three (3) days of Care Level 2 (at the 2025 rate), plus seven (7) days of Care Level 1 (at the 2025 rate). [Per LPA’s own calculations, the total should approximate $427.07, but Licensee is encouraged to double-check and correct as needed.] By the POC due date, Licensee agreed to E-mail written proof of the refund/credit being applied to R1’s outstanding owed balance.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Community Business Director Patricia “Kitty” Totorica and Resident Services Director Ashley Baino-Jaimes. LPA also met with Executive Director Julia Lopez, who arrived shortly after. Today's visit was in response to Licensee’s self-reported death of Resident #1 (R1), received at the CCLD San Diego Regional Office on 03/28/2026. [See LIC 811 Confidential Names List for a description of R1]. Per the report, R1 passed away on 03/27/2026. During today’s visit, LPA performed a brief facility tour and welfare check on remaining residents, finding no immediate safety concerns. LPA also collected copies of pertinent records. No deficiencies were observed or cited during this welfare check. An exit interview was conducted with Community Business Director Patricia “Kitty” Totorica, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today's visit.the state’s words, verbatim · CDSS document, Apr 1, 2026

Allegation investigated: Licensee pursued unlawful eviction of resident.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Receptionist Tessa Randolph. LPA then met with Engage Life Director Naomie Peterson. The Complainant alleged that Licensee pursued an unlawful eviction of Resident #1 (R1). [See LIC811 Confidential Names List for a description of R1.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of pertinent residents, facility staff, and outside sources. The Department also reviewed relevant care records and monthly billing statements. [CONTINUED ON LIC 9099-C] Unsubstantiated [CONTINUED FROM LIC 9099] Records and interviews aligned to show: On 03/11/2026, Licensee served R1 with an eviction letter citing nonpayment of rent and fees. The effective date of the eviction listed in this letter was 04/24/2026, which was more than the required thirty (30) day minimum. The dollar amount demanded in this letter accurately represented the portion of the balance which R1 owed to Licensee, and which was also more than ten (10) days past due. The letter also contained the required text disclosures described in regulations, as far as the spirit of the law is concerned. Interviews of R1 and staff, corroborated by LPA observation, aligned to showed: During the pertinent review period, R1 received help in practice from facility direct care staff with medication storage and administration, and with emptying and managing their urinary catheter. Licensee assessed and billed R1 at the care and medication levels corresponding to practice. Prior to the issuance of the 03/11/2026 eviction letter, Licensee had made multiple attempts to communicate with R1’s Responsible Person (RP) to resolve R1’s past due balance, but the problem was not solved. As of the commencement of CCLD’s investigation, Licensee had not received any payment on R1’s account for the preceding two (2) months, and R1’s past due balance was actively growing. Based on records and interviews, a preponderance of evidence does not exist to show that Licensee pursued an unlawful eviction of R1. The allegation is therefore Unsubstantiated, and no deficiency was cited for it. LPA issued one (1) Technical Violation regarding letter formatting (refer to the LIC9102-TV page) and provided Technical Assistance (TA) regarding promoting a resident’s independence. An exit interview was conducted with Engage Life Director Naomie Peterson, to whom a copy of this report, the LIC9102-TV page, the LIC9102-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 08-AS-20260325112312

Allegation investigated: Licensee pursued unlawful eviction of resident.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to continue a Complaint Investigation regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Receptionist Tessa Randolph. LPA later met with Executive Director Julia Lopez and Community Business Director Kitty Totorica. The Complainant alleged that Licensee pursued an unlawful eviction of Resident #1 (R1). [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved multiple unannounced facility tours/welfare checks, review of care and billing records on R1, and interviews of R1, multiple pertinent staff, and outside sources. [CONTINUED ON LIC 9099-C] Substantiated [CONTINUED FROM LIC 9099] Records and interviews showed: On 01/08/2026, Licensee served R1 with a written thirty (30) day notice eviction letter due to non-payment of rent. The letter read, in part: “This letter (the “Notice”) constitutes thirty day’s notice to pay or your Residency Agreement dated 5/31/2023 (the “Agreement”) with Atria Collwood, License No. 374600890 (the “Community”) will be terminated pursuant to the Agreement. This Notice is based on your non-payment of all fees and charges within ten days of the due date. The total amount now due and owing as of the date of this letter is: $15,054.00. You must pay this amount by 2/21/2026, or within thirty days of service of this Notice upon you, whichever is later (the “Effective Date”). Unless you pay this amount, you are required to move from and surrender possession of your apartment on or before the Effective Date.” This letter included various elements customary and required in RCFE eviction letters, such as the disclaimer paragraph specified in HSC 1569.683(a)(4), a disclaimer about the resident’s right to file a complaint and contact information for CCLD and the Long-Term Care Ombudsman, and resources available to assist in identifying alternative housing and care options. However, LPA’s review of R1’s monthly billing statements, confirmed by interview of the facility’s Community Business Director, showed: As of 01/08/2026, the date of service of R1’s eviction letter, R1’s total unpaid past due balance owed to Licensee was $14,829.00. Of this past due balance, the portion/segment that was over ten (10) days past due was $8,707.00. [Per CCR 87224(a)(1), a Licensee may issue a “thirty (30) days written notice” to a resident for “nonpayment of the rate for basic services within ten days of the due date.”] For an eviction letter dated and served on 01/08/2026, it was only this last amount which Licensee was legally allowed to list. Also, the amount listed in Licensee’s eviction letter to R1 did not match the amount listed in Licensee’s own monthly billing statement issued to R1. Based on records and interviews, a preponderance of evidence exists to show that Licensee pursued an unlawful eviction of R1. The allegation is therefore Substantiated, and one (1) deficiency was cited for it, per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Executive Director Julia Lopez and Community Business Director Kitty Totorica, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. [CONTINUED FROM LIC 9099-A] Records and interviews showed: R1 moved into the facility during May 2023 and was their own payee and responsible person. Per R1’s LIC602 Physician’s Reports, since move-in, R1 has been diagnosed with Lung Cancer, Chronic Obstructive Pulmonary Disease (COPD), Gait Instability, and Fatigue. R1 did not have Dementia or Mild Cognitive Impairment (MCI) and showed no sign of memory loss to LPA. While R1 had a diagnosis of Schizophrenia, R1 also displayed to LPA that they were fully oriented to persons, time, date, and place. Electronic date and timestamped charting/progress notes, corroborated by facility care records and care staff interviews, showed: For most of R1’s residency, R1 was independent in Activities of Daily Living (ADLs), requiring no care services from Licensee, beyond basic room and board. However, R1 had a general worsening in their baseline breathing ability during the complaint period. For example, between 08/11/2025 and 01/12/2026, facility staff called 911 on at least six (6) separate occasions due to R1’s difficulty breathing / shortness of breath episodes. Following one of their hospital visits in September 2025, a foley-type urinary catheter was prescribed to R1 (which R1 continues to use). R1’s updated LIC602 Physician’s Report from 09/16/2025 mentioned R1 having “acute lower respiratory infection,” “acute hypoxic respiratory failure,” “elevated brain natriuretic peptide level” (indicates increased stress, pressure, or fluid overload on the heart), and “urinary retention due to benign prostatic hyperplasia.” R1’s updated LIC602 Physician’s Report from 12/30/2025 mentioned R1 having “acute hypoxic and hypercapnic failure,” “COPD exacerbation,” and earlier “pneumonia.” On 10/22/2025, Licensee performed a formal care plan reassessment / reappraisal on R1, determining that R1, as of that date, required caregiver assistance with dressing once (1) per day, catheter care four (4) times per day, daily housekeeping, visual status checks three (3) times per day, and scheduled meal tray / room service three (3) times per day. These changes placed R1 at what Licensee called “Level 3” Care. On 01/22/2026, Licensee performed a second formal care plan reassessment / reappraisal on R1, determining that R1, as of that date, no longer required dressing assistance or meal tray / room service. However, R1 continued to require catheter care four (4) times per day and daily housekeeping. Also, visual status checks on R1 increased to six (6) times per day. These changes placed R1 at what Licensee called “Level 2” Care. [CONTINUED ON LIC 9099-C, 2 of 2] [CONTINUED FROM LIC 9099-C, 1 of 2] CCLD concluded that Licensee’s 10/22/2025 and 01/22/2026 care reappraisals / reassessments of R1’s needs were reasonable, given R1’s overall change in condition. Although R1 claimed that Licensee did not clearly explain to them how their monthly costs would change in connection with these care level changes, R1’s signature did appear on each of these reassessment / reappraisal documents. Manager interviews showed License verbally explained to R1 how their costs would change, and did mail R1 written disclosures reflecting the changes in their costs (i.e., showing before vs. after). Interview of R1, combined with interviews of multiple frontline caregivers and housekeepers, showed that Licensee’s staff delivered the above assessed care services to R1, in practice, during the effective dates. LPA also reviewed date-stamped electronic care task logs, which showed facility caregivers consistently initialed/signed that these assessed care tasks were delivered to R1 during the effective dates, in practice. Based on records and interviews, a preponderance of evidence does not exist to show that Licensee charged R1 for services not provided. The allegation is therefore Unsubstantiated, and no deficiency was cited for it. An exit interview was conducted with Executive Director Julia Lopez and Community Business Director Kitty Totorica, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 08-AS-20260206081522

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(1) · Plan of correction due date: Feb 20, 2026

87224 Eviction Procedures: “(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required…(1) Nonpayment of the rate for basic services within ten days of the due date.” This requirement was not met, as evidenced by: Based on records and interviews, Licensee issued a thirty (30) days written notice to 1 of 85 residents (R1) for nonpayment of basic services, but Licensee claimed a figure which was beyond the amount that was more than ten days past due. This posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee agreed to personally serve R1 with a letter informing them that the eviction letter dated 01/08/2026 is rescinded, due to an identified error. Licensee agreed to E-mail LPA a copy of the rescission letter, by the POC due date. (This does not preclude Licensee from reissuing a 30-day notice eviction letter to R1, with an amended date and dollar amount.)

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Receptionist Tessa Randolph. LPA later met with Executive Director Julia Lopez and Community Business Director Kitty Totorica. On 01/08/2026, Licensee served Resident #1 (R1) with a 30-day eviction notice letter, claiming nonpayment of fees/rent owed to Licensee. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] However, neither a written report nor a copy of R1’s eviction letter was sent to CCLD within five (5) days, as required by CCR 87224(f). One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Executive Director Julia Lopez and Community Business Director Kitty Totorica, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224 · Plan of correction due date: Feb 18, 2026

87224 Eviction Procedures: “(f) A written report of any eviction shall be sent to the licensing agency within five (5) days.” This requirement was not met, as evidenced by: Based on records review, Licensee did not send a written report of eviction regarding 1 of 85 residents (R1) to the licensing agency within five (5) days. This posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: CCLD has since received a copy of the eviction letter to R1 dated 01/08/2026, and investigated it. No further action is needed. Licensee agreed to discuss this learning point with Atria’s Collections Department. The Plan of Correction is Satisfied.

Allegation investigated: -Licensee did not provide needed level of care to resident. -Licensee did not ensure resident’s room was safe and healthful.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Resident Services Director Ashley Baino-Jaimes. The Complainants alleged that Licensee did not provide the needed level of care to Resident #1 (R1) and that Licensee did not ensure R1’s room was safe and healthful. [See LIC811 Confidential Names List for a description of R1.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of R1 and relevant staff and outside sources. The Department also reviewed pertinent care and administrative records. [CONTINUED ON LIC 9099-C, 1 of 2] Substantiated [CONTINUED FROM LIC 9099] The Complainants said between September 2025 and the filing date of the complaint (01/12/2026), R1 in practice needed help with mobility/transferring, personal hygiene tasks, and managing medical appointments, but facility staff were not consistently providing R1 this needed help. They also said R1’s room was malodorous and messy/cluttered, to include potential tripping hazards on the floor. Review of R1’s care records showed R1 diagnoses included Schizoaffective Disorder and Congestive Heart Failure. During his own 01/20/2026 site visit, LPA met and interviewed R1 inside their private apartment. R1’s room was malodorous with a strong fecal smell. LPA observed R1 did not flush their toilet after a bowel movement, and there was fecal staining around R1’s toilet seat, on the outside of R1’s toilet bowl, on R1’s bathroom floor, and on the carpet of R1’s bedroom. While R1’s clothes were clean during this visit, R1’s hair was dirty/unkempt, and their facial hair was about an inch-long and messy. While R1 was reluctant to pay more money for a higher level of care, R1 statements to LPA also revealed that they currently needed 1-Person Assistance from staff with Mobility/Transferring, Dressing, Grooming, Bathing, Bathroom Assistance, Status Checks, Medication Management, and Daily Housekeeping. Interview of facility management, corroborated by R1’s facility care records, showed: When R1 first moved-in on 11/13/2020, Licensee assessed R1 as then needing help with Transferring (Minimal Assist), Bathing (Standby Assist Once Per Week), Status Checks (Three Times Per Day), Medication Assistance, and Once-Per-Week Housekeeping, and Licensee prepared R1’s care plan accordingly. Then on 03/03/2021, Licensee reassessed R1, determining R1 now needed zero help with personal care tasks or status checks, beyond Medication Assistance and Once-Per-Week Housekeeping, and Licensee updated R1’s care plan accordingly. Then on 09/22/2025, Licensee again reassessed R1, determining R1 now needed help with Status Checks (Three Times Per Day), Medication Assistance, and Once-Per-Week Housekeeping, and Licensee updated R1’s care plan accordingly. Then on 01/19/2026, Licensee again reassessed R1, determining R1 now needed help with Mobility/Escorting (Limited), Bathing (Standby Assist Twice Per Week), Status Checks (3 Times Per Day), Medication Assistance, and Daily Housekeeping, and Licensee updated R1’s Care Plan accordingly. [CONTINUED ON LIC 9099-C, 2 of 2] [CONTINUED FROM LIC 9099-C, 1 of 2] CCLD received the complaint on 01/12/2026. While Licensee reassessed R1’s care needs as recently 01/19/2026, the level of care that Licensee determined still fell short of R1’s true, current care needs. Interviews of facility management and multiple visiting outside medical professionals (who were assigned to R1) showed that during the complaint timeframe, Licensee did not provide the level of hygiene care that R1 actually needed. Interviews showed Licensee did connect R1 to professional organizers/movers and a storage unit to reduce the clutter in R1’s bedroom during the complaint time frame. However, during LPA’s own 01/20/2026 visit, he saw multiple objects still on R1’s bedroom floor which were potential slip/trip hazards. Interview of R1 and manager, corroborated by past self-submitted LIC624 Incident Reports received at CCLD from Licensee, showed R1 had a history of falls. [During today's visit, LPA directed Licensee’s staff to provide immediate housekeeping services for R1's bedroom.] Per interview of facility management, Licensee is currently assisting R1 with managing their medical appointments. Based on records and interviews, a preponderance of evidence exists to show that at least during the complaint time frame, Licensee did not provide the needed level of care to R1 and that Licensee did not ensure R1’s room was safe and healthful. Both allegations are therefore Substantiated. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). Plans of Correction were jointly developed with the Licensee. An exit interview was conducted with Resident Services Director Ashley Baino-Jaimes, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. A duplicate set of these same documents was E-mailed to Executive Director Julia Lopez.the state’s words, verbatim · CDSS document, Jan 20, 2026 · control 08-AS-20260112145952

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 20, 2026

87464 Basic Services: “(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident…with those activities of daily living such as dressing, eating, bathing…” This requirement was not met, as evidenced by: Based on LPA observation, records, and interviews: Licensee did not provide all personal assistance and care that was needed by 1 of 88 residents (R1), which posed a potential health and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 20, 2026

Plan of correction: During today’s visit, Licensee performed a written reappraisal of R1’s care needs and updated R1’s care plan, with the effect that R1 will receive staff assistance with Mobility/Escorting, Transferring, Dressing, Grooming, Bathing (Standby Assist Twice Per week), Bathroom Assistance, Status Checks (3 Times Per day), Medication Assistance, and Daily Housekeeping. The Plan of Correction is Satisfied.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(2) · Plan of correction due date: Jan 20, 2026

87307 Personal Accommodations and Services: “(d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.” This requirement was not met, as evidenced by: Based on LPA observation and interviews, Licensee did not provide a safe and healthful environment to 1 of 88 residents (R1), which posed a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 20, 2026

Plan of correction: During today’s visit, Licensee agreed to immediately deep clean R1’s bedroom carpet, bathroom floor, and toilet, and to perform thorough housekeeping in R1’s bedroom. R1’s current care plan already has them set up on daily housekeeping services. The Plan of Correction is Satisfied.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Dang Nguyen conducted a return visit to continue a Required Annual Inspection that began on 12/16/2025. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Community Business Director Kitty Totorica. LPA also met with Resident Services Director Ashley Baino-Jaimes and Maintenance Director Omar Zamudio. According to the facility’s license, the facility has a maximum capacity of one-hundred-eighty-five (185) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Additionally, the facility has an approved waiver for ten (10) hospice care residents. Per LPA observation, care records, and staff interviews: During today’s inspection, there were a total of ninety-four (94) residents in care, of whom sixty-seven (67) were non-ambulatory, twenty-seven (27) were ambulatory, and none were bedridden. Two (2) of these residents were under hospice care. LPA reviewed records for multiple residents and multiple staff. LPA interviewed multiple residents and multiple staff. LPA, accompanied by Licensee’s staff, also toured the interior and exterior of the facility, and inspected all common areas and multiple resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 72 F. [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] Where tested, hot water temperature at taps accessible to residents were all compliant: Room #101 Sink was 111.9 F, Room #113 Sink was 116.1 F, Room #122 Sink was 111.7 F, Room #128 Sink was 115.3 F, Room #202 Sink was 113 F, Room #207 Sink was 117.5 F, Room #221 Sink was 107.1 F, Room #227 Sink was 114.4, Room #303 Sink was 108.1 F, Room #305 Sink was 107.4 F, Room #314 Sink was 107 F, Room #317 Sink was 109.2 F, Room #401 Sink was 106.9 F, Room #415 Sink was 108.9 F, and Room #425 Sink was 108 F. Appliances to preserve perishable food were also all compliant in temperature: Main Walk-In Refrigerator was 40 F. Freezers were 0 F. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No fireplaces, pools, or bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detectors, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. There were reserve supplies of Personal Protective Equipment (PPE). Licensee presented proof of current business liability insurance. During the facility tour, LPA observed, and manager interview confirmed: The facility has two (2) perimeter exit doors which have 15-second delayed-egress mechanisms. However, the facility’s existing Fire Clearance document (dated 02/15/2011) did not include approval for delayed-egress devices. During a review of client records, LPA observed, and manager interview confirmed: For five (5) of five (5) sampled residents [Resident #1 (R1) through Resident #5 (R5)], Licensee did not have in their record of care the name, address, and telephone number of the residents’ dentist to be called in an emergency, as required. For one (1) of five (5) sampled residents (R1), Licensee did not have documentation that the resident received an annual routine visit (also known as an annual “physical” or “check-up”) with their respective licensed medical professional (or alternatively, documentation of the resident and responsible person’s refusal or such), as required. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] Three (3) deficiencies were cited per California Code of Regulations, Title 22 (refer to the LIC809-D pages). Plans of Correction were jointly formed with the Licensee. LPA also issued Technical Assistance (TA) regarding periodically measuring residents’ body weights and regarding specific skills training for direct care staff (refer to the attached LIC 9102-TA pages). An exit interview was conducted with Maintenance Director Omar Zamudio and Dining Services Director Fernando Soto. A copy of this report, the LIC 809-D pages, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were during today’s visit. Copies of the same were E-mailed to Executive Director Julia Lopez, Resident Services Director Ashley Baino-Jaimes, Community Business Director Kitty Totorica, and Maintenance Director Omar Zamudio.the state’s words, verbatim · CDSS document, Dec 30, 2025

Allegation investigated: Staff threatened resident. Staff engaged in inappropriate behaviors with resident.

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to conclude a complaint investigation and deliver findings. LPA identified herself with Community Business Director (CBD) Totorica and explained the purpose of the visit. On October 14, 2024, the Department received a complaint alleging that Resident 1 (R1) was threatened by staff and that staff engaged in inappropriate behaviors with R1. The Department’s investigation included a review of a coinciding complaint filed on September 5, 2024, alleging sexual abuse of R1 by a staff member that was investigated by the Department and determined Unsubstantiated on September 26, 2025, the investigation included interviews with R1, as well as interviews with additional facility staff, and outside sources, and a facility records review, It was alleged that approximately five weeks prior to the filing of the complaint, a male staff member with access to R1’s room would enter and wait for R1 to return. It was further alleged that the staff member asked R1 to engage in acts implying sexual assault, covered R1’s mouth, and threatened to kill R1 if they disclosed the incidents. Unsubstantiated During an interview with R1, they were unable to provide any identifying details about the alleged perpetrator beyond their gender. A review of the Department’s investigation conducted in September of 2024, revealed that multiple entities; including the Department, law enforcement, the facility’s Executive Director (ED), additional facility staff, and outside sources all corroborated that during interviews with R1 they exhibited signs of confusion, disorganized thought, and provided inconsistent statements. R1’s accounts varied significantly in terms of timelines, events, and specific details. A review of the police report indicated that law enforcement determined no criminal activity had occurred and subsequently closed the case. Additionally, a medical examination conducted in response to the allegations revealed that R1 tested positive for a urinary tract infection (UTI), which was cited by the attending physician as a contributing factor to R1’s confusion and inconsistent reporting. Based on interviews conducted and records reviewed, the allegations are determined to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged incidents did or did not occur. An exit interview was conducted with CBD Totorica. A copy of this report, along with the Appeal Rights, was provided. Signature below confirms receipt of the report.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 08-AS-20241014143933

Allegation investigated: Staff did not prevent inappropriate interactions between residents while in care

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to conclude a complaint investigation and deliver findings. LPA identified herself with Receptionist Tessa Randolph, met with CBD Totorica, and explained the purpose of the visit. The Department’s investigation included interviews with staff and residents, as well as reviews of facility, residents, and outside source records. On February 10, 2025, the Department received a complaint alleging that staff failed to prevent inappropriate interactions between residents while in care. An interview with Resident 1 (R1) disclosed that Resident 2 (R2) had groped them at the facility. Staff 1 (S1) reported that R1 disclosed the incident to them, stating that R2 touched them inappropriately. S1 informed R1 that they intended to contact law enforcement to file a report; however, R1 declined and requested that facility staff handle the situation internally. An interview with Staff 2 (S2) revealed they discussed personal rights with R2 to whom they agreed to be more respectful to residents in care. Unsubstantiated [Continuation from LIC 9099] A review of R1’s records revealed they were admitted to the facility on February 3, 2025. Prior to admission, R1 had undergone two hip and knee replacements and was diagnosed with Mild Intellectual Disorder (MID), macular degeneration, depression, hypertension, and anxiety. R1 was non-ambulatory, considered a fall risk, but was able to leave the facility unassisted. A review of R2’s records showed they were admitted on February 29, 2024, following a stay at a Skilled Nursing Facility (SNF) due to a hip fracture. R2 was non-ambulatory and diagnosed with MID, atrial fibrillation (A-fib), hypertension, chronic obstructive pulmonary disease (COPD), depression, anxiety, Hyperlipidemia, arthritis, alcohol use disorder (ETOH), and alcoholic hepatitis. Records also indicated R2 was easily agitated but generally kept to themselves. Interviews with S1 and the facility’s Executive Director (ED) described R2 as quiet and non-problematic, and both expressed surprise at the allegation. They confirmed that no further incidents had occurred. The ED, who was informed of the incident by R1, stated that R1 and R2 had crossed paths at the facility and were in each other’s way when R2 swatted R1 on the bottom. Additionally, Staff 3 (S3) reported that no staff witnessed the incident and that all residents were gathered in the dining hall for dinner at the time. A review of outside source records corroborated that R1 preferred the facility to handle the situation, and did not wish to press charges. An additional interview conducted with R1 corroborated and they confirmed no other occurrences have happened at the facility . The incident was self reported to the Department on February 8, 2025, the day of the incident. Based on interviews and records reviews the allegation was determined to be Unsubstantiated. An Unsubstantiated finding means, although the allegation may be valid there was not a preponderance of evidence to prove the violation had occurred. An exit interview was conducted with CBD Totorica, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided. Signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 08-AS-20250210133700

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Julia Lopez and Community Business Director Kitty Totorica. During today’s visit, LPA briefly toured the lobby area, interviewed managers, and reviewed a selection of employee/personnel records. During review of personnel files, LPA observed, and manager interview confirmed: One (1) of forty-six (46) employes, Staff #1 [S1], did not have a Criminal Background Clearance to work, as required. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] S1 had worked at the facility since March 2024. For two (2) of five (5) sampled personnel records [Staff #2 (S2) and Staff #3 (S3)], Licensee did not have on file a copy of that employee’s LIC503 Health Screening (or similar proof of a pre-employment physical exam with a physician), as required. (Both caregivers had proof of a negative Tuberculosis result, however.) For one (1) of five (5) sampled personnel records (S3), Licensee did not have proof that the employee had current First Aid Training from persons qualified by such agencies as the American Red Cross, as required. S3 was direct care staff. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection. Three (3) deficiencies were cited today per California Code of Regulations, Title 22 (see the attached LIC809-D pages). Since one of these deficiencies was regarding a staff background clearance, and immediate civil penalty of $500 was assessed (refer to the LIC421-BG page). Plans of Correction were jointly formed with the Licensee. An exit interview was conducted with the Executive Director Julia Lopez and Community Business Director Kitty Totorica, to whom a copy of this report, the LIC809-D pages, the LIC421-BG page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Dec 16, 2025

Allegation investigated: Facility staff yelled at resident in care. Facility staff did not respond to residents' requests for assistance in a timely manner.

Licensing Program Analyst (LPA) Tiffany Holmes conducted a facility visit to conclude a complaint investigation. LPA gained access to the facility, identified herself and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. The Department’s investigation consisted of staff and resident interviews, a facility tour, and a facility records review. The initial visit was on 09/16/2024. It was alleged that the facility staff yelled at resident in care and the facility staff did not respond to residents' requests for assistance in a timely manner. Interviews conducted with facility staff revealed Resident 1 (R1) walked into the kitchen where it is noted that no residents are allowed and the staff asked R1 to leave. Interviews revealed they did not yell at R1 but was adamant about the resident leaving for their own safety. Interviews revealed R1 was able to get in the kitchen area and the staff tried to explain to R1 that they needed to leave out due to many reasons for instance, the floors can be wet, there are sharp objects, hot items, etc. Interviews revealed R1 eventually left out of the kitchen. Interviews revealed when residents need assistance they hit their call button/ pendant that is around their neck or their watch. Once the pendant is activated the alert goes to all care providers. They have at least 10 minutes to assist the residents by going to their room and asking what they need. The pendant is reset by touching the residents and staff pendant and then the care team recieves a text that it has been reset. Interviews revealed there haven't been any complaints to the ED that the residents needs have not been met. Based on the evidence obtained, there was insufficient evidence to prove that the facility staff yelled at resident in care and facility staff did not respond to residents' requests for assistance in a timely manner. The allegations are unsubstantiated. An exit interview was conducted with Lopez, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 11, 2025 · control 08-AS-20240813104131

Allegation investigated: Unlawful eviction Staff did not permit resident access to personal belongings Staff did not prevent residents from engaging in inappropriate behavior Staff speak inappropriately to residents Staff did not provide transportation assistance to residents’ medical appointments Staff do not ensure the facility is clean and sanitary

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude a complaint investigation and deliver findings. LPA identified herself to and met with Community Business Director (CBD) Tortarica to whom was explained the purpose of the visit. The Department's investigation included facility and resident records reviews and resident, staff, and outside source interviews.The investigation also included a facility tour. A review of Resident 1’s (R1) records revealed R1 moved into the facility on April 18, 2022. On June 4, 2025, the Department received a complaint that alleged R1 was unlawfully evicted. Interviews with the Executive Director (ED), facility staff, and residents confirmed R1 had purchased a motorized scooter and repeatedly failed to follow staff instructions regarding safe operation. R1 was reportedly reckless, crashing into the front desk, medication cart, and nearly colliding with residents and staff. Documentation showed that on January 21, 2025, R1 was issued a 30-day notice citing multiple safety concerns related to their use of the scooter. Unsubstantiated It was also alleged that staff restricted R1’s access to personal belongings, specifically a television and phone. An interview conducted with the ED disclosed that R1’s family member picked up all of R1’s belongings. A resident record review showed no items listed on R1’s inventory list of personal belongings. Additionally, It was alleged that staff failed to transport R1 to medical appointments and began charging for transportation services. Per the facility admission agreement, the facility’s policy states transportation is provided at no cost within a 10-mile radius, with a $25 fee beyond that. Staff 1 (S1) stated in the past, new residents were not charged the $25 fee for transport over 10-miles to allow them time to adjust and understand the facility’s transportation policy, and schedule visits accordingly. Records showed that transportation was offered and provided to R1 in accordance with policy. It was also alleged staff speak inappropriately to residents in care. Interviews with staff and residents did not corroborate this allegation. All parties reported that staff did not speak inappropriately to R1. However, multiple sources (staff and residents) stated that R1 frequently used inappropriate language toward staff and residents, including political rants, blocked access to elevators and doorways, and made derogatory remarks. It was also alleged that two residents engaged in explicit behavior on the facility transport bus. However, the residents involved were not identified, and staff interviewed had no knowledge of the incident. Lastly, it was alleged the facility is not clean and sanitary. Specifically, It was alleged the ED brings their dog to the facility and the dog urinated and defecated around the facility, including the communal dining area. Interviews conducted with staff and residents, and a facility tour yielded no corroborating evidence. At the time of facility tour it was observed to be clean and sanitary. Additionally, during the tour cleaning staff were observed throughout the facility. During several unrelated visits, for long periods of time, LPA has met the ED’s dog and never observed the dog having an accident and has never received any complaints or negative feedback regarding the dog. There are several residents at the facility that have dog,, for residents that are unable to walk their dog the facility has/had dedicated staff to take them on walks to use the bathroom and is included int their care plan. In addition, facility policy states pets are not allowed in the communal dining area. Based on record reviews and interviews with facility staff and outside sources the above-mentioned allegations were determined to be Unsubstantiated. An Unsubstantiated finding means the preponderance of evidence to prove the violation/s occurred was not met. An exit interview was conducted with CBD Tortarico, to whom a copy of this report, and Licensee Rights (LIC 9058), will be provided. The signature below confirms receipt of the reportsthe state’s words, verbatim · CDSS document, Nov 19, 2025 · control 08-AS-20250604134152

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Julia Lopez. Today's visit was in response to an SOC341 Report, which licensee self submitted to the CCLD San Diego Regional Office (received on 10/24/2025). According to the SOC341, on 10/15/2025, Resident #1's (R1's) Outside Source (OS1) [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] reported R1 was missing money. The facility followed their theft and loss protocol and immediately investigated the report of missing money. During today’s visit, LPA performed a facility tour; R1 is currently at the hospital, and LPA was unable to interview R1. OS1 was unable to be interviewed at this time due to being out of town on vacation. LPA interviewed pertinent managers and collected relevant care records on R1 during the visit. According to their LIC602 Physician’s Report, R1’s documented on the LIC602, No Cognitive Impairment, and their doctor had determined that R1 was able to make their own decisions. The Needs and Services Plan (Care Plan), which the Licensee authored, reiterated that R1 is their own responsible party and is able to make their own decisions.”R1 needed assistance with activities of daily living. R1 was admitted to the facility on 10/14/25 and is currently at the hospital. [Continue on LIC809C] [Continued from LIC809] No immediate health or safety risks were observed and no deficiencies were cited during this visit. Additional case management will be provided for this incident, including subsequent visits and resident and outside source interviews, as needed. An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22) were left with the Administrator Julia Lopez, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Oct 28, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Engage Life Director Naomie Peterson. LPA also met briefly with Resident Services Director Ashley Baino-Jaimes, LVN. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 10/13/2025). According to the LIC624, on 10/13/2025, Resident #1 (R1) eloped from the facility (left without staff supervision), walking to a nearby grocery store to buy beer. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] Facility staff located R1 around 1 to 2 hours later and brought them back to the facility, unharmed. During today’s visit, LPA performed a brief facility tour and welfare check and interview of R1, verifying that they were safe and uninjured from the incident. LPA interviewed multiple pertinent managers and frontline staff and collected relevant care records on R1. According to their LIC602 Physician’s Report, R1’s diagnoses included Mild Cognitive Impairment (MCI), and their doctor had determined that R1 was not safe to leave the facility unassisted. The Needs and Services Plan (Care Plan) which Licensee authored reiterated, “[R1] must be supervised when leaving the community.” [CONTINUED ON LIC 809-C, 1 of 2] [CONTINUED FROM LIC 809] Records and interview showed: Prior to 10/13/2025, R1 had no prior elopements or elopement attempts, and did not exhibit agitation, wandering, or exit-seeking behaviors. On 10/13/2025, facility receptionist Staff #1 (S1) last saw R1 enter the facility's first floor public restroom around 3:00 PM. R1 was calm at that time; R1 did not say anything to S1 about wanting to go to the store or wanting to leave the facility. Around 4:00 PM, caregiver Staff #2 (S2) went to R1’s bedroom to escort them to dinner in the dining room. Upon finding R1 and their walker absent from their bedroom, S2 alerted teammates. Facility managers placed timely phone calls to R1’s responsible person (RP) and physician/hospice personnel, to notify them of the problem. A dining room waitstaff/server Staff #3 (S3) quickly came forward to report that sometime earlier around 3:10 PM, they had personally observed R1 on the sidewalk outside the facility, walking up a hill and near a crosswalk that was less than 100 yards from the facility. (However, S3 at that time did not recognize this as a safety problem and did not notify their teammates; S3 was unsure whether R1 was allowed to leave the facility unassisted.) Two (2) facility managers thus got into cars and traveled in that general direction, locating R1 in a grocery store parking lot around 4:45 PM. R1 was unharmed, and given a ride back to the facility. Per LPA’s interview of R1, although they were somewhat forgetful, R1 confirmed on the date in question, they walked went to the store to buy beer, and that they exited the facility via the lobby front door. During today’s visit, LPA observed/evaluated the layout of the facility’s lobby from different angles, with a focus on where the receptionists’ chair at the front desk is positioned in relation to the facility’s front door. LPA observed that the receptionist’s line of sight, from their chair to the front door, is currently partially impeded, due to the chair not being well-aligned with the front door. It was therefore possible for a resident to exit the common area “activity room” and reach the front door, all without the receptionist seeing them. LPA observed that by slightly rearranging items on the existing front desk (without changing out or moving the desk), it would be possible to slide the receptionists’ chair over by one (1) foot and thus give them full view of the lobby front door, from where they sit. LPA queried two (2) receptionists, who agreed such an arrangement could comfortably work for them. [This will be part of Licensee’s Plan of Correction.] [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] CCLD’s investigation concluded: Licensee had an Absentee Notification Plan for R1, as required, and essentially followed it during this incident. However, R1 was able to leave the facility without S1 observing/noticing, which represents a temporary lapse in supervision. S3 saw R1 outside the facility but did not immediately recognize this as a safety risk, which represents a lapse in competency/training. CCR 87468.2(a)(4) guarantees residents’ right to care and supervision that “meet their individual needs and are delivered by staff that are sufficient…in competency to meet their needs.” One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Engage Life Director Naomie Peterson, to whom a copy of this report, the LIC809-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 16, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a) …residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in…competency to meet their needs.” This requirement was not met, as evidenced by: Based on records and interviews, Licensee did not ensure that 1 of 98 residents (R1) had the care and supervision needed to meet their individual needs. This posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: On 10/14/2025, Licensee performed an elopement drill and training for staff. Licensee agreed to: a) Rearrange the layout of the facility’s front desk, such that the receptionists can sit fully to the far left edge of the desk, with an unobstructed view of the lobby front door; b) Add resident photographs to the existing document/list of residents who are not able to safely leave the facility unassisted; and c) Post or make this document readily viewable to staff in each division/department (i.e., reception, med room, care office, activity office, maintenance office, etc.). Licensee agreed to photograph (a) through (c), and to send proof of completion to LPA, by the POC due date.

Allegation investigated: Sexual abuse

Licensing Program Analyst (LPA) Sarah Hurt conducted a zoom call on 09/26/2025 to deliver Complaint findings. LPA spoke with facility Administrator Julia Lopez and explained the purpose of the telephone call. Regarding the allegation of sexual abuse. The Investigations Branch reviewed the allegation and determined Resident 1 provided inconsistent statements regarding the alleged incident. Law enforcement was notified and determined no criminal activity occurred. Medical evaluation confirmed the resident had a medical condition, which possibly contributed to confusion. Facility records and staffing schedules showed no evidence supporting the allegation. Based on interviews conducted and records reviewed, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged did or did not occur. Nothe state’s words, verbatim · CDSS document, Sep 26, 2025 · control 08-AS-20240905110634

Allegation investigated: Facility did not notify residents of planned power outage. Facility did not ensure adequate emergency lighting. Facility did not ensure a comfortable temperature for residents.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above complaint allegations. LPA Correia was greeted by front lobby Receptionist Muhammad Wright, identified herself, and discussed the purpose of the visit. LPA then met with Executive Director (ED) Julia Lopez to whom was explained the purpose for the visit. The Department’s investigation included staff, resident, Outside Source interviews, and a review of Outside Source records. It was alleged staff did not ensure a safe environment during a 7-hour power outage on December 18, 2023. On December 19, 2023, the Department received a complaint regarding a planned power outage that the facility did not prepare for. An interview conducted with the Executive Director (ED) revealed they believed power outage was not planned and did not have prior knowledge of the outage. [Continued on LIC9099C] Substantiated [Continuation of LIC9099] An interview conducted with Staff1 (S1) reported on December 18, 2023, when leaving their shift at approximately 10:00PM, saw the street in front of the facility had been blocked off. S1 stated they walked back into the facility and observed the facility lights were off and all power was shut down. S1 stayed to assist the two (2) other care staff (S2 and S3) until 6:00 AM the following morning. S1 also disclosed they, along with S2 and S3, checked on the residents with flashlights every 2 hours, and the Director of Maintenance (DOM) came to the facility for approximately 1.5 hours. An interview conducted with the DOM corroborated they came to the facility to confirm the generators that provided electricity to the facility kitchen and resident hallways were operational. DOM also revealed the generators did not provide power to the resident rooms. An Outside Source interview and a review of secured Outside Source records confirmed the power outage was planned. Outside Source also confirmed a notification letter was sent to the corporate office on December 4, 2023, and an Outside Source interview revealed an additional 2 automated notification calls were sent a week prior and the day of the power outage. [See LIC 811 for Confidential Names] Based on evidence obtained, the allegation is substantiated because the preponderance of the evidence standard has been met. Deficiency is being cited in accordance with the California Code of Regulations, Title 22, Division 6 Chapter 8, and listed on the attached 9099D. An exit interview was conducted with ED Lopez. ED Lopez was informed a copy of this report along with the Licensee Rights (LIC 9058 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 08-AS-20231219090838

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(d)(5) · Plan of correction due date: Jul 30, 2025

Reporting Requirements (d) The Licensee shall notify… all residents… in writing within two business days of…the following… (5) A utility company has sent a notice of intent to terminate electricity… within…15 days…. This requirement was not met as evidenced by: Based on a resident and staff interviews the facility did not provide advanced written notice of a planned power outage in December to R1. This posed a potential Health and Safety, and Personal Rights risk to [R1], 1:91 residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: ED Lopez agreed to call Corporate office to ensure utility ageency notifications are brought to the communities attention. ED will provide CCL with written documentation of Corporate communication with all utility agencies regarding notification of any disturbance in service by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303)(h) · Plan of correction due date: Jun 23, 2025

Maintenance and Operation (h) Emergency lighting shall be maintained. ...this shall include flashlights, or other battery powered lighting, readily available in appropriate areas accessible to residents and staff. This requirement was not met as evidenced by: Based on a resident and staff interviews the facility did not provide readily available emergency lighting or heat to R1's room. This posed a potential safety risk to [R1], 1:91 care.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: ED Lopez will ensure an emergency supply is easily accessible to staff to ensure adequate lighting for residents in care throughput the facility. LPA observed and secured photos of the current supply of readily available battery powered lighting for residents in care. Deficiency is cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b)(1) · Plan of correction due date: Aug 25, 2025

Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times.(1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not met as evidenced by: Based on a resident and staff interviews the facility did not provide alternative forms of heat during a power outage to R1's room. This posed a potential Personal Rights risk to [R1], 1:91 residents in care.the state’s words, verbatim · CDSS document, Jul 23, 2025

Plan of correction: ED will ensure an extra supply of blankers are available to residents in care in the case of a power outage or any malfunction of an HVAC unit. LPA observed and secured photos of the current supply of readily available blankets for residents in care. Deficiency is cleared.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Case Management visit. LPA met with Executive Director (ED) Lopez and discussed the purpose of the visit. During today's visit LPA obtained signatures on an amended complaint. An exit interview was conducted with ED Lopez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) will be provided.the state’s words, verbatim · CDSS document, Jul 23, 2025

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude a complaint investigation. LPA was greeted by front lobbyist Muhammad Wright, introduced herself, and met with Resident Service Coordinator (RSC) Irma Miranda who was notified about the purpose of the visit. It was alleged that the facility served Resident1 (R1) an unlawful eviction on June 13, 2025, an amended version of a 30-day eviction R1 was served on June 4, 2025. On June 4, 2025, the Department received a complaint regarding the eviction being unlawful. A review of the eviction notice dated June 13, 2025, revealed the eviction was issued to R1 for non-compliance with medication management which was included in the original eviction notice and is also included in the complaint. [See LIC811 Confidential List of Names] A review of R1’s facility records revealed they were admitted to the facility on February 23, 2023, with a primary diagnosis of Complex Regional Pain Syndrome (CRPD), was non-ambulatory, suffered from depression, and was not allowed to leave the facility unassisted however, R1 was able to self-medicate. [Continued on LIC 9099C] *This is an amended report of the original version dated July 15, 2025. Unsubstantiated [Continuation of LIC 9099] A review of R1’s facility records dated February 24, 2023, revealed R1’s Primary Care Physician (PCP) concurred that self-storage and administration is safe,” “and the “Resident agrees to keep medications in a locked cabinet or drawer and will lock apartment door when not in apartment. Further review of R1’s resident records showed R1’s history of non-compliance regarding safeguarding their medication when R1 was still deemed able to self-medicate. Records include the following but are not limited to; facility records dated March 10, 2023, revealed facility Staff1 (S1) documented that R1 had medications out in their room and S1 and Staff 2 (S2) both told R1 they needed to purchase a lock box to store their medications however R1 got upset and refused. On April 4, 2023, the Executive Director (ED) observed R1 had opened bottles of medications out in their room, the ED emailed R1’s PCP regarding non-compliance with self-medicating. A review of R1’s facility records also revealed on April 27, 2023, R1 had misplaced their medication and subsequently a new prescription was ordered and staff delivered them to R1 by 9:00 am the following morning. Additionally, on June 7, 2023, R1 reported they never received that same prescription that had been ordered twice, and facility staff were able to locate the bottle under R1’s bed. On March 25, 2025, the Department received a 3-Day eviction notice that disclosed R1 received a prescription of a 224 count of Narcotic Painkillers, on that same day, prior to access to their prescription had made suicidal threats to Staff 3 (S3) by means of taking their entire bottle of pain killers at once. Upon S3 notifying management safety measures were put in place, including a search of R1's room for the medication, that were not found and remain unaccounted for to date. The Resident Service Director (RSD) also revealed they found other medication bottles in R1’s room that contained medication that did not match the prescription label. An interview with the ED revealed they followed the facility protocol, removed all R1’s medications that were found from their room, placed R1 on 1:1 supervision, and contacted R1’s PCP for an updated Physician’s Report. However, the PCP only sent a letter that stated R1 can handle their own medication. A follow-up interview conducted with the ED, on July 12, 2025, revealed after multiple requests to the PCP, they have not sent an updated Physician’s Report to date. [Continued on LIC 9099C] This is an amended version of the original report delivered on July 15, 2025. [Continuation of LIC 9099C] On June 23, 2025, the facility received a complaint that alleged a Personal Rights violation due to the facility staff taking R1’s medications, and after a thorough investigation by LPA Nguyen, that revealed R1 was not in-compliance with facility protocol regarding procedures of safeguarding Narcotic medication, and R1 was not taking their medication as prescribed, the complaint was determined unsubstantiated which allowed the facility to continue centrally storing R1’s medication and implement Medication Management, and had R1 re-assessed by a third party Physician’s Assistant (PA), that determined R1 was not able to manage their own medication. In the event R1’s PCP conducts a reassessment of R1 and deems them able to self-medicate, California Code of Regulations (CCR) Section 87463(e) supports the right and responsibility of Licensees to conduct their own care assessments parallel to medical assessment(s). When health/safety concerns and/or unresolved questions are identified, regulation requires Licensees to further communicate with the physician to obtain recommendations on these issues. However, Licensees retain some independence in forming the written record of care that the resident shall receive while living at the facility, particularly when provisions reasonably uphold resident health/safety in balance with resident rights.” The interview conducted with ED on July 12, 2025, as previously mentioned, revealed R1 remained non-compliant even after being placed on Medication Management. The ED revealed R1 continued to have their Prescriptions refilled and have picked them up from Pharmacies on their own. In addition, R1 has prohibited staff from removing them from their possession. R1 also continues to have their medication unsecured and sprawled around their room. Due to R1’s continued noncompliance with medication management R1 was given a 30-day eviction notice on June 4, 2025, and an amended version on June 13, 2025, which resulted in the current complaint regarding and unlawful eviction that was under investigation. Based on staff interviews and record reviews revealed a preponderance of evidence that R1 has displayed disregard to the facility’s policy regarding safeguarding their medication, therefore the complaint regarding an unlawful eviction was determined to be unsubstantiated. An UNSUBSTANTIATED finding means that there was not a preponderance of evidence to prove the violation occurred. An exit interview was conducted with Irma Miranda,, to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) will be provided after the conclusion of the visit. This is an amended complaint from the original version dated July 15, 2025.the state’s words, verbatim · CDSS document, Jul 13, 2025 · control 08-AS-20250604143643

Allegation investigated: Licensee did not allow resident to keep their own medication.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Community Business Director Kitty Totorica. LPA then met with Executive Director Julia Lopez and Resident Services Director Ashley Baino-Jaimes, who arrived later during the visit. The Complainant alleged that Licensee did not allow Resident #1 (R1) to keep their own medication without just cause. [See LIC811 Confidential Names List for a description of person identifiers used in this report.] CCLD’s investigation involved multiple unannounced facility tours, a welfare check, and interviews of R1 and facility staff. The Department also reviewed pertinent care records and correspondence. [CONTINUED ON LIC 9099-C, 1 of 3] Unsubstantiated [CONTINUED FROM LIC 9099] Records and interviews of R1 and facility staff aligned to show: Leading up to the complaint time frame, R1 was diagnosed with depression and a chronic neurological condition which caused them constant and intense pain. R1, who was their own responsible person, was also responsible for storing and taking their own medications, which included opioids. On 05/25/2025, R1 told Staff #1 (S1) that they were in so much pain they wanted to kill themselves by ingesting an entire bottle of medication. S1 quickly escalated this information to facility manager Staff #2 (S2). S1 and S2 both told LPA they interpreted R1’s statement at that time as a credible plan to harm self, with access to method/means present. R1 told both S2 and LPA they were speaking dramatically and not literally on 05/25/2025, and had no desire to commit suicide. Records and staff interviews further showed: Licensee took quick action that day to safeguard R1, which included calling 911 and notifying R1’s assigned physician (P1). R1 declined to go to the hospital for a psychiatric evaluation. P1 told first responders via phone they supported R1’s decision. R1 thus did not go to the hospital. Licensee also utilized a third-party home-care agency to provide continuous one-on-one supervision of R1, pending a psychiatric assessment to clear R1 of suicide-risk. That same day, Licensee also requested from P1 an updated list of prescribed medications for R1, which Licensee needed to successfully reevaluate R1’s ability to accurately self-manage their medications per their prescriptions. However, P1 replied they were out of town, away from their computer, and could not timely send such a list. In lieu of a fast response from P1, and with R1’s consent, Licensee arranged for R1 to be evaluated face-to-face on 05/28/2025 by a mobile, third-party psychiatric nurse practitioner (P2), operating under the oversight of a physician assistant (P3). P2 and P3 were not entirely new providers; each healthcare professional had previously treated/visited R1 in the past. P2’s psychiatric assessment concluded that R1 had “low to moderate risk” of suicide. However, P3 subsequently authored an updated LIC602 Physician’s Report, indicating that facility staff should store and administer R1’s medications. On 06/02/2025, facility managers met with R1 to take over storage and management of R1’s medications. [CONTINUED ON LIC 9099-C, 2 of 3] [CONTINUED FROM LIC 812-C, 1 of 3] On 06/03/2025, P1 evaluated R1 via a tele-medicine appointment, then sent a signed letter to Licensee essentially saying that while P1 was aware of what earlier transpired on 05/25/2025, they had been assigned to R1 over two years and believed R1 was “not actively suicidal.” P1 determined that one-on-one supervision was not needed, that evaluation by a psychiatrist was not needed, and that R1 should go back to independently storing and taking their own prescribed medications. Upon receipt of this letter, Licensee discontinued one-on-one supervision for R1. However, Licensee then requested from P1 an updated list of R1’s prescribed medications and an updated LIC602 Physician’s Report showing that R1 could self-manage medications (to override/overturn the earlier LIC602 completed by P3). As of 07/01/2025, Licensee had not received these documents from P1 and was thus continuing to centrally-store and manage R1’s medications. CCLD interviewed R1 twice for this case, a few days apart, finding: To the lay observer, R1 was alert, oriented, and articulate, with no signs of memory-impairment. R1 continued to deny intent to commit suicide. However, LPA identified areas of potential concern, requiring further research, assessment, and/or education w/ R1: 1) The pharmacy prescription label on R1’s bottle of Oxycodone immediate-release tablets for pain lacked clear dosage instructions, saying instead, “Please see attached for detailed instructions.” The corresponding pharmacy paperwork that arrived with this medication also said, “Please see attached for detailed directions.” When LPA asked R1 how they typically took their Oxycodone medication, R1 gave inconsistent answers regarding the time-spacing and maximum number of tablets they would consume per typical day; 2) During his 06/27/2025 site visit, LPA observed inside R1’s room an empty bottle which once contained Oxycodone extended-release tablets for pain. The prescription label showed one tablet was to be taken twelve (12) hours apart. R1 said they took this medication just twice per day. However, per the label, sixty (60) tablets were dispensed on 06/02/2025; that R1 ran out of tablets suggests there were days earlier in the cycle when R1 consumed more than two tablets per day; 3) Regarding their as-needed Clonazepam tablets for anxiety, R1’s statements showed they did not consistently adhere to the prescribed time-spacing instructions for this medication; 4) Regarding their as-needed Hydroxyzine tablets for itching, R1’s statements showed they did not adhere to the prescribed maximum daily dose for this medication; 5) LPA observed multiple bottles of wine/liqueur near R1’s bed. Staff interviews showed a recent increase in R1’s ordering of wine/alcohol from outside sources (which have been dropped off at the facility’s front desk). Per R1’s own statements, they are nearly continuously medicated with opioids during their waking hours. P1 should clarify for Licensee if alcohol is contraindicated with R1’s current medications. [CONTINUED ON LIC 812-C, 3 of 3] [CONTINUED FROM LIC 812-C, 2 of 3] The totality of available evidence showed: R1’s verbalizations on 05/25/2025 raised a credible safety concern at that time, to which Licensee diligently responded. Licensee’s taking over control of R1’s medications starting 06/02/2025, following the receipt of P3’s written medical assessment on R1 recommending such, was also justified. As the primary care physician of R1 for over two years, P1’s authority in this case supersedes that of P3’s. P1’s signed 06/03/2025 letter to Licensee was indeed valid physician instruction. However, California Code of Regulations (CCR) Section 87463(e) supports the right and responsibility of Licensees to conduct their own care assessments parallel to medical assessment(s). When health/safety concerns and/or unresolved questions are identified, regulation requires Licensees to further communicate with the physician to obtain recommendations on these issues. However, Licensees retain some independence in forming the written record of care that the resident shall receive while living at the facility, particularly when provisions reasonably uphold resident health/safety in balance with resident rights. At the conclusion of CCLD’s complaint investigation, there remained unresolved questions and documentation which P1 needed to clarify/address for Licensee. Such information is needed to effectively evaluate if R1 can safely and accurately manage their own medications, or if R1 can be educated/coached to do such, if applicable. Based on records and interviews, a preponderance of evidence does not exist at this time to show that Licensee did not allow R1 to keep their own medication without just cause. The allegation is therefore Unsubstantiated, and no deficiency was cited for it. An exit interview was conducted with Executive Director Julia Lopez and Resident Services Director Ashley Baino-Jaimes, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 08-AS-20250623121858

Allegation investigated: Staff are charging resident for services not rendered.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to commence and conclude a complaint investigation regarding the above-mentioned allegation. LPA identified herself to Front Receptionist Griselda Pacheco and met with the Director of Maintenance (DOM) Omar Zamudio and Executive Director (ED) Julia Lopez and discussed the purpose of the visit and the basic elements of the allegation. The Department's investigation included staff and resident interviews, and facility and resident records reviews. On June 28, 2023, the Department received a complaint that alleged staff were charging Resident1 [R1] for services not rendered. More specifically, R1 alleged being billed through June of 2023, for assistance with showering that were never received. A resident records review revealed R1 was admitted to the facility on February 23, 2023, and at the time of admission R1 required assistance with showering. Unsubstantiated Further review of R1’s records revealed as of May of 2023, R1 had refused staff assistance with showering,. On July 05, 2023, revealed R1 requested assistance with showering to be removed from their care plan and subsequently facility records showed on that same day, July 5, 2023, staff requested authorization (marked urgent) from R1’s Primary Care Physician (PCP) to allow R1 to shower on their own which was approved and signed on July 10, 2023. Interviews conducted with other residents in care revealed no issues with staff assistance with care on their plan of care, Based on facility, resident, and outside source records reviews, and staff and resident interviews the Department determined the allegation to be unsubstantiated. This finding means there was not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with Med-tech Barajas and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to staff at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 10, 2025 · control 08-AS-20230628101740

Allegation investigated: Staff are not assisting resident with bathing.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude a complaint investigation regarding the above-mentioned allegation. LPA identified herself to Front Receptionist Griselda Pacheco and met with the Director of Maintenance (DOM) Omar Zamudio and Executive Director (ED) Julia Lopez and discussed the purpose of the visit and the basic elements of the allegation. The Department's investigation included staff and resident interviews, and facility and resident records reviews. On June 5, 2023, the Department received a complaint that alleged facility Staff were not assisting resident with bathing. A resident records review revealed Resident1 (R1) was admitted to the facility on February 23, 2023, and at the time of admission R1 required assistance with showering. Unsubstantiated Further review of R1’s resident records revealed as of May of 2023, R1 had refused staff assistance with showering, including an Outside Agency (OS1) that would also assist R1. Facility records dated July 05, 2023, revealed R1 requested assistance with showering to be removed from their care plan and subsequently facility records showed on that same day, July 5, 2023, staff requested authorization (marked urgent) from R1’s Primary Care Physician (PCP) to allow R1 to shower on their own which was approved and signed on July 10, 2023. Interviews conducted with staff corroborated R1 would refuse assistance with being showered. in addition, interviews with other residents in care revealed no issues with staff assistance with bathing. Based on facility, resident, and outside source records reviews, and staff and resident interviews the Department determined the allegation to be unsubstantiated. This finding means there was not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with Med-Tech Amy Barajas and a copy of this report and Licensee/Appeal Rights (LIC 9058) will be provided to staff at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 10, 2025 · control 08-AS-20230605091507

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Case Management Visit. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. During the visit the LPA secured report signatures and delivered an amended report. An exit interview was conducted with Lopez, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, May 22, 2025

Allegation investigated: Staff are not providing a comfortable environment for resident. Staff did not ensure resident's room was free from odor.

This is an amended report to a report originally signed on 5/7/2025. Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Maintenance Director Omar Zamudio. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not provide a comfortable environment for a resident. On October 11th, 2024, it was reported to the Department a resident screaming at the facility had made a resident feel uncomfortable. Interviews with staff and residents revealed Resident # 1 (R1) would scream, yell at R1’s television, and kept R1’s television volume loud. Interviews and review of records revealed staff encouraged R1 to lower the television volume, or keep R1’s bedroom door closed, to minimize the noise. (See LIC 9099-C for continuation of report.) Unsubstantiated R1 consistently refused, made verbal threats and attempted to physically assault staff. Residents in the vicinity of R1’s bedroom did not report being afraid but described R1’s behaviors as a nuisance. Interviews with residents confirmed staff would attempt to redirect R1, but R1 would come verbally and physically aggressive. An interview with the facility’s Executive Director, and a review of records, revealed the facility had advised R1 to follow house rules stipulated in R1’s admission agreement. R1 did not comply, and the facility provided R1 a thirty (30) day eviction notice. The facility pursued an unlawful detainer action through the court, and R1 was subsequently escorted off the facility by the Sheriff’s office. Although R1’s behaviors had become a nuisance to residents, the facility admonished R1 to comply with house rules, and the facility followed eviction procedures. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. It was also alleged staff did not ensure a resident's bedroom was free from odor. On October 11th, 2024, it was reported to the Department Resident # 1’s (R1) bedroom smelled of urine. Interviews with both staff and residents confirmed R1 often refused to have staff clean R1’s bedroom. Although each bedroom was scheduled to be cleaned once per week, R1’s bedroom was consistently being cleaned more than one time per week. R1 made verbal and physical threats to staff who attempted to assist R1. Interviews with staff revealed R1’s bedroom carpet was frequently washed to prevent odors, and R1 was encouraged to maintain the bedroom clean, but R1 disregarded staff. The Department attempted to interview R1, but R1 was no longer residing at the facility. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Zamudio, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, May 7, 2025 · control 08-AS-20241011124100

Allegation investigated: Staff are not addressing mold at facility.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced visit to deliver investigative findings on the above complaint allegation. The LPA introduced himself and disclosed the purpose of the visit to Maintenance Director Omar Zamudio. The Department’s investigation included staff and resident interviews, a review of facility records, facility tour, and secured photos. On November 5, 2024, the Department received a complaint alleging facility staff did not address mold at the facility. Specifically, Resident1 (R1) revealed there was mold in their room. An interview with R1 revealed the facility staff had placed buckets in the hallways to catch water that leaked through the roof from recent rain (exact date unknown). and the leak caused mold to grow around their air conditioner (AC) unit. An interview with the Executive Director was not aware of mold issues or roof leaks at the facility. Unsubstantiated An additional interview conducted with Staff1 (S1) revealed the residue around R1’s AC unit was not mold but dirt that accumulated from the unit’s air filtration system, and this is typical for all ACs. At the time of LPA’s visit R1 had recently moved out of the facility and their room was vacant and had not yet been cleaned. LPA inspected R1’s room and observed the AC unit had a dark film around the air vent slats. LPA was able to easily wipe the film off. During the tour LPA observed other resident’s rooms and their AC units that were consistent with S1’s statement about the AC filtration system. A review of facility records included a log of all maintenance requests made by residents between October 15, 2024, and November 14, 2024, revealed 82 maintenance requests were submitted by residents but not one of them was made by R1, nor were there requests made by any residents regarding issues with mold or flooding at the facility. Interviews conducted with residents that resided at the facility during the time the complaint was lodged revealed no issues with mold in their room or the facility in general, nor any knowledge of leaks that occurred at the facility. Based on the investigation the allegation was determined to be Unsubstantiated. An Unsubstantiated finding means although the allegation could be valid the preponderance was not met to support the violation occurred. An exit interview was conducted with Zamudio, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided. Signatures below confirms receipt of the reports.the state’s words, verbatim · CDSS document, May 7, 2025 · control 08-AS-20241105124844

Allegation investigated: Resident personal belongings were stolen from bedroom.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced visit to conclude a complaint investigation. LPA was greeted by Maintenance Director Omar Zamudio, to whom the LPA dislcosed the purpose of the visit The Department's investigation included facility, resident, and outside source records reviews, and resident and staff interviews. On November 27, 2024, the Department received a complaint that alleged Resident1 (R1) had a theft of their personal belongings from their room on the morning of that same day. An interview with R1 reported there were two bonds in the amount of $50 dollars missing from their room. Law enforcement came to the facility to take a report. ED Lopez also reported the responding officer did not take a police report because there was no evidence to support the allegation. [Continued on LIC9099C] Unsubstantiated [Continuation of LIC9099] During the interview with R1 they reported the ED misinformed the responding officer by stating since R1 was independent staff do not have access to their room, however R1 revealed caregivers, and housekeeping entered their room each week. A review of R1’s care plan dated October 2, 2024, corroborated R1 was independent and did not require care, however the facility's basic plan included standard laundry and housekeeping services that were provided each week. In addition, it was disclosed the ED informed the responding officer that this was the first theft allegation made against the facility however a facility file review revealed an additional complaint was filed regarding the theft of another resident’s property on June 23, 2023, and on June 21, 2023, a complaint was filed that alleged a staff member was found digging through a resident’s belongings. A review of facility records revealed, per the facility's Admission Agreement and Health and Safety Code, the facility shall maintain a log (for 12 months) of all reported theft over $25.00 be maintained at the facility however the facility did not produce the record for the Department. Additionally, interviews conducted with facility staff and residents revealed no concerns of theft at the facility nor experienced any of their property stolen while residing at the facility. One Resident interview revealed they heard that another resident had money stolen at the facility but could not recall the Resident's name and believed they were no longer living there. Based on interviews ad records reviews the allegation was determined to be Unsubstantiated. An Unsubstantiated finding means, although the allegation may be valid there was not a preponderance of evidence to prove the violation had occurred. An exit interview was conducted with Zamudio, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided. Signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, May 7, 2025 · control 08-AS-20241127101919

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Case Management visit. The LPA introduced himself and disclosed the purpose of the visit to Maintenance Director Omar Zamudio. During the visit, the LPA secured report signatures, and delivered an amended report. An exit interview was conducted with Zamudio, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, May 7, 2025

Allegation investigated: Neglect/lack of supervision resulted in resident altercation. Staff did not treat resident(s) with dignity. Licensee did not assist resident with incontinence care.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged neglect/lack of supervision resulted in a resident altercation. On March 20th, 2025, it was reported to the Department staff and residents had physically assaulted Resident # 1 (R1). It was alleged one year and half prior, an unknown staff threw coffee at R1. It was also alleged an unknown resident hit R1’s head with a walker. (See LIC 9099-C for continuation of report.) Unsubstantiated An interview with the Executive Director (ED) revealed the ED had worked at the facility since 2021, and R1 had not reported any concerns regarding staff throwing coffee, or other items at R1. The ED recalled and incident where R1 and a separate resident were involved in a verbal argument. R1 refused to allow the other resident to enter the dining area, therefore, the other resident pushed through with a walker. The walker made contact with R1’s wheelchair, not R1’s head. R1 initially declined having any injuries, but later demanded R1 be transported to the hospital. R1 was transported, was evaluated, and returned with no injuries, nor orders. The ED had not received any reports of staff mistreating any of the residents. Interviews with external and internal sources, including staff and residents, did not recall ever witnessing staff, or residents, assaulting residents. Staff intervened and redirected residents when verbal arguments were observed. These interviews also revealed R1 had outbursts and displayed behaviors that were considered to rude to other residents. R1 could become verbally aggressive toward other residents. It was alleged staff did not treat residents with dignity. On March 20th, 2025, it was reported the facility staff treated residents poorly. Interviews with internal and eternal sources revealed staff treated residents with dignity. These sources had not witnessed any of the facility staff mistreat the any of the residents. Staff interactions with residents were described as good, nice, and having no concerns. It was alleged the licensee did not assist a resident with incontinence care. On March 20th, 2025, it was reported to the Department R1 went without incontinence briefs for one day while at the facility. Interviews with several residents did not reveal any concerns regarding lack of incontinence supplies. Interviews with staff revealed the facility had extra incontinence supplies stored at the facility, in case a resident needed them. The LPA toured the facility and observed the stored supplies, including incontinence briefs, and mattress pads. The LPA confirmed the medication technician on shift had a key to access these supplies. The LPA also observed residents’ personal incontinence supplies and residents reported having enough supplies. Interviewed staff did not recall R1 ever reporting not having incontinence briefs. The LPA attempted to interview R1, but R1 no longer resided at the facility. Based on the evidence obtained, the allegations were unsubstantiated. An exit interview was conducted with Lopez, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 08-AS-20250320090340

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged the facility unlawfully evicted Resident # 1 (R1). On April 7th, 2025, it was reported to the Department R1 was being evicted based on claims R1 was not behaving properly. Review of records obtained from the facility revealed the facility provide R1 a thirty (30) day notice to vacate the facility on June 19th, 2024, as R1 continuously refused to follow house rules. The thirty-day notice, along with a review of R1 admission agreement house rules, revealed R1 violated multiple house rules. These house rules included respect for others, dress and attire, noise, and alcohol use at the facility. Unsubstantiated Interviews with staff and residents corroborated R1 would display aggressive behaviors toward staff and residents, often getting into arguments. R1 would at times walk out of R1’s bedroom without any clothing on. R1 would scream and keep R1’s television volume loud. Interviews also revealed R1 would consume alcohol at the facility and that may have contributed to R1’s behaviors. R1 was to vacate the facility on July 22nd, 2024, but R1 refused. The facility then pursued an unlawful detainers order from the Superior Court of California, County of San Diego. According to the facility’s Executive Director, on April 3rd, 2025, a San Diego Sherriff’s Office Deputy advised R1 that R1 needed to vacate the facility by April 9th, 2025. R1 refused to vacate and the Sheriff’s office returned on April 22nd, 2025, and escorted R1 off the property. Based on review of records, and interviews with several sources, R1 did not follow house rules stipulated in R1’s admission agreement. The facility followed proper eviction procedures, therefore, the allegation was unsubstantiated. An exit interview was conducted with Lopez, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 08-AS-20250407130536

Allegation investigated: Staff did not respond to resident's calls for assistance.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not respond to a resident's call for assistance. On March 13, 2024, it was reported to the Department staff did not respond to Resident # 1’s (R1) call for assistance with retrieving medication from under R1’s bed. It was reported R1 called the front desk, but the front desk did not answer the phone. (See LIC 9099-C for continuation of report.) Unsubstantiated Interviews with staff and residents revealed the facility’s front desk phone line was transferred to a cordless phone after 7pm. The cordless phone was them answered by the medication technician on duty. Some interviews revealed there were occasions when the phone malfunctioned and calls would not go through, but this was addressed promptly. Residents were advised to use the call pendant for emergencies, falls, and incontinence care. Residents were encouraged to call the front desk for any other services required. Interviews with staff and residents revealed residents were still able to press the call pendants when the front desk phone line was not operating properly. Residents did not report any concerns with lack of medication assistance, nor concerns with staff not responding to pendant calls. Residents did not recall being discouraged from using the pendants to summon staff for assistance. An interview with R1 confirmed R1 was not part of the facility’s medication management program. R1 confirmed R1 had additional dosages of the medication in question, and R1 did not miss a scheduled dose. R1 confirmed housekeeping staff retrieved R1’s medication on a subsequent day. Although some interviews revealed conflicting statements on if residents were encouraged, or discouraged to use the call pendants; the interviewed residents did not have any concerns with staff not responding to pendant calls for assistance. Therefore, the allegation was unsubstantiated. An exit interview was conducted with Lopez, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 08-AS-20240313085040

Allegation investigated: Questionable Death

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources. It was alleged lack of care and supervision resulted in Resident # 1 (R1) falling on July 20th, 2024, and sustaining multiple fractures, which subsequently led to R1’s death on August 14th, 2024. R1 was admitted to the facility on March 19th, 2022, with a diagnosis of Atrial Fibrillation, Hypertension, Mild Cognitive Impairment (MCI). (See LIC 9099-C for continuation of report.) Unsubstantiated Based on R1’s physician’s report dated October 2023, R1 was able to communicate R1’s needs and follow instructions; however, R1 was not able to independently transfer to and from bed. R1 utilized the call pendant when R1 needed help; most of the staff verified that R1 knew how to use the call pendant, but others reported that R1 would forget to use it. R1 had a history of previous falls that had not resulted in any injuries. Interviews with caregivers, medication technicians and resident care coordinator reported R1 received fall-risk checks and status checks. One caregiver reported checking on R1 every fifteen (15) to twenty (20) minutes, whereas other caregivers checked on R1 every one or two hours. Additional staff reported that they would escort R1 to the dining area, placed R1’s walker near R1, and assisted R1 to a recliner, and or bed before leaving R1’s room. On July 20th, 2024, staff checked on R1 between 0600 and 0700 hours and reported R1 was not ready to get up yet. At 0745 hours, the facility’s Resident Care Coordinator found R1 on the floor. R1 reported pain and hitting R1’s head. The care coordinator then summoned emergency medical services and R1 was transported to the hospital for further evaluation. Interviews and review of hospital records confirmed R1 lived at the facility until R1’s fall on July 20th, 2024, when R1 sustained several fractures such as fractured rib, right shoulder and right scapula fracture, right wrist fracture, right clavicle fracture and right elbow fracture. A CT scan of R1’s head and cervical spine showed no evidence of fracture or brain bleed. R1 was later moved to a board and care, after the facility determined they would not be able to meet R1’s needs post fall. A review of R1’s hospice records noted R1 was placed on hospice care on July 22nd, 2024, due to senile degeneration of brain and noted comorbidities as dementia, hypertension, hyperlipidemia, Type II diabetes, gout, deep vein thrombosis, osteoporosis, obesity, venous stasis ulcers. A medical examiner’s report was requested, but there was no autopsy report available. Review of R1’s death certificate noted R1 expired on August 14, 2024, at approximately 0900 hours and R1’s cause of death was senile degeneration of brain, not elsewhere classified. There were no other underlying factors that contributed to R1’s death noted. Several contact attempts were made with R1’s Primary Care Physician (PCP) but were unsuccessful. Contact was made with a source, who assisted with providing information on behalf of R1’s PCP. R1’s PCP had not seen R1 since October of 2023, therefore, the PCP would not have known R1’s most recent mobility/ambulation status pertaining to R1’s falls. (See additional LIC 9099-C for continuation of report.) Based on the evidence obtained, R1’s fractures were not the cause of R1’s death. There was insufficient evidence to prove that facility neglected, or did not provide care and supervision to R1 that resulted in R1 falling on July 20, 2024. The allegation was unsubstantiated. An exit interview was conducted with Lopez, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 08-AS-20240816145042

Allegation investigated: Licensee coerced resident to sign documents

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegation. LPA met with Executive Director Julia Lopez and discussed the purpose of the visit. On June 22, 2023, Community Care Licensing (CCL) received a complaint alleging Licensee coerced Resident 1 (R1) to sign documents. According to R1's Physician Report dated January, 2023, R1 is able to communicate needs. During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. According to the allegation, Resident 1 (R1) was forced to sign a document agreeing to a higher level of care. Interview with R1 revealed that R1 was told by Staff 1 to sign the document to continue receiving assistance with activities of daily living. Substantiated Resident Functional Need Assessment Document signed February 6, 2023, collected from R1’s file, shows R1’s signature along with the words “under duress” on the documents signature line. Interview with an outside source confirmed that R1 communicated being forced to sign document R1 did not agree with. Interview with Executive Director revealed they were unaware of this incident and S1 is no longer present at the facility. Based on interviews, and records reviewed, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to. It was also alleged that R1 was issued an unlawful eviction. Records collected established that R1 was issued an eviction notice for a past due balance. R1 stated that they were aware of the balance due and had not issued payment. Outside source established that R1 was past due on balance due to increase in care needs. Lastly, it was alleged that R1 was not properly reassessed by licensee. Records collected revealed that R1 had a change in condition in January of 2023, which resulted in multiple falls and increased hospital visits. Interviews with staff revealed that R1’s health was declining and needed more assistance, therefore a new care plan was created. Interview with R1 established that R1 was reassessed using information from medical providers. Interview with Executive Director revealed that using medical information and interviewing medical providers is a standard practice for reassessments. Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 25, 2025 · control 08-AS-20230622123846

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: May 8, 2025

(a) Residents shall have all of the following personal rights:...(3)To be free from intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met: Based on records reviewed the licensee intimidated 1 of 88 persons in care (R1]) into signing documents which posed a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 25, 2025

Plan of correction: ED states S1 is no longer present and states they will provide a signed statement on how refusal of signatures are handled.

Allegation investigated: Staff did not provide resident records within 2 business days.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude a complaint investigation. LPA was greeted by the front Receptionist Griselda Pacheco, identified herself, and met with Director of Culinary Services (DCS) Soto to whom LPA discussed the purpose of the visit. The Department's investigation included facility and resident records reviews and resident and staff interviews. On September 10, 2024, the Department received a complaint alleging that facility staff did not provide Resident1 (R1) their records within two days from requested as stated in regulation. An interview with Staff1 (S1) revealed that all residents and/or their Responsible Party's (RP's) receive a monthly itemized invoice. A review of facility records confirmed that itemized invoices were distributed each month. [Continued on LIC9099C} Unsubstantiated [Continuation of LIC9099] The interview with S1 also disclosed that R1 had requested a cumulative itemized bill dating back to their admission with all itemized fees, to the day of their date of admission. S1 reported during the prior two months from the month the complaint was filed, they had accommodated R1’s request, which was not the standard facility procedure. S1 explained that their billing system was not set up to generate cumulative billing, it required a substantial amount of additional work, and the process was burdensome and time-consuming. A review of facility records, Licensing regulations, and Health and Safety (H&S) code revealed that residents have the right to their records within two days from requesting them, however this included records maintained on file by the facility, and required records per mandate. The records reviews showed that only itemized monthly billing are required, and there were no cumulative bills for residents in care covering the time from admission generated and/or maintained on file. Based on interviews and records reviews, the above allegation was determined to be Unsubstantiated. An Unsubstantiated finding means the standard of evidence was not met to prove there was a violation. An exit interview was conducted with DCS Soto, and a copy of this report and Licensee Appeal Rights (LIC 9058) were left for facility records.the state’s words, verbatim · CDSS document, Apr 24, 2025 · control 08-AS-20240910110707

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with Julia Lopez, Executive Director, to discuss the purpose of the visit. Today's visit is in response to a self reported incident regarding Resident 1 (R1). LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date. An exit interview was conducted with Julia Lopez, Executive Director, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 4, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to conduct a Case Management visit regarding a Death Report by the Department LPA was greeted by Front Lobbyist Griselda Pacheco, identified herself, then met with Executive Director (ED) Lopez and Resident Service Director (RSD) Baino-Jaimes to whom was explained the purpose of the visit. Today's visit was in response to a Death Report received on December 30, 2024 by Community Care Licensing (CCL) regarding Resident1 (R1). LPA conducted a resident records request and interviewed staff. [See LIC 811 for confidential names]. No deficiencies were cited during today's visit. LPA notified RSD Baino-Jaimes follow up visits and or phone calls are necessary before a determination if a violation had occurred. An exit interview was conducted with RSD Baino-Jaimes and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of the report. LPA left to conduct other time sensitive work related visits during today's Case Management visit.the state’s words, verbatim · CDSS document, Jan 2, 2025

Allegation investigated: Staff did not provide a comfortable environment

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not provide a comfortable environment. On 09/18/2024, it was reported to the Department Resident # 1 (R1) yelled and slammed a door causing a resident to not feel comfortable at the facility. It was also reported the gardening crew had conducted gardening work in the early morning hours, therefore, making a resident not feel comfortable. (See LIC 9099-C for continuation of report.) Unsubstantiated Interviews with multiple residents residing in the vicinity of R1 did not recall any similar incidents, nor concerns with R1. These residents recalled the gardening crew working in the area but did not have any concerns and mentioned feeling comfortable in their bedrooms. Interviews with several staff members did not recall any similar behaviors from R1 and did not recall other residents reporting any concerns. These staff did not recall receiving any complaints from residents regarding the gardening crew’s work disturbing the residents. An interview with Executive Director Lopez revealed there was an instance when R1 became upset a smoke alarm battery was low and kept chirping. The LPA attempted to interview the staff who was present during this incident on multiple occasions, but the LPA was not successful. An interview with the local Long Term Care Ombudsman office did not reveal any knowledge, nor concerns with R1, nor with the gardening crew disturbing the residents. Based on the information revealed during the investigation, there was not enough evidence to prove the alleged violation occurred, therefore, the allegation was Unsubstantiated. An exit interview was conducted with Executive Director Lopez, to whom a copy of this report, LIC 811, and Licensee/Appeals Rights (LIC 9058), were provided via email. An email read receipt confirms the documents were received by Lopez.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 08-AS-20240918091515

Type of visit: Case Management - Annual Continuation

The narrative section of the state’s online copy of this report is blank.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced case management visit at the facility. LPA gained access to the facility, identified herself, and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. During today's visit LPA conducted a staff interview and secured resident records. Today's visit was in response to an Incident Report received on November 22, 2024, by Community Care Licensing (CCL) regarding Resident 1 (R1). No deficiencies were cited during today's visit.(See LIC 811 for confidential name). An exit interview was conducted with ED Lopez and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, Dec 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Correia met with front lobbyist Griselda Pacheco, identified herself and met with Executive Director (ED) Lopez to whom was explained the purpose of the visit. This facility serves one hundred and eighty-Five (185) residents 60 and above; all may be non-ambulatory. LPA conducted a resident and facility records review. Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA conducted a thorough review of In-service training procedures. At this time, due to time constraints the annual inspection will be completed at a later date. An exit interview was conducted with ED Lopez, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt and a copy of the report was given to ED Lopez after the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 5, 2024

Allegation investigated: Staff did not provide a comfortable environment for resident

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Executive Director Julia Lopez and we discussed the purpose of the visit and elements of the complaint. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observation, records review and interviews with facility staff, residents and outside sources. It was alleged that the facility did not provide a comfortable environment for Resident 1 (R1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the residents.) Specifically, it was reported that Resident 2 (R2) entered R1's room, causing distress. LPA interviewed R1 who stated that some "new person" that recently moved into the facility walked into R1's room. Unsubstantiated R1 stated that R2 should not be living there since R2 has "dementia." R1 stated that R2 entered R1's room which R1 usually keeps unlocked. R1 stated that R1 yelled from R1's bed "who is it" and R2 responded. R1 stated that R2 is completely "out of it." LPA interviewed R2 who stated that R2 recently moved into the facility and is still unfamiliar with the facility layout. R2 acknowledged having walked towards R1's room due to confusion over room numbers. R2 indicated that the door was slightly open, and R2 called out, but did not actually enter the room. R2 clarified that all interactions occurred at the door entrance. LPA reviewed R2's physician's report which indicated that R2's overall health was fair. Physician's report further revealed that R2 may have slight confusion at times but R2 does not have a dementia diagnosis. LPA interviewed outside agency (OA) who stated that they are familiar with the incident and they conducted their own investigation. OA stated that they determined that R2 was confused due to R2 being new to the facility. OA stated that they also determined that although R2 did approach R1's room R2 never entered R1's room. OA stated that the investigation was then closed. OA stated that they have been working closely with the facility and the executive director who has been doing a great job of making improvements throughout the facility. LPA interviewed Executive Director (ED) who stated that in a community setting it is hard to control residents getting lost. ED stated that R2 accidentally entered R1's room due to confusion and immediately walked out when R2 realized it was not R2's room. ED stated that R2 was new so R2's name was not their door yet which added to the confusion. Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid. An exit interview was conducted with Julia Lopez. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Julia Lopez whose signature below verifies receipt of these rights.the state’s words, verbatim · CDSS document, Sep 26, 2024 · control 08-AS-20240627112813

Type of visit: Case Management - Other

Licensing Program Manager (LPA) Debbie Correia conducted an unannounced case management visit to obtain signatures, and deliver two (2) amended reports. LPA identified herself to, and met with Driver John Rodriguez to whom was explained the purpose of the visit. During the visit, LPA delivered on two (2) amended version of reports originally delivered on September 19, 2024, and obtained signatures. An exit interview was conducted with Driver Rodriguez and copies of this report and Licensee Rights (LIC 9058 01/16) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, Sep 25, 2024

Allegation investigated: Facility staff is not providing adequate toileting supplies.

Licensing Program Analyst (LPA) Debbie Correia conducted a facility visit to conclude a complaint investigation. LPA gained access to the facility, identified herself and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. The Department’s investigation consisted of staff and resident interviews, and a facility tour. It was alleged that the facility did not provide adequate toiletries. An interview conducted with Resident 1 (R1) revealed being in need of more toilet paper and had notified facility staff. Howerver, the interview revealed R1 was never provided with extra toilet paper. R1 revealed being notified by facility staff that residents are provided with two rolls of toilet paper a week and that additional rolls are provided for a dollar a roll, or residents are responsible for buying their own. An interview conducted with the Executive Director (ED) and Staff 2 (S2) also revealed residents are provided with two rolls of toilet paper week and additional toilet paper are the resident's responsibility. The interview with the ED also revealed during COVID the facility would provide additional toiletries due to the shortages, and the facility had no issues providing extra toiletry supplies to residents that are experiencing temporary circumstantial issues, and residents that dont request extra services/supplies in excess. Unsubstantiated Interviews conducted with residents in care revealed no issues with obtaining toiletry supplies, including toilet paper. Resident interviews corroborated receiving two rolls of toilet paper a week and that was an adequate amount or more than enough. Based on staff and resident interviews, the finding regarding the above allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid there is not a preponderance of evidence to prove that the alleged violation occurred. LPA conducted an exit interview with Julia Lopez who was notified a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 19, 2024 · control 08-AS-20240715144450

Allegation investigated: Staff does not ensure residents' bathrooms are in good repair. Staff do not ensure residents laundry is done in a timely manner.

Licensing Program Analyst (LPA) Debbie Correia conducted a facility visit to conclude a complaint investigation. LPA gained access to the facility, identified herself and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. The Department’s investigation consisted of staff and resident interviews, a facility tour, and a facility records review. It was alleged that the facility did not ensure residents' laundry was returned in a timely manner. Interviews conducted with facility Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3) all stated laundry is scheduled for each resident for one day the week. Interviews also revealed the facility housekeeping will pick up and return residents' laundry on the same day, and occasionally the following day depending on the time the laundry was picked up. Interviews conducted with Resident 1 (R1), Resident 2 (R2), and Resident 3 (R3) corroborated the statements made by facility staff. All resident interviews expressed satisfaction with the facility's housekeeping/laundry services and had no complaints. A facility records review also confirmed the laundry procedures. This is an amended version of the original report delivered on 9/19/2024. Unsubstantiated It was also alleged that facility Staff did not ensure residents' bathrooms were in good repair. An interview conducted with R1 revealed being very happy with the housekeeping at the facility. R1 revealed having a clogged toilet in the past and maintenance came right away and fixed it. R1 also revealed that the maintenance staff was very pleasant. Additional interviews conducted with R2 and R3 both corroborated no issues with their bathrooms or the common bathrooms throughout the facility. All resident interviews revealed the facility housekeeping and maintenance staff were very kind and did a great job. During a facility tour LPA did not observe any issues with the resident or facility restrooms or toilets. Based on staff and resident interviews, facility records reviews, and a facility tour the findings regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid there is not a preponderance of evidence to prove that the alleged violations occurred. [See LIC811 for list of confidential names] LPA conducted an exit interview with ED Lopez who was notified that a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided at the conclusion of the visit. This is an amended version of the original report delivered on 9/19/2024.the state’s words, verbatim · CDSS document, Sep 19, 2024 · control 08-AS-20240812103833

Allegation investigated: Staff are not ensuring residents are taken to their appointments.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced facility visit to conclude a complaint investigation. LPA gained access to the facility, identified herself and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. The Department’s investigation consisted of staff and resident interviews and facility and resident records reviews. It was alleged that facility staff did not ensure residents are being transported to their appointments. A facility records review revealed at admission residents agree to the terms of transportation set forth by the facility that entail a schedule be maintained to accommodate all resident’s needs. Further review of facility records corroborated the facility has a schedule for resident’s transport needs. An interview conducted with facility Staff 1 (S1) revealed residents go to the lobby front desk to request transportation and be added to available transport openings per the facility schedule. Thisis an amended version of he orginal report delivered on September 19, 2024. Unsubstantiated The interview with S1 also revealed transportation on Monday, Wednesdays, and Friday’s are typically reserved for outings, and errands, and Tuesday’s and Thursday are reserved for medical related appointments. Interviews conducted with the Executive Director (ED) corroborated S1’s statement regarding transportation on Monday, Wednesdays, and Friday’s are typically reserved for outings, and errands, and Tuesday’s and Thursday are reserved for physician and/or medical related appointments, and the details of the transport schedule are posted in resident rooms. The interview also revealed that facility staff are flexible with transportation and will accommodate resident's needs when there is a pressing matter. Interviews conducted with S2 and S3 both corroborated S1's statements regarding the facility's transportation systems in place. Interviews conducted with R1, R2, and R3 all revealed no issues with obtaining transportation by facility staff. The resident interviews all concurred the transport driver does a great job and will go out of their way to accommodate transportation for the residents and have not ever encountered an issue with their transportation needs. [See LIC811 for Confidential Names] Based on staff and resident interviews and facility records reviews, the finding regarding the above allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid there is not a preponderance of evidence to prove that the alleged violation occurred. LPA conducted an exit interview with Julia Lopez who was notified a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058). This is an amended version of the original complaint delivered on September 19, 2024.the state’s words, verbatim · CDSS document, Sep 19, 2024 · control 08-AS-20240909101903

Allegation investigated: Staff does not provide a comfortable temperature for residents in care.

Licensing Program Analyst (LPA) Debbie Correia conducted a facility visit to conclude a complaint investigation. LPA gained access to the facility, identified herself and met with Resident Service Assistant (RSA) Sharmaine Osea to whom was explained the purpose of the visit. The Department’s investigation consisted of staff and resident interviews and a facility tour. It was alleged the facility staff did not provide a comfortable temperature for residents in care. An Interview conducted with the Executive Director revealed each resident room has their own Air Conditioning (AC) unit and the residents can control the temperature of their rooms. Interviews conducted with Staff 1 (S1) and Staff 2 (S2) both corroborated residents can control the temperature of their rooms. An interview conducted with Resident 1 (R1) also corroborated they had their own AC unit and can control the temperature of their room. The interview with R1 also revealed no issues with their AC unit. Unsubstantiated An interview conducted with Resident 2 (R2) revealed they have had trouble adjusting the temperature of their AC unit however maintenance was able to fix the issue. An additional interview conducted with Resident 3 (R3) corroborated they have their own unit and can adjust the temperature to their preference. During a facility tour LPA observed individual AC units in residents rooms that have temperature controls for resident use. [See LIC 811 for confidential names] Based upon the information obtained during the investigation it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the violation occurred and is therefore UNSUBSTANTIATED. An exit interview was conducted with RSA Osea whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights. (LIC9058 3/22). LPA Correia had to leave the facility and return at a later time to deliver findings.the state’s words, verbatim · CDSS document, Aug 30, 2024 · control 08-AS-20240826113532

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to obtain signatures on an amended report. During today’s visit, LPA was greeted by the Resident Service Assistant (RSA) Sharmaine Osea, identified herself, and discussed purpose of the visit. During today’s visit, LPA obtained RSA Osea signature on an amended version of a report originally delivered on August 29, 2024. An exit interview was conducted with and a copy of this report and the Licensee Appeal Rights (LIC 9058 3/22) were provided.the state’s words, verbatim · CDSS document, Aug 30, 2024

Allegation investigated: Staff did not provide transportation to resident in care.

Licensing Program Analyst (LPA) Debbie Correia conducted a facility visit to conclude a complaint investigation. LPA gained access to the facility, identified herself and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. The Department’s investigation consisted of staff and resident interviews and a facility and resident records reviews. It was alleged that facility staff did not provide transportation to a resident in care. An Interview conducted with Resident 1 (R1) revealed on August 27, 2024, facility staff did not provide them with their transportation needs. The interview also revealed R1 needed transport that day but R1 was told there were no available staff and they would have to wait until the following day. An interview conducted with ED Lopez revealed on August 27, 2024, the driver was booked, and staff needed at least 24-hour notice for transport. An interview conducted with Staff 1 (S1) corroborated the facility has a sign-in schedule for transport although the driver will try to accommodate or prioritize certain situations. The interview with S1 also revealed R1 was provided transportation the following day. This is an amended version of the original reprort dated August 29, 2024. Unsubstantiated An interview conducted with Staff 2 (S2) revealed residents come to or call the front desk to request transport and S2 will review the calendar to check for availability and put the requesting resident on the calendar. In addition, interviews conducted with residents in care revealed no issues with the transport services at the facility and were aware there is a scheduling system. Resident 2 (R2) also revealed the facility driver does a really good job with accommodating and prioritizing transportation based on the resident’s needs. Interviews conducted with Resident 3 (R3) and Resident 4 (R4) also provided positive feedback regarding the transportation provided at the facility. A review of R1's resident records revealed agreement to the policy that the facility provides transportation however there must be a schedule maintained to meet all requests. A facility records review revealed the calendar was booked the day of August 27, 2024, and corroborated R1 was provided transportation the following day, August 28, 2024. [See LIC 811 for confidential names] Based upon the information obtained during the investigation it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the violation occurred and is therefore UNSUBSTANTIATED. An exit interview was conducted with Ashley Baino-Jaimes Resident Service Director (RSD), whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22). This is an amended report of the original report Dated August 29, 2024. During today's visit LPA left the facility and returned at a later time.the state’s words, verbatim · CDSS document, Aug 29, 2024 · control 08-AS-20240827164134

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced case management visit at the facility. LPA gained access to the facility, identified herself, and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit. During today's visit LPA conducted staff and resident interviews and secured records. Today's visit was in response to a Special Incident Report (SIR) received on August 25, 2024, by Community Care Licensing (CCL) regarding an incident that involved Resident 1 (R1) eloping from the facility on the prior day, August 24, 2024. A review of facility records revealed on August 24, 2024, R1 left the facility at approximately 11:15 AM and was found by a neighbor on the community corner who who activated 911 and R1 was picked by the local police department and brought to a family member's home who brought R1 back to the facility at approximately 9:00 PM. [See LIC 811 for confidential names] No deficiencies were cited during today's visit. LPA notified ED Lopez follow up visits and or phone calls are necessary before a determination if a violation had occurred. An exit interview was conducted with ED Julia Lopez and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) were provided at the conclusion of the visit. Signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, Aug 29, 2024

Allegation investigated: Staff does not provide a comfortable temperature for residents in care

Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced complaint visit to open an investigation regarding the above mentioned allegation. LPA was greeted by and identified himself to Administrator, Julia Lopez. LPA explained the purpose of the visit and basic elements of the complaint. It was alleged that staff does not provide a comfortable temperature for residents in care. The Department's investigation consisted of facility inspection, LPA observation, record reviews and interviews with residents, staff, and pertinent outside sources. Based upon the information obtained during the investigation it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the violation occurred and is therefore UNSUBSTANTIATED. An exit interview was conducted with Julia Lopez, Administrator, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22). Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 7, 2024 · control 08-AS-20240801100152

Allegation investigated: Staff did not treat resident with dignity

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced a follow up complaint investigation visit, and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not treat a resident with dignity. On 7/26/24, it was reported to the Department a facility staff member had yelled at a resident. Interviews with internal and external sources did not reveal any concerns with staff and resident interactions, including staff raising their voice, nor yelling at residents. An interview with the staff who had allegedly yelled at a resident, recalled the incident in question, denied yelling at the resident, and instead noted the resident had yelled at staff. (See LIC 9099C for continuation of report.) Unsubstantiated An interview with the Executive Director did not yield any evidence that would corroborate the incident occurred. Although the incident may have occurred, there was no evidence to corroborate it did, therefore, the allegation was Unsubstantiated. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Aug 7, 2024 · control 08-AS-20240726170444

Allegation investigated: Licensee did not provide fresh fruit. Staff was unable to communicate residents needs due to language barrier.

Licensing Program Analysts (LPAs) Nacole Patterson and Ryan Fulton conducted an unannounced 10-day visit to initiate a complaint investigation and deliver findings regarding the above mentioned allegations. LPAs introduced themselves and disclosed the purpose of the visit to Executive Director Julia Lopez. On 6/25/24 it was alleged that Licensee did not provide fresh fruit, and facility staff were unable to communicate residents needs due to language barrier. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, residents, and records review. Staff interviews revealed that during the timeframe of complaint, fresh fruit was offered and/or served during each meal. Staff informed that residents had the option to choose a different fruit offering such as apples, oranges, strawberries, blueberries, or canned fruit. Staff members advised that while there were specific residents with particular food preferences, dining staff were aware and made efforts to accommodate them, including special fresh fruit orders. (Continued on LIC9099-C p.2) Unsubstantiated (Continued from LIC9099 p.1) Staff interviews revealed that specific canned fruit items such as canned apples and pears were sometimes combined with fresh fruit to accommodate resident chewing and swallowing needs. Resident interviews did not corroborate the allegation, residents informed that the facility offered a variety of fresh fruit and vegetables at each meal. No residents interviewed expressed concern regarding inaccessibility to fresh fruit. Review of facility records revealed invoices of food orders that included fresh kiwi, grapes, pineapple, strawberries, celery, romaine lettuce, bananas, potatoes, spinach, shredded cabbage, and green onions. Records review also showed monthly and daily menus with fresh fruit offerings. During an unannounced facility visit, LPAs directly observed the food supplies, preparation, and meals served to residents. LPAs observed a variety of fresh fruit, including pineapple, cantaloupe, bananas, cut watermelon, sweet potatoes, Russet potatoes, onions, oranges, apples, lemons, limes, shredded carrots, sliced mushrooms, romaine lettuce, celery, and tomatoes. LPAs observed posted signs in two locations of the kitchen advising of the specific fresh fruit to be served each day. LPAs also observed daily menus on dining room tables with the fresh fruit offerings, and a posted monthly menu that also included fresh fruit offerings. Additional records included notes from a monthly meeting between the Director of Culinary services and residents that address fresh fruit offerings and the Licensee's accommodation of such. Regarding resident communication and language barriers, staff interviews revealed that caregivers did not have issues communicating with residents or caring for their needs. No staff interviewed advised of a resident expressing concerns regarding a language barrier with another staff. Residents interviewed did not advise having communication issues with staff; residents informed that staff were friendly and assisted them with their needs with no language barrier. No records were found to corroborate that staff were unable to meet any resident needs due to a language barrier. During an unannounced facility visit, LPAs observed caregiving, housekeeping, and dining room staff communicating with residents. No communication issues were observed. During staff interviews, LPAs observed caregiving, housekeeping, and dining staff to communicate in a way that was understandable and the staff responses indicated that they understood what was being said. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 3, 2024 · control 08-AS-20240625095223

Type of visit: Case Management - Other

Licensing Program Manager (LPA) Debbie Correia conducted an unannounced case management visit to deliver an amended report. LPA identified herself to Receptionist Griselda Pacheco and met with Business Director Kitty Totorica, and met with Business Director Kitty Totorica to whom was explained the purpose of the visit. During the visit, LPA delivered an amended version of a report and obtained signatures. An exit interview was conducted with Business Director Kitty Totorica and copies of this report and Licensee Rights (LIC 9058 01/16) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt of the rights and a copy of this report.the state’s words, verbatim · CDSS document, May 30, 2024

Allegation investigated: Facility staff do not maintain fire alarm system in good repair.

Licensing Program Analyst (LPA), Debbie Correia, conducted a follow up visit to a complaint investigation. The LPA introduced herself to the facility Receptionist Griselda Pacheco then met with Maintenance Director (MD) Omar Zamudio and disclosed the purpose of the visit. The Department's investigation included staff and outside source interviews, and facility records reviews. It was alleged the facility does not keep their fire alarm system in good repair. A facility records review revealed on April 9, 2024, the facility underwent a fire inspection conducted by a contracted company. Records revealed the inspection yielded six deficiencies. An interview conducted with Outside Source1 (OS1) and a records review revealed the facility repaired two of the deficiencies identified during the inspection, however there were four other deficiencies the facility has not repaired. This is an amended version of the original report dated 5/29/24. Substantiated Based on LPA's interviews and a facility records review, the above allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. LPA Correia conducted an exit interview with MD Zamudio. At the time of the exit interview MD Zamudio was notified a copy of the Complaint Investigation Reports (LIC9099 and LIC 9099D) and Licensee Rights (LIC9058 01-2016) will be provided at the conclusion of the visit. Signature on this report acknowledges receipt of the documents. This is an amended version of the original report dated 5/29/24.the state’s words, verbatim · CDSS document, May 29, 2024 · control 08-AS-20240521140128

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: May 31, 2024

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life... against fire and panic. (1) Nonambulatory persons. (2) Bedridden persons This requirement was not met as evidenced by: Based on interviews and record reviews the Licensee did not address 4 facility doors that did not pass a fire system inspection (conducted on April 9,2024) due to the doors not latching or dragging. This posed an immediate threat tol 92 residents in care. This is an amended version of the original report dated 5/29/24.the state’s words, verbatim · CDSS document, May 29, 2024

Plan of correction: Maintenance Director Zamudio agreed to contract with an outside agency to repair the doors indentified during the fire inspection by the POC due Date. LPA will conduct a visit to confirm POC completion.

Allegation investigated: Facility Plumbing is in disrepair

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Maintenance Director Omar Zamudio. On January 23, 2024 Community Care Licensing (CCL) received a complaint alleging the facility plumbing is disrepair. During the investigation, LPA Domingo conducted a facility inspection, collected pertinent records, and conducted interviews. According to allegation received, Resident 1 (R1), (Please refer to LIC811 confidential names list), stated that the facility had no running water to wash resident hands after using the restroom. R1 was interviewed and R1 stated that the facility has poor plumbing. R1 was unable to provide dates of when R1 encountered the poor plumbing except for January 23, 2024. R1 stated that there was not any running water in R1's bathroom to wash R1's hands after using the bathroom. R1 was asked if an alternative room was made available and R1 was unable to recall but stated that R1 Unsubstantiated Continued from LIC9099 On January 31, 2024 LPA Domingo interviewed Staff 1 (S1) and S1 provided information regarding plumbing repairs that were completed on January 23, 2024. S1 stated that an alternative bathroom was provided for residents that needed repairs in their rooms. S1 stated that the repairs were completed on the same day that the plumbing needed repairs. Outside Source 1 (OS1) was interviewed and stated that OS1 was aware of the repairs that were needed to resident rooms that the plumbers were working on. OS1 stated that there were rooms available that had no plumbing issues for residents to temporarily use until the repairs were completed. Resident 2 (R2) was interviewed and had no complaints or concerns regarding the plumbing issue that occurred on January 23, 2024. R2 stated that the management made the residents aware of the repairs and provided alternative rooms, including bathrooms for residents to utilize during the repairs. Resident 3 (R3) was interviewed and R3 stated that the management informed the residents of the repairs and provided alternative rooms and bathrooms to use during the repairs. Based on interviews, LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Maintenance Director Omar Zamudio, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, May 17, 2024 · control 08-AS-20240123162901

Allegation investigated: Staff did not provide resident with water.

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Maintenance Director Omar Zamudio On January 23, 2024 Community Care Licensing (CCL) received a complaint alleging staff did not provide resident with water. During the investigation, LPA Domingo conducted a facility inspection, collected pertinent records, and conducted interviews. Continued on LIC9099C Unsubstantiated Continued from LIC9099 According to allegation received, Resident 1 (R1), (Please refer to LIC811 confidential names list), stated that a facility staff did not bring R1 water when R1 requested water. LPA Domingo observed several unopened bottles of water. R1 was interviewed and R1 stated that the facility provided the bottled water and there are amble water bottles available. Outside Source 1 (OS1) stated that there are water bottles available to residents and water stations available at all times for residents. Staff 1 was interviewed and S1 provided a tour of all the water stations on all the floors, the dining area and staff provide water bottles to residents as needed. LPA Domingo toured the facility and observed the multiple water stations, and water bottles throughout the facility. Resident 2 (R2) was interviewed and stated that there are no concerns regarding staff providing water bottles or water when requested. Outside Source 2 (OS2) was interviewed and OS2 stated that there has been no concerns regarding the availability of water when requested and there is water stations throughout the facility. Based on interviews, and direct LPA observations a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Maintenance Director Omar Zamudio, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, May 17, 2024 · control 08-AS-20240202104641

Allegation investigated: Staff did not meet a resident's needs

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced follow up complaint investigation visit, and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez. Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources. It was alleged staff did not meet a resident's needs. On 3/29/24, it was reported to the Department Resident # 1 (R1) asked staff to escort R1 to R1’s room, but staff was not available to assist with the escort. Review of records, including care plans, assessments, pre-appraisal, and invoices for services, revealed the following information. (See LIC 9099C for continuation of report.) Unsubstantiated R1 was able to ambulate by walking on her own and using a wheelchair on some occasions. A Physician’s Report, interviews with internal and external sources and an observation by the LPA, confirmed R1 was able to ambulate by walking, or using a wheelchair. Initial care plans noted R1 was receiving and being charged for escorting services. Additional care plans and invoices, along with an interview of the administrator, revealed R1 declined the continuation of escorting services due to the additional charge. The facility administrator agreed to remove the charge and service, as R1’s assessments did not indicate a need for such service. Interviews with internal and external sources, including the alleged staff that was present, did not report any concerns regarding lack of assistance from staff. Review of R1’s account history revealed the facility had begun to only charge for basic services, not including escorts or other care, since September of 2023. Based on the evidence obtained, there was not enough evidence to prove the alleged violation occurred, therefore, the allegation was Unsubstantiated. An exit interview was conducted with Executive Director Lopez, and Maintenance Director Omar Zamudio, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, May 9, 2024 · control 08-AS-20240329084536

Allegation investigated: Staff are not properly cleaning resident's restroom Staff are not properly addressing pest infestation in facility Staff did not assist resident in a timely manner Staff did not ensure to empty resident’s trash can

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit regarding the above mentioned allegations. LPA stated the purpose of the visit, was granted entry by and met with Patricia "Kitty" Totorica, Business Director. LPA briefly toured the facility, and obtained copies of pertinent facility records. LPA conducted interviews with staff and residents. It was alleged that the staff are not properly cleaning resident's restroom. Interviews revealed that Resident 1 (R1) gets their room cleaned weekly. This consists of the shower being cleaned, floors are being swept and mopped, and the sink is being cleaned. The bed sheets are usually changed once a week but for R1 they are usually changed every two weeks unless otherwise noted. The housekeeper also empties the trash and vacuums the room. Interviews did not provide supporting information that staff are not properly cleaning resident's restroom. Unsubstantiated It was alleged that staff are not properly addressing pest infestation in the facility. Interviews revealed that they have not seen any ants or silverfish in R1's room or around the facility. Interviews with R1 revealed they saw two ants yesterday, 03/04/2024 and no ants today. LPA observation did not reveal ants on the dresser or on the trash can as R1 stated. There were no dead ants or any trace of ants or silverfish in the bedroom or the bathroom. Interview with R1 also revealed that they believe that if the housekeeper saw the silverfish they would have picked it up. "It was an accident that they missed it". Interviews did not provide supporting information that staff are not properly addressing pest infestation in the facility. It was alleged that the staff did not assist resident in a timely manner. Interviews revealed that the staff assists all residents in a timely manner. Interviews revealed R1 demands that the staff help them right at that moment. Interviews revealed that when the request is made, it will be completed by staff. Interviews revealed all of R1 needs are met and they will ask for assistance and the staff assist them. R1 made a complaint about the ants to the maintenance director about 3 weeks ago and they came right in and put ant bait around the room. Interviews revealed all requests are not of immediate action although R1 treats all request as an emergency. Interviews with other residents revealed the staff are kind and assist them with their needs and they do not have to wait a long time to be helped. There were no complaints of the staff not assisting residents or not being timely. Interviews did not provide supporting information that staff did not assist resident in a timely manner. It was alleged that the staff did not ensure to empty resident’s trash can. Interviews revealed the trash is emptied everyday. Interviews with R1 revealed their trash is emptied daily but sometimes its in the middle of the afternoon. Interviews revealed staff are usually doing their rounds in the am and into the afternoon. Interviews with staff revealed they all have been notified not to knock or go into R1's room until after 10am. Interviews revealed all trash is picked up daily and if a resident request that their trash be emptied again the staff have no problem emptying it again. Interviews did not provide supporting information that staff did not ensure to empty resident’s trash can. Based upon the evidence gathered during this investigation, insufficient information was obtained to support the allegations of staff are not properly cleaning resident's restroom, staff are not properly addressing pest infestation in facility, staff did not assist resident in a timely manner and staff did not ensure to empty resident’s trash can. The Preponderance of Evidence Standard was not met. As such, the allegations are Unsubstantiated. An exit interview was conducted with Patricia "Kitty" Totorica, Business Director. and a copy of the report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Director, whose signature confirms receipt of receiving the documents.the state’s words, verbatim · CDSS document, Mar 5, 2024 · control 08-AS-20240226111527

Allegation investigated: Staff did not provide resident with clean linens. Staff yelled at resident.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Julia Lopez. On 2/23/24 it was alleged that staff did not provide resident with clean linens, and staff yelled at a resident. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, resident, outside source, and records review. Regarding the allegation, "Staff did not provide resident with clean linens", staff members interviewed consistently informed that the resident in question had a preference that their sheets were to be washed upon request only. Staff interview revealed that staff attempted to change the bedding on the assigned day, but the resident did not inform them they wanted their bedding washed. Staff interview, corroborated by facility records, revealed that staff did change the resident's bedding the next day, upon the resident's request. Interview with the resident in question confirmed that they made their request known to staff, and staff accommodated the request the same day. (Continued on LIC9099-C p.2) Unsubstantiated (Continued from LIC9099 p.1) Outside source interview revealed that external investigations have been conducted regarding the resident's laundry service and it was found that staff abide by the housekeeping and laundry schedule. Outside sources did not have concerns regarding laundry service or the resident being provided clean linens. LPA directly observed the bedding in question, and it was observed to be clean with no stains, debris, or odors indicating that it had not been washed. Regarding the allegation, "Staff yelled at a resident", staff interviews did not corroborate the allegation, informing that the staff in question had never yelled at a resident, or any other staff. Staff interview further revealed that a witness was present during the incident in question. LPA interviewed the witness who confirmed that no yelling was done during the incident, and all parties were calm and maintained composure the entire time. Interview with the resident in question did not corroborate the allegation. The resident in question was unable to recall the specifics of the event and informed that the staff member did not yell at them. Outside sources did not corroborate the allegation, informing that the resident in question had a pattern of perceiving that staff yelled at them but they did not. The outside source informed that external investigations have been conducted regarding similar complaints from this resident, and they have been found to be untrue. No records were found that gave evidence to the allegation. During unannounced facility visits, LPA has observed staff and resident interactions. No observations made corroborated the allegation. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 08-AS-20240223150940

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with Julia Lopez, Executive Director, to discuss the purpose of the visit. Today's visit is in response to the self reported incident of second degree burns regarding Resident 1 (R1 - see LIC811 Confidential Names List). LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date. An exit interview was conducted with Julia Lopez, Executive Director, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Feb 29, 2024

Allegation investigated: Unlawful eviction Staff does not ensure basic laundry service is provided in a timely manner Staff mismanaged resident’s medication

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit regarding the above mentioned allegations. LPA stated the purpose of the visit, was granted entry by and met with Executive Director Julia Lopez. LPA briefly toured the facility, and obtained copies of pertinent facility records. LPA conducted interviews with staff and residents. It was allleged that the facility gave resident an unlawful eviction. Interviews revealed the eviction is lawful and is still in effect as of today. The eviction was given to Resident 1 (R1) due to partial payments being made since R1 has been living at the facility. R1 was given an eviction back in May, 2023. The facility continued to accept partial payments and that voided the evictiion. The resident was given another eviction on January. 22, 2024 due to non payment again. On February 5, 2024, R1 attempted to make a partial payment and it was refused. Then R1 proceeded to make another partial payment at the front desk after having knowlege of the facility not accepting any more partial payments from them. A record review revealed partial payments made to the facility since February 2023 when R1 first moved in. Eviction was given to R1 due to non payment of monies owed in the amount of over 10,000. Interviews did not provide supporting information that the facility gave the resident an unlawful eviction. Unsubstantiated It was alleged that the staff does not ensure basic laundry service is provided in a timely manner. Interviews with housekeeping revealed that R1 gets their room cleaned weekly on Wednesdays. Interviews revealed that they clean the floors, toilet, sink and shower to remove excess hair, and they change the bedding about two times a month upon the residents request. Interviews with R1 revealed the staff come in and clean their room. Interviews with laundry attendants revealed that they wash the laundry weekly and for R1 it is on Tuesdays. The residents are supposed to have the laundry ready for the attendant to pick up and take, although interviews revealed R1 does not get their items ready and expect the staff to pick up all of their unclean laundry. There was an incident the other day regarding R1 and unclean rugs and R1 admitted that the staff took the rugs and cleaned them. Interviews revealed that staff needed a bag and gloves to pick up the soiled mats and was going to leave to get bags when R1 offered a few bags to the staff. Interviews did not provide supporting information that the facility does not ensure basic laundry service is provided in a timely manner. It was alleged that the staff mismanaged resident’s medication. Interviews revealed that R1 manages their own medications. Upon LPA observation R1 had all of their medications in their room. Interviews revealed that R1 ordered a refill of an Iron medication and thought it was delivered. R1 asked the staff about the medication and the staff explained to R1 that the medication had not been delivered and if it was, it would have been in their mailbox and delivered to them with the rest of their mail. Interviews with R1 revealed that they contacted Care Mark a mail order services through CVS and they admitted to R1 they messed up and did not deliver the medications although R1 thought they did. Interviews with staff revealed anything that comes in through the mail they put into the residents mailboxes and that they don't open the residents mail so they don't know what the residents are getting in packages. Interviews did not provide supporting information that the facility staff mismanaged resident’s medication Based upon the evidence gathered during this investigation, insufficient information was obtained to support the allegations of unlawful eviction, staff does not ensure basic laundry service is provided in a timely manner and staff mismanaged resident’s medication. The Preponderance of Evidence Standard was not met. As such, the allegations are Unsubstantiated. An exit interview was conducted with Executive Director, Julia Lopez and a copy of the report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Director, whose signature confirms receipt of receiving the documents.the state’s words, verbatim · CDSS document, Feb 14, 2024 · control 08-AS-20240208123756

Allegation investigated: Staff handled resident(s) in a rough manner. Staff did not treat resident(s) with dignity.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Julia Lopez. On 1/2/24 it was alleged that staff handled resident(s) in a rough manner, and staff did not treat resident(s) with dignity. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA direct observations. Regarding the allegation, "Staff handled resident(s) in a rough manner", Staff interviews did not corroborate the allegation, staff members informed that they had never seen another staff assist a resident roughly or in a way that hurt a resident. No staff members interviewed had been informed by a resident or responsible party regarding rough handling. (Continued on LIC9099-C p.1) Unsubstantiated Resident interviews did not corroborate the allegation, residents stated that staff were very gentle and respectful when assisting with their needs. Outside source interview did not corroborate the allegation, providing observations counter to the allegation and informing that staff provided good care to residents. No outside sources verbalized concern regarding resident care at the facility. No records were found to support the allegation. During three (3) unannounced facility visits, LPA directly observed residents being provided care by staff; LPA did not observe any staff member make physical contact with a resident in a way that was unwelcome or harmful. Regarding the allegation, "Staff did not treat resident(s) with dignity", it was alleged that two staff (S1, S5) yelled at and/or spoke disrespectfully to three (3) residents (R1, R2, R6). Interviews with staff revealed that while dynamic issues existed between specific residents and staff, no observations were made regarding staff members speaking rudely to residents or not honoring their dignity. Staff interviews further revealed that the incidents in question were internally investigated by management and did not result in staff being at fault for lack of dignity. Management informed that their investigations revealed lapses in communication, language barriers, and unreasonable/unrealistic expectations by residents. Resident interviews confirmed the staff information of specific dynamic issues, but did not corroborate the allegation; residents stated that staff were respectful and nice when speaking to them. The investigation revealed that the situations in question were related to residents requesting staff to perform duties outside of their job description and being declined. Outside sources interviewed did not corroborate the allegation, advising no concerns with staff treatment of residents. An outside agency investigation for this claim was conducted and resulted in no evidence that the allegation was valid. No records were found to support the allegation. During three (3) unannounced facility visits, LPA directly observed residents receiving assistance from staff, including the staff in question. No observations were made regarding staff speaking to residents in an undignified manner. Based on interviews, direct LPA observations and records review, the investigation did not yield sufficient evidence to conclude that staff handled resident(s) in a rough manner, or that staff did not treat resident(s) with dignity. Based upon the foregoing, the allegations are unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 12, 2024 · control 08-AS-20240102083619

Allegation investigated: Staff inappropriately spoke to resident in care Staff inappropriately made false accusation against a resident in care

On 2/6/2024 at about 10:30 AM, Licensing Program Analyst (LPA), Daniel Pena, conducted an unannounced visit to the facility. The purpose of the visit was to follow up on a complaint investigation. LPA spoke with Receptionist, Karen Eugene, and after identifying himself, was permitted into the facility. LPA met with Executive Director, Julia Lopez, and discussed the complaint. At the conclusion of today's visit, LPA delivered findings to Director Lopez. On 5/22/2023, the Department received a complaint alleging staff inappropriately spoke to and made false allegations against a resident in care. The investigation consisted of unannounced facility tours, record review and interviews with pertinent residents, staff, and outside sources. It was alleged that staff verbally assaulted Resident (R1). When asked how staff verbally assaulted R1 no details were provided. According to an interview with R1, staff said the resident was suicidal and implemented one on one supervision. R1 told facility management they did not require extra supervision Unsubstantiated and would not pay for the additional care. The resident stated that the facility charged additional fees for “personal care.” Additionally, it was alleged that the facility said R1 made threats to kill relatives in another state. When interviewed, R1 denied making the statements. The facility self-reported the incident. Reporting noted that the facility called 911 because R1 wanted paramedics to check their blood pressure and blood sugar. The records reflect that upon assessment, responding medics checked R1’s vitals and they were normal. Due to the statements made, the facility also called police and a crisis team to evaluate R1. Reporting and statements concluded that R1 refused treatment and denied making the threat. R1 was not hospitalized. Interviews with staff and outside sources indicate that R1 did in fact make the statements. Following the incident, the facility admittedly applied one to one supervision of R1 without the resident’s consent. R1 told the facility they would not pay for the additional care and supervision. LPA conducted interviews and reviewed facility records associated with this incident. Records and interviews indicate that the facility did apply the additional services due to safety concerns for R1. However, records showed that R1 was not charged for the additional services. Additionally, the facility has policy to implement one to one supervision for safety reasons and it’s noted in R1’s Admission Agreement. Outside source interviews reported that R1 held an unrealistic expectation of the service they should be provided by the facility staff. LPA interviewed an outside source close to R1 and assisted R1 in their admission into the facility. The outside source told LPA that R1 became very demanding of them and facility staff. The source did not know but thought it was R1's health conditions were worsening that were causing R1's difficult behavior. At one point, this source asked the facility to remove them as an emergency contact to R1. Based upon the evidence gathered during this investigation, insufficient information was obtained to support the allegations. The Preponderance of Evidence Standard was not met. As such, the allegations are Unsubstantiated. An exit interview was conducted with Director, Lopez and a copy of the report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Director, Lopez, whose signature confirms receipt of receiving the documents.the state’s words, verbatim · CDSS document, Feb 6, 2024 · control 08-AS-20230522153113

Allegation investigated: Licensee did not provide resident's personal care needs

On 01/26/2024, at about 2:00 PM, Licensing Program Analyst (LPA) Daniel Pena conducted a complaint investigation visit to the facility. After identifying himself, and explaining the purpose of the visit, LPA was allowed inside the residence. LPA discussed the elements of the complaint with Executive Director, Julia Lopez. The Department's investigation included facility visits, interviews with pertinent staff and outside sources and review of facility and resident records. On 07/17/2023, the Department received a complaint alleging staff did not provide a resident’s personal care needs. Records and statements revealed that Resident 1 (R1) did not receive a shower on July 15, 2023. An outside source stated that on July 15, 2023, they went to the facility to visit R1. An outside source asked a staff member when R1 would receive a shower. Records indicate R1 was scheduled to receive a shower on that date. Staff confirmed to the outside source that they would assist R1 at their scheduled shower time. Substantiated Later that same evening, a staff notified the outside source by telephone informing them that staff would not be able to provide R1 with a shower because staff was limited. Staff interviews contend R1 refused the shower. When reviewed, shower records did not reflect a notation that R1 refused their shower. Statements and records did confirm R1 received a shower on July 16, 2023. Record reviews showed that R1 also did not receive a scheduled shower on July 18, 2023. Staff interviews could not state for certain whether the resident refused the shower, or if one was offered. Staff interviews revealed that staff are not trained to document if and when a resident refuses showers. Based on interviews and record reviews, the Department’s investigation obtained sufficient evidence to support the allegation that the facility did not afford resident’s personal care needs. The Preponderance of Evidence standard has been met. Therefore, the allegation is Substantiated. California code of Regulations, Title 22, Division 6 & Chapter 1 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058 01/16) were provided to Director, Lopez whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jan 26, 2024 · control 08-AS-20230717144036

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87464(f)(4) · Plan of correction due date: Mar 1, 2024

(f)…shall at a minimum include…(4) Personal assistance and care…with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure R1 was provided personal assistance, which posed a potential health, safety, and personal rights risk to 1 of 185 residents in care.the state’s words, verbatim · CDSS document, Jan 26, 2024

Plan of correction: Licensee agreed to procure vendorized training on Personal Rights and Basic Services and ensure 100 percent staff participation. Licensee will furnish written proof of contract to CCLD by 01/29/2024. Licensee will ensure training is completed and submit written proof no later than 03/01/2024.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Dang Nguyen and Juliana Barfield conducted an unannounced Case Management - Incident visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Executive Director Julia Lopez. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 01/05/2024), involving Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1]. During today’s visit, LPAs performed a brief facility tour, collected copies of pertinent records, and interviewed relevant staff. According to the LIC624 and corroborated by staff interviews: Sometime between 12/23/2023 and 12/26/2023, an item of jewelry was stolen from R1’s nightstand, which was inside their bedroom. Records review, confirmed by manager interview, showed: Licensee did not possess and maintain a complete written personal property inventory for R1, which was required from time of R1’s move-in to the facility. Licensee also did not maintain a written record of lost and stolen resident property from over the last 12-months having a value of $25 dollars or more. One (1) deficiency was cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D). Plans of Correction was jointly developed with the licensee. An exit interview was conducted with Lopez, to whom a copy of this report, the LIC 809-D, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jan 9, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218(a)(1) · Plan of correction due date: Feb 8, 2024

87218 Theft and Loss: “(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.” This requirement was not met, as evidenced by: Based on records review and interview, for 1 of 87 residents (R1), Licensee did not maintain a personal property inventory, completed by the licensee and the resident and/or their representative, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: Per records and interviews, R1 has since passed away. Licensee agreed to audit files to ensure that all remaining residents have a complete and signed LIC621 Personal Property Inventory. Licensee also agreed to retrain all its admissions staff on the requirements of Regulation 87218 Theft and Loss, and to submit the training sign-in sheet to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.153(c) · Plan of correction due date: Feb 8, 2024

1569.153 Theft and Loss Program, ect.: "A theft and loss program shall be implemented by the residential care facilities for the elderly…The program shall include all of the following: (c) Documentation of lost and stolen resident property with a value of twenty-five dollars ($25) or more within 72 hours of the discovery…for the past 12 months…” This requirement was not met, as evidenced by: Based on records review and interview, Licensee did not maintain documentation of lost and stolen resident property with a value of twenty-five dollars ($25) or more within the past 12 months. This posed a potential personal rights risk to 87 of 87 residents (R1 through Resident #87).the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: Licensee agreed to complete and maintain an LIC9060 Theft and Loss Record, to document any theft/loss against any resident over the last 12 months where the value lost was $25 or more. Licensee agreed to E-mail the completed LIC9060 to LPA, by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility Executive Director Julia Lopez, after identifying herself and stating the purpose of the inspection. This facility serves one hundred and eighty Five (185) residents 60 and above; all may be non-ambulatory. LPA was accompanied by Executive Director Lopez during a tour of the facility. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. There are two building on site, connected by a recreational indoor breezeway. Signal systems are in place and operational. PPE supplies are onsite. Passageways were free from obstructions. Facility does feature delayed egress doors or a locked perimeter. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars and Non-skid strips. Hot water temperature in residents’ bathrooms were compliant. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room not assessable to residents. Centrally stored medications were properly stored and locked in a medication room. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPAs conducted a thorough review of In-service training procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted with Executive Director Lopez, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt and a copy of the report was given to Executive Director Lopez.the state’s words, verbatim · CDSS document, Dec 14, 2023

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced complaint visit. LPA gained access to the facility and met with Executive Director Julia Lopez and explained the purpose of the visit which was to deliver findings for the above allegation. The Department’s investigation consisted of a facility records reviews, interviews with staff, resident, and outside sources. It was alleged Resident 1 (R1) was unlawfully evicted from the facility. Interviews with staff and outside sources revealed that R1 had a change in health condition that required a higher level of care. A records review revealed the 30-day eviction notice, dated 10/20/2023, was in compliance with Title 22 mandate. Unfounded Based on records reviews and interviews, the complaint allegation was determined unfounded, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, as to the above listed allegation, the facility was in compliance with Title 22 regulation at this time, and we have dismissed the complaint. An exit interview was conducted with ED Lopez and a copy of this report and Licensee/Appeal Rights (LIC 9058 01/16) were provided to the licensee following the visit. Signature below confirms receipt of the records.the state’s words, verbatim · CDSS document, Nov 29, 2023 · control 08-AS-20231115104846

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Julia Lopez. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 10/18/2023). According to the LIC624: on 10/15/2023, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of C1.] Shortly after, R1 was returned to the facility unharmed. During today’s visit, LPA performed a welfare check on R1, finding they were indeed safe and unharmed. LPA toured the facility and tested staff alert devices/alarms on each of the facility’s exterior/perimeter doors, finding all were audibly working. LPA also collected copies of pertinent care records and interviewed R1 and relevant staff. According to their latest LIC602 Physician’s Report (dated 04/07/2022), R1 did not have any cognitive impairment diagnosis and their doctor determined that they were able to safely leave the facility unassisted. R1’s doctor also wrote that they were not confused/disoriented, able to follow instructions, and able to communicate needs. R1 was also independent in Activities of Daily Living (ADLs). Staff interviews showed: Aside from medication assistance, R1 was independent with all ADLs. Around 2:45 AM on 10/15/2023, staff responded to the facility’s front door being ajar. They saw R1 across the street, accompanied by a police officer, who walked R1 back to the facility. The police officer told staff that R1 had seen and approached their parked patrol car, which was near the facility. Following the incident, licensee performed a reappraisal of R1’s care needs and requested a new/updated LIC602 from R1’s physician. [CONTINUED ON LIC 809-C] [CONTINUED ON LIC 809] R1 corroborated the above timeline and told LPA they remembered laying down in bed to sleep on the evening in question, but could not recall how or why they subsequently exited the facility’s front door that night, or what they were looking for. No deficiencies were cited during today's visit. However, LPA issued two (2) Technical Violations (TVs), regarding Reporting Requirements and regarding Delayed Egress Doors. An exit interview was conducted with Lopez, to whom a copy of this report, the LIC9102-TV pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 31, 2023