Atria Grand Oaks

Allegation investigated: Staff has not promptly provided resident's records

Licensing Program Analyst (LPA) Sandra Urena arrived unannounced at 11:10 a.m. to conduct a subsequent visit to deliver the findings for the allegation listed above. The LPA met with Executive Director (ED) Brian Larios and explained the reason for the visit. On 02/17/2023, Licensing Program Analyst (LPA) Sandra Urena arrived unannounced at 10:15 a.m. to conduct an initial complaint investigation for the allegation listed above. The LPA met with Executive Director (ED) Brian Larios and explained the reason for the visit. During the visit, the LPA interviewed the Executive Director. The ED stated they would contact the facility's Support Center/Corporate Office to gather additional information about the documents requested for R1. Continues on LIC 9099C... Substantiated On the allegation that, ‘Staff has not promptly provided resident's records’, the complainant’s concern is that they have requested records from the facility pertaining to Resident #1(R1) and the facility has failed to provide the requested records in a timely manner. To investigate the allegation, the LPA interviewed the ED on 02/17/2023 about the records requested by the complainant. The ED stated that records pertaining to residents who have left the facility are maintained at the corporate office. The ED stated that they would communicate with the corporate office to gather additional information for the documents requested and would inform the LPA once they received the records. During today’s visit the LPA asked the ED if the records requested by the complainant had been received from the corporate office. The ED stated that all records pertaining to R1 have already been provided to the complainant. No additional documents were found when the ED sent the request to the corporate office. Based on the investigation, there is sufficient evidence to support the claim that the facility was unable to promptly provide R1’s facility file in a timely manner. The original request was made on 01/26/2023, via a letter which was faxed to Atria Grand Oaks listing the records requested: Resident Notes, Resident Functional Needs Assessment, and Medication Administration Records (MARs). The licensee failed to relinquish the records as of 06/10/2023. Whereas Medication Administration Records (MARs) are not a required document under licensing, it is a form utilized by this community and thus shall be relinquished upon written consent from the resident or the resident’s designated representative, Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview conducted with facility representative. The reports and appeal rights were reviewed and issued.the state’s words, verbatim · CDSS document, Jun 10, 2023 · control 29-AS-20230209134721

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Jun 16, 2023

87468.2(a)(19) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following personal rights: (19) To have prompt access to review all of their records and to purchase photocopies of their records... records shall be provided within two (2) business days. This requirement is not met as evidenced by: Based on interview and records review, the licensee did not comply with the section cited above, as the licensee did not provide R1’s additional missing documentation requested on 2/17/23, which poses a potential personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2023

Plan of correction: 1. Submit a Statement of Understanding, detailing how the community will maintain compliance as it relates to the retention and relinquishing of requested resident files. Submit Statement to CCL by 06/19/2023.

Allegation investigated: Resident cannot access their bathroom sink. Facility personnel are not sufficient in numbers to meet resident needs. Staff are not allowing resident to leave the facility for outings. Staff are not meeting resident's hygiene and/or grooming needs.

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit. On 11/16/2022, the LPA toured the facility, obtained documents, and conducted staff and resident interviews from 9:30 a.m. - 11:00 a.m. On 01/27/2023, the LPA interviewed six (6) residents from 10:20 a.m. - 2:00 p.m. Additional staff interviews were conducted on 02/03/2023 at 11:50 a.m. and 2:13 p.m. On 02/06/2023, the LPA interviewed seven (7) staff from 1:20 p.m. - 3:30 p.m. Today, the LPA interviewed residents five (5) residents from 9:35 a.m. – 10:50 a.m. The LPA also obtained and reviewed additional documentation. Unsubstantiated PAGE 2 Regarding the allegation: Resident cannot access the bathroom sink It was alleged that for residents that utilized a motorized scooter, residents were unable to access their bathroom sink to wash their hands or to care for their personal hygiene needs. The LPA interviewed residents whom utilized a motorized scooter and residents communicated no concerns regarding their ability to use their bathroom sink. Staff also denied claims that any resident whom utilized a motorized scooter had mentioned concerns with an inability to use their bathroom sink. Staff noted that in the case of Resident #1 (R1) they had removed R1’s bathroom door to allow better access for R1’s motorized scooter. The LPA also interviewed R1, whom utilized a motorized scooter while residing in the facility, and R1 denied claims that they were unable to access the bathroom sink. During the course of the investigation, the LPA was unable to obtain sufficient information to determine that resident(s) could not access the bathroom sink. Based on the information obtained, this allegation is deemed Unsubstantiated at this time. Regarding the allegation: Facility personnel are not sufficient in numbers to meet resident needs It was alleged that the facility is understaffed because if residents fall at night, staff are unable to lift the resident and call 9-1-1 for a lift assist. It was an indication that the facility required additional staff at night, versus depending on 9-1-1. It was also alleged that the facility was understaffed because the facility did not allocate staff to accompany residents on outings for residents that are deemed unable to leave unassisted. This is addressed in a separate allegation. Lastly, insufficient staff was reported in the dining room, yet this was addressed in complaint #29-AS-20220610141057 and deficiencies were issued on 10/28/2022. The investigation revealed an instance where Resident #1 (R1) suffered a fall overnight and staff were unable to assist with lifting R1 up from the floor, which led to R1 being on the floor for an extended period of time. The LPA interviewed the staff whom responded to R1 requiring a lift assist during the overnight/NOC shift, and communicated that they were unable to lift R1 on their own and as a result, they called 9-1-1 for a lift assist. Staff admitted they were the only person the assisted living side and mentioned that whereas there was a staff on the memory care side, they were unable to leave the memory care residents unattended. Staff interviews claimed that at night, if a resident is on the ground, unless the resident is able to assist with the lift, staff will call 9-1-1 for lift assistance for the safety of the resident and the staff. PAGE 3 The challenge is that the facility is at the mercy of the responsiveness of the emergency personnel, as one cannot determine how long it may take for emergency personnel to respond to a lift assist. A review of staff schedules indicated that in December 2022, the community has one (1) care staff for the assisted living community during the overnight shift primarily on Saturdays, Sundays, and Mondays. Yet staff schedules demonstrated that for from Tuesday-Friday, there are generally two (2) care staff on shift for the assisted living community during the overnight shift. Resident interviews supported claims that in general, residents believe that staff were responsive regarding care if assistance is required at night. A review of incident reports confirmed that the facility staff have occasionally utilized 9-1-1 for lift assist for the safety of the resident and the staff person, regardless of staff persons on shift. Whereas this is the policy of Atria to call 9-1-1 for a lift assist, it is not an immediate indication of insufficient staffing. Based on the information obtained, there is insufficient evidence to support the allegation of insufficient staffing as it pertains to residents that fall during the overnight shift. Per interviews, it is Atria policy to not support the use of two-person assist and believe the utilization of emergency personnel for lift assist is beneficial for all parties involved. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff are not allowing resident to leave the facility for outings. It is alleged that R1 cannot attend community outings, and it was alleged to be a violation of their personal rights. Interviews and records review show that R1’s physician’s report dated 6/29/2021 indicates that R1 is unable to leave the facility unassisted due to physical limitations. R1 claimed that their physician did not agree with the claim, but the LPA was unable to identify documentation from R1's physician to confirm that R1 was able to attend community outings. Staff interviews stated that for those whom are unable to leave unassisted, the resident would need to be accompanied by a companion or a family member. Staff confirmed that, at the time, they did not have additional staff to accompany those whom cannot leave unassisted. Yet, a review of Atria’s Program Plan did not indicate that a staff person is designated nor required to accompany a resident on a community outing if they are deemed unable to leave unassisted. Staff claim that they were abiding by the orders as determined by R1’s physician as to whether R1 can leave unassisted. The LPA advised management to consider the circumstances regarding residents whom would like to participate in community outings and do not have the means to provide a 1:1 companion or family member. PAGE 4 Whereas some staff claimed that the above-mentioned residents with outing restrictions could potentially attend the scenic drives where a resident does not leave the bus, the internal policy can be viewed as limiting. Based on the information obtained, there is insufficient evidence to support the claim that staff are not allowing resident(s) to leave the facility for outings. Residents whom cannot leave unassisted as per their physician’s report are able to leave the facility for outings; however, the facility is not required or mandated to provide the 1:1 companion in those cases. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff are not meeting resident’s hygiene and/or grooming needs it was alleged that staff are unable to meet the hygiene and grooming needs of residents in this facility, as it was communicated that staff cannot clip resident nails. Staff interviews revealed that only a podiatrist is able to clip resident nails, and it was communicated that a podiatrist comes to the facility on a regular basis. The LPA reviewed documentation that confirmed that a podiatrist comes to the facility weekly. Staff claimed that if they observe that the resident’s nails are long or require attention, they would inform management and a referral to the podiatrist could be made. Interviews with R1 confirmed claims that R1 was aware that staff could not clip their fingernails and toenails, but communicated that staff assisted with other aspects of hygiene and grooming. Further investigation confirmed that depending on the insurance that a resident has, they are able to use the facility podiatrist and the resident can file a claim with their insurance to cover the benefit, or the resident would have to pay out of pocket. The use of the facility podiatrist is not included in basic services. During the course of the investigation, the LPA was unable to obtain sufficient information to determine that staff were not meeting the resident hygiene and or grooming needs. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 7, 2023 · control 29-AS-20220701165224

Allegation investigated: Facility has inadequate staffing to meet resident's needs Staff do not provide adequate food service Improper rent increase

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit. On 11/18/2022, the LPA toured the facility, obtained documents, and conducted staff and resident interviews from 9:30 a.m. - 11:00 a.m. On 01/27/2023, the LPA interviewed six (6) residents from 10:20 a.m. - 2:00 p.m. Additional staff interviews were conducted on 02/03/2023 at 11:50 a.m. and 2:13 p.m. On 02/06/2023, the LPA interviewed seven (7) staff from 1:20 p.m. - 3:30 p.m. Today, the LPA interviewed residents five (5) residents from 9:35 a.m. – 10:50 a.m. The LPA also reviewed pertinent documentation. Unsubstantiated PAGE 2 Regarding the allegation: Facility has inadequate staffing to meet resident's needs. It was alleged that the facility is understaffed in the areas of the front entrance, activities and housekeeping. The complainant reports that the facility does not have a receptionist at the desk twenty-four hours a day, which is a safety concern. However, regulatory standards do not require this facility to have a receptionist on duty twenty-four hours a day. A review of the resident agreement, which is provided to all residents upon admission to the facility, it indicates ‘For your added security, the front doors are locked at sundown and will reopen at dawn.’ Staff indicated that there isn’t a receptionist in the facility after 8:00 p.m. and the protocol for residents entering after 8:00 p.m. is to either call the main number 10-15 minutes prior to re-entry, or to press the alert button outside of the facility to alert staff of their arrival to the facility. It was communicated that staff on duty should respond to the alert buttons and/or the calls to open the front door quickly. Out of the eleven (11) resident interviews, less than a majority of the residents indicated that they had experienced wait-times upwards to twenty-five (25) minutes when they have requested entry into the facility after 8:00 p.m. However, those residents had not called prior to arriving to the facility as preferred per protocol. The majority of residents indicated that they had received a prompt response when requesting entry into the facility after 8:00 p.m. Staff interviews revealed that at times, they are unable to respond to the front door timely due to the claim that they are assisting other residents, but staff indicated that they did carry a mobile phone and would be responsive if they were aware of a resident arrival. The LPA reviewed data from January 2023 and noted that on two occasions on 01/07/2023 and 1/11/2023, the response time for responding to the alert was between 86-93 minutes. However, it is unknown if this was an anomaly. Two occasions displayed on 1/21/2023 and 1/22/2023 in the evening was approximately 13.5 minutes, whereas there were various other times that ranged from 0-7 minutes in response time. Regarding activities, staff interviews confirmed that the facility does not have an Activities Director. However, there are several assistants whom provide activity services and residents confirmed that the facility continues to host daily activities throughout the week. However, due to insufficient staffing in the activities department, the facility has temporarily limited community outings and has focused transportation needs to serving residents that require transportation to doctor’s appointments and grocery shopping. PAGE 3 Lastly, resident interviews revealed that that out of the eleven (11) resident interviews, at least four (4) residents indicated that they were without housekeeping services for approximately three weeks, such as vacuuming, laundering, and bathroom cleaning. Staff interviews confirmed that the housekeeping department had experienced some continual challenges with hiring housekeepers. Interviews with the Maintenance Director supported claims that as needed, they have stepped in to clean rooms and that if concerns are brought to the forefront by residents, they make attempts to address them. Residents communicated that they have communicated this concern to management, and staff supported claims that they were aware of the issues as it pertains to housekeeping. Residents and staff have indicated that recently, the facility has hired additional housekeepers and have not experienced recent challenges with receiving services. Based on the investigation, there is insufficient evidence to support the claim of insufficient staffing. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time. Regarding the allegation: Staff do not provide adequate food service It was alleged that the quality and quantity of food serviced is not nourishing or adequate. Interviews conducted revealed that residents have voiced concerns regarding food service, which include the portion sizes, provided choices, and quality of proteins. However, residents also supported claims that they are able to order other meal options as needed and communicated that staff are accommodating as needed. A review of the facility menus indicated that although the menu had less options than previously offered, residents still were afforded options. Interviews conducted with wait staff and culinary management revealed that the facility is constantly trying to maintain and improve on food quality by way of taking resident suggestions, implementing strategies to increase resident satisfaction, and hosting Food for Thought talks on a monthly basis to ensure continued communication between staff and residents. Staff interviews revealed that the facility can offer low salt meals, limited concentrated sweets, and regular diets. A review of Atria’s program plan revealed that the community is unable to offer any other diets. This is also reflected in the resident handbook and admission’s agreement. However, staff interviews revealed that they will attempt to assist residents with meal selections for those that are gluten-free or have other dietary substitutions. PAGE 4 On 01/27/2023 and 02/06/2023, the LPA toured the kitchen and observed that the perishable and non-perishable food was of good quality. The LPA did not observe food that was expired, of poor quality, nor in poor condition. Based on interviews, observation and documentation review, there is insufficient evidence to support the claim that the staff do not provide adequate food service. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: improper rent increase It was alleged that the licensee provided an improper rent increase. Resident interviews revealed that the rent increase appeared excessive, given that the quality of care and services has not improved. However, interviews and a review of the provided notices indicated that residents and resident responsible parties were provided a notice of rent increase on approximately 10/27/2022, with notice that the new increase would be in effect 01/01/2023. The notice stated that the reason for the increase was due to the cost of inflation, cost of living and labor costs, along with programmatic needs such as activities, housekeeping, transportation, and so on. The notice also included an addendum that reflected the new rate for care levels and rental rates. Based on review of documents and regulatory standards, there is insufficient evidence to support the claim that the rent increase was improper. Whereas it has been deemed excessive by many residents at the facility, all regulatory standards were followed as the facility followed regulation in accordance with the required notice requirements. Per Health and Safety Code 1569.147(b), ‘Licensed residential care facilities for the elderly are not subject to controls on rent imposed by any state or local agency or other local government entity’. Based on the information obtained, this allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 7, 2023 · control 29-AS-20221116122904

Type of visit: POC

Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Plan of Correction inspection due to deficiencies observed during the investigation of complaint control # 29-AS-20220610141057. In summary, the facility was cited on 06/20/2022 for 87303(a) Maintenance and Operation, due to the claim that there were several areas on the second and third floor of the facility that required repair. A subsequent visit was conducted on 10/28/2022 and it was determined that floor repairs had not begun. The licensee was re-cited under 87303(a) Maintenance and Operation. During that visit, it was communicated that the licensee will send a layout of the building, indicating the flooring sections that will require repair no later than 11/9/2022. The licensee had until 11/28/2022 to complete the project. If the licensee required an additional thirty (30) day extension, the request for a thirty (30) days extension needed to be communicated before 11/28/2022. As of 12/09/2022, the Department did not receive a request for an extension, nor did the community submit a layout of the sections that required repairing. On 12/09/2022, civil penalties were issued in the amount of $1,100 for the period between 11/29/22 - 12/09/22 due to failure to comply with the Plan of Correction. The licensee was made aware that penalties would accrue at $100 per day until the corrections were made. On 12/12/2022, the LPA participated in a virtual conference call with Atria, in which a plan was communicated as to when the facility would begin floor repairs. It was communicated that the flooring will be an extensive project, yet management communicated their commitment in gaining regulatory compliance, and came to an agreement to temporarily eliminate any tripping hazards observed on the second and third floor. Interviews and documentation supported claims that the repairing of the subflooring took place on 12/16/2022. The Plan of Correction is met at this time. However, civil penalties will be issued from the period between 12/10/2022 - 12/16/2022, which is a total of seven (7) days, at $100.00 per day. No additional deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 7, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit. The LPA met with Executive Director Brian Larios and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. Kitchen: At the time of the visit, there was a sufficient supply of two-day perishable and seven-day nonperishable food. The menu was posted, and the facility offers a daily specials and a standard selection at every meal. Appliances appeared to be in operable condition. Common Areas: The facility is a three-story building, and it also has a basement level. There are resident rooms on all three floors, units are designated for assisted living residents on all three floors and a separate unit on the first floor is designated for residents in the memory care unit. There is a central entry point for universal screening and temperature checks. Staff were observed wearing appropriate face coverings throughout the visit. There was hands-free hand sanitizer interspersed throughout the common grounds. There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. The fire extinguishers were charged and last serviced 6/2022. Smoke detectors and carbon monoxide detectors are tested monthly and were operable at the time of the visit. At the time of the visit, one elevator was in disrepair and was being repaired at the time of the visit. However, residents and staff have use of the second elevator. Activities: Planned activities are offered, and the activity schedule was posted, and is provided to the residents on a weekly basis. Activity rooms and common spaces appeared clean and in good repair. Rooms: The LPA toured randomly selected rooms in both the memory care and assisted living unit. Rooms appeared clean, well kept, and appropriately furnished. Restrooms: Restrooms on all floors were clean and sanitary. Restrooms were fully stocked with supplies, and hand hygiene signs were observed in all restrooms. The water temperature was tested on all floors, including the basement level, and water temperature ranged from 111.6 -117 degrees Fahrenheit. Outside areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There was an enclosed patio for residents whom reside in the memory care unit. There was a locked pool with appropriate gating; however at 10:05 a.m., the LPA observed that the gate to the pool was open. The LPA informed staff. However, the LPA observed that the pool area was not locked upon notice, and was not closed as of 2:20 p.m. This is a zero tolerance violation; a civil penalty in the amount of $500 is assessed. Infection Control: The community has an adequate supply of Personal Protection Equipment (PPE) and can obtain additional supplies. The community's cleaning protocol is sufficient. This facility has records of staff and resident vaccinations. The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. Staff are up to date regarding guidelines pertaining screening recommendations, masking requirements of staff and visitors, and reporting procedures. The community's policies and procedures pertaining to infection control were adequate. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Civil penalties assessed. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 27, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Plan of Correction inspection due to deficiencies observed during the investigation of complaint control # 29-AS-20220610141057. During the initial visit on 06/20/2022, the LPA observed several areas in which there appeared to be a ‘hole’ or a noticeable dip in the flooring. The licensee was cited for 87303(a) Maintenance and Operation, and the licensee was required to communicate a plan of action regarding the floor repairs, as it was highlighted as an extensive project. On 07/01/2022, the Executive Director communicated a tentative plan that the repairs would begin in August or September of 2022. It was noted that the licensee planned to remove the carpet, refinish the subfloor, and place new flooring over the subflooring. A subsequent visit was conducted on 10/28/2022 and it was determined that floor repairs had not begun. The licensee was re-cited under 87303(a) Maintenance and Operation. During that visit, it was communicated that the licensee will send a layout of the building, indicating the flooring sections that will require repair no later than 11/9/2022. The licensee had until 11/28/2022 to complete the project. If the licensee required an additional thirty (30) day extension, the request for a thirty (30) days extension needed to be communicated before 11/28/2022. The LPA followed up with Executive Director Brian Larios on 11/10/2022, whom communicated that the facility had been unable to secure a vendor at that time, despite best efforts. The LPA reiterated the time frame to complete the project, and the fact that the licensee could ask for a thirty (30) day extension. As of today, the licensee failed to submit a layout of the building to indicate the sections that require repair, nor did the licensee submit a request for an extension by 11/28/2022. Civil Penalties will be issued for period between 11/29/22 - 12/09/22, which is a total of eleven (11) days, at $100.00 per day. Civil Penalties will accrue until plan of correction is met. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Dec 9, 2022

Allegation investigated: Insufficient staffing

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit. During the initial visit on 6/20/2022, the LPA conducted a tour at 10:20 a.m., observed lunch service from 12:00 p.m. – 12:40 p.m., interviewed staff at 9:15 a.m. and 11:32 a.m., and spoke with residents at 10:30 a.m., 10:43 a.m., 10:50 a.m., and 10:59 a.m., and throughout lunch service from 12:42 p.m. – 1:00 p.m. On 7/11/2022, additional resident interviews took place on 10:10 a.m., and 10:40 a.m. On 10/19/2022, the LPA interviewed staff at 10:32 a.m., 10:38 a.m., and 11:16 a.m., and interviewed nine (9) residents from 9:15 a.m. – 10:30 a.m., and an additional resident interview was conducted at 1:00 p.m. Today, the LPA conducted a tour, reviewed schedules, and interviewed staff at 11:20 a.m., and 11:40 a.m. Substantiated Regarding the allegation: Insufficient staffing It was alleged that the facility was insufficiently staffed, specifically in the dining room and housekeeping. Interviews confirmed that as a result of staff shortages in the dining room, sections of the dining room had been previously closed to allow for residents to sit in a centralized location rather than throughout the dining room. Staff claimed that there should be three (3) dining staff at breakfast, five (5) dining staff during lunch service, and five (5) to six (6) dining staff during dinner service. It was communicated that there are usually two (2) person for breakfast, three (3) persons during lunch, and four (4) to five (5) staff during dinner. Residents claimed that they understood the wait times, as they expressed that the dining room was understaffed. However, it was confirmed that there were long waits. Some residents also communicated that due to insufficient staffing in the housekeeping department, some experienced not having their apartment cleaned at least once a week. Staff interviews confirmed that although management staff have had to step in to assist, there have been shortages in the housekeeping department. It was communicated that fully staffed in the housekeeping department meant having four housekeepers ad a laundry attendant. However, staff claimed that they tend to have between two (2) to three (3) housekeepers per shift. Based on interviews and record review, there is sufficient evidence to support the claim of insufficient staffing, specifically in dining and housekeeping. This allegation is deemed Substantiated at this time. Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D). Exit interview conducted, today's report and appeal rights were issued. Regarding the allegation: Staff did not provide a safe and comfortable environment for residents in care It was alleged that due to the number of wheelchairs and walkers present during meal service, it poses a safety and tripping hazard. Staff interviews reveal that they inform all residents that ambulate with a walker, wheelchair, or motorized scooter that once they come into the dining room, their device will be placed along the wall and would be retrieved at the close of service. Staff admitted that for some residents, some prefer that their ambulatory device is within arms reach for safety reasons. However, staff said that the majority of the residents comply and are agreeable to the process of having staff move their ambulatory device against the wall and retrieving it at the end of food service. The LPA observed dining service on 6/20/2022 and 10/19/2022 and observed minimal ambulatory devices in the main dining room and observed many around the perimeter of the dining room. Interviews conducted with residents whom use ambulatory assistive devices communicated that staff will place their device against the wall during service; the only concern communicated was near the end of service, it takes time for staff to retrieve their device. Based on the information obtained, there is insufficient evidence to support the claim that staff did not provide a safe and comfortable environment for residents. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff did not provide adequate food service It was alleged that residents were unhappy with the food options. Resident interviews revealed that various food options were available from the specialty and standard menu; however, if concerns were raised regarding meal quality, staff were accommodating and would either change the meal out for the resident or take it back for it to be prepared to their liking. Interviews with kitchen staff revealed that there may be varied time in getting food, depending on meals that are made-to-order, versus specialty items that are made in bulk prior to the start of service. Staff also admitted that due to product limitation from the company’s chosen food vendors, staff are now ordering food in advance to identify which food items are available, and communicating menu changes to the residents in a timely manner. Staff communicated that they are also working at cycling out some meal choices to allow for a variety of new meal options, with understanding that some of the residents may be dissatisfied with some meal options that are temporarily discontinued. CONT 9099-C Staff interviews revealed that the facility can offer low salt meals, limited concentrated sweets, and regular diets. A review of Atria’s program plan revealed that the community is unable to offer any other diets. However, staff interviews revealed that they will attempt to assist residents with meal selections for those that are gluten-free or have other dietary substitutions. Most residents whom are on a special diet communicated that they were made aware of the facility's policy as it relates to the dietary restrictions they were able to meet, and said that they selected options that fit their needs. However, concerns were raised regarding staffing in the dining room and extended wait times to receive food. This was addressed in another allegation and the licensee was cited for insufficient staffing. Based on the information obtained in interviews and record review, there is insufficient evidence to support the claim that the staff did not provide adequate food service. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 28, 2022 · control 29-AS-20220610141057

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Nov 4, 2022

87411(a) Personnel Requirements. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews and record review, licensee failed to ensure that the facility had an adequate number of staff to meet the residents needs in dining and housekeeping departments, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: The Administrator agreed to the following: 1. Submit a Staffing Plan by 11/4/2022. Staffing Plan shall detail the efforts the licensee has employed to ensure adequate staffing in dining and housekeeping departments. Plan shall detail steps taken in response to call-outs.

Allegation investigated: Facility has mold

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for an initial 10-day visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit. Today, the LPA conducted a physical plant tour from 10:10 a.m. – 11:10 a.m., and interviewed staff at 10:17 a.m., 10:47 a.m., 10:50 a.m., 11:00 a.m., and 11:20 a.m., and 11:40 a.m. It was alleged that the facility had mold. The LPA toured all common spaces in the facility on the first floor, second floor, third floor, and in the basement level. Common spaces throughout the facility included: restrooms, bistro, library, dining/seating area, staff conference room, wellness center, medication rooms, activity rooms. The LPA observed a random selection of resident rooms on all three floors. CONT 9099-C Substantiated At 10:20 a.m., the LPA observed a black-like substance on the vents near the dining room, adjacent to the kitchen. At 10:30 a.m., the LPA toured the basement level of the facility. The LPA identified what appeared to be mold in the staff conference room. The LPA toured the two (2) common restrooms on the basement level and observed a black-like substance, which appeared to be mold, in both restrooms. The LPA again toured conference room and the two (2) restrooms found in the basement area with the Maintenance Director at 11:05 a.m., whom confirmed that the panel in the staff conference room would need to be removed in order to properly treat the mold. Based on the information obtained, there is sufficient evidence to support the claim that the facility failed to keep the facility free of mold. This allegation is deemed Substantiated at this time. Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D). Exit interview conducted, today's report and appeal rights were issued.the state’s words, verbatim · CDSS document, Oct 28, 2022 · control 29-AS-20221026161448

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 18, 2022

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the licensee did not comply in the section cited above, as mold was observed in the conference room and a black like substance was observed in the basement common restrooms and on the vents near the dining room, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: The Licensee agreed to do the following: Treat the mold observed in the bathrooms, vents, and and staff conference room. If repairs are required, communicate the time frame in which the mold will be removed. Mold removal must take place within the next three weeks. Submit proof of completion no later than 11/18/2022.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Case Management- Deficiencies inspection at the facility today due to deficiencies observed during the investigation of complaint control # 29-AS-20220610141057. During the initial visit conducted on 06/20/2022, the LPA observed several areas in which there appeared to be a ‘hole’ or a noticeable dip in the flooring. The licensee was cited for 87303(a) Maintenance and Operation, and the licensee required to communicate a plan of action regarding the floor repairs, as it was highlighted as an extensive project. On 07/01/2022, the Executive Director communicated a tentative plan that the repairs would begin in August or September of 2022. It was noted that the licensee planned to remove the carpet, refinish the subfloor, and place new flooring over the subflooring. As of today, the project has not begun. Today, the licensee will be re-cited under 87303(a) Maintenance and Operation. The licensee will send a layout of the building, indicating the flooring sections that will require repair no later than 11/9/2022. At this time, the licensee will have until 11/28/2022 to complete the project. If the licensee requires an additional thirty (30) day extension, the request for a thirty (30) days extension will need to be communicated before 11/28/2022. At this time, if an extension is requested, the flooring project will need to be completed by 12/28/2022. Failure to correct the deficiencies may result in additional civil penalties due to failure to correct. See 809-D for deficiency. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 28, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 28, 2022

87303(a) Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above as the flooring is uneven, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: The Licensee has agreed to do the following: 1. The licensee will send a layout of the building, indicating the flooring sections that will require repair no later than 11/9/2022. 2. Repairs must be completed by 11/28/2022. a request for an additional thirty day extension must be submitted before 11/28/2022.

Allegation investigated: Facility has fire hazards

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct an initial 10 day visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit. During today's visit, the LPA interviewed staff at 9:30 a.m. and 11:45 a.m., and interviewed residents at 10:10 a.m., and 10:40 a.m., and collected pertinent documents. Regarding the allegation: Facility has fire hazards It was alleged that the facility has a fire hazard, as they disable the doors at night and residents are unable to leave the facility without the assistance of staff. Interviews confirmed that staff lock the doors from the inside due to safety concerns, and claimed that residents can contact staff if they need to exit the community at night. However, this practice is a personal rights violation. Based on the information gathered, the above-allegation is deemed Substantiated at this time. Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D). Exit interview conducted, today's report and appeal rights were issued. Substantiatedthe state’s words, verbatim · CDSS document, Jul 11, 2022 · control 29-AS-20220701165224

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Jul 12, 2022

87468.1 Personal Rights of Residents in All Facilities (a) Residents ... shall have all of the following personal rights:(6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as the exterior doors to the facility are locked from the inside, which poses an immediate personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 11, 2022

Plan of correction: The Administrator agreed to do the following: 1. Submit a statement, detailing how the community will regain compliance with Regulation 87468.1(a)(6). Submit statement to CCL no later than 7/12/2022, end of day.

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility is in disrepair

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for an initial 10-day visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit. Today, the LPA conducted a tour at 10:20 a.m., observed lunch service from 12:00 p.m. – 12:40 p.m., interviewed staff at 9:15 a.m. and 11:32 a.m., and spoke with residents at 10:30 a.m., 10:43 a.m., 10:50 a.m., and 10:59 a.m., and throughout lunch service from 12:42 p.m. – 1:00 p.m. Regarding the above allegation, it was alleged that the flooring is uneven on the second and third floor. During the physical plant tour, the LPA observed several areas where there was a ‘hole’ or a noticeable dip in the flooring. Resident interviews confirmed that residents were worried about tripping and falling, as many residents ambulate with a walker or a wheelchair. Observations confirmed that the uneven surfaces pose a safety hazard to the residents. There is sufficient evidence to support the claim that the facility is in disrepair. This allegation is deemed Substantiated at this time. Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D). Exit interview conducted, today's report and appeal rights were issued. Substantiatedthe state’s words, verbatim · CDSS document, Jun 20, 2022 · control 29-AS-20220610141057

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 5, 2022

87303(a) Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above as the flooring is uneven, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 20, 2022

Plan of correction: The Administrator agreed to do the following: 1. Submit a Plan of Action to CCL, documenting the proposed plan in repairing the flooring (ie. holes) on the second and third floor. A reasonable timeline to repair the holes must be proposed. Plan of Action shall be submitted no later than 7/5/2022. Approved plan shall also be shared with residents at this facility.

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility is malodorous Facility equipment in disrepair

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for an initial 10-day visit. The LPA met with Excecutive Director Brian Larios and explained the reason for the visit. During today’s visit, the LPA interviewed staff at 9:10 a.m., 9:16 a.m., and 9:20 a.m., observed the facility dining area from 9:23 a.m. – 9:27 a.m.; and, interviewed residents from 9:45 a.m. – 10:00 a.m. Regarding the above allegations, it was alleged that the salad bar was inoperable, and an odor was emitting from the area where the salad bar is placed in the dining area. CONT 9099-C Unsubstantiated Staff interviews revealed that approximately four to six weeks ago, a sewage smell was emitting from the area where the salad bar was placed. Records review confirmed that on 4/4/2022, a plumbing company came out to service the plumbing issue and the licensee was notified that the issue was corrected. However, the smell returned, and the Administrator continued to communicate with the plumbing company in efforts to resolve the issue in a timely fashion. It was discovered that there were two pipes connected to the salad bar. As such, on 4/30/2022, a plumbing company returned to the facility to continue working on the plumbing issue. Interviews confirmed that in order to address the sewage smell, the plumbing company had to ‘cap’ the pipes leading directly to the salad bar. As a result, it makes the salad bar inoperable at this time. Interviews confirmed that due to the COVID-19 pandemic, the facility stopped utilizing the salad bar for safety and sanitary purposes. Residents were informed that they could still order salads, yet they would be ordered through dining staff and prepared in the kitchen. During today’s visit, the LPA observed the salad bar that is placed in the dining room. At this time, the LPA could not identify a malodorous or unpleasant smell emitting from the area. Interviews conducted with staff and residents confirmed that at this time, there is no smell coming from the salad bar. Lastly, the salad bar is currently inoperable, yet it is due to the need to ‘cap’ the pipes leading to the salad bar, as it has caused the odor. Based on the information obtained, there is insufficient evidence to support the above allegations. The Administrator has made efforts to address the malodorous smell on numerous occasions and in order to properly address it, the pipes had to be capped to stop the smell. As a result, the current salad bar is inoperable cannot be utilized. The Administrator claimed that they are planning to either remove the mechanism altogether or will replace the salad bar in the near future. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, May 6, 2022 · control 29-AS-20220503103617

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit, which has an emphasis on infection control practices and procedures. The LPA met with Executive Director Brian Larios and informed them of the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. Kitchen: The facility had a sufficient supply of two-day perishable and seven-day nonperishable food at the time of the visit. Food is prepared based on the resident’s diets. The menu was posted and the facility offers an alternate menu. Facility uses Cisco Foods for food deliveries, and delivery takes place twice a week. Snacks and beverages are available for residents. Common Areas: The facility is a three-story building, and it also has a basement level. There are resident rooms on all three floors, units are designated for assisted living residents on all three floors and a separate unit on the first floor is designated for residents in the memory care unit. Upon entry to the facility, there is a central entry point for symptom screening and temperature checks for residents, staff, and visitors. Staff were observed wearing appropriate face coverings throughout the visit. In addition, the LPA observed hands-free hand sanitizer interspersed throughout the common grounds. There were no obstructions and/or tripping hazards throughout the facility. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. There are fire extinguishers throughout the facility, which were charged and last serviced 2/2022. Planned activities are offered. Activity schedule is posted throughout the facility. The LPA observed staff engaging residents in group activities. All activity rooms and common spaces appeared clean and in good repair. Outside areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is a locked pool with appropriate gating. Parking is available for residents and visitors. Common Restrooms: The LPA observed common restrooms on all three floors. Whereas hand-washing signs were observed on the first floor, the LPA informed the Executive Director that signs promoting good hand hygiene should be placed in all common restrooms in the facility. However, all restrooms were fully stocked with soap and paper towels. During today’s visit, the LPA tested water temperature on all three floors, and the temperature averaged between 139.7 – 146.6 degrees Fahrenheit. The Executive Director informed the LPA the facility was actively working on this issue and a vendor was coming out to fix the building’s boiler. Infection Control: During today’s visit, the LPA spoke with the Executive Director regarding the community's infection control practices. The LPA encouraged the Executive Director to create a centralized location with COVID-19 signs that promoted hand hygiene, physical distancing, and cough/sneeze etiquette. The community has an adequate supply of Personal Protection Equipment (PPE) and is able to obtain additional supplies. The community's cleaning protocol is sufficient. This facility has records of staff and resident vaccinations. If needed, the facility has the capacity to designate isolation zones if there is a confirmed case of COVID-19. The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. Staff are up to date regarding guidelines pertaining to visitation and vaccine requirements. The community's policies and procedures pertaining to infection control were adequate. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 4, 2022

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

Allegation investigated: Residents are being forced to stay in their rooms

Licensing Program Analyst (LPA) Kelly Dulek initiated an unannounced subsequent complaint investigation for the purpose of delivering findings for the allegation listed above. LPA met with Maintenance Director Marco Perez. Executive Director was unavailable during today’s visit. Entrance interview conducted. During today’s visit, LPA Dulek and Maintenance Director Marco Perez toured the facility at 10:05AM. No health and safety hazards were observed at that time. During the initial visit on 04/09/2020, LPA Dulek conducted a telephone visit and interview with the Administrator Carmy Jerome at 4:25PM. On 04/10/2020, LPA conducted a FaceTime visit to interview residents from 1:05-2:04PM. LPA then conducted a virtual facility tour with the administrator at 2:10PM. The LPA requested copies of the staff schedule for the current week. The LPA then conducted 3 staff interviews telephonically on 04/30/2020 from 1:05PM-1:35PM and also 4:03-4:19PM. Additionally, during the course of the investigation, LPA reviewed state-issued and county-issued documents related to the complaint allegation. The following was then concluded: Report Continued on LIC 9099-C Unsubstantiated A stay safe at home order was issued on 03/17/2020 and subsequently modified on 03/20/2020. This order indicated those age 65 and older were to “self-isolate in their place of residence to the maximum extent feasible to slow the spread of COVID-19 to the maximum extent possible.” Ventura County Public Health issued a stay well at home order indicating “all individuals currently living within Ventura County, equal to or older than 75 years of age, or equal to or older than 70 years of age with an active or unstable comorbidity, are ordered to shelter at their place of residence from March 18, 2020 to April 1, 2020.” Interviews revealed that although residents may not like staying in their individual apartments, most residents have no problem doing so. Some residents come out of their room to walk around and are then gently reminded to return to their room for their safety. No residents interviewed felt they have been forced to stay in their rooms. Additionally, interviews revealed that the facility is offering exercise and social opportunities in the doorways to keep residents entertained and healthy while practicing social distancing. No witnesses interviewed have ever seen staff raise their voice or physically return residents to their room. Based on documents reviewed and interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did occur, therefore, the allegation that “residents are being forced to stay in their rooms” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of the report was provided via email.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 31-AS-20200330093523