Atria Grand Oaks

Allegation investigated: Staff denying authorized representative resident’s medical records.

Licensing Program Analysts (LPAs) Angela Barutyan and Quoc Huynh arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegations listed above at 10:07AM. LPAs met with staff and Executive Director (ED) Eden Tolentino who arrived shortly thereafter. Reason for the visit was explained. During today’s visit, LPA conducted a physical plant tour, interviewed four (4) staff, and obtained copies of pertinent documents. During the initial complaint visit which took place on 11/06/2025, LPA Barutyan conducted interviews with three (3) staff and three (3) residents, reviewed and obtained copies of pertinent documents relevant to the investigation, conducted a brief physical plant tour, and discussed allegations with ED. Report Continued on LIC 9099-C. Substantiated It was alleged that the facility did not provide Resident #1 (R1)’s medical records to R1/R1’s authorized representative. LPA interviewed ED Tolentino who stated that records requests go through the facility’s legal team for review and the process takes about seven (7) days. ED also stated that resident admission agreements and incident reports are released, but resident care plans, appraisals, and the facility’s “resident service guidelines” are not released. Interviews with R1’s responsible party stated that no records for R1 were received. Record review revealed that R1’s responsible party made an initial request for records on 10/20/2025. The facility released an incident report and SOC341 for R1 to R1’s responsible party on 10/22/2025. A second request for R1’s "whole file" was made on 10/22/2025. The facility released two (2) incident reports on 10/26/2025, R1’s admission agreement on 10/27/2025, and R1’s medication list on 11/04/2025. Records were released via email to R1’s responsible party. Record review and staff interview confirmed that no care plans or medical records were released. Regulation states that residents or their authorized representatives shall have the personal right to copies of records within two (2) business days. Therefore, based on interview and record review, the allegation “Staff denying authorized representative resident’s medical records” is deemed SUBSTANTIATED at this time. The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Administrator was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted. Appeal rights and a copy of the report were provided. It was alleged that Staff #1 (S1) and Staff #2 (S2) forced Resident #1 (R1) to shower and wash their hair. LPA interviewed five (5) staff, two (2) residents, and one (1) witness who denied staff forcing showers. Staff and witness interviews stated that R1 was not forced to shower or wash their hair. Staff stated that R1 would often refuse showers but sometimes accept hair washing. LPA observed shower logs for R1 and observed documented refusals for four (4) out of eight (8) showers in October 2025 and refusals for two (2) out of nine (9) showers in September 2025. LPA also observed resident rights, abuse and neglect, and activities of daily living trainings for S1 and S2. Based on interviews and record review, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation “Staff forced resident to shower” is deemed UNSUBSTANTIATED at this time. It was further alleged that the facility was scheduling medical appointments for R1 without consent from R1’s responsible party(ies). Staff and witness interviews conducted stated that the facility does not make appointments on behalf of residents without consent. Staff stated that R1’s physician was contacted multiple times due to changes of condition and behaviors. LPA reviewed fax communications between the facility and R1’s physician regarding R1’s change of condition on 08/12/2025 and 09/24/2025 with the physician’s response to schedule a visit. Per staff interviews, R1 did not attend the medical appointments as transportation was not provided. Responsible parties were responsible for providing transportation to the medical appointments for R1. Record review of R1’s admission agreement signed and dated 08/22/2022 states that “You authorize us to contact your designated…personal health care providers…to assist you to make arrangements for health care services with your providers and to coordinate with those providers regarding your care needs in the Community.” Based on interviews and record review, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation “Staff scheduling doctors appointments without consent from authorized representative” is deemed UNSUBSTANTIATED at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 19, 2026 · control 29-AS-20251030082501

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Mar 26, 2026

(a) In addition to the rights listed...residents...shall have all of the following personal rights: (19)To have prompt access to review all of their records...Photocopied records shall be provided within two (2) business days... This requirement is not met as evidenced by: Based on interview and record review, licensee did not comply with the section cited as Resident #1's records were not provided within 2 business days and medical records were not provided to an authorized representative. This poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 19, 2026

Plan of correction: ED stated they will submit a signed statement of understanding of the section cited to CCL by the due date. ED will also provide the medical records to R1's authorized representative and submit proof.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Angela Barutyan and Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:07AM. LPAs met with staff and Executive Director (ED) Eden Tolentino who arrived shortly thereafter. Reason for the visit was explained. Beginning at 11:22AM, LPA Barutyan along with ED Tolentino, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed: The facility is a three-story building, with 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 memory care residents. KITCHEN: At 11:24 AM, LPA observed the kitchen and dining area. Kitchen area remains inaccessible to residents. Knives are inaccessible to residents in care. Kitchen appliances are in operable condition. Chemicals and cleaning supplies were stored separately from the food and food preparation area. The facility has a sufficient supply perishable and non-perishable food. The menu was posted outside the dining area. Snacks and beverages are available for residents. BEDROOMS: LPA observed ten (10) randomly selected resident rooms throughout facility. Rooms were furnished with clean linens, appropriate furniture, and sufficient lighting. RESTROOMS: LPA observed restrooms in ten (10) resident units. All restrooms were fully stocked with supplies. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperature was measured in all bathrooms and were between 105.7-111.2 degrees Fahrenheit, which is within the required range. Continued on LIC 809-C. COMMON AREAS: LPA observed common area to be relatively clean and properly furnished. LPA observed the fire extinguishers throughout the facility to be fully charged and last serviced on 02/19/2026. The facility's smoke alarms are hard wired, and the facility is equipped with a sprinkler system. Fire alarm/sprinkler system were last tested on 02/11/2026 and 03/17/2026 by a third-party vendor. Inside temperature was maintained at a comfortable level. OUTDOOR SPACE: 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. At 12:05PM, LPA observed the pool gate to be unlocked and accessible as the latching mechanism was inoperable. Maintenance was contacted during the visit and repaired the latch. LPA retested the pool gate at 03:54PM and observed the pool gate to properly lock. ACTIVITIES/OTHER: Planned activities are offered, and the activity schedule was posted. The activity schedules are distributed to the residents and are also located near the elevators for residents to pick up if needed. Activity rooms and common spaces appeared clean and in good repair. Medications and first aid kits are located in locked medication rooms. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor closets/maintenance closets. RECORD REVIEW: Beginning at 11:22AM, LPA Huynh conducted a file review for ten (10) residents and eight (8) staff for documents including but not limited to: medical records, care plans, Admission Agreement, TB test, health screening, staff training, first aid/CPR, and fingerprint clearance. Resident and personnel files were in order. Emergency drills are conducted quarterly, with the last drill conducted on 02/26/2026. The LPAs reviewed facility's Infection Control Plan and Emergency and Disaster Plan which was observed to be complete and updated. At 03:41PM, LPAs observed the facility’s liability insurance policy with an expiration date of 06/01/2025. ED was unable to provide proof of an active policy during today’s visit. MEDICATION REVIEW: Starting at 04:36PM, LPA Huynh conducted a review of medication and medication documentation with staff for two (2) residents and observed that medications were properly documented and assisted with as prescribed. No concerns or errors were observed. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalty was issued in the amount of $500 for accessible bodies of water. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 19, 2026

Allegation investigated: Illegal Eviction

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a subsequent complaint investigation with the purpose of delivering findings for the allegation listed above at 01:08PM. Upon arrival, LPA met with Executive Director (ED) Eden Tolentino. Entrance interview conducted. During an initial complaint visit, conducted by LPA Dulek and LPA Angela Barutyan on 09/26/2025, LPAs conducted a brief physical plant tour between 09:15AM-02:10PM, conducted interviews with three (3) staff, two (2) residents, and attempted an interview with one (1) resident between 09:33AM-02:05PM, reviewed and obtained copies of pertinent documents relevant to the investigation between 12:05PM-02:20PM, and discussed allegation with ED at 03:05PM. During a subsequent complaint visit conducted by LPA Dulek on 12/16/2025, LPA spoke with Sales Director at 01:54PM, Business Director Sarah Dodd at 01:57PM, conducted a telephone interview with staff at 02:00PM, and resident interview at 02:31PM. LPA also obtained copies of relevant documents. Throughout the course of the investigation, LPA reviewed all documents Report Continued on LIC 9099-C Substantiated obtained, including additional correspondence with the facility. The following was then determined: The complaint alleges that Atria issued an eviction notice to Resident #1 (R1) and the reason for the eviction was not valid. LPA reviewed the 30-day notice to terminate which indicated that during an incident that occurred on 08/30/2025, R1 violated the facility’s house rules and as thus, R1’s residency will terminate effective 10/05/2025. According to the house rules, which R1 signed upon admission to the facility and as stated in the notice to terminate, “residents…must display respect for others in the community. Neither verbal, nor physical abuse towards residents, employees, visitors and/or anyone who is present in the Community will be tolerated.” Interview with Executive Director, who was not present during the alleged incident on 08/30/2025, revealed ED believed R1’s behavior that day did in fact constitute verbal abuse. However, interview with all parties that were directly involved in or observed the alleged incident, which included two (2) residents and two (2) staff, revealed that although R1 did appear to be upset and raised their voice, at no time was R1’s behavior abusive. The staff running the activity stated R1 was upset with Atria and the choice of activities. However, none of R1’s comments were directed at the staff nor was R1 yelling at the staff. Staff interviewed indicated that other residents have yelled directly at the staff, called staff names and cursed, which the staff did identify as abuse, but R1 did not engage in any such behavior during this incident or at any other time. Staff noted other residents who they believed were being verbally abusive are still residing at the facility. ED indicated R1 was angry the whole time and R1’s behavior instigated the other resident present, who also got upset. LPA reviewed all incident reports received at the Regional Office (RO), and this alleged incident was not reported to the RO. It is unclear why if this behavior was so extreme as to constitute abuse, an incident report detailing the event was not sent to the RO. Following a meeting held including R1 and their legal representative, an addendum to termination notice was issued, which extended the date of the eviction to 01/31/2026. The eviction notice was not rescinded. Prior to the facility issuing the eviction notice, R1 frequently attended activities, however, after the notice was issued, staff and residents reported R1 no longer attended activities and R1 remained mainly in their own room. LPA was informed during the subsequent complaint visit that R1 moved out of the facility on 12/11/2025. Interview with R1 revealed that the reason for the move was due to the eviction notice issued. Based on the information gathered during the investigation, the preponderance of evidence standard has been met, therefore, the allegation is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 9099-D). ED was informed that failure to correct to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of today’s report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 13, 2026 · control 29-AS-20250919115058

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(3) · Plan of correction due date: Jan 27, 2026

87224(a)(3) Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section, as R1 was issued an eviction notice for violating house rules, however all parties involved did not believe R1’s behavior was abusive, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 13, 2026

Plan of correction: Executive Director agreed to write a statement of understanding regarding evictions and send to CCL by POC due date.

Allegation investigated: Staff do not provide adequate food service Staff do not ensure the facility is clean and sanitary

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegations listed above at 10:10AM. Upon arrival, LPA met with Executive Director (ED) Eden Tolentino. Entrance interview conducted. During today's visit, LPA interviewed ED, toured the dining room area with ED at 10:27AM, interviewed Resident #1 (R1) at 10:40AM, and LPA observed lunch. During an initial complaint visit conducted by LPA Angela Barutyan on 07/31/2025, LPA conducted a physical plant tour between 12:24PM-01:30PM, conducted interviews with five (5) residents and four (4) staff between 12:25PM-01:20PM, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegations with ED Remon Pagels. The following was then determined: Report Continued on LIC 9099-C Substantiated The complaint alleges that on 07/17/2025, the meal served during dinner service was not prepared properly, with the meat and potatoes undercooked. R1 brought this concern to the ED at that time. Interview with ED revealed that on that specific date, the beef cooked was prepared cooked medium and that R1 prefers their beef well done. Staff interviewed stated residents can make requests about cooking preference as well as alterations to their preferred entree. This information is then relayed from the serving staff to the cook staff to accommodate the residents. In the case of R1, R1 had not asked for their meat to be served well done, so R1 was served the meal as prepared. Interviews with staff revealed that on that date, once the food was served and the chef was made aware, the chef did reheat R1's beef and potato to their preference. On another unknown date, R1 was concerned that the cornbread was undercooked. R1 saved the cornbread in their refrigerator since the date it was served. LPA observed the cornbread did appear to be moist in the center, but it is unclear how much moisture gathered while the item was stored in the refrigerator and how much was present when the cornbread was served. Other residents interviewed indicated the food served is to their liking; many commented that the chef is excellent. The posted menu contains a variety of items in all food groups. There is also an everyday menu, with items residents can choose as an alternative to the meal served. Some residents indicated these everyday items are not always available, but there are choices. Additionally, R1 was concerned about the cleanliness of the dining room tables and chairs. LPA observed the dining chairs, which consist of a wood frame and padded seating. Observation of the chairs revealed the chairs are older and the varnish on the chairs is wearing, producing a somewhat sticky cloudy appearance on the wood portion of the chairs. ED stated that all the chairs are being sanded and re-varnished due to the appearance. Approximately 25 chairs have been refinished by the maintenance staff. Due to the dry time of the varnish, repairs need to be made after dinner service is completed and chairs dry overnight to not interrupt resident use. To expedite the process, the facility is contracting with an outside vendor to complete the remaining chairs and re-finish the tables as well. Both staff and residents interviewed stated the tables and chairs are wiped down after every use. Based on observation, it appears the concern is with the pedestal stands for the tables, not the table tops and the backs of the chairs. During the inspection, the LPA observed the tables and chairs to have some buildup and the food was reportedly underdone on specific occasions, however, LPA determined there is no impact direct impact to the residents, presented no danger, and did not effect the overall operation of the facility. This is considered a technical violation and no citations are being issued at this time. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Aug 20, 2025 · control 29-AS-20250723095127

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Angela Barutyan arrived on July 31, 2025 for an unannounced inspection to follow up on an investigation of a self-reported incident by the facility. The LPA met with Remon Pagels, designated Executive Director. On November 12, 2024, the Department concluded an incident report investigation regarding the following incident: facility staff physically abused resident (R1). The licensee was cited for California Code of Regulations (CCR) 87468.1(a)(3) Personal Rights of Residents in All Facilities. At the time of the incident report investigation, the licensee was informed that a civil penalty might be assessed based on Health and Safety Code § 1569.49(f). The Department has concluded an analysis and has determined that a civil penalty is warranted for physical abuse. The Welfare and Institutions Code Section 15610.63 for physical abuse means (b) Battery, as defined in Section 242 of the Penal Code. This is evidenced by the facility surveillance video showing that the staff willfully committed violence against R1 by pulling R1 to the ground, kicking R1 and hitting R1 with R1’s shoe. Today, July 31, 2025, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49(f) for a violation that the Department constitutes as physical abuse in the amount of $10,000. Exit interview conducted. A copy of the report issued. Appeal rights provided. Remon Pagels and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: Facility staff do not maintain facility walkways free from hazards

Licensing Program Analysts (LPAs) Angela Barutyan and Emily Peraldi arrived at the facility unannounced to conduct an initial complaint investigation for the allegation listed above at 09:50AM. Upon arrival, LPAs met with staff and Executive Director (ED) Eden Tolentino who arrived at 10:15AM. Entrance interview conducted. During today's visit, LPAs conducted a full physical plant tour between 10:26AM-11:55AM, interviewed seven (7) residents between 11:07AM-11:49AM, three (3) staff members between 11:36AM-02:02PM, and the ED at 02:38PM, and reviewed and obtained copies of pertinent documents relevant to the investigation between 02:50PM-03:30PM. CONTINUED ON LIC 9099-C. Unsubstantiated It was alleged that the rug outside of the front entrance of the facility and the outdoor walkways posed safety hazards to residents. Upon entry at 09:50AM, LPAs did not observe a rug by the front door entrance. Interviews conducted with staff and residents confirmed that there used to be a rug at the entrance, but it was removed due to several reports of the rug getting caught on resident walkers. It was further alleged that the outdoor passageways are too narrow and pose concerns for walker usage. LPAs observed the outdoor passageways which were maintained in good repair and not obstructed. Seven (7) out of seven (7) residents interviewed did not report any current safety concerns. At 01:57PM, LPA along with the Maintenance Director, measured the outdoor passageway by the side of the facility to be 37 inches, and at 01:59PM the outdoor passageway leading to the front of the facility to be 60 inches. The average walker measures around 23-28 inches. No concerns of the width of the passageways were noted. Staff interviewed did not have current physical plant safety concerns. LPAs did not observe any immediate safety concerns or deficiencies during the physical plant tour. Minor physical plant concern in the laundry room on the third floor is being addressed by the ED. LPAs had a conversation with the ED to ensure that all rugs in the facility shall have protective devices such as nonslip materials and to ensure that there are no tripping hazards throughout the facility. Based on LPAs’ observation, interviews, and record review, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation “Facility staff do not maintain facility walkways free from hazards” 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, Mar 19, 2025 · control 29-AS-20250313114055

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Emily Peraldi and Angela Barutyan arrived at the facility unannounced to conduct a required annual visit. At 9:50 a.m., the LPAs met with staff and explained the reason for the visit. At 10:15 a.m., the Executive Director (ED) Eden Tolentino arrived at the facility. At 10:26 a.m., the LPAs, along with the ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The facility is a three-story building, with 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 memory care residents. KITCHEN: At 10:28 a.m., the LPAs observed the kitchen and dining area. Kitchen area remains inaccessible to residents. Knives are inaccessible to residents in care. Kitchen appliances are in operable condition. Chemicals and cleaning supplies were stored separately from the food and food preparation area. The facility has a sufficient supply perishable and nonperishable food. The menu was posted outside the dining area. Snacks and beverages are available for residents. BEDROOMS: The LPAs observed ten (10) randomly selected resident rooms throughout facility. Rooms were furnished with clean linens, appropriate furniture and sufficient lighting. RESTROOMS: The LPAs observed restrooms in ten (10) resident units and common area restrooms. All restrooms were fully stocked with supplies. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was tested throughout the visit and measured within the required range. Continued on LIC 809-C. COMMON AREAS: The LPAs observed common area to be relatively clean and properly furnished. The LPAs observed the fire extinguishers throughout the facility to be fully charged and last serviced on 01/28/2025. The facility's smoke alarms are hard wired, and the facility is equipped with sprinkler system. Fire alarm/sprinkler system was last tested on 07/09/2024 with the Ventura County Fire Protection District. Inside temperature was maintained at a comfortable level. OUTDOOR SPACE: The LPAs 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 area with appropriate gating. No immediate concerns noted. ACTIVITIES: Planned activities are offered, and the activity schedule was posted. The activity schedules are distributed to the residents and are also located near the elevators for residents to pick up if needed. Activity rooms and common spaces appeared clean and in good repair. OTHER: Medications and first aid kits are located in locked medication rooms. There is also a mail room next to the receptionist area. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor closets/maintenance closets. There are laundry rooms observed the second and third floor of the facility. FILES: Between 1:40 p.m. and 3:22 p.m., the LPAs conducted a file review for nine (9) residents and six (6) staff. The nine (9) resident records were reviewed for, but not limited to: care plans, medical assessments, admissions agreement, consent forms. Resident records were in order. Six (6) personnel records were reviewed for, but not limited to: health assessments, first aid/CPR training, and training documentation. Personnel files were in order. Facility fire drill was last conducted on 02/26/2025. Emergency evacuation drill was last conducted on 02/27/2025. The LPAs reviewed facility's Infection Control Plan and Emergency and Disaster Plan which was observed to be complete and updated. Starting at 2:05 p.m., the LPA conducted a review of medication and medication documentation with staff for three (3) residents and observed that medications were properly documented and assisted with as prescribed. No concerns or errors were observed. During the physical plant tour, the LPAs conducted interviews with seven (7) residents and four (4) staff. During the time of the visit, the LPAs obtained a copy of the liability insurance, resident roster and LIC 500 personnel report. No deficiencies cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Angela Barutyan conducted an unannounced case management - incident visit at 10:32AM. The purpose of this visit is to conduct an investigation regarding a self-reported incident that occurred on 01/22/2025. Upon arrival, the LPA met with staff and Executive Director (ED) Eden Tolentino. Entrance interview conducted. During today’s visit, LPA Barutyan conducted a brief physical plant tour to ensure there are no health and safety hazards and conducted interviews with two (2) staff members and and one (1) resident. On 01/24/2025, the Department received two SOC 341s for suspected abuse of Resident #1 (R1) by an unknown staff member. Per the SOC 341, it was reported to Staff #1 (S1) that another staff member dragged R1 to the bathroom who then had to crawl back to their bed. ED reported the incident to Adult Protective Services (APS) and the Long-Term Care Ombudsman (LTCO) and informed R1’s responsible party. Ventura County Sheriff Officer conducted a visit on 01/24/2025 and determined the incident to be unfounded with no suspicion of crime. On 01/28/2025, the Department received an incident report for the incident. The incident report and SOC 341 stated that 911 was contacted when the suspected abuse was first reported on 01/24/2025. Paramedics conducted a full-body assessment and did not observe bruising, injuries, or rug burns on R1. R1 was not transported to the hospital. Facility management investigated the incident and interviewed AM, PM, and NOC shift staff, no concerns were noted. LPA interviewed R1 and no concerns were noted. Based on information obtained during the investigation, there is not sufficient evidence to prove a violation did occur. No citations issued. Copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2025

Allegation investigated: Facility staff destroyed residents' personal belongings.

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with Executive Director (ED) Eden Tolentino and explained the reason for the visit. During today's visit, LPA interviewed the ED starting at 11:35, staff 1 (S1) at 12:07 p.m. and staff 2 (S2) at 12:21 p.m. S2 assisted LPA with locating records regarding the medication management for resident 1 (R1). During LPA's previous visit on 3/20/2024, LPA interviewed staff and R1. Regarding the allegation facility staff destroyed R1's personal property, this complaint was specifically about staff destroying R1's over-the-counter supplements and/or medications. (continued on LIC9099C) Unsubstantiated (continued from LIC9099) R1 had a hospital stay starting on or about 6/22/2023. On 8/15/2023, R1's physician sent a new medical assessment to the facility indicating R1 could no longer store or manage their own medications. Facility staff removed all medications, including over-the-counter medications/supplements, from R1's room. Facility staff ensured they received orders from R1's physicians for all of the medications and supplements. Any medications that had a change of dose or were discontinued were destroyed. Medication destruction records show there were medications destroyed on 8/25/2023, 10/3/2023, 1/17/2024, and 1/25/2024, which included some over-the-counter supplements/medications. Records from R1's physician showed there were supplements that were discontinued between 11/20/2023 - 12/8/2023, including Vitamin B-12 and Folic Acid. Those supplements were destroyed. There were other medications which were discontinued or changed; those were also destroyed. On 1/22/2024, R1's physician completed a medical assessment indicating R1 was capable of storing and managing their own medications. On 2/1/2024, the facility completed a new Service Plan indicating R1 no longer required medication management. Records show all medications, including supplements, the facility was storing and managing for R1 were released to R1. Based on information obtained, the facility staff did indeed destroy some of R1's medications and over-the-counter supplements. However, R1's physician had submitted a list to the facility indicating which medications, including supplements, were discontinued or had a change in dosage. The destruction of these medications and supplements occurred during the period when the facility was managing R1's medications due to R1's physician stating the need for medication management. Therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Nov 21, 2024 · control 29-AS-20240314110052

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent case management visit with the purpose of continuing the investigation into a self-reported incident. LPA arrived at the facility at 12:12PM and was greeted by front desk staff. LPA met with Executive Director (ED) Eden Tolentino at 12:16PM. Entrance interview conducted. An incident report was received at the Woodland Hills Regional Office on 02/12/2024. Incident report indicated that on the night of 02/11/2024, Staff #1 (S1) admitted to another staff that S1 was frustrated with Resident #1 (R1) and that S1 had kicked R1. The document states that the incident was reported to Long Term Care Ombudsman and Ventura County Sheriff in addition to Community Care Licensing and the resident's responsible party. LPA Christine Yee conducted an initial case management visit related to this incident on 02/14/2024 from 10:45AM to 03:05PM. During the initial visit, LPA Yee conducted an interview with Brian Larios, Executive Director at 11:38am, an attempted interview with R1 at 11:26am, telephone interview with Staff #3 at 1:38pm and attempted telephone interviews with S1 at 1:58pm and Staff #2 at 1:21pm. Video camera footage was reviewed at 12:48pm and a copy taken at 1:08pm. Copies of facility documents were collected throughout the visit. LPA Yee was informed that as a result of the incident, S1’s employment at the facility was terminated. During today’s subsequent visit, LPA Dulek conducted an interview with ED Tolentino at 12:20PM, reviewed and obtained copies of relevant documents, and briefly toured the facility with ED at 12:45PM. No immediate health and safety hazards were observed during facility tour. LPA Dulek reviewed recorded video footage of the incident, which shows S1 pulling R1 by their hands and R1 falling to the ground. R1 then raises their feet and kicks at S1, then S1 kicks R1. S1 then picked up R1’s shoe and appears to hit R1 with their shoe before walking away down the hall, leaving R1 on the floor. LPA Report Continued on LIC 809-C Dulek confirmed the facility conducted an internal investigation into the incident and as a result terminated S1’s employment effective 02/13/2024. LPA confirmed S1 is no longer associated to this facility in Guardian. Review of S1’s staff file did not contain additional write ups or performance concerns. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or CA Health and Safety Code. Failure to correct the deficiency may result in civil penalties. Executive Director was informed that at a later date, civil penalties might be assessed based on health and safety code 1569.49(f). Exit interview was conducted with Executive Director. A copy of today’s report and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, Nov 12, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Nov 19, 2024

87468.1 Personal Rights of Residents in All Facilities (a) (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: The facility did not comply with the above cited section, as based on review of video footage, S1 is seen physically abusing R1, which posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: As a result of the incident, S1 was terminated. ED agreed to provide personal rights and abuse training to all current staff and provide proof of training to CCL by POC due date.

Allegation investigated: Staff do not ensure signal systems calls are answered promptly for residents in care

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegation listed above. LPA arrived at the facility at 09:40AM and was greeted by front desk staff. At 09:50AM, LPA met with Executive Director (ED) Eden Tolentino. Entrance interview conducted. During an initial complaint visit conducted on 04/18/2024, LPA interviewed previous ED at 12:02PM, toured the facility at 12:20PM, conducted resident and staff interviews from 12:48 PM to 02:32 PM. Additionally, LPA received copies of pertinent documents. LPA then reviewed all documents obtained and spoke with reporing party related to the allegations. The following was then determined: It was alleged that residents are waiting too long when requesting assistance by utilizing their call buttons. Interview with staff revealed that the facility utilizes Phillips Lifeline for their resident pendants. Each resident in Assisted Living receives a pendant upon move in and Memory Care residents do not use pendants. Staff Report Continued on LIC 9099-C Unsubstantiated stated that all pendants are inspected monthly to ensure functionality. Staff interviews revealed that staff are assigned a group of residents, however, if one staff is busy, another caregiver will assist the resident. According to staff, typical response time is under 15 minutes. Administrator stated that all call logs are reviewed daily and if response time is greater than 15 minutes, staff need to provide an explanation for the late response. LPA interviewed residents as well, who indicated the care they receive is good and response time is adequate. There was a resident interviewed who indicated they had fallen, but their pendant was not on their body and was not within reach at the time of the fall. So the staff were unaware the resident had fallen. LPA spoke with reporting party who indicated they personally had no concerns with the call times, but had heard from others that they had a problem. Residents interviewed, including those the reporting party identified, indicated there had been no recent concerns related to the call response system. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation "Staff do not ensure signal systems calls are answered promptly for residents in care" is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20240415104028

Allegation investigated: Residents are not being provided with transportation

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct an initial complaint investigation for the allegation listed above at 10:35AM. LPA met with staff and Interim Executive Director (ED) Eden Tolentino and explained the reason for the visit. During today's visit, LPA reviewed and obtained copies of pertinent documents, conducted a brief physical plant tour at 11:35AM, and conducted interviews with three (3) residents, two (2) staff, and ED between 10:40AM – 11:50AM. Report Continued on LIC 9099-C Unsubstantiated It was alleged that residents are not being provided with transportation. The reporting party (RP) stated that the facility does not have a current regular driver to provide transportation. Interviews with staff and ED explained that the previous full-time driver was terminated in the beginning of August 2024. The activity directors and management have been providing transportation in the meantime. Staff #1 (S1) manages AM transportation while Staff #2 (S2) manages PM transportation, both with the four-passenger facility vehicle. Staff #3 (S3) works part-time and has a Class B driver’s license and is therefore able to drive the sixteen-passenger facility bus on Saturdays and Sundays. ED stated that they are receiving applications for the driver position opening and have a few interviews this week to fill the position. Furthermore, LPA reviewed and obtained transportation sign-up sheets which document names of resident’s transportation appointment, destination of address, and pick-up time. Time slots are in thirty-minute intervals. Staff stated that a 24–48-hour notice is requested of residents when they would like to schedule transportation. LPA observed the welcome brochure and transportation schedule stating that “transportation is limited to a 10-mile radius, rides must be booked 24-hours in advance or earlier, and priority will be allotted to appointments, shopping trips may be rescheduled if needed.” The transportation schedule also states that the facility will help residents obtain public transportation such as Uber/Lyft or Dial-A-Ride at the resident’s expense if transportation needs cannot be met within the policy. LPA also observed scheduled events such as church rides offered every Sunday at 08:15AM, scenic drives, food outings, and sign-up sheets for these group outings. File review of the facility’s plan of operation states that the facility will provide “assistance in arranging transportation for all residents to medical and dental care appointments, shopping and recreational facilities, and religious activities.” Assistance in arranging also includes helping residents book public transportation services not provided by the facility. Interviews with residents explained that there is no issue when it comes to booking the facility car and that management are providing transportation, but the bus has a shortage due to the license class required to drive the vehicle. Residents also stated that there are group social outings offered such as Christmas light viewing and possible road trips in the future. Based on interviews and record review, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation “Residents are not being provided with transportation” is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Oct 16, 2024 · control 29-AS-20241011153018

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Barutyan conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20241011153018). The purpose of the visit is to issue a citation for a deficiency observed during the initial complaint investigation. During the visit on 10/16/2024 at 12:30PM, LPA observed Staff #1 (S1) without a criminal record clearance and Staff #2 (S2) without a criminal record clearance transfer. S1 will be on leave for two weeks and Exective Director (ED) Tolentino stated they will not schedule S1 until obtaining a criminal record clearance. S2 was associated to the facility during the time of the visit. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Civil penalties were issued in the amount of $1000. Failure to correct the deficiency may result in additional civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 16, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Oct 17, 2024

87355 Criminal Record Clearance (e) all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Based on record review, the licensee did not comply in that one (1) staff member did not have a criminal record clearance and one (1) staff member did not have a criminal record clearance transfer which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2024

Plan of correction: Facility associated staff without a criminal record transfer during the visit. ED stated that the staff without clearance is going on leave effective today and will not be working until obtaining clearance.

Allegation investigated: Staff are not following proper infection control requirements

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation finding. Upon arrival LPA met with Brian Larios and explained the reason for the visit. Entrance interview conducted. On 11/03/2023, Community Care Licensing Division received the above complaint allegation. Investigation into the allegation consist of facility physical plant tour on 11/08/2023. Furthermore, records review, random resident and staff interviews was conducted on 11/08/2023 and 05/11/2024. Reporting party (RP) was contacted on 11/07/2023, 01/21/2024, and 05/11/2024 for additional information. Reporting party refuse to speak with LPA. Following is a summary of the allegation and investigation finding: Unsubstantiated Allegation) Staff are not following proper infection control requirements. It was alleged that facility staff who tested positive for Covid on 10/28/2023 were asked to continue work a couple of day later even though staff were still having symptoms. Staff interviewed reported that the facility policy and procedures were followed during the outbreak. Staff denied allegation and stated that no one was asked to work following a positive test result. Staff stated that after five (5) days if symptoms are better and they have no fever they were cleared to work. Facility Infection Control procedures regarding employee screening and return to work protocols reviewed reflect that staff may return to work five (5) days after a positive test if symptoms are improving and fever free without any fever-reducing medication. According to the staff interviews they were never asked to work following a positive (COVID) test result or with any COVID related symptoms. Random residents interviewed expressed that facility staff maintain proper infection control procedures. Reporting party was contacted several times through the course of the investigation to determine the validity of the allegation however RP was not willing to speak with LPA. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff are not following proper infection control requirements” is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report provided.the state’s words, verbatim · CDSS document, May 21, 2024 · control 29-AS-20231103112815

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Teresa Camara and Martha Arroyo arrived unannounced to conduct a required annual visit. LPAs met with Executive Director Brian Larios and explained the reason for the visit. LPAs 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. The facility has a comprehensive disaster plan. The facility conducts a full evacuation of the facility annually and conduct monthly fire drills. The facility uses Johnson Controls to inspect their fire suppression system with the last inspections being conducted in August 2023 and January 2024. The facility maintenance staff conducts monthly inspections of all smoke and carbon monoxide detectors with the last inspection being conducted on March 2024. Kitchen: At the time of the visit, there was a sufficient supply of perishable and nonperishable food. The facility also has an emergency supply of food and water. The menu was posted and copies are available near the elevators for residents to take. The facility offers 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 memory care residents. There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature. The rooms have separate thermostats so residents can adjust the temperature to their preference. The fire extinguishers were charged and last serviced January 2024. Both facility elevators were operating properly. There are three stairwells that all have emergency evacuation chairs. (continued on 809-C) (continued from LIC809) Activities: Planned activities are offered and the activity schedule was posted. The activity schedules are distributed to the residents and they are also located near the elevators for residents to pick up if they need another copy. Activity rooms and common spaces appeared clean and in good repair. Rooms: LPAs toured ten randomly chosen rooms; two in memory care, four on the second floor and four on the third floor. Rooms appeared clean, well kept, with sufficient lighting and appropriately furnished. Restrooms: Restrooms on all floors were clean and sanitary. Restrooms were fully stocked with supplies. The hot water temperature was tested on all floors and ranged from 112.8 -117.6 degrees Fahrenheit. Outside areas: LPAs 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 area with appropriate gating. 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. The community's infection control plan is adequate. Records: LPAs reviewed ten resident files and ten staff files starting at 2:15 p.m.; all were complete. Medications were reviewed at 3:50 p.m. and appeared to be given as prescribed. Interviews: LPAs interviewed five residents and four staff; no concerns were noted. No deficiencies cited. Exit interview conducted and report issued to ED.the state’s words, verbatim · CDSS document, Mar 20, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced 24 hour case management visit to investigate the incident reported to the Department on 2/12/24 regarding Resident #1 being abused by Staff #1. LPA Yee initially met with Sarah Dodd, Community Business Director upon arrival. Brian Larios was contacted via telephone and he arrived at 11:25am to conduct the visit. The reason for today's visit was explained. On today's visit, LPA Yee conducted an interview with Brian Larios, Executive Director at 11:38am, an attempted interview with Resident #1 at 11:26am, telephone interview with Staff #3 at 1:38pm and attempted telephone interviews with Staff #1 at 1:58pm and Staff #2 at 1:21pm. Video camera footage was reviewed at 12:48pm and a copy taken at 1:08pm. Copies of facility documents were collected throughout the visit. Based on the information obtained during today's visit, additional interviews need to be conducted and other information collected before a final decision can be made and the appropriate course of action to be taken regarding the resolution of this incident. At this time, information was provided that Staff #1 is no longer employed at the facility and does not pose a further threat to Resident #1 while the investigation is being conducted. Exit interview was conducted.the state’s words, verbatim · CDSS document, Feb 14, 2024